We carried out a review of the data available to us about St Joseph's Hospice Association on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about St Joseph's Hospice Association, you can give feedback on this service.
St Joseph’s Hospice is operated by St Joseph’s Hospice Association.
The hospice cares for over 200 patients and their families each year from across Liverpool, Knowsley and Sefton. St Joseph’s Hospice is registered as a charity but receives 40% of its funding through the NHS.
St Joseph’s Hospice has 29 beds across three units. St Francis House has two units. St Francis Upper has 10 rooms on the first floor and St Francis Lower has eight on the ground floor. San Jose has 11 rooms, all on the ground floor. We inspected adults’ services on all units.
We carried out an unannounced visit to the hospice from 7 to 9 August 2018. We inspected this service using our comprehensive inspection methodology. Our inspection was unannounced (staff did not know we were coming) to enable us to observe routine activity. We inspected all five key questions.
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.
The main service provided by this hospital was hospices for adults.
Services we rate
Our rating of this service improved. We rated it as good overall because:
The service had sustained improvements seen at the previous inspection in December 2017.
We saw the service had continued to improve how medicines were given to patients and recorded. The non-medical nurse prescriber had their competencies regularly checked and reviewed annually by a medical supervisor.
Care records showed patients’ care plans reflected their needs, preferences and choices. Staff completed care monitoring charts and recorded patients’ level of pain, fluid intake and output and how much food they got through two hourly ‘comfort rounds’.
Since the last inspection the service had introduced the ‘safety thermometer’ to monitor patient outcomes and service performance on pressure ulcer care and falls.
Staff received a good level of support through regular supervision and annual appraisal. Staff told us they received good support from the clinical director and the inpatient unit manager.
We saw that consent was sought from patients and their advocates around key decisions and recorded in care plans. Staff followed the principles of the Mental Capacity Act 2005 and made appropriate applications under Deprivation of Liberty Safeguards when patients lacked capacity to consent to care and treatment.
The service continued to store confidential information securely. Staff respected confidentiality and updated records and discussed care in the nurses’ station where they could not be overheard or overlooked.
Systems and processes for assuring standards at the hospice were embedded. Trustees and senior managers showed awareness of issues and had acted to mitigate against these. Improvements and challenges were effectively monitored through finance and clinical governance sub-committees.
The service ensured there were sufficient number of staff on duty to care for patients. We saw they were actively recruiting qualified nurses. The management had closed one unit to any admissions until enough qualified nurses were recruited to provide safe care and treatment.
We saw the service had introduced structured handovers of care of patients between shifts which were thorough and attended daily by a senior manager.
The service had developed links with other providers and hospices in the local area to share learning and good practice. There were many examples of positive engagement with the local community.
However, we also found areas of practice that require improvement:
Though the service had improved how medicines were given and recorded staff still had to handwrite onto to medicines charts and a second member of staff did not always check and sign these records. There was no information for health care assistants on how often to apply topical preparations and creams.
We saw that used and full oxygen cylinders were not stored in line with the manufacturer’s best practice guidelines on storage of medical gases.
Not all communal areas that were used by patients had call bells so patients could not call for assistance if they fell or became unwell when alone in these areas.
Volunteers who directly supported patients did not receive safeguarding for adults and children training.
Staff did not use a recognised tool to assess the level of pain experienced by patients who could not speak.
The service did not provide facilities for patients from different religious or cultural backgrounds.
Following this inspection, we told the provider that it should make improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.
Ellen Armistead
Deputy Chief Inspector of Hospitals (Hospitals North)
At the previous inspection of 4, 5 & 7 July 2017 the provider was found to be inadequate and the service was placed in ‘special measures’ by CQC. We found breaches of regulations in all key questions we inspect (Is the service safe, effective, caring responsive and well led?).
The purpose of 'special measures' is to:
Ensure that providers found to be providing inadequate care significantly improve.
Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.
Services placed in 'special measures' are inspected within six months of the publication of the inspection report.
At this inspection we found improvements had been made. This meant the service was no longer rated inadequate and could be removed from 'special measures' by the Care Quality Commission (CQC).
Following the inspection in July 2017 we issued an urgent statutory notice requiring the provider not to admit any further people to St Joseph’s Hospice. The urgent statutory notice also required the provider to carry out a review of the quality assurance systems that were in place; the introduction of medicines management audits; the introduction of clinical compliance checks; appraisal of the individual competencies of all persons employed and also the directors at St Joseph’s Hospice and to issue a policy that is in accordance with the requirements of the Mental Capacity Act 2005 (MCA) in relation to the use of covert medication and administration of covert medication.
In light of the improvements we found at the December 2017 inspection we have now lifted this statutory notice which prevented people being admitted to the service. The provider had also complied with the other conditions of the urgent statutory notice.
We have revised the rating for the hospice following our inspection; however the service cannot be rated as ‘good’. To improve the rating to ‘good’ would require a longer track record of consistent good practice.
St Joseph’s Hospice provides care and support to terminally ill people and their families within the Liverpool and Sefton areas.The hospice provides care for people with progressive, degenerative conditions and for people with a brain injury. The hospice also provides end of life care and support to families of terminally ill patients. The hospice has accommodation and facilities for 29 people. At the time of our inspection 17 people were receiving a service at the hospice.
People in a hospice receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service 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 of the Health and Social Care Act 2008 and associated regulations about how the service is run.
At the inspection in July 2017 we found a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, as medicines were not administered safely. We found concerns around the way some medicines were administered and recorded which placed people at high risk of harm. There were issues in the way some medicines were stored.
At this inspection reviewed the management of medicines. The hospice was working closely with external health professionals to improve the medicines arrangements in the hospice. We saw that people now received their medicines safely. Staff who had administered medicines had been trained and had their competencies checked. Storage conditions had improved. This breach of regulation had been met.
At the inspection in July 2017 we found a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, as the hospice did not always support people to provide effective outcomes for their health and wellbeing, this included monitoring of pain.
At this inspection we saw staff completed care monitoring charts, for example, recording of people’s intake and output to help monitor people’s health and provide a care evaluation. Care records showed people’s plan of care was written in a way that reflected their wishes, preferences, needs and choices. This included reporting on medical conditions and formulating a plan of care for pain management. This breach of regulation had been met.
At the inspection in July 2017 we found a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, as some food supplements were not administered in accordance with instructions.
At this inspection we found food supplements were given as prescribed in accordance with people’s nutritional assessment. This breach of regulation had been met.
At the inspection in July 2017 we found a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, as staff were not supported through appraisal, supervision and the hospice's training programme.
At this inspection we saw staff received a good level of support and training. Staff had also had an annual appraisal. Staff told us they received good support from the registered manager and that they had access to a variety of training courses. This breach of regulation had been met.
At the inspection in July 2017 we found a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, as when people were unable to consent, the principles of the Mental Capacity Act 2005 (MCA) were not always followed, in that an assessment of the person’s mental capacity was not made.
At this inspection we saw consent was sought from people around key decisions, including the administration of covert medication. This breach of regulation had been met.
At the inspection in July 2017 we found a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, as there was a failure to maintain accurate and complete records of care and treatment for people and people’s care notes were taken to the dining room by staff for annotation. This room was used by relatives and confidential notes could be overlooked by relatives within this area.
At this inspection we saw confidential information was securely stored and staff made annotations to people’s notes in the office or nurses’ station. Staff were aware of how to main confidentiality and told us how this was respected. This breach of regulation had been met.
At the inspection in July 2017 we found a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, as some of the systems for auditing the quality of the service needed further development and did not provide adequate monitoring of standards in the hospice. We found repeated failings with the service with the provider not able to meet statutory requirements.
At this inspection we found systems and processes for assuring the standards at the hospice were consistent and robust. We saw sight of the effectiveness of the improvements and also how the service was initiating further changes to support the development of the service. Clinical governance was well monitored and discussed at clinical governance meetings. We were assured by the measures taken. This breach of regulation had been met.
People who received in-patient care told us there were sufficient numbers of staff on duty to care for them. Staffing rotas evidenced staffing numbers and skill mix. People told us the staffing levels helped them feel safe and supported.
Staff had been checked when they were recruited to ensure they were suitable to work with vulnerable adults.
Staff had a good knowledge of safeguarding procedures. The hospice had reported actual or potential harm to the relevant local safeguarding authority and agreed protocols had been followed in terms of investigating. This helped to ensure any lessons could be learnt from and effective action taken. We had also been notified of safeguarded incidents in accordance with our statutory notifications.
A four week menu was in place and we saw people offered choice of well balanced meals. People told us the food was very good. People’s nutritional needs were assessed and recorded.
The environment and equipment was well maintained and subject to service contracts and safety checks. All areas seen were clean and kept hygienic.
Staff sought advice from external health and social care professionals at the appropriate time. This ensured people’s health was monitored effectively.
People who received in-patient care told us that staff were kind and caring and that they were treated with respect by staff. We saw good level of engagement between people receiving in-patient care and the staff. It was evident that the staff knew people and their relatives well.
Staff were aware of how to maintain people’s independence, taking in account current risks and how to manage these effectively.
People receiving in-patient care and their relatives had been involved with formulating the plan of care. We discussed ways of recording this in more detail to evidence their inclusion.
We saw good standards of privacy and dignity for people receiving in-patient care. This we evidenced by our observations, feedback from people receiving in-patient care, relatives and by looking at care records.
Social activities were arranged including holistic treatments suc
This was an announced inspection which took place over three days on 4, 5 & 7 July 2017.
The service 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 of the Health and Social Care Act 2008 and associated regulations about how the service is run.
The service last received a full comprehensive inspection in July 2016 and at that time we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations; we rated the service as ‘requires improvement’. A Warning Notice was served in relation to Regulation 12, of the Health and Social Care Act 2008, Regulated Activities Regulations 2014, by way of unsafe medicine management.
We completed a ‘focused’ follow up inspection in October 2016 and we found breaches relating to care and treatment, medicines, safeguarding and acting on complaints had been met; the service remained in breach of regulations regarding good governance because they failed to ensure the proper arrangements were in place to assess, monitor and improve the quality and safety of services and maintain accurate complete records of the treatment provided to people. The hospice retained an overall rating of ‘requires improvement’.
We returned in July 2017 to carry out this comprehensive inspection and found the service had not improved and there were further breaches of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014. The service had been unable to demonstrate sustained compliance with standards of quality and safety and there was a failure to sustain improvement, by way of safe medicine management at the hospice. In turn, we found a failure of governance and oversight by the registered persons. We found breaches of regulations with respect to; Regulation 12 Safe care and treatment (medicines management), Regulation 11 Consent to care and treatment, Regulation 17 Good governance and Regulation 18 Staffing (with respect to support and competency of staff).
We found medicines were not administered safely. We found failings with safe and secure storage of medicines, lack of safe administration including missed dosages of medicines and lack of consultation and safe protocols when people refused medicines, lack of guidelines for specialist administration of medicines and lack of adequate records for the administration of prescribed thickeners (used for thickening fluids for people with swallowing difficulties). We found there was a failure to assess the risks to people’s health and wellbeing.
We found that when people were unable to consent, the principles of the Mental Capacity Act 2005 were not always followed.
We found the nursing staff was not receiving periodic supervision and staff employed were not appraised to ensure acceptable levels of competence were maintained or they demonstrated the necessary competences and skill to carry out specialised care safely.
Some of the systems for auditing the quality and safety of the service were not being carried out consistently and had not identified the failings we found. Overall governance did not provide adequate monitoring of standards in the hospice and we found repeated breaches of regulations. There was a failure to maintain accurate and complete records of care and treatment for people. We also found that care documents were not always stored securely which compromised their confidentiality.
Following the inspection we found the seriousness of the breaches of regulations posed a 'high' risk to people receiving care at the hospice. We used our enforcement procedures and served an urgent notice telling the provider to take action to put things right. The notice also told the provider not to admit any more people to the hospice until the areas of risk we identified had been addressed. The statutory notice we issued remains in place at this inspection.
We found examples where people’s privacy and dignity was not always upheld.
You can see what action we took with the provider at the back of the full version of the report.
Care plans were completed and were being reviewed so people’s care could be monitored. We found care plans ‘generic’ and lacking in personal preference and identity of people’s individuality. We made a recommendation regarding this.
Prior to our inspection we received information of concern regarding staffing levels at the hospice. At the time of our inspection we found staffing levels were appropriate to meet the care needs of the people staff supported.
People receiving care at the hospice told us the meals were good and well presented. People were offered a good choice of hot and cold meals and plenty of drinks throughout the day.
We observed positive interactions between staff and people receiving care at the hospice. Feedback from people and relatives was very positive in respect of the staff.
We looked at how staff were recruited and the processes to ensure staff were suitable to work with vulnerable people. We saw checks had been made so that staff employed were ‘fit’ to work with vulnerable people.
Staff receive safeguarding training and policies and procedures around abuse and whistleblowing were available. Contact details for reporting an alleged incident to the local authority were displayed for staff to refer to.
A complaints procedure was in place and people, including relatives, we spoke with aware of how to complaint and felt comfortable in raising any concerns with the staff.
On the inspection we visited all of the units in the hospice and found them to be clean. Staff were seen to adhere to basic infection control practice when attending to people and serving meals. We saw there were hand wash facilities available in all bathrooms and toilets including liquid soap and paper towels for staff use.
The registered manager was aware of their responsibility to notify us [The CQC] of any notifiable incidents in the hospice.
Special measures:
The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:
• Ensure that providers found to be providing inadequate care significantly improve
• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.
Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.
After the comprehensive inspection, the provider wrote to us to tell us what they would do to meet legal requirements in relation to the breaches. We undertook a focused inspection on 25 & 26 October 2016 to check that they had they now met legal requirements. This report only covers our findings in relation to the specific area / breach of regulation. This covered three questions we normally asked of services; whether they are 'safe', ‘responsive’ and ‘well led.’ The question 'was the service effective' and ‘was the service caring' were not assessed at this inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for St Joseph’s Hospice on our website at www.cqc.org.uk.
There has been a change of manager since the last inspection. A new manager was in post and they have applied for the position of registered manager for St Joseph’s Hospice. 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.
St Joseph's Hospice is run by St Joseph's Hospice Association which is a registered charity and company which also runs a number of hospices overseas.
The hospice has accommodation and facilities for 29 people across Liverpool, Sefton and West Lancashire. There are three units; St Francis House with eight ground floor rooms and 10 single rooms on the first floor; San Jose building has 11 ground floors single rooms.
St Joseph's Hospice provides care and support people with progressive, degenerative conditions and for people with brain injury and terminal illness. The hospice also provides end of life care and support to families of terminally ill patients. The service is supported by a local consultant in palliative medicine, other consultants who specialise in psychiatry and elderly medicine and local GPs with an interest in palliative care.
At our last inspection in July 2016 we had found the home in breach of regulations relating to the safe administration of medicines. This was because medicines were poorly managed and medicine practices at that time put people at risk. At this inspection we found people were protected against the risks associated with medicines. We saw improvements around gaps in recording of controlled drugs (medicines that require extra checks and special storage arrangements because of their potential for misuse); medicines that required refrigeration; the practice for staff to ‘share’ medicines belonging to one person with another had ceased; clear directions for the application of creams and appropriate records for the use of thickening agents for drinks to aid swallowing were in place. This breach had been met.
At the last inspection we had concerns that the service was not following agreed local authority protocols for reporting allegations of abuse with the local authority or with us the CQC. At this inspection our findings showed staff were aware of the safeguarding protocol to follow and on-going training was provided around the safeguarding of adults (protecting people from abuse). This breach had been met.
At the previous inspection we found the system for recording and responding to complaints was not effective. No complaints have been received by members of the public since our last inspection however we saw how concerns such as medicine or other untoward incident were recorded, investigated and lessons learned with the staff. Staff were aware of their role in reporting and acting on complaints and the manager informed us they were introducing a complaint log sheet to improve the overall recording of concerns and complaints. This breach had been met.
In respect of care planning and monitoring people’s care needs, we found at the last inspection a lack of care documentation to support people’s care and wellbeing and poor monitoring of people’s care. We found at this inspection people’s care needs were recorded in a plan of care and care monitoring records such as diet, fluid and positioning charts were completed to provide an evaluation of care needs. This breach has been met.
We were concerned that the systems and process in place to monitor and develop the service were not effective at the last inspection. At this inspection we found the overall management of the hospice had improved. A clinical governance framework was in place to improve the quality of the service and ensuring good standards of care.
Systems and processes, including audits (checks) had been developed to help assure and monitor the service. In respect of medicine management the shortfalls we identified during the inspection had not however been picked up by the current auditing system. These arrangements therefore need to be more robust to assess, monitor and improve the quality and safety and records of treatment.
The CEO (Chief Executive Officer) and manager appreciated that although a significant number of improvements have been made, work remains in progress in particular around the management of medicines, that all the changes being made across the service need time to embed and consideration needs to be applied to the future development of the service.
You can see what action we told the provider to take at the back of the full version of this report.
St Joseph’s Hospice provides care and support people with progressive, degenerative conditions and for people with brain injury and terminal illness. The hospice also provides end of life care and support to families of terminally ill patients. St Joseph’s is run by St Joseph’s Association which is a registered charity and company which also runs a number of hospices overseas.
The hospice has accommodation and facilities for 29 people across Liverpool, Sefton and West Lancashire. There are three units; St Francis House with eight ground floor rooms and 10 single rooms on the first floor; San Jose building has 11 ground floors single rooms.
The service is supported by a local consultant in palliative medicine, other consultants who specialise in psychiatry and elderly medicine and local GPs with an interest in palliative care. The hospice is partially funded by the NHS and through fund raising.
People were admitted to the hospice from their own home, hospital, or by a local clinical commission group (CCG). CCGs are clinically-led statutory NHS bodies responsible for the planning and commissioning of health care services for their local area.
There was a registered manager in post. ‘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’.
St Joseph’s has a board of Trustees, a number of committees, including a clinical governance committee, a chief executive officer (CEO), clinical director (registered manager) and director of income generation.
During our inspection we found a number of breaches in our regulations.
We looked to see if there were systems in place to ensure the proper and safe handling of medicines. We found medicines were poorly managed and current practices put people at risk.
The staff we spoke with described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported. We found on inspection however that the safeguarding process had not always been followed to protect people from abuse. Incidents that affected people’s welfare had also not always been reported to us in accordance with our regulations. This showed a lack of monitoring around risk.
People’s care planning lacked sufficient detail to help ensure their care needs were being met. Care monitoring records such as diet, fluid and positioning charts were not always completed which meant that an accurate evaluation of care needs could not be made.
The service did not operate an effective system for handling, recording and responding to complaints.
Although systems were in place there appeared to be a fragmented approach in respect of identifying and controlling risks and concerns, reporting on lessons learnt and actions taken. This meant the governance was not robust to assure a safe effective service.
People were supported by sufficient numbers of staff to provide care and support in accordance with individual need. We saw that people received care from a multi-disciplinary staff team which included nurses who were trained in end of life care, care staff, volunteers for complimentary therapies, pastoral staff and a family support officer. People told us the staffing numbers were good and that they received support when they requested and needed it.
Staff sought advice and support from health professionals to optimise people’s health and provide continuity of care. Medical cover was provided at the hospice Monday to Friday and staff had access to the routine ‘out of hours’ GP service and telemedicine via a local clinical commissioning group (CCG).
Risk assessments were in place to ensure people’s health and safety. The risk assessments helped to help mitigate those risks and to protect them from unnecessary harm.
The provision of family support was seen as important and people who used the service and relatives had access to a family support officer. Their role also included pre and post bereavement support.
A high standard of cleanliness was maintained at the hospice. Systems and processes were in place to monitor standards of hygiene and control of infection.
The hospice provided suitable accommodation and equipment to meet people’s individual needs.
Recruitment procedures were robust to ensure staff were suitable to work with vulnerable people.
Arrangements were in place for checking the environment to ensure it was safe. For example, health and safety audits were completed and contracts in place for services and equipment. This included fire prevention.
Staff told us they were supported through induction, on-going training, supervision and appraisal. The formal training programme for staff included end of life qualifications as part of their professional development. Staff told us the training programme was good.
The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to hospices. Staff were trained in the principles of the MCA and the DoLS and were knowledgeable in the main principles of the MCA that they applied in practice. They assessed people's mental capacity when necessary and when applicable they held meetings to make decisions on their behalf and in their best interest. This meant that people's rights were protected and respected. People’s consent was documented in the care files we saw to evidence their inclusion around their care and treatment.
People’s dietary needs were assessed and people told us they enjoyed the food. We saw people were offered a variety of nutritious meals.
Our observations showed staff placed a high value on building close relationships with the people they supported. Staff showed a caring nature when supporting people; staff took time to listen and to respond in a way that the person they engaged with understood.
People told us their privacy was respected and staff approach was genuine and warm. They told us they were pleased with the care and treatment they received. A person said, “The care is brilliant.”
People were involved in the planning and review of their care. People told us their views were listened to and their wishes were recorded in care. We saw staff sought consent when supporting people with their care.
There was a clear management structure and staff said they were supported by the management team.
You can see what action we told the provider to take at the back of the full version of this report.
We looked at staff training supervision and appraisal. We also spoke with a person who received care and support from the staff which helped to evidence their competency and their approach to care. Their comments included, ‘’Staff take care of me well." Staff interviewed told us they supported each other and had access to staff training. For example, moving and handling, infection control, end of life care, dementia care and safeguarding adults. The training provided helped to ensure the staff had the skills, knowledge and expertise to care for people.
Staff informed us they received supervision on a 'one to one' basis to discuss issues and support further learning and development. We were shown dates when the supervision meetings had been held. We also saw a system of staff appraisal to help support professional development and performance.
When talking with relatives, they spoke of how staff had been caring and supportive towards them, acknowledging it can often be a very upsetting time for family members. One relative said, “They [the staff] make the families feel very welcome.” Another relative told us, “I got asked at the beginning how involved I wanted to be with things.” Relatives informed us that staff have taken the time to listen and support them when they have been upset.
We observed staff interacting with patients and relatives in a respectful manner. Staff were aware of the need to maintain and protect the dignity of patients, knocking before entering rooms, and explaining any intervention. When we spoke with staff they were clearly passionate about the work they did. Staff members knew the patients by name and were able to give detailed accounts of each patient's particular clinical and care needs. However, when talking to staff a significant number of them raised concern about well supported they were to deal with patients with complex needs. Our findings are detailed at page(s) 13-14.
We spoke to another family member of a person living at the home. They told us “I can’t praise the staff enough; I can’t find words to explain the care they give to my relative.” They told us that they felt their relative was well looked after and that the staff at the home were welcoming to all family members and kept them fully informed of any changes or concerns. One relative told us “It is a homely environment for all of us to spend quality time together.”
Throughout our visit we observed staff being attentive to the needs of the people in the home and their tone and manner was respectful and caring; showing dignity and respecting privacy as they delivered the care.
Staff told us they had a handover period which was lead by the nursing staff. Staff said they had regular meetings and they felt they were knowledgeable about the people who lived at the home and were aware of their care needs. The staff meetings were split into the teams they worked within; we reviewed the minutes of a meeting which took place 4th July 2012 as part of our evidence for staff support.