The inspection visit at St John’s hospice was undertaken on 26 July 2016 and was announced. We gave 24 hours’ notice of the inspection because of the sensitive nature of the service provided. We wanted to ensure people who used the service, staff and visitors were available to talk with us.St John’s hospice provides palliative and end of life care for adults with life limiting illnesses. The staff team support people and their families, providing medical, nursing, personal, emotional and spiritual care. They also offer a hospice at home service in the local community to assist individuals living at home and a variety of day and support services. At the time of our inspection, there were four people inpatient at St John’s hospice.
St John’s hospice is situated in a residential area close to local amenities. The service supports people in the main hospice inpatient unit and a day therapy unit. They also support people in their own homes.
A registered manager was in place. A registered manager is a person who has registered with the Care Quality Commission (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 led and managed.
At the last inspection on 13 February 2014 we found the provider was meeting all the requirements of the regulations inspected.
We spoke with people who used the service, relatives, staff and other professionals during this inspection. They told us the service provided an exemplary level of care and the leadership was exceptional. They spoke extremely highly of staff. One person told us, “From being in despair I am now able to focus on what matters. All with the help from the staff.” A relative said, “The support from the hospice staff exceeded anything we had hoped for. It was fantastic.”
Care planning was extremely flexible, person centred and proactive. People and their families told us staff championed people’s right to choose how, where and when they wanted their care provided. They said staff were especially proactive and ‘made things happen’ in order to provide exceptional care for people. We saw staff had to support people to attend special family events with staff support and helped patients with arrangements to marry in the hospice.
People said staff were extremely caring and respectful, listened to them and assisted them promptly. They told us staff always ‘went that extra mile and beyond’. We saw end of life care plans were informative and personalised and staff were remarkable in their determination to help people to carry out their final wishes. This included providing advice, support and staff at a person’s home so they could remain in the comfort of their home with loved ones.
Families told us staff were extremely competent and compassionate in the way they assisted people to have control of illness symptoms and pain. They commended staff for the practical, emotional and spiritual support provided and outstanding care that enabled their relative to have a dignified, peaceful and pain free death. Written comments from families included, ‘Thank you for making the end of [family member’s] life so calm and dignified and filled with love’. And ‘You worked miracles and [person] died serenely and comfortably. Thank you.’
The management team and trustees worked collaboratively with other agencies to develop best practice, excellent partnership work and support for people. They carried out innovative research with local and national organisations and influenced best practice and policy-making. This further improved care practices and helped develop innovative support in the hospice and the community
The management team set up numerous forums and support groups to seek people’s views, provide support and information and ensure people received person centred flexible care that fully met their needs. One comment we saw stated, ‘Nothing needs changing the care is superb.’ Another person had written, ‘Your wonderful, warm personalities create such a lovely friendly atmosphere. You are amazing and do a fantastic job.’
The management team used multiple ways of monitoring and auditing care and seeking the views of people who used the service, their families, other professionals and staff. This assisted staff to provide care that was personalised and exceptionally flexible. Other professionals were extremely complimentary about St John’s hospice, the staff attitudes and their competence.
Staff demonstrated a highly sensitive and compassionate understanding of protecting and respecting people’s human rights. We found staff were passionate about providing a non-discriminatory and tremendously supportive service.
People who used the service, their families and staff were supported throughout their ‘journey’. They were provided with complementary therapies such as reflexology and massage to assist with relaxation and reduce anxiety and distress. The care by hospice staff did not end when a person died; The hospice team continued to support families after their family member’s death. They were offered bereavement counselling and support groups for emotional well-being.
Recruitment and selection was carried out safely with appropriate checks made before new staff were appointed. There were enough staff to provide safe, personalised and timely care.
The provider had an extremely positive and constructive response to complaints and carried out their duty of candour with an open and transparent approach. People told us they knew how to raise a concern or complaint and staff encouraged them to express any ideas or concerns.
The registered manager had systems to monitor and manage accidents and incidents to maintain everyone’s safety. One person confirmed, “I feel safe and supported here and not worried.”
People were complimentary about the meals and told us they were offered a choice. Staff ensured people’s dietary and fluid intake was sufficient and they received appropriate nutrition. Drinks and
snacks were available at all times. The management team had begun to develop a nutritional Support Worker role to focus on meeting people’s preferences and nutritional needs on the ward.
Staff were confident in their knowledge of the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards and demonstrated good awareness of related principles. Care records held documented evidence of the person’s agreement to care.
Staff received relevant and timely training. They also provided education and training to care homes, other professionals, universities and colleges in end of life care. This enabled them to spread best practice in end of life care.