St Luke's Hospice -Turnchapel

Updated 20 October 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 carried out 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. At our last inspection in March 2014 the service was compliant with all the standards we looked at.

This inspection was carried out on 6 and 9 June and 1 August 2016 by a lead adult social care inspector, a pharmacist inspector, an expert by experience and two specialist advisors in palliative care. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. It was an unannounced inspection on the first day.

Before our inspection we looked at records that were sent to us by the registered manager and the local authority to inform us of significant changes and events. The registered manager sent us a Provider Information Return (PIR). The PIR is a form that asks the provider to give some key information about the service, what the service does well and what improvements they plan to make.

We looked at the premises, spent time in the inpatient unit, the offices at 3-5 Brookland Campus, and in the clinics and went out on visits with the community nurse specialists. We were able to visit people in their own homes with their permission. We looked at six sets of records that related to people's care. We looked at the systems in place for managing medicines, spoke to two staff involved in the administration of medicines, and examined ten people's medicines charts. We looked at six people's assessments of needs and care plans. We consulted documentation that related to staff management and looked at four staff recruitment files. We looked at records concerning the monitoring, safety and quality of the service. We observed a 'ward round' and the administration of medicines. We sampled the services' policies and procedures.

We spoke with four people who were receiving care in the inpatient unit and seven of their relatives to obtain their feedback about their experience of the service.

We spoke with the registered manager/head of quality and compliance, clinical director, chief executive, head of education, development and research, head of social care, six volunteers, the cook and kitchen staff, a domestic, infection control lead and the inpatient unit manager. We also attended a community multidisciplinary team meeting (MDT), a strategic team meeting and inpatient unit meeting. We also spoke with two community nurse specialists, two team leaders and seven registered nurses, a nursing student, an occupational therapist and three health care workers on the inpatient unit. We had feedback from two community health professionals.

Updated 20 October 2016

St Luke’s Hospice, Turnchapel serves the people of Plymouth, South West Devon and East Cornwall. They provide palliative symptom control and end of life care, advice and clinical support for people with progressive, life limiting illnesses and their families and carers. They deliver physical, emotional and holistic care including bereavement counselling support, a lymphoedema service which provides advice and treatment (for people who experience swellings and inflammations usually of arms and legs) and an outpatient service. They offer occupational therapy, complementary therapies and physiotherapy, chaplaincy and spiritual support, as well as social workers, clinical nurse specialists and volunteer services. The hospice inpatient unit at Turnchapel was purpose built can care for up to 12 adults. The average length of stay is two weeks. The service provides acute specialist palliative care for people and does not provide a respite service or longer stay beds. The majority of people are cared for by hospice community specialist nurses in the community, currently around 300 people on the active caseload.

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. They held the post of head of quality and compliance and were supported by a leadership team that included the chief executive and directors and department managers.

The registered manager was open and transparent in their approach. They promoted the service mission of ‘Hospice without walls” providing and promoting high quality end of life care accessible to anyone. Staff demonstrated this vision in their practice and gave person centred, individualised care. All staff felt valued by the leadership team and supported to provide high quality care throughout the service.

The service provided outstanding end of life care which enabled people to experience a comfortable, dignified and pain-free death. The environment was accessible for people with disabilities. It was welcoming, well maintained and suited people's needs. Clinics, therapies and support groups were held in the unit and people, in wheelchairs or beds could enjoy the view looking out over Plymouth Sound. There were well maintained grounds which were also accessible for people to enjoy.

The service continuously looked at the local community to see how best they could provide the service and had done excellent work in identifying the needs of the local population developing services to meet those needs. This had resulted in the provision of a Crisis Team service in 2014. It was identified that at times people experienced unnecessary hospital or hospice admissions when they would have preferred to remain at home. As part of the service mission to provide a “Hospice without Walls”, the Crisis Team aimed to respond within an hour to provide a short 72 hour intervention to enable people to stabilise their symptoms and facilitate rapid discharge home from hospital or hospice.

The team of registered nurses and health care assistants operated 24 hours a day, 7 days a week. This assisted and supported families and carers to respond to people’s rapidly changing situations to enable them to continue supporting their loved one. The Crisis Team staff were employed by St Luke’s and worked closely with other health care professionals in the community.

St Luke’s Hospice staff also worked at Derriford Hospital, Plymouth where they provided a specialist palliative care service for any hospital patient with a progressive life limiting illness and working closely with an extended multidisciplinary team. Services included assisting hospital staff with people’s complex discharge arrangements to their preferred place of care. The hospice had also set up their own domiciliary care agency in response to community need and we inspect this separately.

Staff were exceptionally well trained and had excellent knowledge of each person and of how to meet their specific support needs. Staff commented on the positive culture and idea of teaching and sharing skills within the service and in the wider community. Staff went that extra mile to ensure people's needs were met in a holistic way including support for people's loved ones. For example, a project was in place to ensure people identified as caring for their loved one at home were supported. For example, by a named hospice social care contact, signpost information and staff ensured carers received their entitled support through national statutory assessment. Attention was paid to people’s individual social and psychological needs in a holistic way that included support pre and post bereavement for carers.

There was an excellent spiritual care service which was inclusive and their ethos was person centred regardless of belief. A spiritual care strategy was on-going to enhance the hospice spiritual chaplaincy team. This promoted spiritual wellbeing champions, specific training development and promoting the hospice vision that, “The spiritual wellbeing of St Luke’s service users, staff, volunteers and those connected to the organisation is everyone’s responsibility and is not the sole responsibility of the Champions.” A dedicated space ‘The Harbour’ provided somewhere for quiet meditation and thought for all.

The hospice had a comprehensive training department. A specialist computer learning management system (LMS) was used to ensure staff were up to date and competent in their roles and all staff had a ‘skills passport ‘of their knowledge and competencies. The department ran thorough orientation and mentorship programmes for new staff and focussed on personal development and quality. All members of care and support service staff received regular one to one or group supervision which ensured they were supported to work to the expected standards.

The service was particularly pro-active in offering training to a wide range of health professionals and those in contact with end of life care. For example, community specialist nurses and the education team had delivered training to hospice staff, school leavers, university, medical and paramedic students and community hospital staff. The service had also made links with projects supporting local homeless communities to ensure their staff were able to recognise end of life and so people accessed appropriate services.

An innovative project based on the nationally recognised ‘Six Steps to Success’ approach had delivered a programme of a series of workshops. These were tailored for care homes and domiciliary agencies in recognition of the challenges of providing high quality care. A ‘train the trainer’ approach was used to develop End of Life Care Champions in these settings along with a toolkit for learning and support. This programme also included additional workshops focussing on end of life care for people living with dementia and a learning disability focussed module. St Luke’s supported vulnerable communities and had launched an easy read future and end of life care plan designed with people with a communication or learning disability in mind.

A compassionate community project at the hospice was already improving care for people in the community. This was based on the national Dying Matters Coalition, led by the National Council for Palliative Care whose mission is to ‘support changing knowledge, attitudes and behaviours towards dying, death and bereavement, and through this to make living and dying the norm.’ The project aimed to build compassionate communities to facilitate more conversations about death, dying and bereavement and provide effective practical community support. [National figures showed around 70 % of people would prefer to die at home, but around 60% die in hospital. We heard examples of how the hospice was working with people to ensure they were able to die in their preferred place].

Another project had facilitated end of life care through training senior healthcare practitioners as champions in the community- the 3R’s project: Right place, right care, right time. A peer learning kit enabled these practitioners then cascade knowledge further. This project had directly led to service improvements, for example in the hospital, drug and alcohol team and prison, and was part of the hospice agenda of creating a ‘compassionate community’.

The service had identified a lack of local access to end of life care for people in prison. The locality included a Dartmoor prison community of over 650. An effective collaboration was in place with the prison and a ‘Living with and beyond Cancer’ group. This had resulted in prisoners being able to access practical end of life care from hospice staff, access appropriate information and support, including personal care in Dartmoor prison.

People's feedback was actively sought, encouraged and acted on. People and relatives were overwhelmingly positive about the service they received. They told us they were extremely satisfied about the staff approach and about how their care and treatment was delivered. Staff approach was exceptionally kind and compassionate. Relatives stated on an independent online feedback website ‘I want great care’, “The care the patient received was above and beyond anything I could of expected, I am not good at asking for help or putting on people but I was made to feel we deserved the help unconditionally!” Relatives told us, “This hospice is outstanding, nothing is too much trouble.” People's feedback about the caring approach of the service and staff was overwhelmingly positive and described it as, "It’s like a 5 star hotel. There is a wonderful garden view” and “I loved seeing my dog, an