• Hospice service

St Leonard's Hospice

Overall: Good read more about inspection ratings

185 Tadcaster Road, York, North Yorkshire, YO24 1GL (01904) 708553

Provided and run by:
St. Leonard's Hospice York

All Inspections

12/04/2022 and 20/04/2022

During a routine inspection

Our rating of this location went down. We rated it as good because:

  • 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 provided good care and treatment, 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, supported them to make decisions about their care, and had access to good information.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
  • The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it.
  • Staff and managers 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:

  • Not all staff had had an appraisal
  • Many staff did not feel aligned to the service’s vision and values and did not understand the long-term strategic view.
  • Many staff told us that they did not feel respected, supported and valued and this affected the overall culture within the organisation.
  • The service did not have a Freedom to Speak Up Guardian to act as an independent source of advice for staff.
  • Although, staff had the opportunity to have contact meetings, there was no system to evidence that all staff had supervision.

Unlike our previous inspection, we did not find substantial evidence of outstanding practice in care and treatment or how the leaders managed the service. However, we did not identify breaches of regulation in the safe, effective, caring and responsive domains. Our inspection found the service now met the rating characteristics of good in most areas.

19 July 2016

During a routine inspection

This inspection was announced and took place on 19 and 20 July 2016. Our previous comprehensive inspection was on 29 April 2014 and was part of the pilot to test the Care Quality Commission's (CQC) new inspection methodology and so although they were rated this was not published.

At the inspection on 29 April 2014 we asked the registered provider to make improvements with regard to Regulation 12 Safe care and treatment; around the management of medicines. This action has now been completed. We revisited the service on 29 September 2014 and found the service was compliant with the regulation.

St. Leonard’s Hospice York provides a 20 bed in-patient hospice care unit (IPU) and a hospice-at-home service which are regulated by CQC. The Sunflower Centre, which is the day hospice is not regulated by CQC. These are based on one site. The hospice holds condition specific clinics, has a social work team, a bereavement support service, therapy services, an education department, a fundraising department and a team of volunteers numbering around 230. There is a hospice-at-home team who provide hospice care in the community to people. There is also a care homes education team who work specifically with care homes in the area. The hospice also has an on-site Chaplain who provides spiritual care to everyone using the hospice service.

The care provided by the hospice is for people that live in the York area of North Yorkshire and Ryedale and some parts of the East Riding of Yorkshire. The service is a registered charity with a board of trustees. Day-to-day the service is run by a senior management team drawn from all departments within the hospice.

The service was responsive and focused on providing a tailored service which people helped plan and develop. There were appropriate systems in place to ensure flexibility to people so that their care needs could be met either at home, in the hospice or in the wider community. In addition the service provided good support to relatives and carers.

Excellent leadership and management was demonstrated at the service. The culture was open and inclusive which meant that people received a tailored service which was flexible to their needs.

There was a registered manager employed for this service. 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. The registered manager was very experienced after being employed by the hospice for a number of years.

The beautiful environment was maintained by the hospice maintenance and gardening team. There were servicing agreements in place for mains services. The premises were extremely clean and tidy with appropriate adaptations in place for people who used the service. The gardens were extremely well maintained and offered people tranquil and pleasant areas in which to sit, chat and spend time with their loved ones.

Staff recruitment processes were followed with the appropriate checks being carried out. There were a high number of staff on duty to meet people's needs in a meaningful way and the service had a team of volunteers who provided additional support. The hospice had a bank of staff who they could contact if they needed additional staff. All staff received annual appraisal and clinical supervision and staff discussion groups were in place. Staff and volunteers received a thorough induction and regular training to ensure they had the knowledge and skills to deliver high quality care which they demonstrated throughout the inspection.

Staff followed risk assessments and guidance in management plans when providing care and support for people in order to maintain people's safety.

Staff were able to describe what it meant to safeguard people and told us how they would report any suspected abuse. There were policies and procedures in place for staff to follow and there was an embedded culture of learning from mistakes.

People brought their own medicines with them to the service and there were systems in place to ensure they were stored and administered safely.

Staff worked within the principles of the Mental Capacity Act where appropriate. People had choices about their care and their consent was sought by staff. They told us they were involved in all decisions about their care.

People were supported to receive a nutritious diet at the service. Their appetite was assessed through talking with them which led to staff being able to give the person the amount and type of food they would be able to eat. There was a choice of menu on the day we inspected and the meals we saw were of a high quality. Drinks and snacks were freely available. People and their families described the food in positive terms.

When people needed specialist healthcare support the day hospice made referrals to specialist services such as occupational therapy or the dietician.

People told us that staff were caring and listened to them. There was a spiritual care co-ordinator who was available to people who used the hospice and their families. This support was across all faiths but specific religious leaders could be accessed through the co-ordinator if a person preferred. We heard examples of the excellent spiritual support provided to people.

The seven protected characteristics of the Equality Act 2010; age, disability, gender, marital status, race, religion and sexual orientation were well provided for within the service; the care records we saw evidenced this and the staff who we spoke with displayed empathy in respect of people's needs. These characteristics were embedded in staff training.

People were able to make decisions about the care and support that they received and told us that staff at the service communicated well with them. Confidentiality was respected through safe storage of records and by the staff who offered privacy when having difficult or sensitive conversations demonstrating respect for people's privacy and dignity. People spoke with such thankfulness about the respect shown to them by staff giving examples of how staff had helped them retain their dignity.

People helped develop their care plans which were person centred. This is when any treatment or care takes into account people's individual needs and preferences. The person’s chosen place of care and place of death was clearly recorded where the person had chosen to share that information. People were given time and support to develop advanced care plans, advance directives and living wills if they wished. People received help with symptom control and management at the day hospice but could also enjoy socialising with others.

People were confident expressing any concerns to staff at the service and knew who to approach if they were not satisfied with the response.

Staff and volunteers shared similar values and worked closely with each other in a mutually respectful way. There were regular team meetings. Accidents and incidents were clearly recorded. Where any mistakes were made these were discussed and reflected upon in order to make improvements. The hospice presented annual quality accounts which looked at patient safety, clinical effectiveness and patient experience. Audits were completed across the organisation providing a thorough and comprehensive system of quality assurance. They also took part in research projects as a means of improving their service and educating staff. The quality of the service was enhanced by these measured and this was reflected in feedback received by the service.

30 September 2014

During an inspection looking at part of the service

St. Leonard’s Hospice is a hospice service that is located on the outskirts of York. The hospice has twenty in-patient beds and incorporates a Hospice@Home service. In addition to this, a maximum of fourteen people per day have access to day care; this part of the service is not required to register with the Care Quality Commission. However, as some people who access day care have also used the in-patient or Hospice@Home service, we spoke to them as part of this inspection. On the day of this inspection some bedrooms were being refurbished so there were only ten people using the in-patient unit.

There was a registered manager in post as the time of this inspection and they had been registered as the manager for two years. A registered manager is a person who is registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

We previously visited St. Leonard's Hospice on 29 April 2014. We had concerns about the management of medicines, particularly the disposal of medication and the recording of fridge temperatures. A focussed inspection was carried out on 30 September 2014 to check that the provider had taken action to ensure that medicines were stored and disposed of safely.

You can read a summary of our findings from both inspections below.

Scheduled Inspection of 29 April 2014

People told us that they felt safe whilst using the hospice. Staff and volunteers had been recruited following robust policies and procedures that ensured only people suitable to work with vulnerable people had been employed and there were sufficient numbers of staff. Staff had undertaken training on safeguarding adults from abuse and they displayed a good knowledge of the action they would take to manage any incidents or allegations of abuse. Staff had undertaken other training that provided them with the skills to carry out their role effectively.

People’s individual circumstances and lifestyle had been taken into account when their care or treatment plan had been devised. People who were important to the person had been consulted and their needs were incorporated into treatment plans. There were appropriate risk assessments in place that ensured people’s safety, allowed people to take responsibility for their actions and be as independent as possible, but remain safe.

There were some quality assurance systems in place that monitored people’s satisfaction with the service and that audited the systems in place. However, there was no overall clinical governance system in place and medication audits had not identified the issues that we raised.

Focussed inspection of 30 September 2014

Staff had a good understanding of the policies and procedures in place on the storage, recording and disposal of medicines. Medication was stored safely, including medication that required refrigeration and medicines that were waiting to be destroyed. Only registered nurses had responsibility for the administration of medicines and access to the medication room.

30 September 2014

During an inspection looking at part of the service

We previously visited St. Leonard's Hospice on 29 April 2014. We had concerns about the management of medicines, particularly the disposal of medication and the recording of fridge temperatures. This inspection was carried out to check that the provider had taken action to ensure that medicines were stored and disposed of safely.

Our inspector visited the service and the information they collected helped answer one of our five questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led? Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with staff who worked at the hospice and from looking at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Staff had a good understanding of the policies and procedures in place on the storage, recording and disposal of medicines. Medication was stored safely, including medication that required refrigeration and medicines that were waiting to be destroyed. Only registered nurses had responsibility for the administration of medicines and access to the medication room.

Is the service effective?

Not applicable.

Is the service caring?

Not applicable.

Is the service responsive?

Not applicable.

Is the service well-led?

Not applicable.

29/04/2014

During a routine inspection

St. Leonard’s Hospice is a hospice service that is located on the outskirts of York. The hospice has twenty in-patient beds and incorporates a Hospice@Home service. In addition to this, a maximum of fourteen people per day have access to day care; this part of the service is not required to register with the Care Quality Commission. However, as some people who access day care have also used the in-patient or Hospice@Home service, we spoke to them as part of this inspection. On the day of this inspection some bedrooms were being refurbished so there were only ten people using the in-patient unit.

There was a registered manager in post as the time of this inspection and they had been registered as the manager for two years. A registered manager is a person who is registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

People told us that they felt safe whilst using the hospice. Staff and volunteers had been recruited following robust policies and procedures that ensured only people suitable to work with vulnerable people had been employed and there were sufficient numbers of staff. Staff had undertaken training on safeguarding adults from abuse and they displayed a good knowledge of the action they would take to manage any incidents or allegations of abuse.  Staff had undertaken other training that provided them with the skills to carry out their role effectively.

People’s individual circumstances and lifestyle had been taken into account when their care or treatment plan had been devised. People who were important to the person had been consulted and their needs were incorporated into treatment plans. There were appropriate risk assessments in place that ensured people’s safety, allowed people to take responsibility for their actions and be as independent as possible, but remain safe.

There were some quality assurance systems in place that monitored people’s satisfaction with the service and that audited the systems in place. However, there was no overall clinical governance system in place and medication audits had not identified the issues that we raised. 

29 April 2014

During an inspection of this service

4 December 2013

During a routine inspection

On this visit we looked at the Hospice@Home service provided by St Leonard's Hospice. This provides end of life care to people in their own home. It is a small service and can currently only provide that service to a small group of people at any one time. The staff team are mainly registered nurses, though healthcare workers are also sometimes used. The professional in overall charge of the person's care is their district nurse.

We spoke with three people by telephone and visited one person in their home. We also spoke by telephone with three healthcare professionals.

All provided very positive comments about the service and the care they delivered. Comments included 'They treat my mum like their own mum.' And 'The staff are all lovely. They're very competent.' One professional said 'The service works really well with the patient and their family.'

People are treated in a kind and respectful manner and are included in decisions about their care.

People receive the right care and support at the time they want it.

Medication is administered safely and appropriately by staff that are skilled, knowledgeable and competent.

Staff are provided with the training and support needed to enable safe and effective care to be delivered.

Whilst informal feedback from people using the service and from healthcare professionals indicates an effective and efficient service the provider may like to consider how they can better evidence this.

23 October 2012

During a routine inspection

The service was routinely talking to people about care and treatment options and gaining people's consent before these were provided. This ensured people understood why that care was needed so could provide informed consent for that care.

We could not speak with many people when we visited because of their complex needs. We did however speak with three people receiving care and one visitor. All were very pleased with the care they received. One person said 'We can't stress how nice this place is. We're really happy with the care.' Another person said 'The staff are absolutely super. The care is first class.'

The service had established infection prevention and control systems which were regularly reviewed. This ensured the risk of harm to patients, visitors and staff from a healthcare associated infection was minimised.

The service followed a robust recruitment process when employing new staff. Checks were completed before recruitment decisions were made. This ensured only staff suitable to work with vulnerable people were employed.

The service took complaints seriously. There were systems in place to enable people to comment on the service they received. Staff were open to receiving any negative comments as they recognised that all comments could be used to help improve the service they delivered.

19 October 2011

During a routine inspection

During this visit we looked at care provided on the In-Patient Unit. We did not visit the area where Day Care is provided.

People we talked with spoke highly of the care and support they received at St Leonard's Hospice. One person commented 'I've been really well looked after.' Whilst another told us 'Care is all that you need', with their relative adding 'I can't fault the care. Anything we need - then we get it straight away.' A third person said 'The care is excellent. I'm so impressed.'

We did not receive any negative comments about the care, the staff group or indeed how the service was being run.

People told us about the excellent meals that were served to them, and the snacks and extra drinks that were available at any time, day or night. One person said it was like a hotel and another told us how they had been offered toast and soup in the night when they couldn't sleep, which had been very welcome.

People pointed out to us the well maintained gardens, rural outlook and also wildlife seen from their rooms. This means the outside environment was having a positive impact on their day to day lives.