St Joseph's Hospice Association

Updated 17 October 2018

St Joseph’s Hospice is operated by St Joseph’s Hospice Association. It is the oldest and largest hospice on Merseyside providing long-term specialised end of life care for patients with a range of life-limiting conditions. It also offers longer-term care for some patients with complex needs.

The association was founded in 1962 and opened St Joseph’s Hospice on the current site in 1974. It is a charitable hospice in 12 acres of woodland in Thornton, Merseyside. The hospice primarily serves the communities of Liverpool, Knowsley, Sefton and West Lancashire.

It has a contract for five beds with Liverpool Clinical Commissioning Group CCG (CCG). At the time of our inspection the contract for five beds with South Sefton CCG had ended and the service was negotiating a new contract. CCGs are clinically-led statutory NHS bodies responsible for the planning and commissioning of health care services for their local area.

At the time of our inspection the ground floor of St Francis House was closed whilst the service recruited sufficient registered nurses. The service accommodated 21 patients, 10 on the upper floor of St Francis House and 11 on San Jose.

The hospice has had a registered manager in post since December 2016. A registered manager is a person who has registered with the Care Quality Commission to manage the service. They 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 time of the inspection, the manager was on a planned leave of absence and an interim manager had been appointed and CQC were notified on 1 August 2018.

At the previous inspection of 4,5 and 7 July 2017 the provider was found to be inadequate and the service was placed in ‘special measures’ by CQC. We place services in special measures to ensure they do not continue to provide inadequate care. Services placed in special measures are inspected within six months of the publication of the inspection report.

Following the inspection in July 2017 we issued an urgent statutory notice requiring the provider not to admit any further patients to St Joseph’s Hospice.

We inspected St Joseph’s Hospice on 11 and 12 December 2017 and found it had improved and rated it as ‘requires improvement’.

In light of the improvements found at the December 2017 inspection we saw the service had met the conditions of the urgent statutory notice. We did not rate the service as ‘good’ as this would require a longer track record of consistent good practice.

We carried out an unannounced comprehensive inspection on 7, 8 and 9 August 2018.

Updated 17 October 2018

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)

Updated 17 October 2018

Hospices for adults was the only activity provided at this location.

The hospice had three units providing specialised long-term end of life care for 29 patients. At the time of our inspection 21 patients were accommodated.

We rated this service as good because it was effective, caring, responsive and well led although safe requires improvement.