We carried out a review of the data available to us about Saint Catherine's - Scarborough on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Saint Catherine's - Scarborough, you can give feedback on this service.
Our rating of this location went down. We rated it as good because:
However:
St Catherine’s Hospice is operated by St Catherine’s Hospice Trust. The hospice currently provides 14 inpatient beds and has the capacity to open up to 16 inpatient beds if the service demands. It also provides a well-being centre and other outpatient facilities. The hospice provides a hospice at home service (in collaboration with Marie Curie) across the Scarborough and Filey region, specialist palliative care services which includes outpatients and in reach to the acute trust as well as support to local care homes. Outpatient services include a lymphoedema clinic, physiotherapy and occupational therapy services, complementary therapy and specialist palliative counselling services which includes a service for families. The hospice also provides a specialist palliative social work service, spiritual care, carer support, education for patients and families and an out of hours telephone support line.
The hospice provides care to adults only although children are included in any family counselling services where appropriate. The hospice cared for 2388 patients from February 2018 to January 2019; 681 were aged 18 to 65 years and 1,825 were over the age of 65. Fifteen children aged from four to 17 were seen through the counselling service offered to families.
We inspected this service using our comprehensive inspection methodology. We carried out the inspection on 14 May 2019 and 4 June 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
We rated this service as Outstanding overall.
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.
Staff completed and updated risk assessments for each patient, risk assessments considered patients who were deteriorating and in the last days or hours of their life. Risk assessments considered patients’ capacity dignity and choice.
Staff recognised and reported incidents and near misses. Managers investigated incidents and shared lessons learned with the whole team and its wider network.
The service provided care and treatment based on national guidance and evidence-based practice.
Doctors, nurses and other healthcare professionals worked together as a team to benefit patients, communicating effectively with other agencies to ensure the best possible care and coordination across services.
There was individual consultation with patients which ensured that food was appropriate to their individual needs and preferences, so it was appealing to the patient and they were not put off by too large portion sizes.
Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs to ensure person-centred care.
Feedback from people who used the service, those who are close to them and stakeholders was continually positive about the way staff treated people. Patients said that staff went that extra mile and their care and support exceeded their expectations. Patient feedback regarding the emotional support from all staff groups and services was consistently, extremely positive.
There were multiple examples of where staff had gone the extra mile to ensure person-focussed, exceptional care.
Staff empowered patients and families to be partners in care, practically and emotionally. People’s individual needs and preferences were central to the delivery of tailored services.
The service was proactive in its approach to understanding the health needs of the local population and working with other providers in the local health economy to ensure the service was planned and delivered in a way that met those needs.
Staff actively encouraged patients to give feedback and dealt with any concerns as far as possible as soon as they were raised. Staff at all levels in the organisation were engaged with improving services as the result of complaints.
Leaders had the integrity, 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. Staff felt supported and valued.
The service had a vision and strategy that were focused on sustainability of services and aligned to local plans within the wider health economy.
All staff were committed to continually learning and improving services. Leaders encouraged innovation and participation in research.
However, we also found the following issues that the service provider needs to improve:
The hospice had undertaken a mapping exercise of safeguarding training with the requirements in the adult and children’s intercollegiate guidance. This had identified gaps in adult safeguarding training requirements at all levels and children’s requirements at levels one and two.Work was underway to address the gaps but this needed to be implemented and embedded. Safeguarding policies / procedures needed updating with the training levels required for the different staff groups.
There was an ongoing review of all policies and procedures to bring them up to date with current guidance and best practice and there were still some policies out of date.
Resuscitation equipment had not always been checked as per the services protocols.
There was no evidence of actions taken, when medicine fridge temperatures went outside of the required range
Only 70% of junior registered nurses had received an appraisal in the last 12 months.
Processes and systems in place regarding; trustee recruitment and oversight/ management of their performance or development needs, audit and performance target setting and monitoring, keeping policies and procedures up to date with current guidance and best practice and oversight of disclosure and barring certificates were not robust.
There were gaps in information to committees and board to enable full oversight and governance of the service.
The business continuity plan was a work in progress.
Following this inspection, we told the provider that it should make some improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.
Anne Ford
Deputy Chief Inspector of Hospitals (Northern Region)
St Catherine’s Hospice Scarborough provides in-patient hospice care and a hospice at home service which are regulated by CQC and a day hospice which is not regulated. These are based on one site. The hospice holds condition specific clinics, has a social work team, a bereavement support service, therapy services, an education department, a fundraising department and a team of volunteers numbering around 600.
There is a hospice at home team who provide hospice care in the community to people. There is also a care homes team of clinical nurse specialists who work specifically with care homes in the area. MacMillan clinical nurse specialists who work with people in their own homes and neurology clinical nurse specialists who work with hospital teams and community services are employed by the hospice. A spiritual care co-ordinator supports people using hospice services across the area.
The exceptional care provided by the hospice is for people that live in the Scarborough, Whitby, Ryedale, Bridlington and Driffield areas of North Yorkshire. The service is a registered charity with a board of trustees. Day to day the service is run by a senior management team drawn from all departments within the hospice.
The service was extremely responsive and focused on providing a tailored service which people helped plan and develop. There were appropriate systems in place to ensure flexibility to people so that their care needs could be met either at home, the hospice or in the wider community. In addition the service provided excellent support to relatives and carers.
Excellent leadership and management was demonstrated at the service. The culture was open and inclusive which meant that people received a tailored service which was flexible to their needs.
The main site is a purpose built facility. The in-patient unit has 18 rooms which are en suite and have doors leading on to a patio and garden. There were 12 people using the service on the day we inspected. There is a day hospice and clinic areas. A separate area houses the education department. They are linked by a corridor which leads to the dining room and kitchens.
The provider has three locations registered with the Care Quality Commission. We found that there were areas that were common to all three services. For example, training, staff meetings and policies and procedures. For this reason some of the evidence we viewed was relevant to all three services.
There was a registered manager employed for this service who also managed the day hospices in Whitby and Ryedale. 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 very experienced after being employed by the hospice for many years.
The beautiful environment was maintained by the hospice maintenance and gardening team. There were servicing agreements in place for mains services. The premises were extremely clean and tidy with appropriate adaptations in place for people who used the service. The gardens were extremely well maintained.
Staff recruitment processes were followed with the appropriate checks being carried out. There were a high number of staff on duty to meet be able to meet people’s needs in a meaningful way and the service had a team of volunteers who provided additional support. The hospice had a bank of staff who they could contact if they needed additional staff. All staff received supervision individually or as a group and annual appraisals were undertaken. Staff and volunteers received a thorough induction and regular training to ensure they had the knowledge and skills to deliver high quality care which they demonstrated throughout the inspection.
Staff followed risk assessments and guidance in management plans when providing care and support for people in order to maintain people’s safety.
Staff were able to describe what it meant to safeguard people and told us how they would report any suspected abuse. There were policies and procedures in place for staff to follow and support available from the safeguarding champions. There was an embedded culture of learning from mistakes.
People brought their own medicines with them to the service and there were systems in place to ensure they were stored and administered safely.
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. They told us they were involved in all decisions about their care.
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 amount of food they would be able to eat. There was a choice of menu on the day we inspected and we sampled food in the dining room which was of a high quality. Patients and their families received the same food unless they had something specially prepared. Drinks and snacks were freely available. Patients and their families described the food in positive terms.
When people needed specialist healthcare support the day hospice made referrals to specialist services such as occupational therapy or the dietician. There was a helpline line for people who used services and their families to use twenty four hours a day which linked directly to the hospice where they could access advice and support. This gave people confidence when they were at home.
People told us that staff were caring and listened to them. There was a spiritual care co-ordinator who was available to people who used the day hospice and their families. This support was across all faiths but specific religious leaders could be accessed through the co-ordinator if a person preferred. We heard examples of the excellent spiritual support provided to people.
The seven protected characteristics of the Equality Act 2010; age, disability, gender, marital status, race, religion and sexual orientation were adequately provided for within the service; the care records we saw evidenced this and the staff who we spoke with displayed empathy in respect of people’s needs. These characteristics were embedded in staff training.
People were able to make decisions about the care and support that they received and told us that staff at the service communicated well with them. Confidentiality was respected through safe storage of records and by the staff who offered privacy when having difficult or sensitive conversations demonstrating respect for people’s privacy and dignity. People spoke with such thankfulness about the respect shown to them by staff giving examples of how staff had helped them retain their dignity.
People helped develop their care plans which were person centred. This is when any treatment or care takes into account people's individual needs and preferences. The persons chosen place of care and place of death was clearly recorded where the person had chosen to share that information. People were given time and support to develop advanced care plans, advance directives and living wills if they wished. People received help with symptom control and management at the day hospice but could also enjoy socialising with others.
People were confident expressing any concerns to staff at the service and knew who to approach if they were not satisfied with the response.
Staff and volunteers shared similar values and worked closely with each other in a mutually respectful way. There were regular team meetings. There was also a newsletter for staff and volunteers, a time out group for carers of people who used the service and a drop in group for newly bereaved relatives to provide support. Accidents and incidents were clearly recorded. Where any mistakes were made these were discussed and reflected upon in order to make improvements.
The hospice presented annual quality accounts which looked at patient safety, clinical effectiveness and patient experience. They benchmarked their safety data against other hospices by engaging with a national initiative and audits were completed across the organisation providing a thorough and comprehensive system of quality assurance. They also took part in research projects as a means of improving their service and educating staff. The quality of the service was enhanced by these measured and this was reflected in feedback received by the service.
St. Catherine’s Hospice is a hospice service that is located on the outskirts of Scarborough in North Yorkshire. The hospice offers an in-patient service for people at the end of their life and also for people who require symptom management or psychological support. The hospice has 20 in-patient beds and incorporates a day centre. On the day of this inspection there were ten people receiving treatment in the in-patient unit. Some people who used the day centre had also used the in-patient unit so we spoke with them as part of this inspection.
There was a registered manager in post as the time of this inspection and they had been in post for thirteen years. A registered manager is a person who is registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.
People told us that they felt safe whilst using the hospice. Staff had been recruited following robust policies and procedures that ensured only people suitable to work with vulnerable people had been employed and there were sufficient numbers of staff. Staff had undertaken training on safeguarding adults from abuse and other training that provided them with the skills to carry out their role safely and effectively.
There were appropriate risk assessments in place that ensured people’s safety, allowed people to take responsibility for their actions and be as independent as possible. People’s individual circumstances and lifestyle had been taken into account when their care or treatment plan had been devised. In addition to this, people who were important to the person had been consulted and their needs and wishes were incorporated into treatment plans. Relatives and friends were able to visit the hospice at any time; they told us that they could stay at the hospice as long as they wished. Bedrooms were spacious and included en-suite facilities, and there was provision for relatives and friends to stay overnight.
People told us that their privacy and dignity was respected by staff and that they felt staff really cared about them. Relatives also told us that they were well supported; this included the bereavement counselling service that was described by some health care professionals who we spoke with as “Excellent”.
The service was responsive to people’s needs and continually looked for ways to improve. They were taking part in two pilot schemes that were aimed at improving care and treatment for people received at the end of their life. They had also identified that the pre-bereavement service they provided could be improved and, as a result, had introduced a variety of support groups for people and their carers.
There were clinical governance systems in place that monitored people’s satisfaction with the service and ensured that the policies, procedures and practices in place were followed so that people received the service they needed. Staff told us that they were well supported by the hospice and that their views were listened to. Clinical staff had monthly supervision that included discussions about medication practices and a ‘learning from incidents’ exercise.
We looked at nutrition and hydration and found that patients could access food and drink when needed. Appropriate support was given and a good range of food was available. We observed that the hospice was extremely clean and hygienic and staff followed robust infection control procedures.
We looked at staff files and recruitment, selection and induction procedures and found these to be robust and followed appropriately. The hospice had comprehensive quality assurance procedures in place and responded appropriately to feedback from patients and staff. Records were accurate and up to date and were stored and disposed of according to data protection guidelines.
The people we talked with spoke positively about the care provided and the competencies of the staff who work there. Their comments include 'The care is first class. The service is first class. It's absolutely marvellous.' They added 'I feel totally up to speed with what's happening to me.'
Another person told us 'They talked with me about how they were going to manage my symptoms. I feel really included in my care.' They added 'I now feel fantastic. This is a fantastic place.' This person also told us of the tailored meals they had received. They said the hospice chef had visited them each day to discuss what they would like to eat. They said 'I could have had anything I wanted.'
This individual also commented positively about the gardens and the environment, which helps their emotional well-being. They told us 'You'd think it would be a depressing place. But it's not at all. Everyone's happy with a smile on their face.'