This inspection took place on 17 and 18 October 2016 and was unannounced. This meant staff at St Luke’s did not know we were coming. Our last inspection at St Luke’s took place in August 2014. The hospice was found to be meeting the requirements of the regulations we inspected at that time and overall we rated the service Good.

St Luke’s Hospice provides a range of specialist palliative care services for adults within a dedicated building offering 20 inpatient beds along with outpatient services. The hospice also has a community team who provide care and support for people and families in the home environment.

At the hospice there is a therapies and rehabilitation centre providing day care support, physiotherapy, occupational therapy (including art therapy), wellbeing services (including complementary therapies), psychology, spiritual care, social work and bereavement services.

St Luke’s had a registered manager. 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. The registered manager also has the role of deputy chief executive and director of patient care.

Day-to-day operation of the hospice is delegated by the Board of Trustees to the Chief Executive Officer (CEO). The CEO discharges responsibilities through the Hospice Executive Team.

At the time of our inspection there were 18 people being cared for on the Inpatient Centre, 10 people were being supported in the therapies and rehabilitation centre and approximately 250 people were being cared for in the community around the city of Sheffield.

People, relatives and healthcare professionals consistently praised the exceptional standards of care, treatment and support provided by hospice staff.

People received exceptional care which was founded on best practice ensuring people were involved and central in the planning and review of their care.

We observed staff supporting people who used the service with consideration, dignity and utmost respect.

People received excellent care and treatment which enabled them to have a dignified and pain free death. Families and those that mattered to the person were supported to spend quality time with them. Relatives were also able to access bereavement support following their family member’s death.

People gave exceptional feedback about the meals and innovation provided by the hospice surrounding their nutritional needs.

St Luke’s Hospice was continually striving for excellence through consultation, research, and reflective practice. The hospice was extremely forward thinking and had a number of new developments underway based on best or evidence based practice to improve care or develop new initiatives.

We saw a number of quality assurance systems and audits to monitor performance and to drive continuous improvement.

The hospice had undertaken innovative work to support people and communicate with different groups of people within the city of Sheffield.

We found suitable arrangements were in place to help safeguard people from abuse. Staff knew what to do if an allegation of abuse was made to them or if they suspected that abuse had occurred.

We found people were cared for by sufficient numbers of suitably skilled, competent and experienced staff who were safely recruited.

We were informed there were over 800 volunteers providing support to the hospice. Volunteers had a wide range of skills and experience. Some worked in the charity shops, others helped with fundraising, running events, collecting donations, driving, bereavement support and many other roles. All the St Luke’s staff, people and relatives we spoke with said volunteers formed a vital part of the St Luke's team.

The service had appropriate arrangements in place to manage medic

We used informal observation to see how members of staff interacted with patients. We saw staff treated people with dignity and respect by using a positive, friendly and professional approach. We found people looked clean, tidy and had their medical, nursing and welfare needs met.

We talked with three patients and four relatives during our inspection. Patients told us they were happy with care at the hospice, liked all the staff who looked after them, thought the hospice was kept clean and they enjoyed their food. Some comments captured included “yes [the care] is very good …excellent”, “staff are very friendly”, “the staff are brilliant”, “nothing is too much trouble”, “[I’ve] been spoilt and pampered” and “wonderful … attend to all my needs.”

Patients were supported to have adequate nutrition and hydration.

We found there were processes in place to ensure the safety, availability and suitability of equipment.

We found there were effective recruitment and retention processes in place.

We found people were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records had been maintained.

We used informal observation to see how members of staff interacted with patients. We saw staff treated people with dignity and respect by using a positive, friendly and professional approach. We found people looked clean, tidy and had their personal care and welfare needs met.

We talked to three patients along with three relatives during our inspection. People told us they were happy with care at the hospice, liked all the staff who looked after them, thought the hospice was kept clean and enjoyed their food. Some comments captured included, "[staff are] friendly and helpful", "good variety food which is served promptly and my dignity is maintained", "fantastic experience...courteous staff" and "[nursing and other staff] absolutely wonderful, they're angels".

On the site visit conducted 24 May 2011 we talked to two patients and three relatives. All had been happy with the nursing care and felt staff members were friendly and helpful.

Some comments captured:

Patient A “[nurses] very busy but they look after you … need more time to chat”.

Relative X “Nurses keep you up to date... [as a relative] kept well informed”.

Relative X “[Staffing levels] There are peaks and troughs… all busy… mum herself has recognised that care is very personalised and patient centred”.

Patient B “Got to ask for information after treatment changed”.

Patient B relative “Great organisation!”

Relative Y “Small community spirit … everybody supports everybody else… there’s a “real sense of community”.

Relative Y “Kept up to date by consultant…never met such a wonderful doctor…all doctors good…they explain in a proper environment”.

Patient A “Lots of different food…accommodate what you need”.

Relative Y “Food absolutely fantastic! – whatever they want they get”.

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 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

The registered manager who was also the deputy chief executive officer was in charge of the day to day running of the hospice. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

St Luke’s hospice provides care and treatment for up to 20 inpatients and people in the community alongside of their GPs and the community professionals. They also provide day service which is out of our scope for registration to help people and their relatives.

We found the services provided by St Luke’s hospice including community service, day care service and the inpatient service to be well led. The management team promoted innovation and encouraged staff and people who used the service to take part in improving the service.

The environment looked clean, comfortable and well maintained. People had access to communal areas and to quiet areas when they wanted to. Visitors were not restricted and they were able to stay and support patients. There were 20 inpatient beds which comprised of 14 single en suite rooms and two three bedded en-suite rooms. There were no mixed sex bays and relatives’ facilities were good. During our inspection there were 16 inpatients.

Staff who worked within the service demonstrated competence, commitment and compassion. There were sufficient numbers of staff to meet the needs of people. People had access to therapy staff. The cook visited people each day to find out their requests for meals. This was well received by the patients.

There was a robust recruitment process and staff had attended induction when they started work. Staff told us that they received support and supervision from their line managers. Staff who spoke with us fully understood their roles and responsibilities, as well as the values of the hospice.

People received person centred care which put them in the centre and took into account their  wishes and therefore people felt they had been included and listened to.

The registered manager used the findings from the quality audits to monitor the service.