This inspection was announced and took place on 16 and 21 June 2016. The service was last inspected in August 2014 and was rated overall as ‘Good’ using the pilot wave inspection methodology in place at the time. St Catherine’s Hospice cares for people across Chorley, Longridge, Preston and South Ribble who are affected by life limiting conditions. Whilst many of the people they support have cancer, they also support people with other conditions such as heart failure, motor neurone disease and parkinson’s disease. St Catherine’s has a multi professional approach in the provision of specialised care.
The in-patient unit can care for up to nineteen people. Outpatient care is offered through their day therapy unit. People can attend for a wide range of medical, nursing, physiotherapy and occupational therapy treatments, as well as complementary therapies such as reflexology and aromatherapy massage.
There was a registered manager in place who had worked at the service for 13 years. 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.
We found the registered manager to be committed, caring and enthusiastic about the service and the comments we received from people and staff reflected this. As the registered manager had been at the service for 13 years this meant that there was stability in how the service was led, in addition to this the management style throughout the service was forward thinking and reflected feedback from staff, other professionals and people and families who accessed the service.
All of the people we spoke with who used the service told us they felt safe. There were robust safeguarding processes in place and we saw evidence that staff were trained in this area. Staff we spoke with could clearly demonstrate a good understanding of how to recognise and report potential safeguarding issues and that people's safety and comfort was of paramount importance to them.
We looked at recruitment processes and found the service had recruitment policies and procedures in place to help ensure safety in the recruitment of staff. Prospective employees were asked to undertake checks prior to employment to help ensure they were not a risk to vulnerable people. There were also robust procedures in place for the recruitment of the large numbers of volunteers the service used. We looked at recruitment files for individual staff and volunteers and found them to contain all the necessary information and to be well organised.
We looked at how the service was staffed, to ensure people's needs could be met safely. People we spoke with told us they felt there were always enough staff on duty, as did all the relatives we spoke with. We observed staffing levels to be in place to meet the needs of the people in the service on the day of the inspection. The hospice used a dependency tool, which was regularly reviewed, to ensure that a sufficient number of clinical and care staff were present and the right skills mix was in place.
Medicines management processes were effective and staff received up to date training in this area. There was good evidence in place that medicines were audited. Procedures were in place to ensure access to emergency supplies of medication.
Staff we spoke with talked positively about the amount and quality of training they received. This included innovative practice such as 'skills blitz' days when staff could drop into training surgeries at a time that suited them. The hospice had a thorough induction process in place and staff who had recently been employed by the service told us it was detailed and tailored to their own background and development needs. Staff induction records were held on personnel files which we reviewed during the inspection and we found these to be thorough and organised.
The service was working within the principles of the Mental Capacity Act and followed the Department of Health guidance for hospices in relation to Deprivation of Liberty Safeguards. We discussed with the registered manager the need for care plans and other associated paperwork and the knowledge of some nursing staff to be in line with clinical staff and the hospices policies in this area.
We saw good evidence within people’s care records that nutritional and hydration needs were being met. Staff were knowledgeable about people's needs in this area and people we spoke with told us they were happy with the food and drink they were offered.
People we spoke with were very happy with the approach of staff who supported them and the care they received. We received very powerful and personal comments from people in terms of how staff cared for them and treated them. This was also conveyed through the large amounts of thanks you cards, letters and messages received into the service.
It was evident when speaking with staff that they knew the people they were caring for well. Staff were able to describe people’s personal needs, histories and preferences as well as their medical needs.
We saw evidence that end of life care was provided with sensitivity, dignity, respect and compassion. We observed this to be the case and were also told by people both in the hospice, and who received care at home, that staff showed them kindness and understanding. Bereavement support was in place for families and friends and regular remembrance services were held at the hospice.
Complaint procedures were in place and people were aware of how to raise concerns. We saw examples of how complaints had been investigated and dealt with.
Care plans contained relevant and appropriate information to ensure that people received the necessary medical and personal care they needed. Staff we spoke with were happy with the contents of people’s care plans and felt that they gave them the information they needed to provide care and support for people. Work was taking place with a local children’s hospice to share the costs of an electronic incident reporting system (Datix). Only the costs are shared, a legal agreement is in place to ensure that each service only accesses and uses data for its own service. This system will improve the efficacy and efficiently of incident reporting which has outgrown a paper based system.
An extensive range of activities were available to people who were staying at the hospice or visiting for day therapy. People who were not well enough to engage in activities told us that staff were attentive to their needs and spent time with them if they were unable to attend planned activities.
People, relatives and staff we spoke with were extremely positive when talking about the culture within the hospice. They told us that it was a caring, professional and calm environment. All the inspection team found this to be the case and echoed these sentiments.
A number of areas for development had been identified to ensure the service was continually improving. These ranged from looking to improve governance arrangements, training, communication and record keeping. We found the management team and service as a whole to be forward facing and one that listened to what people and other professionals told them.
There were a number of partnerships in place with local businesses. This helped the service to look at ways to improve from leading businesses in the area that were not always in the care sector but had proven systems in place that could be adapted into a hospice setting. We saw examples of this that had already happened and plans in place for additional adaptions and improvements into the service as a result of partnership work with other businesses in the local community.