Background to this inspection
Updated
29 June 2016
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This inspection took place on 11 April 2016 and was announced. We gave the service 48 hours’ notice of the inspection because it is a day service and we needed to be sure that there was anyone the service and if people were being supported there. This provider has three locations registered with the Care Quality Commission (CQC). We found that there were areas that were common to all three services. For example training programmes, quality assurance systems and policies and procedures were used across all three services. For this reason some of the evidence we viewed was relevant to all three services. Our individual findings for each service are discussed in separate reports.
The inspection team consisted of one inspector and one expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. Their area of expertise was in adult social care settings and included experience of palliative and end of life care.
In order to plan our inspection we looked at statutory notifications we had received. Statutory notifications are documents that the registered provider submits to the Care Quality Commission (CQC) to inform us of important events that happen in the service. Before the inspection, the provider completed a Provider Information Return (PIR).This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We used the information they had given us to help with our planning.
During the inspection we were shown around the day hospice by the nursing sister who was in charge. We looked at the communal areas and treatment rooms. We spoke with one person who used the service, one care worker and one volunteer and had discussions with the registered manager and nursing sister in charge of the day hospice.
We pathway tracked three people care records on Systmone and observed practice throughout the day. Systmone is a clinical record system used to record patient care electronically in real time and make referrals to other healthcare professionals. We reviewed other records relating to the running of the day hospice such as some policies and procedures, safety checks and maintenance records and saw the comments made by people in a recent survey by the service. A lot of the records relating to the running of this service were kept at St Catherine’s Hospice main site. We looked at the appropriate records that related to this service on 13 and 14 April 2016 when we inspected St Catherine’s Hospice- Scarborough. We also looked at all policies and procedures, staff recruitment and training records relating to those staff on duty during the inspection, quality assurance systems including audits and the hospice trust business plan which referred to the day hospice.
Following the inspection we requested feedback from a social worker, a GP, a member of the respiratory team at Scarborough Hospital, an occupational therapist and district nurse.
Updated
29 June 2016
This inspection took place on 11 April 2016 and was announced. It was the first inspection for this service under their current registration. St Catherine’s Day Hospice-Ryedale provides free day care to adults with a life limiting condition or a diagnosis of cancer that live in the Ryedale area of North Yorkshire. The service operates on Mondays between 9am and 3pm with capacity for up to eight people. There was one person using the service on the day we inspected. The service is based in a local hospital ward and so had little control over the décor or environment although these met the needs of people who used the service. People had access to consultants and medical care, nursing care, physiotherapy, occupational therapy, social workers and spiritual support to meet their needs.
There was a registered manager employed for this service who also managed the main site, a hospice at home service and another day 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. The registered manager was very experienced after being employed by the hospice for many years.
The day to day running of this service was managed by a nursing sister employed by St Catherine’s Hospice Trust. Staff followed risk assessments and guidance in risk management plans when providing care and support for people in order to maintain their 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.
Staff recruitment processes were followed with the appropriate checks being carried out. There were sufficient staff on duty to meet people’s needs 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 supervision individually or as a group and annual appraisals were undertaken. New staff received a thorough induction and regular training to ensure they had the knowledge and skills to deliver high quality care.
The safety of the environment was managed by the NHS. Staff working at the day hospice had plans in place if people needed to be evacuated in the event of a fire. They also had their transport checked, maintained and serviced regularly. The premises were clean and tidy with appropriate adaptations in place for people with a physical disability such as wide corridors and doors for wheelchair access and adapted toilets. There was equipment available to help staff but also to maintain people’s independence such as care chairs which people could adjust themselves.
People brought their own medicines with them to the service. 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.
People were supported to receive a nutritious diet at the service which was provided by the NHS. There was a choice of menu on the day we inspected and drinks and snacks were freely available. When people needed to receive nutrition by other means they were supported by staff that were trained.
When people needed specialist healthcare support the day hospice made referrals to specialist services such as occupational therapy or the dietician. People and their families could access advice and support through a helpline line twenty four hours a day which linked directly to the hospice.
People told us that staff were caring, friendly and supportive. There was a spiritual care co-ordinator who was available to people who used the day 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.
The seven protected characteristics of the Equality Act 2010; age, disability, gender, marital status, race, religion and sexual orientation were adequately provided for within the service; the care records we saw evidenced this. The staff who we spoke with displayed empathy in respect of people’s needs.
People were able to make decisions about the care and support that they received. They us that staff at the service communicated well with them. Confidentiality, privacy and dignity were respected through safe storage of records and by the staff who offered privacy when having difficult or sensitive conversations with people.
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 persons 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. There were regular team meetings for staff to share their views about the service. There was also a newsletter for staff and volunteers, a time out group for carers of people who used the service and a drop in group for newly bereaved relatives to provide support.
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. They benchmarked their safety data against other hospices by engaging with a national initiative and audits were completed across the organisation providing a thorough and comprehensive system of quality assurance.