St Nicholas Hospice

Updated 6 August 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 19 and 20 April 2016 and was unannounced.

The membership of the inspection team consisted of an inspector, a pharmacist, a specialist adviser and an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. Our specialist adviser currently worked in services provided to people affected by life limiting illness.

Information was gathered and reviewed before the inspection. This included notifications of significant events that affect the health and safety of people who used the service.

We spoke with 19 people who used the inpatient service and hospice at home service, 12 relatives/visitors, five volunteers, over 15 staff members and this included nurses, physiotherapist and health care assistants. In addition we talked to a pharmacist, a consultant, the chief executive and also the registered manager for St Nicolas Hospice.

We reviewed people’s care plans to see how their support was planned and delivered. We looked at a selection of medication records to check medicines were managed safely. We looked at a range of policies and procedures, quality assurance and clinical audits and meeting minutes for different departments.

Updated 6 August 2016

This unannounced inspection took place on 19 and 20 April 2016. At previous inspection the hospice had been compliant with regulation and offered a quality service.

St Nicholas Hospice provides day, community and inpatient care and support to people of West Suffolk and into Norfolk. The Sylvan ward in Bury St Edmunds provides palliative and also respite care for up to 12 people. The Orchard Centre in Bury St Edmunds and the Burton centre in Haverhill provide support, care and activities for day patients and their families. The Community Hospice Team provides care, support and advice to patients in their own homes. St Nicholas Hospice also runs a Hospice Neighbours scheme - trained volunteers offer people companionship and practical support. Approximately 500 people were being supported in the community and 150 through the day centres.

There was a registered manager in place and they participated fully in the inspection process. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

St Nicholas Hospice is an outstanding service. It is truly focussed on the individual needs of people that they support, giving people support at the time they need it in a way and place that best suits them and their family. People spoke overwhelmingly of the positive support, guidance and healthcare interventions they had received. People were full of praise of the staff in terms of their kindness, compassion and knowledge about end of life matters. People viewed the healthcare clinicians as expert in their knowledge.

People spoke of a service that was tailor-made for them and their families saying that staff truly went the extra mile to offer understanding, empathy and choices that were based upon information and keeping people informed and involved. Informed consent was embodied into all work that was undertaken at the hospice. The various departments within this hospice worked well together so that people had a seamless experience of moving from one department to another as the need arose.

Staff were motivated and keen to convey to inspectors their pride in the service they worked at. Staff were involved, listened to and empowered with training and support to offer excellent end of life healthcare and support.

Management were inclusive and promoted a culture of excellence. They listened to people and involved them in the running and development of the service. They actively sought out people’s views and used criticism as an opportunity to improve and develop the service. There was a kindness and warmth about the management team that made them approachable to everyone and people knew them by their first names and told us they were visible, approachable and solved matters raised. Governance of the service was of a high standard that was benchmarked against similar services and communication was very good. The board of governors and others who needed oversight were appropriately informed of how the hospice operated. The measures of quality in place showed that people were right to have the confidence in this local hospice.