St Luke's Hospice

Updated 20 April 2017

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.

We inspected the inpatient unit on 14 December 2016. This inspection was unannounced. Following the inspection visit we contacted people and their relatives who used the hospice services to get feedback about the service they received. We also asked the registered manager to share our contact details with visitors, partner agencies and staff so they could give us feedback about the hospice. We received numerous e-mails from staff, health and social care professionals and volunteers following the inspection visit.

The inspection visit was carried out by one inspector, a pharmacy inspector and a specialist advisor. The specialist advisor had experience of working as a nurse within the community and within the field of palliative care.

Before the inspection, we asked the provider to complete a Provider Information Return (PIR). This is a form that requires them to give some key information about the service, what the service does well and improvements they plan to make. We also reviewed information we held about the service including statutory notifications. Statutory notifications include information about important events which the provider is required to send us by law.

We spoke with three people who used the hospice services on the day of the inspection visit, four relatives, and seven staff (nurses, clinical lead and care assistants). We talked to a social worker and heads of in-patient services and head of day hospice, out-patients and therapy services. We spoke with the Head of Quality and Education, Human Resource Manager and the Director of Care Services who was the registered manager for St Luke`s Hospice.

Following the inspection we received feedback from members of the Board of Trustees from the hospice and managers from the organisations working in partnership with St Luke`s Hospice.

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

Updated 20 April 2017

This inspection took place on 14 December 2016 and was unannounced. Following the inspection we received feedback from family members of the people who used the service, volunteers and other services working in partnership with St Luke`s Hospice.

St Luke`s Hospice is registered to provide specialist palliative care, advice and clinical support for adults with life limiting illness and their families. The service delivers physical, emotional, spiritual and holistic care through teams of nurses, doctors, counsellors and other professionals including therapists. The service provides care for people through an In-Patient Unit, Day Service and Out- Patient Care. St Luke`s Hospice contracted with a registered nursing care provider to run a ‘hospice at home service’. The hospice at home service and a fast response team called ‘One Response’ were based and had their offices in St Luke`s Hospice and offered a service for people with palliative care needs living in the community.

The 'One Response' service was an innovative fast response service which offered support, assessment and advice to people with life limiting condition living in their own homes over 24 hour seven days a week. The support could be accessed via telephone where the call was triaged and staff could arrange specialist visits to people within two hours. This service was run in conjunction with Macmillan nurses, Marie Curie nurses and end of life specialists. At the time of our inspection the service was supporting approximately 300 people either with direct care or by telephone support.

At the time of the inspection there were three people using the inpatient service and around 500 people using day services. The day services offered a range of services to people recently diagnosed with life limiting conditions, their carers and families. The service provided specialist advice, courses, complementary therapy sessions and outpatient clinics. It aimed to empower people to be in control of their condition and achieve what was important to them.

St Luke`s Hospice had a registered manager in post. 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.

Staff had permanent support and guidance from a social care professional employed by the hospice and were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to report any concerns they had. Risks to people`s well-being were assessed by staff daily and there were measures in place to mitigate risks and keep people safe. Risk assessments were reflective of people`s changing abilities and needs and measures to ensure people were as safe as possible were implemented accordingly.

People received care based on best practice from experienced staff with the knowledge, skills and competencies to support their complex health needs. People and families received care from staff and volunteers who developed positive, caring and compassionate relationships with them. The service promoted a culture that was caring and person centred. Staff worked together as a multidisciplinary team to provide the care people wanted and needed.

People told us they were fully involved in setting their priorities for care. Care plans in regard to all aspects of people`s medical, emotional and spiritual needs were personalised and written in partnership with people. Staff delivered support to people respecting their wishes and preferences.

People who used the various services offered at the day hospice told us the help and support they received was invaluable for them and their family. They valued the support they received from the different activities, courses and clinics which helped them to live with and manage their symptoms to maximise their health and helped them prepare for the future. They also appreciated the opportunity to meet with people in similar conditions and the social aspect of the services provided.

People told us that staff understood their individual care needs and were compassionate and understanding. Staff told us they undertook training which enabled them to provide good quality care to people in the inpatient unit, in the community and in the day hospice.

Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced. Staff reported any concerns so these could be reviewed and discussed to identify if lessons could be learnt to reduce the likelihood of recurrence.

Recruitment procedures were robust and ensured that staff working at the service were qualified and skilled to meet people`s complex needs. Staff told us they worked and trained towards their personal development plans and were happy with the support from their managers. There were sufficient numbers of staff to ensure people received support when they needed it.

People’s medicines were administered by trained and qualified staff who had their competency to give medicines safely assessed regularly by their manager. Any changes in people`s medication were discussed by the medical team, nurses and pharmacist to manage and support people’s symptoms and pain management. Medicines were regularly reviewed and audited to ensure they met people’s needs.

The registered manager and staff were clear about their responsibilities around the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and were dedicated in their approach to supporting people to make informed decisions about their care.

The registered manager was committed to improve and broaden the services the hospice offered. They established seamless working relationships with other organisations to be able to reach out to as many people with complex needs as possible. They were constantly involved in research and development of new services together with partner organisations and promoted coordinated personalised care for people in the community. The services provided by the hospice had the support of volunteers who were closely involved in every aspect and department the hospice operated.

The service actively encouraged and provided a range of opportunities for people who used the service and their relatives to provide feedback and comment upon the service in order to continue to drive improvement.

There was a comprehensive auditing programme for all the services the hospice provided carried out by the quality and education service team. Action plans were comprehensive in detailing actions taken, time frames and the person responsible for the actions.