St Barnabas House

The service includes a 20 bed In-Patient Unit, a Day Hospice with 18 places, a Community Palliative Care team, a Family Services team, a ‘Hospice at Home’ team and an Education Department. The care is delivered through a team that consists of doctors, nurses, social workers, counsellors, a chaplain, physiotherapists, complementary therapists, an artist-in-residence, a Hospice at Home team and volunteers. Services are free to people and St Barnabas House is largely dependent on donations and fund-raising by volunteers in the community.

This inspection was carried out on 22, 23 and 24 February 2016 by two inspectors and one pharmacist inspector. It was an unannounced inspection.

There was a manager in post who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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. The registered manager was also the Director of Adult Nursing and oversaw the running of the service. They were part of a senior leadership team that included a chief executive officer and a deputy, a director of human resources, a finance director and an income generation director.

Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow or ensure people were protected from harm.

There was a robust system in place to monitor accidents and incidents and identify how the risks of recurrence could be reduced.

There were sufficient staff on duty to meet people’s needs. Staffing levels were calculated and adjusted according to people’s changing needs. There were thorough recruitment procedures in place which included the checking of references.

Medicines were ordered, stored, administered and disposed of appropriately as per legal requirements. The hospice had opted to be part of a national study on benchmarking of medicines administration errors which meant that it continually reviewed its practices. The hospice shared learning with other local hospices and pharmacists at the local hospital. People could be confident that the service paid particular attention to all aspects of practice relevant to medicines.

There was an effective system in place to ensure people remained as safe as possible from the risk of acquiring an infection. The premises were cleaned and maintained to a high standard.

Staff understood how they should respond to a range of different emergencies and creative thinking underpinned practices in regard to keeping people safe from risk of fire, such as when practising fire drills.

People described the delivery of care as, "Exceptional" and "Second to none." They told us, “The staff are so knowledgeable and incredibly efficient, they are obviously very well trained as they have exceptional skills, they really understand me.”

Staff had appropriate training and experience to support people with their individual needs. Staff told us, “The training we get here is just phenomenal.” The service had creative ways of training their staff that made sure they put their leaning in practice to deliver outstanding care that met people’s individual needs.

There was an effective system of communication between services that ensured effective continuity of care. Communication was very effective within the service, with people and with external healthcare professionals. This meant that duplications of documentation were reduced and people did not have to reply to the same questions during multiple assessments.

Staff knew how to communicate with each person and understood their individual needs. Consent was sought from people, obtained and recorded before any aspect of their care and treatment was carried out.

The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to hospices. Staff were trained in the principles of the MCA and the DoLS and were knowledgeable in the main principles of the MCA that they applied in practice. They assessed people’s mental capacity when necessary and when applicable they held meetings to make decisions on their behalf and in their best interest. This meant that people's rights were protected and respected.

Staff protected people effectively from the risks of poor nutrition, dehydration, swallowing problems and other medical conditions that affected their health. People praised the food that was offered and told us it was, “Truly excellent” and, “Remarkably good.”

People were referred to healthcare professionals when necessary and their advice was sought and acted on by staff.

The premises had been adapted to meet people’s needs effectively. They were well designed, welcoming, well maintained and suited people’s needs.

People were proactively supported to express their views and staff were skilled at giving people information and explanations they needed and the time to make decisions.

People valued their relationships with the staff team and told us that they often went ‘the extra mile’ for them, when providing care and support. The service took account of people’s cultural, religious and linguistic needs. The staff valued practice that acknowledged diversity and promoted equality.

Clear and comprehensive information about the service and its facilities was provided to people, relatives and visitors through a wide range of methods, to enable them to make informed choices.

Family support was recognised by staff as vital to people’s wellbeing and staff strived to meet the emotional and practical needs of people and their families. Continual emotional support for families was provided in addition to the provision of care for people.

People were at the heart of the service and were fully involved in the planning and review of their care, treatment and support. People, relatives, visitors and health care professionals shared very positive views and opinions about how people's needs were responded to. Individual needs were met and responded to in a way that may exceed people’s expectations. Staff anticipated how people felt when planning their care and support so people felt valued and understood. Staff delivered support to people according to their unique support plan and responded to their specific needs.

People took part in discussions with staff to express their views, preferences and wishes in regard to their care, support and treatment, and were invited to take part in ‘advance care plans’. Their views, wishes and plans were respected.

Staff understood how to respond to people’s artistic and emotional needs at times that mattered to people. Innovative activities were provided to stimulate people’s interests and creativity.

The service actively sought the views of others through creative and innovative methods. The feedback that was sought and obtained from people, relatives, healthcare professionals and staff was extremely positive. A comment included, “Your professionalism, warmth, responsiveness and effectiveness have been an inspiration.” People were actively encouraged to give their views and raise concerns or complaints. Complaints were addressed promptly and followed up with an action plan in order to drive improvement and lessons were learned as a result.

The service took a key role in the community and was actively involved in building further links. It had the support of approximately a thousand volunteers.

There was an open and positive culture which focussed on people. People’s feedback about the way the service was led described it as “Really excellent management” and, “If more businesses were run like this, the world would be a much nicer place”.

Staff praised the provider and the leadership team for their approach and consistent, effective support. All of the staff we talked with spoke extremely positively about the registered manager’s style of leadership and told us they led by example. They described them as, “Exceptional”, “Totally approachable” and, “Inspiring.” The registered manager worked in partnership with other organisations to raise standards of care at a national level.

The service took part in several projects to reach more effectively an increasing number of people in the community and meet their needs. A particular Outreach Project had been implemented and sustained over time which had a positive impact on people in the community as it promoted inclusion.

There was a robust system in place to maintain and monitor the quality of the service across all departments, which was effective in driving continuous improvement. Comprehensive audits were carried out about every aspect of the service to identify how it could improve. When needs for improvement were identified, remedial action was taken to improve the quality of the service and care.

Care plans were written in a way that was individual and detailed. Care plans were regularly reviewed and changes were recorded and passed to care staff during shift handover.

People who used the service were protected from the risks of abuse because all staff were trained to recognise the signs of abuse and knew how to report potential abuse.

Staff working in the hospice were provided with comprehensive training and felt supported in their roles. Staff had access to onsite counsellors and were given regular reflection sessions to help them cope with the difficulties of the job.

The provider had systems in place to regularly assess quality standards in the hospice. Patient assessments were carried out and patient feedback was encouraged.

Staff talked about obtaining consent from people before undertaking care. We observed staff knocking on doors before entering rooms and heard them explaining care, discussing options and ensuring people were happy with their approach. One person told us, 'They really spend a terrific amount of time talking to you. They ask me about everything.'

People who used the service had detailed assessments of their needs and comprehensive care plans. One person told us, 'It couldn't be better. This is five star service.' They also told us, 'Quality and dignity are so important and this is what I am getting.'

There was a comprehensive policy relating to infection control and staff were able to describe the key elements and their particular role in the process. One person who used the services told us, 'They keep the place wonderfully clean.'

There were effective recruitment and selection processes in place. Up to date Disclosure and Barring Service (DBS) checks had been made and doctors and nurses were registered with the relevant professional bodies.

There was a detailed and comprehensive complaints policy with clear procedures and timescales by which responses should be made. One person told us, 'I've no complaints; but if I did have a complaint I think everyone would be round here sorting it out.'