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St Julia's Hospice Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 29 November 2018

St Julia’s Hospice is operated by Cornwall Hospice Care Limited. The hospice provided care and treatment within nine inpatient beds. Cornwall Hospice Care Limited also provided a service at Mount Edgecumbe hospice which was located within St Austell.

The hospice provides care and treatment for patients with a life-limiting condition aged 18 years or over.

We inspected this service using our focussed inspection methodology. This unannounced inspection took place on 18 July 2018. We focussed on the safe and well-led domains following concerns raised to us. The concerns were in respect of staffing levels, staff training, low staff morale and allegations of bullying.

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.

There was a registered manager in post, Dawn Tame-Battell. 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.

During the inspection visit, the team spoke with 12 members of staff, including registered nurses, health care assistants, consultants, occupational therapist, administration staff, hospitality staff, community engagement nurse, head of care, the clinical lead, the chief executive officer, the medical director and the registered manager. We also spoke with four patients to seek their views of the service provided. We reviewed five sets of patient records and relevant documents, including policies, procedures and meeting minutes.

The Care Quality Commission last inspected the service in May 2016 and rated the provider as outstanding overall. We have not re-rated the service at this inspection.

We regulate hospice services but we do not currently have a legal duty to rate them when they are inspected as a focussed inspection. We highlight good practice and issues service providers need to improve and take regulatory action as necessary.

We found the following areas of good practice:

  • Staff were familiar with safeguarding processes which ensured patient safety and knew how to safeguard adults from abuse.
  • Systems prevented and protected patients from healthcare-associated infections. The hospice environment was clean and hygienic in appearance.
  • Systems to manage the environment and equipment kept patients safe.
  • Patients were monitored for deterioration in their condition.
  • Eligibility criteria ensured patients were suitable to be admitted to the hospice.
  • Sufficient staff were available to provide care and treatment for patients at the time of the inspection.
  • Patient records were well maintained and stored securely.
  • External professionals had access to a 24-hour support and advice line from the hospice. Patients and their representatives were advised to telephone the hospice directly following their discharge. This enabled a system of support to patients following their discharge.

  • The leadership structure within the organisation was clear and staff were aware who they reported to.
  • Staff were familiar with the organisation’s strategy, vision and values and were provided with the opportunity to be involved in the development of these.
  • The executive team had taken action to address low morale and allegations of bullying through the provision of meetings and reintroduction of the staff.

We found areas of practice that require improvement:

  • The system for monitoring staff training did not ensure all mandatory and additional training had been completed. Safeguarding children training was not provided and not all staff had completed safeguarding adults training. This included volunteers, clinical staff, board members and trustees. Training had not been provided to all staff who were required to investigate incidents.
  • There had been an increased turnover of staff at the hospice and this had resulted in staff not being able to be released to complete mandatory training.
  • The system for checking resuscitation equipment was not fully compliant with the organisation’s policies as weekly checks were not consistently undertaken.
  • Staffing levels were not assessed in relation to patient dependency. There was no tool for assessing how many staff were needed in relation to patient dependency levels. Filling shifts at short notice was challenging for the ward and impacted on the work being undertaken.
  • The management of prescription pads (FP 10) did not ensure an audit trail of prescriptions used.

While staff reported incidents, learning was not currently shared between the provider’s two hospices and there was no agreed standard used to assess the seriousness of an incident. Medicine errors were investigated and appropriate action taken, but this learning was not shared across the organisation.

  • Staff were not familiar with relevant national guidance and recommendations to ensure they were providing up to date care and treatment.
  • The board of executives and trustees were not always accessible to staff. The organisation was aware of this and had taken measures to address this.

Following this inspection, we told the provider it must take some actions to comply with the regulations and it should make other improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Amanda Stanford

Deputy Chief Inspector of Hospitals (South)

Inspection areas

Safe

Good

Updated 29 November 2018

We regulate hospice services but we do not currently have a legal duty to rate them when they are inspected as a focussed inspection. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

  • A system of annual mandatory training was provided for staff to ensure they were suitably skilled for their jobs.
  • Staff were familiar with safeguarding processes to ensure patient safety and knew how to safeguard adults from abuse.
  • Systems prevented and protected patients from health associated infections.
  • Systems to manage the environment and equipment kept patients safe.
  • Patients were monitored for deterioration in their condition.
  • Staffing was managed to ensure sufficient staff were available.
  • Patient records were well maintained and stored securely.
  • Incidents were recorded and reviewed to provide learning and prevent reoccurrence.

However:

  • Safeguarding children training was not provided and not all staff had completed safeguarding adults training.
  • We saw weekly checks of resuscitation equipment were not consistently completed.
  • Staffing levels were not assessed or related to patient dependency. Filling shifts at short notice was challenging for the ward and impacted on the work being undertaken.
  • The management of prescription pads (FP 10) was not managed to ensure an audit trail of prescriptions used to minimise misuse
  • The findings from investigations into reported incidents was not widely shared across the organisation to improve practice.

Effective

Outstanding

Updated 29 November 2018

We did not inspect this domain as part of the focussed inspection.

Caring

Outstanding

Updated 29 November 2018

We did not inspect this domain as part of the focussed inspection.

Responsive

Outstanding

Updated 29 November 2018

We did not inspect this domain as part of the focussed inspection.

Well-led

Outstanding

Updated 29 November 2018

We regulate hospice services but we do not currently have a legal duty to rate them when they are inspected as a focussed inspection. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

  • The leadership structure within the organisation was clear and staff were aware of who they reported to.
  • Staff were familiar with the organisation’s strategy, vision and values and were provided with the opportunity to be involved in the development of these.
  • The executive team had taken action to address low morale and allegations of bullying with the provision of meetings and the reintroduction of the staff forum.
  • The organisation had taken steps to improve the accessibility of trustees and executives to staff. Increased numbers of visits to clinical areas were being made and additional staff meetings were held.
Checks on specific services

Hospice services for adults

Updated 29 November 2018

The hospice provided care and treatment to patients 18 years and

older with a life limiting condition.

The hospice was managed by Cornwall Hospice Care Limited who

also provided services at a hospice located in St Austell.

Staff were mainly based at this hospice but could work across

both sites when required.

We regulate hospice services but we do not currently have a legal duty

to rate them when they are inspected

as a focussed inspection. We highlight good practice and issues service

providers need to improve and take regulatory action as necessary.

We

inspected the safe and well led domains as part of this focussed inspection.