St Barnabas House hospice is a local registered charity that provides specialist palliative care to adults with advanced progressive life-limiting illnesses, both within the hospice and in the comfort of their homes. Palliative care is the total care of people whose illness is not responsive to curative treatment.

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. C

People who used the service were involved in their plan of care and were given appropriate information to help them make informed decisions.

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.

During our inspection we examined three people's care plans, looked at four staff files, talked to two people who used the service and seven members of staff.

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.”

Everyone that we spoke with told us that they or their relatives received outstanding care and treatment from the staff team at St Barnabas House. They talked about the warmth and compassion that was coupled with exceptional skill and attention to detail.

People told us that they felt each and every staff member “went the extra mile.” We were told about the domestic staff that always had time for a chat and kept people in touch with the wider world and the hardworking and committed nursing staff who always managed to find that important extra few minutes to explain something or who found space to just listen.

Most people said that they had mixed feelings about being referred to a hospice but that they were so pleased that they had been as the care was “unbelievably good”.