This inspection took place on 19, 20 and 22 July 2016 and was announced. The service was last inspected in September 2013 and at that time was meeting all the regulations we looked at.

St Raphael’s Hospice is a voluntary organization, part of the registered charity of the English Province of the Daughters of the Cross of Liege. The hospice provides end of life and palliative care to people living in the South London Boroughs of Sutton and Merton. The hospice accepts referrals made by GP’s, specialist nurses or hospital consultants. A team of specialist consultants, doctors, nurses, health care assistants and a range of other health and social care professionals, therapists and volunteers provide care, treatment and support to people with a life-limiting illness and their families/carers and friends.

The hospice comprises of a 14 bedded in-patient ward, the Jubilee day care centre, overnight family accommodation and a café known as the Orangery that is open to the public. There are various community teams that operate out of the hospice which include the Clinical Nurse Specialist Community Palliative Care Team (CPCT), “Hospice at Home” and “Hospice neighbours” services that provides people and their families care and support at home. The hospice also has a respite care service for people and a pastoral and counselling service for both people and their families. At the time of our inspection there were eight people staying on the ward at St Raphael’s and approximately 250 people receiving community palliative services at home.

The service had a registered manager who was also the hospice’s Director of Care Services (DCS). 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 a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

Management, staff and volunteers were highly motivated and committed to ensuring people and their families received the best possible end of life care, treatment and support. The hospice enabled people to experience a positive, comfortable and dignified death that was delivered in accordance with a person’s personal needs, choices and preferences. Practical and emotional support was provided to people and their families.

People received personalised care, treatment and support. People were supported to make informed choices about their end of life care and to have as much control as possible about what happened to them before and after their death. They were involved in planning their care and supported to make decisions on their preferred place of death. Consent to care was sought by staff prior to any support being provided.

The management team demonstrated a strong commitment to delivering people with high quality and safe end of life care. The management structure showed clear lines of responsibility and leadership. The service had developed effective governance systems and there was a strong emphasis placed on continuous improvement of the service. The service regularly reviewed their performance and where further improvements were identified appropriate actions were taken. Managers used learning from near misses, incidents and inspections to identify improvements that would positively enhance the lives of people receiving a service from St Raphael’s.

The hospice was committed to working collaboratively with others. Staff worked in close partnership with external health and social care professionals and other organisations to deliver and share best end of life practice and care for people affected by a life limiting illness.

People told us they were very happy with the service they received from St Raphael’s. We saw staff looked after people in a way which was kind, respectful and compassionate. Feedback we received from people, their families and external commun

During our inspection we spoke with four people who received services from St Raphael’s and three of their relatives. People told us they were extremely happy with the care and support provided by the hospice and that the staff who worked there were always kind and compassionate. One person told us “the staff are incredible here. I think they are angels without wings. I don’t know what we would have done without them”. Another person said “the support we’ve received has been marvellous. I can’t fault the place”.

We also talked to several members of staff that included the deputy manager, five nurses/carers, a GP, the head of training and three volunteers.

We saw patients received safe and appropriate care and support that was individualised. This was because there were enough suitably qualified, skilled and experienced staff to meet each patient’s end of life care needs and wishes. We also saw patients and their families were treated with respect by staff and were involved in discussions about the care provided by the hospice.

We found patients were protected against the risks associated with poor medication handling practices because the provider had appropriate arrangements in place to manage medicines safely. This meant patients were given the medicines they needed, when they needed them. The provider also had effective quality checking systems in place to regularly monitor the standard of the end of life care patients received from St Raphael’s.

St Raphael’s Hospice provides care for people with cancer and other terminal illness. People may be admitted for respite, for management of their symptoms or at the latter stages of their illness.

In addition to inpatient facilities the service provides care and support to people in their own homes and their families. There is also a day centre providing various activities and courses for people to participate in.

The service provider is a religious organisation, The Congregation of the Daughters of the Cross of Liege, however the hospice cares for people of any or no faith. 25% of its funding is provided by the National Health Service and the remaining income comes from donations and fundraising events.

During our inspection we were able to speak to the medical director, members of the management team, staff and people using the service.