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Archived: St Clare's Hospice Inadequate


Inspection carried out on 12 September to 13 September 2018

During an inspection to make sure that the improvements required had been made

St Clare’s Hospice is a standalone hospice provider, which is a charitable incorporated organisation but receives over 40% funding by the local commissioning group. The hospice which had been in operation since 1987, is based in Jarrow and offers specialist palliative care for adults who live south of the Tyne. The health of people in South Tyneside is worse than the England average. Deprivation is higher than average and life expectancy for both men and women is lower than the England average. 2.9% (2011 census) of Jarrow’s population is non-white British making Jarrow the least ethnically diverse major urban area in Tyneside. The service operates both day hospice and inpatient hospice services and provides palliative and end of life care for over 451 patients.

The inpatient unit is an eight-bed facility which provides respite and longer term care for adults with a life limiting illness including, chronic obstructive pulmonary disease, motor neurone disease, supranuclea palsy, heart failure as well as cancer. The Hospice has a day care facility which caters for up to 15 patients per day Tuesday to Friday. In addition the hospice offers bereavement counselling and befriending services.

The hospice is situated in a single story building within the grounds of a local hospital. All rooms have wheelchair access with all inpatient rooms leading to a paved garden area.

We inspected this service using our comprehensive inspection methodology. We carried out the inspection on 12 and 13 September.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

Services we rate

Our rating of this service went down. We rated it as inadequate overall.

We found areas of practice that were inadequate in relation to St Clare’s:

  • We saw significant safety concerns in areas such as medicines management, risk identification and incident investigation and subsequent learning. Safety is not sufficient priority and we saw patient harm had occurred as a result of this.
  • There is insufficient attention to safeguarding. Staff displayed limited safeguarding understanding and the interim safeguard lead was appointed to the role without agreement or knowledge of doing so.
  • Staff were not supported with mandatory training and managers had no oversight of training needs required for the role.
  • Patient records and assessments were incomplete and routine assessments were not completed for all patients, including those deemed to be high risk. Opportunities to prevent or minimise harm were missed.
  • Patients care and treatment does not reflect current evidence based guidance, standards and practice.
  • None of the nursing staff had received an appraisal in the 12 months leading to inspection.
  • There is no formal process to monitor patient’s outcomes of care and treatment and there was little appetite by managers to drive improvement.
  • Patients receive care from staff that do not always have the skills or training that is needed through regular completion of mandatory training.
  • Staff and teams work largely in isolation and do not seek support or input to actively improve services for patients.
  • People are unable to access the care they need. Access and flow within the service was interrupted without due consideration for patients waiting for services.
  • Complaints and concerns are not taken seriously and patients concerns and complaints do not lead to improvements in the quality of care.
  • Staff do not understand the vision and values and the strategy is not underpinned by detailed realistic objectives and plans.
  • The governance arrangements and their purposes are unclear. Financial and quality governance are not integrated to support decision making.
  • Leaders do not have the necessary experience, knowledge, capacity, capability or integrity to lead effectively.
  • Staff told us there was a culture of bullying and instances of conflict between individuals.
  • There is minimal engagement with people who use the service, staff and public.
  • There is minimal evidence of learning and reflective practice.

Following this inspection we undertook due process regarding the significant safety concerns and had begun the process to suspend related activities at the hospice. However following a discussion with the provider they chose to voluntarily suspended services. In addition, we told the provider that it must take some actions to comply with the regulations. We also issued the provider with five requirement notices that affected St Clare’s Hospice. Details are at the end of the report.

Ellen Armistead

Deputy Chief Inspector of Hospitals (North)

Inspection carried out on 22 January 2018

During a routine inspection

The inspection took place on 22 January and 30 January 2018 and was announced. This meant the provider knew prior to the inspection we were due to visit the hospice. St Clare's Hospice provides in–patient care for up to eight people with life limiting illnesses. At the time of our inspection four people were staying at the hospice.

At the last inspection in July 2016 we asked the provider to take action to make improvements to medicines management and good governance. Following the inspection we asked the provider to complete an action plan to show what they would do and by when to improve the key questions; is the service safe, effective and well-led to at least good. We found during this inspection significant progress had been made towards completing these improvements.

Medicines administration records were accurate. However, we found further improvements were required to evidence people had been included in discussions about using medicines off-licence and to ensure medicines prescribed for other people did not continue to be used. We also found people were not fully protected against the risks associated with medicines because appropriate arrangements to oversee the management of medicines needed further development. The provider had made significant improvements to strengthen the governance arrangements in the hospice. For example, the provider had developed a structured approach to supporting staff and systems to implement robust quality audits.

The hospice 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.

People said they received good care at the hospice from a kind and caring staff team. The provider received a significant number of compliments from people and relatives praising the care provided at the hospice.

Staff had no concerns about people’s safety. They showed a good understanding of safeguarding and the provider’s whistle blowing procedure. Staff told us they would have no hesitation to raise concerns if required.

Staffing levels were sufficient to meet people’s needs. People told us staff responded quickly to their requests for help. They also said they saw a doctor every day. Staff confirmed staffing levels were appropriate.

The provider completed a range of pre-employment checks to ensure new staff were suitable to work at the hospice.

Regular health and safety checks were carried out help keep the hospice and equipment safe. For example, checks of fire, water, gas and electrical safety. The emergency procedures were currently being reviewed and updated.

Incidents and accidents were investigated and action taken to help keep people safe.

Staff told us they were well supported and received the training they needed.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

Staff supported people with their nutritional needs in line with their assessed needs. The hospice medical team were available to plan and meet people’s care and treatment. People confirmed they saw a doctor at least every day.

People’s needs had been fully assessed which included discussing their hopes and preferred outcome from their stay at the hospice. Care plans were in place but these continued to be generic with very little personalisation to the needs of each person. We have made a recommendation about this.

Care records recorded people’s wishes for their future care needs, such as their preferred place of care.

The provider gathered feedback from people using the service through various surveys. They were in the process of gathering feedback from bereaved rela

Inspection carried out on 4 July 2016

During a routine inspection

This inspection took place on 4 and 5 July 2016 and was announced. We last inspected the service on 20 July 2013 and found the provider was meeting the regulations we inspected against.

St Clare’s Hospice provides in–patient care for up to eight people with life limiting illnesses. At the time of our inspection eight people were staying at the hospice.

The hospice 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 provider had breached the regulations relating to medicines management and good governance. We found people were not protected against the risks associated with medicines because appropriate arrangements were not in place to manage medicines. Although staff said they were well supported, we found no evidence of a structured approach to supporting staff. The provider did not have an agreed supervision and appraisal policy and procedure. Records we viewed were not always reflective of people's views about pain relief and their future care needs. Some important policies and procedures were overdue for review. You can see what action we told the provider to take at the back of the full version of the report.

People and a relative gave us positive feedback about their care. One person told us, “It’s brilliant, I am definitely well cared for.” Another person said, “This place is a life line.” One relative said, “I can’t fault it. It is the best place for [my relative]. It took a weight of our minds with [my relative] being in here. They are keeping [my relative] calm and relaxed.”

People and a relative told us staff were kind and caring. One person commented, “Staff are lovely, just like one of the family.” One relative said, “I can’t fault the staff.”

People told us the hospice was a safe place. One person said it was “definitely safe”.

Staff had a good understanding of safeguarding and whistle blowing and knew how to report concerns. One staff member commented, “I think things would be fully investigated. There is an open environment. I wouldn’t have any qualms, I would do it [raise concerns].”

There were sufficient staff on duty to meet people’s needs. One person commented, “Oh yes, they come quickly. You don’t wait very long, they are pretty prompt.” Effective recruitment checks were in place to ensure new staff were suitable to work at the hospice.

Health and safety checks were carried out keep the hospice safe, including checks of the fire safety systems, water safety, gas safety and the environment. The provider had procedures in place to keep people safe in an emergency.

Incidents and accidents were logged and investigated. Action had been taken to prevent the situation happening again and to minimise the risk of future harm to people.

Staff received the training they needed to fulfil their respective roles in the hospice.

The provider acted in accordance with the Mental Capacity Act (MCA) 2005 including the Deprivation of Liberty Safeguards (DoLS). DoLS authorisations had been requested when people were deprived of their liberty. Staff had a good understanding of MCA and knew how to support people with decision making.

Staff supported people with their nutritional needs as required. One person said, “I am unable to eat, they are going to get a dietitian.” Meals were supplied from the local health trust each day. The hospice has a supply of food so that people could be offered alternatives.

People’s health care needs were met by the in-house medical team. This included consultants, a GP with special interest, an occupational therapist and a physiotherapist. One person said, “I saw the doctor yesterday.”

Improvements had been within the hospice so that people living with demen

Inspection carried out on 18 June 2013

During a routine inspection

People we spoke with told us the service had met or exceeded their expectations. There were a range of patient and carer information booklets clearly displayed and accessible throughout the hospice. We saw the service focussed on supporting people to achieve their individual aims and expectations and to maintain their independence. This was reflected in the individual patient records throughout the organisation. People felt they were treated with dignity and respect and welcomed the range of activities and facilities provided. People’s needs were being assessed and support plans put in place ensuring that people were provided with the safe and effective care. Staff with appropriate qualifications and experience were available during each working day to provide the required level of care and support to people using the service. Staffing levels were consistent and staff were available to provide individual patient care according to the care plans.

People who use the service and staff were supported to give feedback in a variety of ways. The quality of the service was monitored at a local level through service user groups, ongoing surveys, audits, and risk assessments and any gaps were acted upon and communicated to the relevant member of staff.

Inspection carried out on 12 June 2012

During a routine inspection

During this visit we could not speak to as many people as we would have liked because of the particular care needs of the people accommodated in the hospice. We did speak with people attending the day care unit who told us they felt they were receiving safe and good care from staff at the hospice. People told us they and their relatives were included in decisions about their care, and staff were approachable and attentive. Another person told us staff had always treated them with respect and dignity.

Reports under our old system of regulation (including those from before CQC was created)