Archived: St Clare's Hospice

Updated 3 December 2018

St Clare’s is standalone hospice, funded in part by the local clinical commissioning group. The hospice primarily serves the community of South Tyneside. It also accepts patient referrals from outside this area.

The registered manager has been in post since 2011. 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. Prior to inspection the provider informed us the registered manager was on unplanned leave and an interim manager was in post.

The provider also informed us prior to inspection that the hospice had voluntarily closed for three weeks in July 2018. This was due to a loss of doctors at the hospice and a number of concerns that the provider wished to rectify, for example staff would undergo a period of intensive training during this time and the hospice would undergo some refurbishments.

The Care Quality Commission carried out a comprehensive inspection of this service in January 2018, where it was rated ‘requires improvement’ overall. Following inspection the provider was asked to make a number of improvements and in addition, take specific action in relation to medicines management and governance. The provider was told to develop an action and improvement plan to include what they would do and by when, to improve these key questions.

We carried out an unannounced comprehensive inspection on the 12 and 13 September 2018. We reviewed the action plan during this inspection and found a significant number of issues had not been addressed.

Updated 3 December 2018

St Clare’s Hospice is a standalone hospice provider, which is a charitable incorporated organisation but receives over 40% funding by the local commissioning group. The hospice which had been in operation since 1987, is based in Jarrow and offers specialist palliative care for adults who live south of the Tyne. The health of people in South Tyneside is worse than the England average. Deprivation is higher than average and life expectancy for both men and women is lower than the England average. 2.9% (2011 census) of Jarrow’s population is non-white British making Jarrow the least ethnically diverse major urban area in Tyneside. The service operates both day hospice and inpatient hospice services and provides palliative and end of life care for over 451 patients.

The inpatient unit is an eight-bed facility which provides respite and longer term care for adults with a life limiting illness including, chronic obstructive pulmonary disease, motor neurone disease, supranuclea palsy, heart failure as well as cancer. The Hospice has a day care facility which caters for up to 15 patients per day Tuesday to Friday. In addition the hospice offers bereavement counselling and befriending services.

The hospice is situated in a single story building within the grounds of a local hospital. All rooms have wheelchair access with all inpatient rooms leading to a paved garden area.

We inspected this service using our comprehensive inspection methodology. We carried out the inspection on 12 and 13 September.

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 service went down. We rated it as inadequate overall.

We found areas of practice that were inadequate in relation to St Clare’s:

• We saw significant safety concerns in areas such as medicines management, risk identification and incident investigation and subsequent learning. Safety is not sufficient priority and we saw patient harm had occurred as a result of this.
• There is insufficient attention to safeguarding. Staff displayed limited safeguarding understanding and the interim safeguard lead was appointed to the role without agreement or knowledge of doing so.
• Staff were not supported with mandatory training and managers had no oversight of training needs required for the role.
• Patient records and assessments were incomplete and routine assessments were not completed for all patients, including those deemed to be high risk. Opportunities to prevent or minimise harm were missed.
• Patients care and treatment does not reflect current evidence based guidance, standards and practice.
• None of the nursing staff had received an appraisal in the 12 months leading to inspection.
• There is no formal process to monitor patient’s outcomes of care and treatment and there was little appetite by managers to drive improvement.
• Patients receive care from staff that do not always have the skills or training that is needed through regular completion of mandatory training.
• Staff and teams work largely in isolation and do not seek support or input to actively improve services for patients.
• People are unable to access the care they need. Access and flow within the service was interrupted without due consideration for patients waiting for services.
• Complaints and concerns are not taken seriously and patients concerns and complaints do not lead to improvements in the quality of care.
• Staff do not understand the vision and values and the strategy is not underpinned by detailed realistic objectives and plans.
• The governance arrangements and their purposes are unclear. Financial and quality governance are not integrated to support decision making.
• Leaders do not have the necessary experience, knowledge, capacity, capability or integrity to lead effectively.
• Staff told us there was a culture of bullying and instances of conflict between individuals.
• There is minimal engagement with people who use the service, staff and public.
• There is minimal evidence of learning and reflective practice.

Following this inspection we undertook due process regarding the significant safety concerns and had begun the process to suspend related activities at the hospice. However following a discussion with the provider they chose to voluntarily suspended services. In addition, we told the provider that it must take some actions to comply with the regulations. We also issued the provider with five requirement notices that affected St Clare’s Hospice. Details are at the end of the report.

Ellen Armistead

Deputy Chief Inspector of Hospitals (North)

Updated 3 December 2018

Hospices for adults was the only activity provided at this location.

The hospice had 8 inpatient rooms providing palliative and end of life care, including respite. At the time of our inspection four patients were accommodated.

Day Hospice, bereavement and counselling services were also provided.

We rated this service as inadequate because we saw concerns across four of the five domains which impacted negatively on the ratings.