St Christopher's Hospice

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We carried out a focused assessment of safeguarding at the hospice. We checked that people were safe and protected from bullying, harassment, avoidable harm, neglect, abuse and discrimination.

The service had an open learning culture and people could raise concerns. Managers investigated safeguarding incidents thoroughly. People were protected and kept safe.

At our last inspection we rated this key question as good. We did not rate safe during this assessment. The rating for this key question is based on the previous rating for safe.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

Safeguarding

The evidence showed a good standard. The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect.

Staff we spoke with knew how to identify people at risk of, or suffering, significant harm or abuse and the service worked with other agencies to protect them. Staff could give examples of how to protect patients from harassment and discrimination, including those with protected characteristics under the Equality Act.

Staff received training specific for their role on how to recognise and report abuse. Staff and volunteers had completed the right level of safeguarding training for both adults and children. Although the hospice cared for adults, staff and volunteers undertook safeguarding training for children to enable them identify children at risk of abuse and act to safeguard such children. Between 90% and 94% of staff and volunteers had completed level 1 and 2 safeguarding training for both adults and children in line with the provider’s target of 90%. Level 3 safeguarding adults training had been completed by 100% of relevant clinical staff. The safeguarding lead had completed level 4 safeguarding training.

In addition, 100% of staff had completed assessing mental capacity training and 94.12% had completed best interest training. Staff could give examples of setting up best interest meetings to discuss patients and their relatives’ needs with other agencies. Best interest meetings were aimed at making decisions for people who lacked the capacity to do so and often involved other agencies to ensure care was cohesive between agencies.

The provider had a clear process for reporting and learning from safeguarding incidents. Staff knew how to make a safeguarding referral and who to inform if they had concerns. They informed us there was an open culture within the service and they could report incidents or raise concerns without fear of blame or victimisation. Staff we spoke with explained the safeguarding referral process and gave examples of when they needed to make referrals. They confirmed that they discussed learning from incidents during huddles and staff meetings. For example, staff informed us that following a safeguarding allegation involving a patient who suffered from delirium, learning was identified to ensure staff worked in pairs when necessary. In addition, leaders reiterated the need for staff to ask patients about their care preferences and consider patient previous history.

We reviewed 4 patient records during our assessment. Staff kept detailed records of patients’ care and treatment. The records were stored electronically, secure and easily accessible by relevant staff. Staff completed the integrated palliative outcome scale (IPOS) assessment. The IPOS was used to assesses the physical, psychological, social and spiritual needs of individuals with advance or life-limiting illnesses. This enabled staff to identify any concerns or required support for the patient. The electronic systems had flags to alert staff if patients had safeguarding concerns. We saw that capacity assessments had been completed for patients in all records reviewed.

We reviewed staff records for 4 substantive staff members and 3 volunteers in patient facing roles. We saw evidence that the service had robust recruitment processes which included identity checks, qualification checks, disclosure barring service (DBS) checks and references. The service checked to ensure all clinical staff maintained their registration with relevant professional bodies. All records reviewed showed staff had completed relevant training required for their role including the appropriate level of safeguarding training.

We reviewed safeguarding records during our assessment. The records reviewed showed staff identified concerns and sought support internally as required. There was a multidisciplinary team approach to gathering further information to clarify concerns and share those concerns with relevant bodies. We saw evidence that staff worked well with patients, their families and safeguarding partners, including members of the safeguarding team, social workers, the local authority and other healthcare providers. We saw that a safeguarding escalation briefing was sent to all staff for learning following the incident that prompted our assessment. There had been a delay in notifying the local authority and the CQC about a safeguarding concern involving a vulnerable patient. A formal support pathway was established for the staff involved and additional training was delivered for a safeguarding session. An immediate after-action review was held which identified learning, this included ensuring all ward managers were aware of the appropriate responses and notifications to be made following a safeguarding incident.

The hospice had a safeguarding policy which was up to date and available on the intranet. The safeguarding policy was comprehensive and reflected national guidance. The policy identified various forms of abuse including sexual abuse or exploitation and female genital mutilation. The policy outlined actions staff should take when they identified a safeguarding concern. Staff we spoke with were aware of the policy and how to access it. They referred to using dedicated safeguarding sections in the electronic system to record concerns. The hospice had a safeguarding lead, and staff knew how to contact members of the safeguarding team. The safeguarding team included a designated board and executive lead, in addition to a safeguarding lead, who together provided oversight, coordinated senior practitioners, and ensured safeguarding processes were embedded across the organisation.

The hospice had published a safeguarding strategy which set out its’ priorities for the next three years and provided a structured approach to ensure that people who used the services, families, staff and volunteers and visitors were safe, listened to, respected and protected. The service had 6 strategic priorities including, safe people, confident workforce, learning and improvement, equity and person-centred safeguarding, partnership working, and governance and assurance. The service also had clear assurance measures which include reviewing safeguarding activity and themes, training compliance, audits, evidence of improvement from learning, feedback from patients, families and carers among others.

Patients and their families received a welcome pack when admitted to the in-patient unit. This provided information about the service and an email address for people to give feedback. However, the information did not explain how to raise safeguarding concerns. We did not see this information displayed anywhere else in the hospice. It was unclear how the service supported people to understand safeguarding and personal safety, or how it empowered them to recognise and report concerns for themselves or others.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe and effective staffing during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.