St Michael's Hospice

Updated 28 June 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 30 and 31 March 2016 and was unannounced.

On the first day of this inspection the team consisted of one inspector, one member of the CQC medicines team and a specialist advisor who is a nurse and a practitioner health lecturer in palliative and end of life care. (Palliative care is specialised medical care focusing on providing people with relief from symptoms and stress of a serious illness). On the second day one inspector concluded the inspection.

We checked the information we held about the service and the provider including statutory notifications. Statutory notifications include information about important events which the provider is required to send us.

We sought information about the quality of service from the local authority and the clinical commissioning team. In addition to this we requested information from Healthwatch who are an independent consumer champion who promote the views and experiences of people who use health and social care. We used this information to help us plan this inspection.

We spoke with four people, six family members and two friends in the inpatient service and one person who attended the day hospice. We saw the care people received which included spending time in the day hospice. We also attended two meetings with groups of staff and volunteers to discuss the needs of people who were using the inpatient and day hospice services.

After our inspection we spoke with three family members of people who used the hospice at home service by telephone. We also sought the views about the quality of the services people were offered at the hospice from a range of professionals. These included a consultant in palliative medicine and a general practitioner (GP).

We spoke the registered manager, medical director and chief executive. We also spoke with a range of staff which included the head of inpatient care, advanced nurse practitioner, social worker, chaplain, two nurses, day service nursing sister, two healthcare assistants, two volunteers and the chef.

We looked at four people’s care documentation which included four medicine prescription charts. We also looked at the reports relating to the management of the service. They included checks of the quality and safety of people’s care, projects, compliments and complaints.

Updated 28 June 2016

This inspection took place on 30 and 31 March 2016 and was unannounced.

St Michael’s Hospice provides care and treatment to people using the 20 bedded inpatient unit, day service, community nurses and hospice at home service and outpatient clinics. People may also receive support from the hospice’s transport and a telephone triage service. All these services provide specialist palliative and end of life care to people over the age of 18 with life limiting illnesses. At the time of our inspection eleven people were using the hospice inpatient service.

There was a registered manager in post who was also known as the director of care. 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.

People were protected from harm and abuse due to the arrangements in place to make sure risks to people were reduced. Where people were at risk due to their health and physical needs these had been identified with measures put in place to help people to manage and reduce any known risks. Staff and volunteers had been suitably recruited and there were sufficient staff with a variety of skills to meet people’s individual needs and to respond flexibly to changes.

Staff received the training and support they needed and were highly motivated to do their roles and deliver sustained high quality care. This included staff having the skills to effectively manage people’s medicines so these were available and administered safely to people. People were extremely confident and positive about the abilities of staff to meet their individual needs.

Staff worked closely and in partnership with external health and social care professionals and providers and health commissioners. They also worked with educators and national organisations concerned with palliative and end of life care. This helped to ensure people received the right care at the right time and that knowledge was appropriately shared and used to influence best practice for people’s care.

People told us they were supported with their nutritional needs with the assistance of the chef. They checked people’s choices with them as they served meals which were both nutritious and presented in a way which met people’s needs so that they could enjoy their meals comfortably.

Staff treated people with care and compassion and were highly motivated and committed to providing people with the best possible palliative and end of life care. Staff were kind and thoughtful to people. People told us staff spent time listening to them, did not rush them, and did all they could to meet people’s individual wishes and requests. People’s individual needs were assessed and staff always encouraged people to make their own choices about their care and treatment. Where this was not possible issues of consent and decisions were made in people’s best interests by people who had the authority to do this.

People received care that was tailored to their individual needs. Both people who used the service and family members were highly complementary and satisfied with the care provided, which they often described as excellent. People and family members felt they mattered and their views were taken seriously and acted on. Staff worked alongside people to enable them to live as full a life as possible and supported people in achieving their wishes with key comments from staff who believed they went the extra mile. People were supported to receive end of life care which met with their needs and wishes to achieve a private, dignified and pain free death. People, their families and staff were provided with the emotional and bereavement support they needed.

People were placed at the heart of the services they received by the strong values held by the management and staff team around supporting people to have quality of end of life care which was responsive to enable people to live their lives as they wished until their died. There was a strong sense of commitment within the management and staff team to source new initiatives and find creative ways of responding to the varied needs of the local population. Education, research and working in partnership was actively encouraged and supported to provide not only care and treatment but therapeutic benefits to people.

People and their family members, staff, board of trustees were actively informed and involved in developing the service. Their views were used to continuously inform service improvements and development and to influence the services people received so that these remained innovative, effective and raised quality where needed. The management team were continuing to make improvements and develop the hospice services further to ensure people received safe and effective palliative and end of life care.