The Hospice of St Francis

Updated 9 September 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 planned 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.

This inspection visit took place on 24 and 25 May 2016 and was unannounced. It was carried out by one inspector and a pharmacist inspector.

Before the inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We also reviewed notifications of significant events that affect the health and safety of people who used the service. We talked to health and social care professionals to ask for feedback about the service.

We spoke with eight people who used the inpatient service and hospice at home service, seven relatives, two volunteers, nine staff including nurses and care assistants. In addition we talked to a pharmacist, social workers, the manager of the hospice at home service, the spiritual leader, the chef, three consultants, the Chief Executive and the Medical Director.

We attended a family carers coffee morning held in the Spring Centre with 12 family carers and the Chief Executive Officer`s monthly update for all staff with a participation of approximately 80 staff members from all departments in the hospice.

We reviewed eight people’s care plans to see how their support was planned and delivered. We looked at a selection of medication records to check medicines were managed safely. We looked at a range of policies and procedures, quality assurance and clinical audits and meeting minutes for different departments.

Updated 9 September 2016

This inspection took place on 24 and 25 May 2016 and was unannounced.

Hospice of St Francis is registered to provide palliative and end of life care, advice and clinical support for people with progressive, life limiting illnesses and their families and carers. They delivered physical, emotional and holistic care including bereavement counselling support for children as well as adults, an outpatient service, occupational and creative therapy, complementary and physiotherapy, spiritual support, social workers, clinical nurse specialists and volunteer services.

The hospice inpatient unit cared for up to 14 adults who required symptom control or end of life care. They delivered physical, emotional, spiritual and holistic care through teams of nurses, doctors, counsellors and other professionals including therapists. The service provided care for people through an ‘In-Patient Unit’ and the `Spring Centre` which included the community service.

The Hospice at Home service provided palliative and end of life care and support to people and their families in their own home during the day, six days a week with access to doctors, registered nurses and care assistants. They worked closely with a partner hospice to ensure if a person needed support during the night this was accommodated.

At the time of the inspection there were 12 people using the inpatient service. The Spring Centre community service reached out to 400 people. The Spring Centre offered a range of services to people recently diagnosed with life limiting conditions, their carers and families. The service provided outpatient clinics, specialist advice, courses, complementary therapy sessions and many other opportunities for people and their families to learn to cope with their illness or their loss.

Hospice of St Francis had a registered manager in post. 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.

People received excellent care, based on best practice from experienced staff with the knowledge, skills and competencies to support their complex health needs. Staff were trained in how to protect people from abuse and harm. They demonstrated a strong sense of responsibility and in -depth knowledge about safeguarding issues and were confident in the procedures they had to follow in reporting any concerns or potential abuse internally and externally.

Risks to people`s well-being were assessed by staff daily and they discussed with people the measures needed to mitigate these risks. Staff respected and recorded people`s choices if they agreed or not to have measures in place to mitigate the risks.

Staff from the community services communicated any risks to people`s health and well-being to health and social care professionals involved in people`s care in the community and also in the regular multi-disciplinary (MDT) meetings they had daily in the in-patient unit. Staff followed up and reviewed risks regularly to ensure these were appropriately managed and mitigated.

People and families received outstanding care from exceptional staff and volunteers who developed positive, caring and compassionate relationships with them. The service promoted a culture that was caring and person centred. Staff worked together as a multidisciplinary team to provide seamless care for people.

People and their relatives were overwhelmingly positive about staff`s approach, kindness and devotion they showed towards meeting people`s needs. People told us staff helped them to live their life in comfort and pain free which improved the quality of their life. Staff anticipated how people felt when planning their care and support so people felt valued and understood.

People were partners in their care, and were consulted and involved in decisions about their care and treatment. They were asked about where and how they would like to be cared for when they reached the end of their life. Staff treated them with the utmost sensitivity, dignity and respect. The knowledge staff demonstrated about people`s needs, their wishes, likes and dislikes even for people who moved in to the in-patient unit in the last 24 hours was exceptional.

The hospice operated a 24 hour admission process for the in-patient unit and on-call system for the community service to ensure people received the same support and advice during the day as during the night. People using the inpatient service had their medical needs met by a team of doctors employed by the hospice including two consultants, one of which worked predominantly in the community.

People who used the various services offered at the Spring Centre told us the help and support they received changed their life and gave them strength. They valued the support they received from the different activities, courses and clinics which helped them to live with and manage their symptoms to maximise their health and helped them prepare for the future. They also appreciated the opportunity to meet with people in similar conditions and the social aspect of the services provided.

People’s medicines were administered by trained and qualified staff who had their competency assessed regularly by the practice development nurse. Any changes in people`s medication were discussed by the medical team with people, nurses and pharmacist to manage and support people’s symptoms and pain management. Medicines were regularly reviewed and audited to ensure they met people’s needs.

The registered manager and staff were clear about their responsibilities around the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and were dedicated in their approach to supporting people to make informed decisions about their care. Nursing staff from the hospice at home service were trained to discuss and record decisions regarding Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR). People were helped to make informed decisions by discussions with the nursing staff which helped them understand the implications this decision had on their life.

There was a positive culture which focussed on people. People's positive feedback about the way the service was led proved that the management team at St Francis promoted excellent leadership which placed people and their families in the centre of all the services provided. Staff praised the provider and the leadership of the management team for their approach and consistent, effective support and how they led through example.

The Chief Executive Officer (CEO) and the registered manager promoted an open and transparent culture which had roots in the values and the ethos the hospice practiced. Staff were extremely motivated and they promoted these values in every aspect of the care they provided to people and their families. They were fully committed to constantly improve the quality of care people received starting with symptom control all the way to end of life and palliative care.

The CEO and the Registered Manager actively sought the views of others which was used to shape and improve the services offered by the hospice. Following research and working in partnership with other hospices and health care organisations the Medical Director has developed services for people with pulmonary fibrosis and heart failure. This made them leaders between other providers and people with pulmonary fibrosis were referred to St Francis even if they resided outside the hospice catchment area to benefit from the excellent care and symptom management they offered.

The CEO ensured that St Francis took a key role in the community and was actively involved in building further links with other charity organisations and local NHS Trusts to promote the hospice services and help improve the quality of end of life care people received. The Medical Director from the hospice worked at the local hospital to identify early the people who were in need of specialist end of life care and to improve staff`s knowledge who worked at the hospital about palliative and end of life care.

The CEO recognised that the changing demographic within North West Hertfordshire had a significant impact on the needs of the people living in the community. They established seamless working relationships with other organisations to be able to reach out to as many people with complex needs as possible. The Medical Director created a Consultant in Palliative Medicine post to provide additional medical support to the multi-professional teams working at St Francis and the partner organisations and promoted coordinated personalised care for people in the community.

The service continuously looked at the needs of the local community and adapted their services to reach and extend the hospice support to as many people and their families as possible. The services provided by the hospice had the support of 1000 volunteers who were closely involved in every aspect and department the hospice was operating. They played an important part in fundraising events and spreading the awareness of the hospice services in their community.

There was a comprehensive auditing programme for all the services the hospice provided carried out by the management team. Action plans were comprehensive in detailing actions taken, time frames and the responsible person for the actions.