St Rocco’s Hospice provides in-patient hospice care, a hospice at home service and a day hospice from one site. The hospice holds clinics, has a family support service, therapy services, a fundraising department and a team of volunteers all based on-site. The service is a registered charity with a board of trustees. Day to day the service is run by a management team drawn from all departments within the hospice.
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 experienced in providing palliative care and had worked at the hospice for a number of years.
People and their families spoke highly of the complementary therapies that were available to both people who used the service and relatives. The hospice provided family support, counselling and bereavement support and had recently appointed a non-denominational chaplain to strengthen their team.
People told us that staff were caring, compassionate and listened to them. People we spoke with who received personal care felt the staff were knowledgeable, skilled and their care and support met their needs.
People’s health care needs were met by the in-house medical team. This included consultants, GP’s with a special interest in palliative care, an occupational therapy team and a physiotherapy team. We saw the service was developing staff by developing the specialist nurse role and supporting nursing staff to undertake a non-medical prescribing course.
Care plans were personalised to include people’s wishes and views. People and relatives told us they were consulted about their care and treatment and that they regularly had the opportunity to speak to medical and nursing staff. Care plans were regularly reviewed in a multi-disciplinary framework. We observed staff caring for patients in a way that respected their individual choices and beliefs.
Staff recruitment processes were followed with the appropriate checks being carried out. There were sufficient staff on duty to meet people’s needs although had experienced some shortness of staff recently although this had not impacted detrimentally on the people using the service. The hospice had a bank of staff who they could contact if they needed additional staff. The registered manager told us they were working on a project to look at the skill mix of staff. Staff and volunteers received a thorough induction and regular training to ensure they had the knowledge and skills to deliver high quality care and support.
Staff followed risk assessments and guidance in management plans when providing care and support for people in order to maintain people’s safety.
People were protected by the service’s approach to safeguarding and whistle blowing. People who used the service told us that they were safe, could raise concerns if they needed to and were listened to by staff. Staff were aware of safeguarding procedures, could describe what they would do if they thought somebody was being mistreated and were aware of who to report safeguarding concerns to.
Staff gave us mixed views about how they felt supported. We explored this with the senior management team who were aware of staff feelings and showed us how they were communicating and engaging with staff over issues they had raised. Staff did tell us they felt optimistic about the outcomes of these issues.
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.
People were supported to receive a nutritious diet at the service. Their appetite was assessed through talking to them which led to staff being able to give the person the type and amount of food they would be able to eat. There was a choice of menu on the day we inspected and drinks and snacks were available at any time. The service also provided a café for people, families and staff to enjoy a drink or snack.
The staff undertook the management of medicines safely and in line with people’s care plans. The service had health and safety related procedures, including systems for reporting and recording accidents and incidents. The care records we looked at included risk assessments, which had been completed to identify any risks associated with delivering the person’s care and their environment.
The registered provider had a system in place for responding to people’s concerns and complaints.
There were effective systems in place to monitor and improve the quality of the service provided. The service was going through a period of transition with new staff members at senior levels, a project looking at the development of non-qualified staff and new service developments such as the SystmOne electronic care planning system which was just being implemented.
Accidents and incidents were clearly recorded. There was an embedded culture of learning from mistakes and to share action plans for improvement work within the service.