St Joseph's Hospice

Updated 18 October 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.

This inspection took place on 27, 28, 29 July and 1, 2 August 2016 and was announced. We gave 48 hour’s notice of the inspection due to the complexity of the service. The inspection team consisted of a lead inspector, a pharmacist inspector, a specialist professional advisor and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of service.

Before our inspection, we asked the provider to complete a Provider Information Return (PIR). The PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We reviewed the information we held about the service. We also received feedback from two external palliative care professionals, Hackney Healthwatch and one commissioning officer.

During the course of the inspection we spoke with, either in person or on the telephone, 10 people who used the service, 12 relatives and two visitors. We also spoke with 35 members of staff and two volunteers. This included the interim chief executive, chair of board of trustees, registered manager, directors of corporate services and quality and care, health and safety officer, director of human resources, head of education, pharmacist, manager of the community palliative care service , volunteer and community engagement manager, in patient unit managers, eight nurses (including clinical nurse specialists), two senior healthcare assistants, a care coordinator, and eight healthcare assistants. We spent time in the inpatient and day care units, observing care and support. We joined a multi-disciplinary meeting and met with the and Specialist Community teams. We also spoke with three doctors including medical lead, Consultant in Palliative Medicine and a Junior Doctor.

We looked at six people’s care records and 15 medicines records. We looked at other records relating to the management of the hospice. This included nine recruitment records. We also looked at duty rosters, accident and incident reports, complaints, compliments, health and safety, maintenance, governance and quality monitoring records.

Updated 18 October 2016

This inspection took place in 27, 28, 29 July and 1, 2 August 2016 and was announced. When we last visited the hospice on July 2015 we rated the service as Requires improvement. Three recommendations were made regarding improving the culture among staff in the hospice, improving staff awareness of how to escalate concerns and whistleblowing, and the management of medicines.

St Joseph's Hospice, Hackney is registered to provide end of life and palliative care for up to 61 people at the main site and a community palliative care team to approximately 350 people. The on-site service is split into three wards including one respite ward where people stay for a short length of time and are supported to gain skills to better support themselves in the community. The provider also runs a day hospice three days a week on-site which both people living on site and in the community can attend. At the time of inspection there were 20 people using the on-site services.

The hospice had 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.

While we were carrying out the inspection we received a number of whistleblowing concerns that there was still a bullying culture among staff at the hospice. The registered manager confirmed that while they had made progress on addressing these issues further work needed to be done to improve the culture among some staff groups within the hospice. Staff spoken to directly while we were inspecting the hospice said this was not an issue and felt supported by management.

People were supported to make choices about how their needs were met. People and relatives were involved in decisions about their care. Where people were unable to make decisions about their care their human rights were protected in that best interests decisions were made on their behalf.

People were kept safe. Risks to people were identified and staff took action to reduce those risks. Staff were available and had the necessary training to meet people's needs. Staff responded to people’s needs promptly.

There were systems in place to ensure that people consistently received their medicines safely, and as prescribed.

People were supported effectively with their health needs.

Care was planned and delivered in ways that enhanced people’s safety and welfare according to their needs and preferences. Staff understood people’s preferences, likes and dislikes regarding their care and support needs.

People were provided with a choice of food, and were supported to eat when this was needed. There was a strong emphasis on the importance of good nutrition and hydration and a commitment to providing people with what they wanted to eat and drink in a flexible manner.

People and their relatives told us that the hospice provided excellent care, and that staff were caring, kind and compassionate. People who used the service comments were, “The service is amazing” and “I'm very happy with the care here.” One relative said that staff were, “Exceptionally kind, I have recommended this service to others.” The hospice provided people with multi-professional and person centred care that ensured their physical, emotional, psychological, spiritual and social needs were met. People were treated with dignity and respect. People and relatives told us they consistently received care that met their individual needs.

There was an accessible complaints policy which the registered manager followed when complaints were made to ensure they were investigated and responded to appropriately.

People using the service, relatives and staff said the registered manager was approachable and supportive. Systems were in place to monitor the quality of the service and people and their relatives felt confident to express any concerns, so these could be addressed.