Saint Francis 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

Patients reported feeling safe and involved in the planning of their care, with consent actively sought before information is shared. Seamless transitions of care were ensured through effective referral pathways and collaboration with local partners. Safeguarding policies were up to date and staff demonstrated a good understanding on managing referrals, following NICE guidelines and conducting risk assessments. Collaboration with multidisciplinary teams ensured coordinated care was being delivered. Patient choice and preference was embedded in care planning and staff were routinely referring to care plans, promoting a person-centred approach to care. Staff kept up to date with mandatory training and had effective systems in place to ensure compliance. The hospice ensured staffing levels were appropriate through advanced planning and managers could utilise a flexible workforce and adjust staffing levels based on patient needs.

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.

Patients we spoke with felt safe and were involved with the planning and decisions regarding their care. The staff discussed this with patients and were involving patients with their care plans. Patients were asked for consent before information regarding their care was shared with other services. Patients and relatives felt hospice input made their experience seamless and shared that the hospice’s ability to access GP and district nursing records reduced the number of times they had to repeat their care needs.

Staff felt safe while performing home visits. Staff used a lone worker phone application when working out of office hours, and we observed staff communicating with on-site hospice staff when they arrived and left a visit. Staff had access to and were routinely referring to care plans and having conversations with patients to identify patient choice as well as establishing a person-centred approach to individual care.

The hospice had clear referral pathways and worked closely with local partners including the local Palliative Care Team, GP’s, district nurses, and other health and social care partners to ensure a coordinated continuity of care. Discharge summaries and records of care were securely shared when necessary and the hospice engaged with multidisciplinary services such as Universal Care Plan to facilitate care.

Effective and up to date safeguarding policies corroborated staff knowledge on how to manage safeguarding referrals. We observed NICE guidelines and quality standards being followed including Preferred Place of Care and Preferred Place of Death information being recorded for patients. Staff knew when and how to complete risk assessments. Staff received training to monitor and act upon any deterioration in a patient’s condition and could describe the process. Staff could explain how to escalate assessments. The hospice used the Karnofsky Performance Status Scale in the community to standardise measurement of patient’s status and we observed staff with cards which they carried to remind them of the points on the scale. Staff worked with the multidisciplinary team to manage the increased risks experienced by people at the end of life. This included information sharing with GP’s, district nurses and conversations with local ambulance services to discuss patient preferences and advance care plans, local care home staff and local hospitals. Staff used electronic patient records and had access to records from primary care providers such as GPs and district nurses.

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

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.

The patients we spoke with described staff as being very knowledgeable and attentive to their needs. Patients described that there were enough staff to deliver a high standard of care.

Staff were up to date with mandatory training and demonstrated they had a good understanding regarding safeguarding, Mental Capacity Act and Deprivation of Liberty Safeguards. Staff received yearly appraisals and said they were supported to develop within their role and completed continued professional development. Managers were monitoring staff training weekly with systems in place to ensure training was kept up to date including email reminders and a RAG report for training provided by the Hospice Education Centre. Volunteers in the Hospice were well supported with an initial induction and a training programme, including an introduction into palliative care, safeguarding and communication training. Staff understood how and when to assess whether a patient had the capacity to make decisions about their care. Staff could describe and knew how to access policies and procedures.

A comprehensive recruitment process ensured the hospice employed competent staff through background checks, professional registration checks where necessary, and ensuring staff met the required competency specification against the role. Clear job descriptions set out expectations and ensure staff have an understanding of their responsibilities. Staff rotas were planned in advance and managers had oversight of staffing levels to ensure services were running with a safe level of staff. Managers could adjust staffing levels depending on patient needs and utilise a flexible workforce where ward managers could draw on resources and staff from other services, including ‘Hospice at Home’, to ensure cover when needed. The hospice was able to utilise regular bank staff when required to ensure staffing levels were kept safe. The hospice developed business continuity plans for individual services to cover events of staff shortages which managers were able to refer to.

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.