This inspection was announced and took place on 16 and 21 June 2016. The service was last inspected in August 2014 and was rated overall as ‘Good’ using the pilot wave inspection methodology in place at the time.

St Catherine’s Hospice cares for people across Chorley, Longridge, Preston and South Ribble who are affected by life limiting conditions. Whilst many of the people they support have cancer, they also support people with other conditions such as heart failure, motor neurone disease and parkinson’s disease. St Catherine’s has a multi professional approach in the provision of specialised care.

The in-patient unit can care for up to nineteen people. Outpatient care is offered through their day therapy unit. People can attend for a wide range of medical, nursing, physiotherapy and occupational therapy treatments, as well as complementary therapies such as reflexology and aromatherapy massage.

There was a registered manager in place who had worked at the service for 13 years. 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.

We found the registered manager to be committed, caring and enthusiastic about the service and the comments we received from people and staff reflected this. As the registered manager had been at the service for 13 years this meant that there was stability in how the service was led, in addition to this the management style throughout the service was forward thinking and reflected feedback from staff, other professionals and people and families who accessed the service.

All of the people we spoke with who used the service told us they felt safe. There were robust safeguarding processes in place and we saw evidence that staff were trained in this area. Staff we spoke with could clearly demonstrate a good understanding of how to recognise and report potential safeguarding issues and that people's safety and comfort was of paramount importance to them.

We looked at recruitment processes and found the service had recruitment policies and procedures in place to help ensure safety in the recruitment of staff. Prospective employees were asked to undertake checks prior to employment to help ensure they were not a risk to vulnerable people. There were also robust procedures in place for the recruitment of the large numbers of volunteers the service used. We looked at recruitment files for individual staff and volunteers and found them to contain all the necessary information and to be well organised.

We looked at how the service was staffed, to ensure people's needs could be met safely. People we spoke with told us they felt there were always enough staff on duty, as did all the relatives we spoke with. We observed staffing levels to be in place to meet the needs of the people in the service on the day of the inspection. The hospice used a dependency tool, which was regularly reviewed, to ensure that a sufficient number of clinical and care staff were present and the right skills mix was in place.

Medicines management processes were effective and staff received up to date training in this area. There was good evidence in place that medicines were audited. Procedures were in place to ensure access to emergency supplies of medication.

Staff we spoke with talked positively about the amount and quality of training they received. This included innovative practice such as 'skills blitz' days when staff could drop into training surgeries at a time that suited them. The hospice had a thorough induction process in place and staff who had recently been employed by the service told us it was detailed and tailored to their own background and development needs. Staff induction records were held on personnel files which we revie

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 and to look at the overall quality of the service.

We inspected St Catherine’s Hospice on 04 August 2014. This inspection was announced, with the staff and provider being given 24 hours’ notice that we would be visiting. We did this so people who used the service could be given notice of our visit and asked if they would be happy to talk with us.

St Catherine’s Hospice cares for people across Chorley, Longridge, Preston and South Ribble who are affected by life-limiting conditions. Whilst many of the people they support have cancer, they also support people with other conditions such as heart failure, motor neurone disease and parkinson's disease. St Catherine’s has a multi professional approach in the provision of specialised care.

The in-patient unit can care for up to nineteen people. Outpatient care is offered through their day therapy unit. People can attend for a wide range of medical, nursing, physiotherapy and occupational therapy treatments, as well as complementary therapies such as reflexology and aromatherapy massage.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

Staff understood people’s individual needs and the support they and their family members required. We saw that care was provided with kindness and compassion. People who used the service and their families spoke very highly about the service. One person told us, “I cannot fault this place.” Another person told us, “I cannot praise the quality of care enough.”

People who used the service and their family members had access to specialist care and treatment from staff that had appropriate knowledge and skills. The registered manager assessed staffing levels to ensure there was enough staff to meet the needs of people who used the service. Arrangements were in place to enable medical support to be requested outside of standard working hours.

People were supported to express their views and wishes about all aspects of their care. People had a plan of care which covered their support needs and personal wishes. We saw care plans for those people on the in-patient unit were reviewed daily. This meant staff had up to date information about people’s needs and wishes.

We saw evidence that end of life care was provided with sensitivity, dignity and respect, and the wishes of people were recorded. One family member told us, “All aspects of care and dying have been fully discussed. The service here is very intimate and highly personalised.”

The management team used a variety of methods to assess and monitor the quality of the service. These included satisfaction surveys and care reviews. 100% of respondents in a recent survey carried out by the hospice, rated the care as excellent.

People spoke openly about their care and treatment at the Hospice. They told us they were cared for very well and all their needs were taken care of. “Everyone makes me feel special and that I matter. I can’t thank them enough.” “People never need to worry if they had to come in here, they would be lucky.” People had care plans that promoted a person centred approach to their care and treatment. Death and dying was treated with sensitivity, dignity and much respect and the needs of family members also considered.

People said they were given their medication when they needed it. They knew what their medicines were for. “I’m always consulted and told what to expect when taking them and the risks and benefits. It’s then up to me to decide.”

People were cared for in a clean and safe environment that was maintained to very good hygiene standards. Systems were in place to minimise the risk of infection.

People were cared for by staff who were suitably trained and supervised. People told us they felt they were in a safe place and that staff were effective in dealing with their care and treatment. "The staff are very kind and make me feel comfortable." “Their bedside manner is excellent. I couldn’t fault any of them. I have every trust in what they do.”

There were opportunities for people to comment on the service they received. We found good evidence that every person using and working in the service ‘mattered’.

People told us they were consulted regarding their treatment and care. They commented, “They always have time to talk to me and discuss my treatment”. And, “I need to know everything that is going on. They are lovely. They explain things in simple terms. They never do anything without my permission even though I think that they know best”. People told us all aspects of their lives were considered. Their treatment, care and support was first class. “Everyone is given their dignity and treated with respect and independence is still encouraged". "I am asked what I want to eat, I can request what I want, the food is excellently presented - like the Savoy!" “I can’t praise them enough, all of them, the doctors, nurses and those who busy themselves around us making sure we are comfortable. I thank God for places like this”.

People commented, "There is a unity of purpose that is striking from all members of staff". “It doesn’t matter who you want to see or speak to, the doctor, manager, nurses and all of the other wonderful people, they are there for you and they have the time to listen. It’s remarkable really”. “It’s a fact I can’t always get hold of my GP, but I know I can ring the Hospice advice line and speak straight away to someone any time day or night”. “Amazing Experience, I have nothing negative to say". “I have nothing but praise for the way I’m treated. Staff are amazing. They will do anything for you”. Angels of mercy, all of them.”

People told us why they had chosen St Catherines for their care and treatment. Some people had been referred to the service because they needed extra support and care, other people had not been managing too well at home and some people were regular attendee’s at the Day Therapy Unit.

People told us they had discussed their care and were able to say what they wanted. They were given information to read and had opportunity to discuss any issues that they were concerned about. One person attending the Day Therapy Unit for treatment said “It’s the first time I have attended. I was really anxious about coming, but it’s nothing like a hospital. It’s really good and I feel I have had a good day out with my treatment thrown in for good measure. Everyone has been very kind. I’m looking forward to my next visit.”

We were told all the staff explained what was going to happen when they were being given treatment and talked to them during procedures. Staff had time for them and they felt in control of everything that was happening. One person said “you can get lost with medical terms, especially where your treatment is concerned but here the Doctors and nurses explain what the treatment will be and what to expect and include me in their discussions”. People told us the medical staff had explained any risks and the benefits of the proposed treatment they had planned. They were pleased with how they were treated and told us “The care here is first class, five star. Nothing is too much trouble for the staff here. The chef comes to see me and asks me about what I would like to eat, if I want something outside of normal mealtimes I just have to ask. I can’t praise then highly enough.” And “I was introduced to different people. A male nurse took me around the grounds and building.” “Everyone is wonderful here”. “The staff are amazing, I’m looked after really well”.

Staff were described as very helpful and spent a lot of time with them. They responded promptly if they required assistance day or night. They could talk to them about any issue they had and were always asked if there was anything they wanted.

People attending the Day Care Therapy Unit said it was a “comforting place” to be. They had confidence in the staff and knew their needs would be met. People were also aware they could seek help at any time by using the advice line.

We were told, all the staff team were very good. They were considered as being professional and very caring and knew what they were doing. Staff were described as being, “excellent, absolutely marvellous and the best.”

St. Catherine’s Hospice (Lancashire) is operated by St. Catherine’s Hospice. The hospice has 19 beds. Facilities include an inpatient unit, a lymphoedema clinic and a clinical nurse specialist community service.

The hospice provides end of life care and palliative services for adults, whilst also seeing children and young people at their lymphoedema clinic. We inspected all the services provided.

We inspected this service using our comprehensive inspection methodology. We carried out an unannounced visit to the hospice on 16 January 2019, with a review of personnel files on 17 January 2019 and attendance at community visits on 18 January 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.

Services we rate

Our rating of this hospice stayed the same. We rated it as Good overall because:

We found good practice in relation to the hospice:

• The service provided mandatory training in key skills to all staff and made sure everyone completed it.

• Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

• The service controlled infection risk well. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection.

• The service had suitable premises and equipment and looked after them well.

• Staff completed and updated risk assessments for each patient. They kept clear records and asked for support when necessary.

• The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.

• Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date and easily available to all staff providing care.

• The service followed best practice when prescribing and giving medications and patients received the right medication at the right dose at the right time. However, some improvements needed to be made around the safe and effective storage of medicines.

• The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.

• The service provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance.

• Staff gave patients enough food and drink to meet their needs and improve their health. They used special feeding and hydration techniques when necessary. The service adjusted for patients’ religious, cultural and other preferences.

• Staff assessed and monitored patients regularly to see if they were in pain. They supported those unable to communicate using suitable assessment tools and gave additional pain relief to ease pain.

• Managers monitored the effectiveness of care and treatment and used the findings to improve them. They compared local results with those of other services to learn from them.

• The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and monitor the effectiveness of the service.

• Staff of different kinds worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.

• The service delivered a full inpatient service for patients receiving palliative care seven days a week.

• Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. They knew how to support patients experiencing mental ill health and those who lacked capacity to make decisions about their care.

• The service planned and provided services in a way that met the needs of local people.

• The service took account of patients’ individual needs.

• People could access the service when they needed it. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were in line with good practice.

• The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with all staff.

• Managers at all levels at the hospice had the right skills and abilities to run a service providing high-quality sustainable care.

• The service had a vision for what it wanted to achieve and workable plans to turn it into action developed with involvement from staff, patients, and key groups representing the local community.

• Managers across the service promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.

• The service had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected.

• The service collected, analysed, managed and used information well to support all its activities, using secure electronic systems with security safeguards.

• The service engaged well with patients, staff, the public and local organisations to plan and manage appropriate services, and collaborated with partner organisations effectively.

  The service was committed to improving services by learning from when things went well and when they went wrong, promoting training, research and innovation.

• Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness and went above and beyond.

• Staff provided emotional support to patients to minimise their distress.

• Staff ensured that patients and those close to them were partners in decisions about their care and treatment.

However,

• The service did not have robust systems in place to offer assurance regarding fit and proper persons and the on-going monitoring of clinical registrations.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, due to a breach in regulation.

We also issued the provider with one requirement notice that affected the well led. Details are at the end of the report.

Ellen Armistead

Deputy Chief Inspector of Hospitals (North West)