St Clare West Essex Hospice Care Trust
St Clare Hospice
St Clare Hospice Outstanding
Overall summary & rating
Updated 23 March 2020
St Clare Hospice is operated by St Clare West Essex Hospice Care Trust. The hospice has eight beds. Facilities include the inpatient unit, day therapy services and hospice at home services.
The hospice provides specialist care for adults that require palliative care.
We inspected this service using our comprehensive inspection methodology. We carried out the initial unannounced part of the inspection on 3 December 2019, along with a second unannounced visit to the hospice on 11 December 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.
The main service provided by this hospice was specialist palliative care.
Services we rate
Our rating of this service improved. We rated it as Outstanding overall.
We found outstanding practice in relation to the hospice care:
The service had enough staff to care for patients and keep them safe. 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 collected safety information and used it to improve the service.
Staff provided outstanding care, 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, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
Staff always treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, were active partners in their care and helped them understand their conditions. Staff recognised and respected the totality of patients' needs and provided emotional support to all patients, families and carers.
The service planned innovative care to meet the needs of local people, proactively took account of patients' individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment. This included people protected under the equality act and people in vulnerable circumstances.
Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service's vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They 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, we also found the following issues that the service provider needs to improve:
Patient medication administration by staff for planned short leave periods should follow national and local management of medicines guidance.
Heidi Smoult
Deputy Chief Inspector of Hospitals, on behalf of the Chief Inspector of Hospitals
Inspection Report Published 23 March 2020 PDF (opens in a new tab)
Our rating of safe stayed the same. We rated it as Good because:
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. They used control measures to prevent the spread of infection before and after the patient died.
The design, maintenance and use of facilities, premises and equipment kept people safe. Staff were trained to use them. Staff managed clinical waste well.
Staff completed and updated risk assessments for each patient and removed or minimised risks. Risk assessments considered patients who were deteriorating and in the last days or hours of their life.
The service had enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Managers regularly reviewed and adjusted staffing levels and skill mix, and gave bank, agency and locum staff a full induction.
The service had enough medical staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Managers regularly reviewed and adjusted staffing levels and skill mix and gave locum staff a full induction.
Staff kept detailed records of patients' care and treatment. Records were clear, up-to-date, stored securely and easily available to all staff providing care.
The service used systems and processes to safely prescribe, administer, record and store medicines.
The service managed patient safety incidents well. Staff recognised and reported incidents and near misses appropriately.
Staff gave patients enough food and drink to meet their needs and support their health. They used special feeding and hydration techniques when necessary.
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. Managers ensured that actions from patient safety alerts were implemented and monitored.
The service used monitoring results well to improve safety. Staff collected safety information and shared it with staff, patients and the public.
Our rating of effective stayed the same. We rated it as Good because:
The service provided care and treatment based on national guidance and evidence-based practice. Managers checked to make sure staff followed guidance. Staff protected the rights of patients subject to the Mental Health Act 1983.
Staff assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely way. They supported those unable to communicate using suitable assessment tools and gave additional pain relief to ease pain.
Staff monitored the effectiveness of care and treatment. They used the findings to make improvements and achieved good outcomes for patients. The service had been accredited under relevant clinical accreditation schemes.
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 development.
All those responsible for delivering care worked together as a team to benefit patients. They supported each other to provide good care and communicated effectively with other agencies.
Key services were available seven days a week to support timely patient care.
Staff gave patients practical support to help them live well until they died.
Staff supported patients to make informed decisions about their care and treatment. They knew how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health.
Our rating of caring improved. We rated it as Outstanding because:
Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs and are empowered as partners in their care.
Staff provided emotional support to patients, families and carers to minimise their distress. They understood patients' personal, cultural and religious needs. People's emotional and social needs are highly valued by staff and are embedded in their care and treatment.
Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment. People who use services are active partners in their care. Staff are fully committed to working in partnership with people and making this a reality for each person. Staff always empower people who use the service to have a voice and to realise their potential. They show determination and creativity to overcome obstacles to delivering care. People's individual preferences and needs are always reflected in how care is delivered.
Our rating of responsive improved. We rated it as Outstanding because:
The service planned and provided care in a way that met the needs of local people and the communities served. It also worked with others in the wider system and local organisations to plan care and improve services
The service was inclusive and took account of patients' individual needs and preferences. Staff made reasonable adjustments to help patients access services. They coordinated care with other services and providers.
Patients could access the specialist palliative care service when they needed it. Waiting times from referral to achievement of preferred place of care and death were in line with good practice.
It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff. The service included patients in the investigation of their complaint.
The service made adjustments for patients' religious, cultural and other needs.
Well-led
Our rating of well-led stayed the same. We rated it as Good because:
Leaders had the skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They were visible and approachable in the service for patients and staff. They supported staff to develop their skills and take on more senior roles.
The service had a vision for what it wanted to achieve and a strategy to turn it into action, developed with all relevant stakeholders. The vision and strategy were focused on sustainability of services and aligned to local plans within the wider health economy. Leaders and staff understood and knew how to apply them and monitor progress.
Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service promoted equality and diversity in daily work and provided opportunities for career development. The service had an open culture where patients, their families and staff could raise concerns without fear.
Leaders operated effective governance processes, throughout the service and with partner organisations. Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service.
Leaders and teams used systems to manage performance effectively. They identified and escalated relevant risks and issues and identified actions to reduce their impact. They had plans to cope with unexpected events. Staff contributed to decision-making to help avoid financial pressures compromising the quality of care.
The service collected reliable data and analysed it. Staff could find the data they needed, in easily accessible formats, to understand performance, make decisions and improvements. The information systems were integrated and secure. Data or notifications were consistently submitted to external organisations as required.
Leaders and staff actively and openly engaged with patients, staff, equality groups, the public and local organisations to plan and manage services. They collaborated with partner organisations to help improve services for patients.
All staff were committed to continually learning and improving services. They had a good understanding of quality improvement methods and the skills to use them. Leaders encouraged innovation and participation in research.
Checks on specific services
Hospice services for adults
Staff provided outstanding 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. Key services were available seven days a week.
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