This inspection took place on 13, 14 and 15 September 2016 and was announced. The service was last inspected on 16 December 2013 and at that time was meeting all the regulations we looked at.

St Christopher’s Hospice has charitable status and provides palliative and end of life care to a population of approximately 1.5 million people living in the five South East London Boroughs of Bromley, Croydon, Lewisham, Southwark and Lambeth. The hospice accepts referrals from anyone in the community who knows a child or an adult with a life threatening or life limiting condition. Care, treatment and support is provided to people with a life threatening/life limiting illness, their families, carers and friends by a range of multi-disciplinary health and social care professionals including doctors, nurses, health care assistants, physiotherapists, occupational therapists, dieticians, social workers, complementary therapists and volunteers. The hospice plays a key role at a local, national and international level by offering information, advice, education/training and research opportunities to individuals, groups and institutions wanting to know more about end of life and palliative care matters.

Although the hospice has two different sites located at Sydenham and Orpington in Bromley, St Christopher’s considers itself a single provider with people in the local community, their families/carers, staff and volunteers visiting or working at both sites. This report relates specifically to the Sydenham site which has 48 beds divided into four wards named Nuffield, City, Alex and Rugby wards. Each ward includes a mix of single occupancy bedrooms and four bedded bays, a kitchen area and small sitting room or conservatory. The Sydenham site also includes the Anniversary day centre and cafe that is open to the public, the Pilgrim multi-faith room, the Pavilion Gardens meeting room and art lodge, a fully equipped gymnasium, a mortuary, various complementary therapies clinics, a conference room and the education and training centre. The hospice is surrounded by well-maintained gardens.

The specialist community palliative care team operates in collaboration with local primary health care teams to provide people, their families and/or carers with end of life care and support. Its primary task is to manage symptoms associated with people’s illnesses and to support them and their families through the illness and into bereavement. The team also offers an advice and visiting service for patients throughout the 24hr period. New patients can be admitted in to the community or inpatient service at anytime.

St Christopher's provides pastoral and counselling/bereavement services for children, adults and families. The hospice has three distinct bereavement services for adults following the death of someone under the care of the hospice, for anyone who is bereaved and lives in Bromley and the Candle project for children and their families.

People in the local community can also access a range of group and social activities at the hospice’s day care unit and Anniversary Centre where individuals, families and carers can relax, socialise, support each other and make use of a range of creative and complementary therapies, which includes a rehabilitation gym. St Christopher’s creative arts and complementary therapy team also work with staff, in care homes and with related projects in the local community.

At the time of our inspection there were 38 patients staying on the wards at the Sydenham site. The community palliative care team supports around 500 people in the community at any one time and offers advice and a 24 hour consultancy hotline for over 100 care homes in South East London. Nearly a thousand people used the facilities at the Anniversary centre in 2015/16. Approximately 120 people access physio sessions in the gym weekly and 20 young adults with life limiting conditions regularly attend social groups run by St Christopher’s.

The service ha

At our inspection on 16 December 2013 we focused our inspection on the experience of people receiving in-patient care at the hospice, as we inspected the hospice's community services at our inspection on 06 March 2013.

People who were in-patients at the hospice and their relatives told us they were very happy with the care they received. One relative could not praise the staff enough, they said "the staff do it for pure love, and there is lots of laughter”. Another relative told us “mum is being looked after very well”. One person told us “the staff are doing their bit, and they always respond to the call button”. People also told us their thoughts about the food. One person told us “the food is not bad” and another said “the food is ok". Overall people were very happy with the care and support they and their family members received.

We found people's needs were assessed to ensure they received the most appropriate care and support. People's care was delivered to promote their comfort and we found they received appropriate nursing and medical input. People were protected against malnutrition and dehydration and they were able to make choices about their mealtimes. We found improvements had been made with infection control practice, and the management of medicines was safe. People were cared for by adequate numbers of appropriately skilled care and medical staff.

People who used the service and their relatives we spoke with told us they were very happy with the community palliative care service they received. One person told us "Staff are very willing. Nothing is too much trouble" and another said "I couldn't say a wrong word about them". One person's relative told us they felt St Christopher's Hospice was a "marvellous organisation". People told us community nurses were quick to respond to their needs, including out of hours and at weekends. One person told us they "would have no hesitation to call" if they needed help or support. People we spoke with told us they were getting all the help they needed and their care was well coordinated by the hospice teams.

We found the provider acted to seek appropriate consent from people, and would act in people's best interests if they lacked capacity to make their own decisions. Appropriate consent practice was followed. People's care and support needs were assessed and care was planned to meet their changing needs. People's care was reviewed on a regular basis to ensure it was appropriate to meet their needs. Staff knew what abuse was and how to report concerns. We found safeguarding adults and children's procedures had been followed in the past when concerns had been raised. The provider's recruitment procedures were sufficient to ensure staff were suitable. The provider acted in accordance with their complaints policy to ensure complaints were investigated and responded to adequately.

People using the service and those supporting them who we spoke to at our inspection praised the care services they received and the staff highly. People told us, “I can’t ask for any more”, and told us that staff and volunteers at St Christopher’s were “very helpful”.

People felt that they were involved in and consulted about their treatment and care, informed of changes, and that their dignity and privacy were well-respected.

People using the service and those supporting them who we spoke to at our inspection praised the all the care services they received and the staff. They told us that they “could not speak more highly of the care provided by the staff”. One family member said she “could sleep easy” because of the quality of care.

During our visit we observed that care was provided in a compassionate and appropriate manner. Staff were friendly, professional, caring and respectful with people using the services and their supporters at all times.

Everyone we spoke with said that they felt safe and well looked after. People felt that if they did have a concern they would be able to raise it with staff, and that they would be listened to and appropriate action would be taken. People knew there was a complaints procedure and how to access it.