We carried out a review of the data available to us about St Clare Hospice on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about St Clare Hospice, you can give feedback on this service.
St Clare Hospice is operated by St Clare West Essex Hospice Care Trust. The hospice has eight beds. Facilities include the inpatient unit, day therapy services and hospice at home services.
The hospice provides specialist care for adults that require palliative care.
We inspected this service using our comprehensive inspection methodology. We carried out the initial unannounced part of the inspection on 3 December 2019, along with a second unannounced visit to the hospice on 11 December 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.
The main service provided by this hospice was specialist palliative care.
Services we rate
Our rating of this service improved. We rated it as Outstanding overall.
We found outstanding practice in relation to the hospice care:
The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
Staff provided outstanding care, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
Staff always treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, were active partners in their care and helped them understand their conditions. Staff recognised and respected the totality of patients’ needs and provided emotional support to all patients, families and carers.
The service planned innovative care to meet the needs of local people, proactively took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment. This included people protected under the equality act and people in vulnerable circumstances.
Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.
However, we also found the following issues that the service provider needs to improve:
Patient medication administration by staff for planned short leave periods should follow national and local management of medicines guidance.
St Clare Hospice is registered to provide specialist palliative care, advice and clinical support for adults with life limiting illness and their families. The service delivers physical, emotional, spiritual and holistic care through teams of nurses, doctors, counsellors and other professionals including therapists. The service provides care for people through an In-Patient Unit, Day Service, Out- Patient Care and Hospice at Home.
At the time of the inspection there were four people using the inpatient service and 230 people using hospice at home and day services. The day services offered a range of services to people recently diagnosed with life limiting conditions, their carers and families. The service provided specialist advice, courses, complementary therapy sessions and outpatient clinics. It aimed to empower people to be in control of their condition and achieve what was important to them.
St Clare Hospice had a registered manager in post. 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.
Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risks to people`s well-being were assessed by staff daily and there were measures in place to mitigate risks and keep people safe. Risk assessments were reflective of people`s changing abilities and needs and measures to ensure people were as safe as possible were implemented accordingly.
People were at the heart of the service and were fully involved in the planning and review of their care, treatment and support. People told us they were fully involved in setting their priorities for care. Care plans in regard to all aspects of people`s medical, emotional and spiritual needs were personalised and written in partnership with people. Staff delivered support to people respecting their wishes and preferences.
Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced. Staff reported any concerns so that these could be reviewed and discussed to identify if lessons could be learnt to reduce the likelihood of recurrence.
Recruitment procedures were robust and ensured that staff working at the service were qualified and skilled to meet people`s complex needs. Staff told us they worked and trained towards their personal development plans and were happy with the support from their managers. There were sufficient numbers of staff to ensure people received support when they needed it.
The service operated a 24 hour service and on-call system for the hospice at home service to ensure people received the same support and advice during the day as during the night. If there was a need for it, staff provided a night sitting service to people in their own homes to give their family carer time to rest. People using the inpatient service had their medical needs met by a team of doctors employed by the hospice.
People who used the day service told us that this service enabled them to meet people with similar conditions and helped them prepare for the future. People told us that staff understood their individual care needs and were compassionate and understanding. Staff told us they undertook training which enabled them to provide good quality care to people in the inpatient unit and in people`s own homes.
People’s medicines were administered by trained and qualified staff who had their competency assessed regularly by their manager. Any changes in people`s medication were discussed by the medical team, nurses and pharmacist to manage and support people’s symptoms and pain management. Medicines were regularly reviewed and audited to ensure they met people’s needs.
The registered manager and staff were clear about their responsibilities around the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and were dedicated in their approach to supporting people to make informed decisions about their care.
People and relatives were very positive about the caring and compassionate attitude of the staff delivering the service. They told us they were completely satisfied with their care and thought highly about staff and management. Staff were very motivated and demonstrated a commitment to providing the best quality end of life care in a compassionate way. People’s wishes for their final days were respected; staff went beyond their duty of care to ensure people could have their last wishes fulfilled.
The registered manager was committed to improve and broaden the services the hospice offered. There were plans to develop bereavement services for children and young people. The hospice offered the chance for young people interested in pursuing a career in medicine, healthcare or charity fundraising to gain a first-hand insight into the hospice sector by working alongside an experienced team through `Young Ambassadors` programmes. The medical team from the hospice was involved in several projects where they concentrated on improving the quality of care that people diagnosed with life limiting conditions received during the time they used the hospice services.
The service actively encouraged and provided a range of opportunities for people who used the service and their relatives to provide feedback and comment upon the service in order to continue to drive improvement.
There was a comprehensive auditing programme for all the services the hospice provided carried out by the quality management team. Action plans were comprehensive in detailing actions taken, time frames and the person responsible for the actions.
The chef told us, 'I speak to patients when they come in. We don't have set menus.' They explained that they ask people about what food they would like to eat and prepare this for them, rather than adhering to menu options. People were supported to eat and drink sufficient amounts to meet their needs.
There was an effective operation of systems in place to ensure that people were protected against the risks of a health care associated infection.
People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.
We saw that equipment at the service was appropriately maintained and suitable for its purpose. We saw that equipment, such as hoists, mattresses and medical devises were regularly serviced and maintained to ensure that they were safe.
They all gave positive feedback about their experiences at the hospice. One person told us, 'St Clare's is one of the finest places in the world'second to none. We found the staff helpful, friendly and caring. They gave X all the care and attention. I can't praise them enough.' Another person told us that they found the hospice, 'Excellent, really, really good. The treatment was first rate and the rooms were excellent with plenty of space. I felt I had perfect dignity.' Another person spoke of their experiences from feeling anxious and isolated to where, 'I now want to give something back. The hospice 'mended' me which was very positive.'
People with whom we spoke with were very happy with the services provided by St Clare West Essex Hospice. One person told us 'There is a warm and friendly ambience as you walk in the door and it never stops'. Another person told us 'It is a wonderful place; it feels like home, you will never find a better place.'
Everybody told us that they were fully consulted about their care and treatment. People attending day services and who had previously received in patient treatment told us continuity of care was good and supportive.
People spoke highly of the meals provided and told us they were always given choices. They praised the chef and kitchen staff and said that meals were always well presented and appetising.
People knew how to raise any concerns and were given the opportunity to provide feedback on the level of service received.
Everyone with whom we spoke with told us that the staff at the hospice were very helpful and kind and knowledgeable about their needs and 'Nothing was ever too much trouble.'
They said the environment was pleasant, restful and clean.