This inspection was announced and took place on 19 and 20 July 2016. Our previous comprehensive inspection was on 29 April 2014 and was part of the pilot to test the Care Quality Commission's (CQC) new inspection methodology and so although they were rated this was not published. At the inspection on 29 April 2014 we asked the registered provider to make improvements with regard to Regulation 12 Safe care and treatment; around the management of medicines. This action has now been completed. We revisited the service on 29 September 2014 and found the service was compliant with the regulation.
St. Leonard’s Hospice York provides a 20 bed in-patient hospice care unit (IPU) and a hospice-at-home service which are regulated by CQC. The Sunflower Centre, which is the day hospice is not regulated by CQC. These are based on one site. The hospice holds condition specific clinics, has a social work team, a bereavement support service, therapy services, an education department, a fundraising department and a team of volunteers numbering around 230. There is a hospice-at-home team who provide hospice care in the community to people. There is also a care homes education team who work specifically with care homes in the area. The hospice also has an on-site Chaplain who provides spiritual care to everyone using the hospice service.
The care provided by the hospice is for people that live in the York area of North Yorkshire and Ryedale and some parts of the East Riding of Yorkshire. The service is a registered charity with a board of trustees. Day-to-day the service is run by a senior management team drawn from all departments within the hospice.
The service was responsive and focused on providing a tailored service which people helped plan and develop. There were appropriate systems in place to ensure flexibility to people so that their care needs could be met either at home, in the hospice or in the wider community. In addition the service provided good support to relatives and carers.
Excellent leadership and management was demonstrated at the service. The culture was open and inclusive which meant that people received a tailored service which was flexible to their needs.
There was a registered manager employed for this service. 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 was very experienced after being employed by the hospice for a number of years.
The beautiful environment was maintained by the hospice maintenance and gardening team. There were servicing agreements in place for mains services. The premises were extremely clean and tidy with appropriate adaptations in place for people who used the service. The gardens were extremely well maintained and offered people tranquil and pleasant areas in which to sit, chat and spend time with their loved ones.
Staff recruitment processes were followed with the appropriate checks being carried out. There were a high number of staff on duty to meet people's needs in a meaningful way and the service had a team of volunteers who provided additional support. The hospice had a bank of staff who they could contact if they needed additional staff. All staff received annual appraisal and clinical supervision and staff discussion groups were in place. Staff and volunteers received a thorough induction and regular training to ensure they had the knowledge and skills to deliver high quality care which they demonstrated throughout the inspection.
Staff followed risk assessments and guidance in management plans when providing care and support for people in order to maintain people's safety.
Staff were able to describe what it meant to safeguard people and told us how they would report any suspected abuse. There were policies and procedures in place for staff to follow and there was an embedded culture of learning from mistakes.
People brought their own medicines with them to the service and there were systems in place to ensure they were stored and administered safely.
Staff worked within the principles of the Mental Capacity Act where appropriate. People had choices about their care and their consent was sought by staff. They told us they were involved in all decisions about their care.
People were supported to receive a nutritious diet at the service. Their appetite was assessed through talking with them which led to staff being able to give the person the amount and type of food they would be able to eat. There was a choice of menu on the day we inspected and the meals we saw were of a high quality. Drinks and snacks were freely available. People and their families described the food in positive terms.
When people needed specialist healthcare support the day hospice made referrals to specialist services such as occupational therapy or the dietician.
People told us that staff were caring and listened to them. There was a spiritual care co-ordinator who was available to people who used the hospice and their families. This support was across all faiths but specific religious leaders could be accessed through the co-ordinator if a person preferred. We heard examples of the excellent spiritual support provided to people.
The seven protected characteristics of the Equality Act 2010; age, disability, gender, marital status, race, religion and sexual orientation were well provided for within the service; the care records we saw evidenced this and the staff who we spoke with displayed empathy in respect of people's needs. These characteristics were embedded in staff training.
People were able to make decisions about the care and support that they received and told us that staff at the service communicated well with them. Confidentiality was respected through safe storage of records and by the staff who offered privacy when having difficult or sensitive conversations demonstrating respect for people's privacy and dignity. People spoke with such thankfulness about the respect shown to them by staff giving examples of how staff had helped them retain their dignity.
People helped develop their care plans which were person centred. This is when any treatment or care takes into account people's individual needs and preferences. The person’s chosen place of care and place of death was clearly recorded where the person had chosen to share that information. People were given time and support to develop advanced care plans, advance directives and living wills if they wished. People received help with symptom control and management at the day hospice but could also enjoy socialising with others.
People were confident expressing any concerns to staff at the service and knew who to approach if they were not satisfied with the response.
Staff and volunteers shared similar values and worked closely with each other in a mutually respectful way. There were regular team meetings. Accidents and incidents were clearly recorded. Where any mistakes were made these were discussed and reflected upon in order to make improvements. The hospice presented annual quality accounts which looked at patient safety, clinical effectiveness and patient experience. Audits were completed across the organisation providing a thorough and comprehensive system of quality assurance. They also took part in research projects as a means of improving their service and educating staff. The quality of the service was enhanced by these measured and this was reflected in feedback received by the service.