Archived: St Catherine's Hospice - Crawley

Updated 1 July 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.

Before the inspection we checked information that we held about the hospice and the service provider. This included previous inspection reports and statutory notifications sent to us by the provider about incidents and events that had occurred at the service. A notification is information about important events which the provider is required to tell us about by law. We reviewed feedback from healthcare and social care professionals. We used all this information to decide which areas to focus on during our inspection

This inspection took place on 17 and 18 February and was carried out by one inspector, a pharmacist inspector and a specialist advisor. A specialist advisor provides specialist clinical advice to the inspection team.

We spoke with the chair of the board of trustees, chief executive, one member of the board of trustees, the registered manager, the medical director, three relatives, six people and eleven members of staff. We looked at six care records, four staff records, medication administration record (MAR) sheets, staff rotas, the staff training plan, logs of complaints, quality assurance audits and other records relating to the management of the service.

The service was last inspected 25 February 2014 and there were no concerns identified

Updated 1 July 2016

St Catherine's Hospice is a charity which provides specialist end of life care and support to adults living within the local area. It provides an 18 bed in-patient beds unit, a day hospice and a community service. A range of other services are also provided including occupational therapy, physiotherapy, counselling, spiritual care and a nursing service to help people with lymphoedema (fluid retention and tissue swelling). The service runs its day hospice and outpatient services from its main site in Crawley and from its site in Caterham. Services are free to people and St Catherine’s Hospice is largely dependent on voluntary fund-raising.

The service has a registered manager. 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.

People valued their relationships with the staff team and felt they often go “the extra mile” when providing care and support. There was a focus on people’s wellbeing and providing emotional support. People and their relatives spoke positively about the caring approach of staff. We were told “To be quite honest with you, the staff make the job, nothing is too much trouble, they are conscientious and have the right type of manner which makes you feel good. They’re attentive, they all take the time to introduce themselves and they make me feel good”.

Staff are highly motivated to offer care which was kind and compassionate and were creative in overcoming obstacles faced to achieve this. Bereavement services were tailored to people’s individual needs and were provided over a significant period of time. People’s spiritual needs were considered in the care that they received. Chaplaincy support was available for people and their family. Relatives were invited to a remembrance service once a year.

Staff are exceptional in enabling people to remain independent and had an in-depth appreciation of people’s individual needs. People were encouraged to set goals and to focus on their possible achievement. The registered manager spoke about their focus on promoting people’s independence and told us “It’s about being there and not taking over”.

People’s care was planned in partnership with them and their family. Staff knew people well and understood how they liked to be supported and used innovative ways of communicating with people to ensure that they were listened to. Staff also had a good understanding of how people may feel when considering their end of life care. Staff ensured that they responded to people’s feelings in an understanding and compassionate way and the services was flexible and responsive to people’s individual needs. Each care plan was person centred and unique to ensure that people felt valued and understood. People told us that staff involved them in decision about their care and listened if they preferred for things done another way. When we asked one person if they felt involved they told us “absolutely I’m involved”.

The hospice was involved in the local community and focused on building a strong positive profile in the community. We spoke with the Patient and Family Support Team who told us about their links with the local schools. They visited local schools and spoke with students about the hospice and provided advice for students that may be experiencing or have experienced the loss of a family member. A staff member spoke with us about one student that had spoken with them about the loss of their family member of the support their family received through the hospice.

There was a strong emphasis on continually striving to improve and staff also told us “Quality is at the heart of this place”. Quality assurance systems were in place to regularly review the quality of the service that was provided. The hospice was working towards achieving an accreditation to the CHKS (Comparative Health Knowledge Systems) accreditation scheme. Accreditation provides independent recognition of the hospices commitment to continuous improvement; the program provides a tool for the hospice which helps them to put improvement systems in place. This allows the hospice to assess their performance in relation to the accreditation standards and identify ways to improve. This accreditation scheme ensures there is a focus on the quality of care provided to people and focus on people’s experience.

The hospice continuously reviewed the service they provided to ensure that the care and support provided reflected the changing needs of the community and that changes to the future support could be planned for. We reviewed the 2013-2018 hospice strategy and saw that this took into consideration the increase in the population of the local community which the hospice supported and changing demographics and the importance of supporting people with non-cancer conditions such as Motor Neurone Disease and organ failure. Training was now provided on specific health conditions such as dementia and neurological disease such as Parkinson’s. We also saw that the hospice provided training to external agencies on managing non-cancer disease at the end of life. This training focused on conditions such as dementia, Parkinson’s disease and Motor Neurone disease.

People told us they felt safe and well looked after. People were cared for by staff who knew how to recognise the signs of possible abuse. Staff were able to identify a range of types of abuse including physical, emotional and neglect. Staff were aware of their responsibilities in relation to keeping people safe.

Risk assessments were in place to identify individual risks and these were reviewed monthly or sooner if needed. Where someone was identified as being at risk actions were identified on how to reduce the risk and referrals were made to health professionals as required. Risk assessments were centred on the needs of people and were reviewed daily by nursing staff.

Accidents and incidents were recorded and monitored to identify trends and reduce the risk of reoccurrence. There were sufficient numbers of staff on duty to keep people safe and meet their needs. Safe recruitment practices were in place and records showed appropriate checks had been undertaken before staff began work.

Policies and procedures were in place to ensure the safe ordering, administration, storage and disposal of medicines. Medicines were managed, stored, given to people as prescribed and disposed of safely.

People’s rights were upheld as the principles of the Mental Capacity Act and the Deprivation of Liberty Safeguards (DoLS) had been adhered to. The registered manager told us that at the time of our inspection no-one was subject to DoLS.

Staff had undertaken appropriate training to ensure they had the skills and competencies to meet people’s needs. Staff spoke with us about the range of training they received which included safeguarding, food hygiene and moving and handling. There was also specific clinical practice training relevant to the administration of medicines and wound care management for clinical staff.

There was a formal supervision and appraisal process in place for staff and action which had been agreed was recorded and discussed at each supervision meeting. The annual appraisal focused on staff performance development plans. The appraisals allowed the opportunity for staff to receive feedback on their performance, looking at areas where they are performing well and those that may need improvement. This ensured that people were cared for by staff that were focused on continuously improving their practice and received the support they need to achieve this.

People spoke positively of the quality of the food and also the choice available. The menus were varied and well balanced. Individual preferences, special diets and allergies were recorded on admission to the In-patient unit and the catering staff were notified. There are two food and nutrition link nurses and they introduced a dietary requirements form which is completed on admission to the inpatient unit.

People were actively encouraged to give their views and raise concerns or complaints. The Voices of Experience group was set up in 2015 and met quarterly. The group was made up of people and family members. The various departments used this group to run ideas passed such as redecoration work to the premises and the introduction of new patient literature. Last year a representative from Crawley and Mid Sussex Clinical Commissioning Group attended the group for advice regarding end of life care delivery in the community. We saw feedback boxes throughout the hospice which people and family were able to post feedback forms in to ensure they were anonymous. Feedback provided by people, relatives and health professionals was analysed to monitor people’s views on the care provided.

Staff were continuously striving for excellence through research and reflective practice. A post of a research nurse had been created that supported the lead for research (one of the hospice's medical consultants). The research lead spoke with us about the value of taking part in research relating to end of life care to ensure best practice and maintain the best quality of life for people. An example of a recent research project focused on the hydration of people receiving end of life care. There was also a research group made up of clinical staff and their responsibility to embed a culture of research in the hospice and participate in local and national research studies and undertake independent research when needed. This involvement in research helps ensure that the hospice follows best practice in the delivery of end of life care and that the care provided is evidence based.