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Inspection carried out on 24 November 2016

During a routine inspection

St Rocco’s Hospice provides in-patient hospice care, a hospice at home service and a day hospice from one site. The hospice holds clinics, has a family support service, therapy services, a fundraising department and a team of volunteers all based on-site.

The service is a registered charity with a board of trustees. Day to day the service is run by a management team drawn from all departments within the hospice.

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 experienced in providing palliative care and had worked at the hospice for a number of years.

People and their families spoke highly of the complementary therapies that were available to both people who used the service and relatives. The hospice provided family support, counselling and bereavement support and had recently appointed a non-denominational chaplain to strengthen their team.

People told us that staff were caring, compassionate and listened to them. People we spoke with who received personal care felt the staff were knowledgeable, skilled and their care and support met their needs.

People’s health care needs were met by the in-house medical team. This included consultants, GP’s with a special interest in palliative care, an occupational therapy team and a physiotherapy team. We saw the service was developing staff by developing the specialist nurse role and supporting nursing staff to undertake a non-medical prescribing course.

Care plans were personalised to include people’s wishes and views. People and relatives told us they were consulted about their care and treatment and that they regularly had the opportunity to speak to medical and nursing staff. Care plans were regularly reviewed in a multi-disciplinary framework. We observed staff caring for patients in a way that respected their individual choices and beliefs.

Staff recruitment processes were followed with the appropriate checks being carried out. There were sufficient staff on duty to meet people’s needs although had experienced some shortness of staff recently although this had not impacted detrimentally on the people using the service. The hospice had a bank of staff who they could contact if they needed additional staff. The registered manager told us they were working on a project to look at the skill mix of staff. Staff and volunteers received a thorough induction and regular training to ensure they had the knowledge and skills to deliver high quality care and support.

Staff followed risk assessments and guidance in management plans when providing care and support for people in order to maintain people’s safety.

People were protected by the service’s approach to safeguarding and whistle blowing. People who used the service told us that they were safe, could raise concerns if they needed to and were listened to by staff. Staff were aware of safeguarding procedures, could describe what they would do if they thought somebody was being mistreated and were aware of who to report safeguarding concerns to.

Staff gave us mixed views about how they felt supported. We explored this with the senior management team who were aware of staff feelings and showed us how they were communicating and engaging with staff over issues they had raised. Staff did tell us they felt optimistic about the outcomes of these issues.

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.

People were supported to receive a nutritious diet at the service. Their appetite was assessed through talking to them which led to staff being able to give

Inspection carried out on 30 July 2013

During a routine inspection

People spoken with said "‘Its given me back my life " ’‘The staff are so lovely, but they are working with you all the time, Another person said " All care at St Rocco’s, the options and their choices were" fully explored with me and I felt at the centre of the process, and I effectively made the decision." One person commented " the doctors are marvellous." They confirmed that they felt fully involved In the care plan for them and could discuss everything, "‘It's taken away so much worry, and I can just now get on with things…"

One person spoken with said " they knew the details of their care plans, but did not generally want to have this in writing except if it was needed and staff would make this available. " They confirmed that any counselling was done carefully and confidentially.

Comments such as "they make me very special, and its all the staff, not just the ones you have more to do with." and "you never see the staff having a huddle or a gossip together, they’re all with patients and they never stop working."

One person spoken with said they strongly would recommend the service and rated as excellent This person added ."many people do not realise how much the service is really about life and living, even though people attending know the circumstances are so difficult."

The patients strongly recommended the service and thought it a shame that people get a bit squeamish at first when hearing the word.’hospice’.

Inspection carried out on 11 December 2012

During a routine inspection

Patients spoken with told us they were very happy with the staff they had no concerns. They told us the staff were "excellent" and "marvellous” . The comments made were “ This place is second to none, the staff are caring and very professional “ We saw care being delivered in a calm and respectful manner. Staff explained why they liked working at the hospice and they felt they had a good supportive team to work with.

Inspection carried out on 14 February 2012

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

We spoke with three people who were resident at the hospice.

People told us that they were well looked after and knew what the service offered. They said that they had been given clear information about St. Rocco’s and where possible what care and support would be provided. People told us that the hospice presented as a place of calm and comfort with helpful people on reception to welcome and assist people during their stay. People said staff were very courteous and treated them with dignity and respect.

People told us they were aware of how to make a complaint and who to speak to if they had any problems. One person said, “I have been given full information about this place and what to do if I need to make a complaint. However I feel very safe and well cared for here so I certainly will not be using the complaint system”.

People told us that staff are wonderful, helpful and kind. Comments included,”I don’t know what I would do without them”, “They are most kind and caring”, “I feel as if I have known the staff for ever, they seem to know exactly what I want and when I want it”. ”I was very ill when I came here. Look at me now, I am able to go home soon thanks to the care and support provided”.

Before we visited the hospice we spoke with staff of Warrington Local Authority who advised that they have provided staff of the hospice with updated safeguarding training. They told us that they did not have any concerns about the service.

Inspection carried out on 27 September 2011

During an inspection in response to concerns

All people spoken with said that they were aware of the treatment and care they were being given and that the senior nurses and doctors spoke with them about their care on a daily basis.

Other comments made included; “The staff are lovely whether I am staying here or at the day centre, the place is a life line” ; “I have been coming to the day centre for some time and this helped me to accept coming in to stay for a while.”

Relatives spoken with said, “The staff are very supportive of me” and “The staff let me help look after my relative.”

People spoken with were aware of how to make a complaint and who to speak to if they had any problems. One person told us, “I can talk to any of the staff but I have no problems with the way they look after me, all the staff are helpful and caring.”

Staff spoken with were unfamiliar with locally agreed safeguarding procedures. They had no knowledge of “No Secrets” or Warrington Borough Council’s safeguarding policy and were unsure about their duty of care to protect vulnerable adults and the action they would take if they have any concerns about abuse. They said that they had not had any supervision sessions and had not had an appraisal for some time.

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