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St Catherine's Hospice (Lancashire) Good

Inspection Summary


Overall summary & rating

Good

Updated 22 May 2019

St. Catherine’s Hospice (Lancashire) is operated by St. Catherine’s Hospice. The hospice has 19 beds. Facilities include an inpatient unit, a lymphoedema clinic and a clinical nurse specialist community service.

The hospice provides end of life care and palliative services for adults, whilst also seeing children and young people at their lymphoedema clinic. We inspected all the services provided.

We inspected this service using our comprehensive inspection methodology. We carried out an unannounced visit to the hospice on 16 January 2019, with a review of personnel files on 17 January 2019 and attendance at community visits on 18 January 2019.

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.

Services we rate

Our rating of this hospice stayed the same. We rated it as Good overall because:

We found good practice in relation to the hospice:

  • The service provided mandatory training in key skills to all staff and made sure everyone completed it.

  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

  • The service controlled infection risk well. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection.

  • The service had suitable premises and equipment and looked after them well.

  • Staff completed and updated risk assessments for each patient. They kept clear records and asked for support when necessary.

  • The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.

  • Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date and easily available to all staff providing care.

  • The service followed best practice when prescribing and giving medications and patients received the right medication at the right dose at the right time. However, some improvements needed to be made around the safe and effective storage of medicines.

  • The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.

  • The service provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance.

  • Staff gave patients enough food and drink to meet their needs and improve their health. They used special feeding and hydration techniques when necessary. The service adjusted for patients’ religious, cultural and other preferences.

  • Staff assessed and monitored patients regularly to see if they were in pain. They supported those unable to communicate using suitable assessment tools and gave additional pain relief to ease pain.

  • Managers monitored the effectiveness of care and treatment and used the findings to improve them. They compared local results with those of other services to learn from them.

  • The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and monitor the effectiveness of the service.

  • Staff of different kinds worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.

  • The service delivered a full inpatient service for patients receiving palliative care seven days a week.

  • Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. They knew how to support patients experiencing mental ill health and those who lacked capacity to make decisions about their care.

  • The service planned and provided services in a way that met the needs of local people.

  • The service took account of patients’ individual needs.

  • People could access the service when they needed it. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were in line with good practice.

  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with all staff.

  • Managers at all levels at the hospice had the right skills and abilities to run a service providing high-quality sustainable care.

  • The service had a vision for what it wanted to achieve and workable plans to turn it into action developed with involvement from staff, patients, and key groups representing the local community.

  • Managers across the service promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.

  • The service had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected.

  • The service collected, analysed, managed and used information well to support all its activities, using secure electronic systems with security safeguards.

  • The service engaged well with patients, staff, the public and local organisations to plan and manage appropriate services, and collaborated with partner organisations effectively.

    The service was committed to improving services by learning from when things went well and when they went wrong, promoting training, research and innovation.

  • Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness and went above and beyond.

  • Staff provided emotional support to patients to minimise their distress.

  • Staff ensured that patients and those close to them were partners in decisions about their care and treatment.

However,

  • The service did not have robust systems in place to offer assurance regarding fit and proper persons and the on-going monitoring of clinical registrations.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, due to a breach in regulation.

We also issued the provider with one requirement notice that affected the well led. Details are at the end of the report.

Ellen Armistead

Deputy Chief Inspector of Hospitals (North West)

Inspection areas

Safe

Good

Updated 22 May 2019

Our rating of safe stayed the same. We rated it as Good because:

  • The service provided mandatory training in key skills to all staff and made sure everyone completed it.
  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.
  • The service controlled infection risk well. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection.
  • The service had suitable premises and equipment and looked after them well.
  • Staff completed and updated risk assessments for each patient. They kept clear records and asked for support when necessary.
  • The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.
  • Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date and easily available to all staff providing care.
  • The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support. The service followed best practice when prescribing and giving medications and patients received the right medication at the right dose at the right time.

However,

  • The service was not properly storing medicines.

Effective

Good

Updated 22 May 2019

Our rating of effective stayed the same. We rated it as Good because:

  • The service provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance.

  • Staff gave patients enough food and drink to meet their needs and improve their health. They used special feeding and hydration techniques when necessary. The service adjusted for patients’ religious, cultural and other preferences.

  • Staff assessed and monitored patients regularly to see if they were in pain. They supported those unable to communicate using suitable assessment tools and gave additional pain relief to ease pain.

  • Managers monitored the effectiveness of care and treatment and used the findings to improve them. They compared local results with those of other services to learn from them.

  • The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and monitor the effectiveness of the service.

  • Staff of different kinds worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.

  • The service delivered a full inpatient service for patients receiving palliative care seven days a week.

  • Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. They knew how to support patients experiencing mental ill health and those who lacked capacity to make decisions about their care.

Caring

Outstanding

Updated 22 May 2019

Our rating of caring improved. We rated it as Outstanding because:

  • Patients were at the centre of everything the staff and hospice did. Patients were cared for with total compassion. Feedback from patients confirmed that staff treated them well and with kindness and went above and beyond. There was a strong, patient-centred culture on the unit from all levels of staff.
  • Patients were consistently treated with kindness, compassion, dignity and respect through supportive relationships with patients and their families.
  • Patients always received a high level of emotional support to minimise their distress. Staff fully understood that patients’ emotional needs were as important as their physical needs.
  • Patient wishes for their final days were heard, respected and acted on by hospice staff. Staff went the extra mile to enable dying patients’ involvement at chosen celebrations and momentous occasions in their final days of life and no ask was too big. Patients and those close to them were partners in decisions about their care and treatment. Relatives and carers unanimously spoke highly of the care their loved one had received and reported that had felt fully involved in all aspects of care and had also had their opinions considered.

Responsive

Good

Updated 22 May 2019

Our rating of responsive stayed the same. We rated it as Good because:

  • The service planned and provided services in a way that met the needs of local people.

  • The service took account of patients’ individual needs.

  • People could access the service when they needed it. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were in line with good practice.

  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with all staff.

Well-led

Requires improvement

Updated 22 May 2019

Our rating of well-led went down. We rated it as Requires improvement because:

  • The service did not have robust systems in place to offer assurance regarding fit and proper persons and the on-going monitoring of clinical registrations.
  • We reviewed 11 personnel files and found inconsistencies with the information kept in each file, as all the files had varying pieces of information for employment, with few having everything needed and others having very little. For example, there were gaps in the evidence of the disclosure and barring service (DBS) checks having been completed on some staff members and issues with the on-going process of the storage of this information.
  • We reviewed a staff file to review evidence of practising privileges for medical staff. We saw evidence of a contract, but saw no evidence of professional indemnity, information from the responsible officer, evidence of an appraisal or relevant qualifications.
  • The provider could not assure itself that it had an appropriate process for assessing and checking that candidates held the required qualifications.

However,

  • Managers at all levels at the hospice had the right skills and abilities to run a service providing high-quality sustainable care.
  • The service had a vision for what it wanted to achieve and workable plans to turn it into action developed with involvement from staff, patients, and key groups representing the local community.
  • Managers across the service promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.
  • The service had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected.
  • The service engaged well with patients, staff, the public and local organisations to plan and manage appropriate services, and collaborated with partner organisations effectively.
  • The service was committed to improving services by learning from when things went well and when they went wrong, promoting training, research and innovation.
Checks on specific services

Hospice services for adults

Good

Updated 22 May 2019

We rated this service as good overall because we rated safe, effective and responsive as good. We rated caring as outstanding and well led as requires improvement.