Inspection on 14/01/10 for St Joseph`s Hospice

This inspection was carried out on 14th January 2010.

CQC found this care home to be providing an Excellent service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

St Joseph`s Hospice 23/02/07

St Joseph`s Hospice 22/02/06

St Joseph`s Hospice 29/09/05

St Joseph`s Hospice 11/02/05

St Joseph`s Hospice 06/05/04

St Joseph`s Hospice 25/03/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 28/03/2010.

Key inspection report Care homes for older people Name: Address: St Joseph`s Hospice Ince Road Thornton Liverpool Merseyside L23 4UE     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Patricia Thomas     Date: 1 4 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 25 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: St Joseph`s Hospice Ince Road Thornton Liverpool Merseyside L23 4UE 01519243812 01519315727 jacintacannon@jospice.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: St Joseph`s Hospice Association care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability terminally ill Additional conditions: Service users in the category TI must be in the age range of 19 years and above. Service users to include up to 12 OP and up to 10 TI and up to 3 PD. The service should employ a suitably qualified and experienced Manager who is registered with CSCI. Date of last inspection Brief description of the care home St. Josephs is a care home, with nursing, for 25 Service Users. The home is owned by St. Josephs Hospice Association (Jospice International) and the manager is Jacinta Cannon. The home is registered in the following categories, 12 Elderly, 3 Physical Disability, 10 Terminal Illness. The home was founded within a Catholic ethos and this is reflected in the character of both the interior and grounds. The home is not exclusive to those of the Catholic faith. People of all denominations and those who have no Care Homes for Older People Page 4 of 25 0 3 10 Over 65 12 0 0 Brief description of the care home religious beliefs may move in, subject to nursing assessment and availability. The service is provided in two buildings, The Academy and San Jose, which have a number of lounges and two dining areas. The majority of bedrooms are singles and some have en-suite facilities. There are extensive and beautiful grounds consisting of woodland, gardens and car parking facilities. The home is situated on a main bus route between Southport and Liverpool with the busy shopping centre of Crosby a five-minute car journey away. Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is three stars (***). This means that people who use this service experience excellent quality outcomes. We made an un announced visit to St. Josephs (Jospice). It took six hours and was done by one inspector. The visit was just one part of the inspection. Before the visit took place, we (the commission) asked the manager to complete a questionnaire that we call an Annual Quality Assurance Assessment (AQAA). The AQAA was very detailed and gave us a lot of information about how Jospice is meeting the needs of the people who live there. It also gave us information about recent improvements to the services and plans for further development. During the visit we walked round the home and checked various records. We spoke to people who live in Jospice and with their visitors and with staff. They gave us their views about Jospice and these are included in this report. To find out more about the care provided in Jospice we sent comment cards to people Care Homes for Older People Page 6 of 25 who use the service. We have received nine replies and the comments we received are included in this report. To check how people are being supported in Jospice, we used a system called case tracking. This is a way of inspecting that allows us to follow a particular situation in order to ensure it was dealt with properly. Reference to we or us represent the Care Quality Commission. Care Homes for Older People Page 7 of 25 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. Care Homes for Older People Page 8 of 25 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 25 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People thinking of moving into Jospice receive sufficient information to help them to make a decision and staff receive enough information to understand the persons needs. Evidence: We found that there are good systems in place to help people who may be moving in to Jospice by giving them information about the home in the service user guide. This helps to inform their choice about whether Jospice will be a suitable home. Some people who move in need end of life care, for others, Jospice is their permanent home. People are invited to visit before they move in to look at the accommodation and meet the other people who live there and staff who work there. Where possible, staff will meet the person before they move in to assess and record their support needs and preferences. For those people who are admitted in emergency circumstances at short notice, an assessment of their needs is faxed to the home manager by the district nurse or hospital discharge co-ordinator. In this way the home has the information Care Homes for Older People Page 11 of 25 Evidence: they need to decide whether the persons needs will be met in Jospice. Jospice has robust equality and diversity policies which apply to the way support is arranged from the time each person is introduced to the home. Records showed us that training is regularly reviewed to ensure staff will develop and maintain the skills they need to meet peoples assessed needs in the way they prefer. We looked at peoples care files which gave us evidence that a full assessment of each persons health, personal care, social and cultural needs had been carried out before they moved in. This gave staff in depth information on which to plan each persons care. We received nine surveys from people who live in this home and they told is they were given enough information to help them decide if the home was the right place, before moving in. They told us they had a written contract of residence and always receive the care and support they need. Care Homes for Older People Page 12 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Detailed assessments and care plans make sure peoples needs and personal aspirations are assessed and responded to properly and safely. Evidence: In surveys returned to us by nine people who use the service they told us that the care in Jospice is good. One person described the culture in the home as one of total wellbeing providing good support for medical and spiritual needs. We looked at care plans for three people and these were clear and easy to follow. We found that the staff team have training in care planning and have worked with the people who use the service developing care plans which are unique to them. This is to help ensure that their choices will be respected and they will receive the right amount of support. We found good systems for assessing and managing risks and reviewing peoples needs to ensure they will stay as independent as possible. For people receiving end of life care, staff follow Liverpool Care Pathways for the dying when supporting them, to ensure they receive all the care they need and are comfortable, pain free and their spiritual needs are met in accordance with their chosen beliefs. Peoples religious and cultural needs are central to the way their support is arranged Care Homes for Older People Page 13 of 25 Evidence: and there are systems to update training for nursing and care staff in line with the needs of people who are living in Jospice. Staff keep good records of how peoples health will be recorded. People living in the home may have a local G.P. of their choosing and all contacts with health professionals are recorded with the outcomes of the visit and any treatment or medication prescribed. This is to ensure staff are up to date with each persons condition and treatment. In addition, Jospice is allocated six G.P. sessions each week by arrangement with the Primary Care Trust. The sessions are shared between two doctors who have special interest in palliative care. There was good evidence of contacts with community health services through regular multi disciplinary meetings (which include Mc Millan nurses, physiotherapists, G.P.s and specialist therapeutic professionals). This is to discuss peoples progress and needs and evaluate the support being given to each individual. We saw evidence that people have access to health care professionals such as physiotherapists and speech therapists and have specialist equipment they need to keep them comfortable and safe. We looked at how peoples medication is managed and tracked medication for two people, which was found to be in stock and correctly stored and recorded. An internal audit of medication is carried out at least weekly to ensure that all medication is accounted for and being given in accordance with pharmacy instructions. There are arrangements for ensuring that drugs are held securely and unwanted drugs disposed of. Arrangements for medication have changed since our last visit as the home now holds a stock of end of life drugs. Staff told us this has cut down on delays and wastage and has improved outcomes for people who are prescribed these drugs. Records show that staff who give out drugs have received training and have the detailed procedural guidance they need when managing medication. For staff guidance, Jospice has procedures on privacy and dignity and the majority of bedrooms are for single occupancy, the few remaining doubles having screens in place to protect privacy. We observed staff knocking on bedroom doors before going in and keeping care records secure to protect confidentiality. Care Homes for Older People Page 14 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Social activities and meals are both well managed and provide daily variation and interest for people who live in the home. Evidence: The origins of Jospice are rooted in the Roman Catholic Faith and there is an integrated chapel. Religious icons are evident in the grounds and in some communal areas. However, this is made known to people when they are introduced to Jospice in the service user guide, as are arrangements for supporting people of all religious denominations and those who do not have religious beliefs. Religious services take place at least weekly and people have access to ministers and priests as they choose. Case tracking showed us that spiritual and emotional support is integral to the care planning process and Jospice has arrangements in place for the services of a bereavement counsellor and independent advocates. This is to ensure people who use the service and their families have all the emotional and practical support they need from those who are best qualified to provide it. The relative of a service user wrote in a survey, I am really grateful to the Jospice for all the care they give my mum and the support they are giving to my dad because my mum is so ill. Care records showed us that people have regular visits from family and friends and there are no undue restrictions on visiting times. There was good evidence of peoples Care Homes for Older People Page 15 of 25 Evidence: preferences and choices being recorded in their care plans and catered for. Jospice is well known to the local community and the AQAA tells us that open days and events are well supported. In surveys returned to us the majority said that activities are arranged for them in Jospice. In some cases they said this is not always the case. Staff should ensure that activities are regularly reviewed in accordance with changes in peoples needs to ensure they are provided with the lifestyle and stimulation they need and which will benefit them. We looked at how meal times are arranged. There are two pleasant dining rooms with freshly laid tables, or people may eat in their bedrooms if preferred. We saw nutritional assessments on peoples care plans and their meal choices are recorded. The kitchen was found to be well equipped and clean and catering records were up to date. There were good food stocks which had been stored safely and menus show that people are given a healthy and nutritious diet and offered choice and alternatives to what is on the menu. On surveys returned to us people said they always or usually like the meals provided in Jospice. Care Homes for Older People Page 16 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are good safeguarding and complaints procedures which are understood by staff. This means that people are able to freely express concerns and they are safeguarded from abuse. Evidence: To ensure people know their complaints will be taken seriously, Jospice has a complaints procedure which is placed in peoples bedrooms and on the main notice boards. The procedure is clear and easy to understand and a record of complaints is kept in the home. We have not received any complaints at CQC about this home since our last review of the service. All the people who returned surveys to us said they knew about how to make a complaint if necessary. One person said, I have never had to raise a concern to staff that they are not already aware of and dealing with. There are clear safeguarding procedures in Jospice, and staff receive training and updates in protection of vulnerable adults. Staff who were spoken with were aware of abuse indicators and reporting systems and of whistle blowing procedures. We saw good evidence that procedures and guidance for staff are reviewed each year to ensure they are relevant and up to date with best practice guidelines. Records showed us that staff guidance and training is provided to ensure people will be protected under the Mental Capacity Act and their right to decision making and independent advocacy will not be compromised. Care Homes for Older People Page 17 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in Jospice are provided with suitably adapted, comfortable and very pleasant surroundings. Evidence: The home provides accommodation in two separate buildings, the Academy and San Jose. The grounds are extensive and provide wooded areas, lawns and planting, off street parking and wheelchair accessible seating and walk ways. Jospice is on the main bus route between Liverpool and Southport and there are shops and local amenities a short car journey away. In addition to the ongoing decoration and maintenance programmes, we saw that a lot of improvements have been made to the buildings since our last visit. A new chapel and new lounges have been built in the San Jose and the previous chapel area in the Academy is now an open lounge for service users and their visitors. A new lift suitable for people being moved on stretchers, has been built in the academy and improvements made to showering facilities. Work is ongoing to obtain planning permission and funding to provide single en suite rooms in the Academy to replace the first floor double rooms in San Jose. The home provides a range of aids such as specialist bathing and showering facilities, specialist beds and seating and pressure cushions and mattresses for those who are at risk of pressure sores. There are passenger lifts in both buildings and level access from outside. The home employs domestic staff and records show they have training in infection Care Homes for Older People Page 18 of 25 Evidence: control and are supplied with protective overalls, aprons and gloves. The building was clean in all the areas we visited and there are facilities to store and manage cleaning materials in accordance with COSHH regulations to keep them safe. All the people who returned surveys told us their home is always clean and odour free. Care Homes for Older People Page 19 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living at Jospice are supported by a well trained, effective staff team who have been suitably vetted. Evidence: Jospice has a rigorous recruitment procedure and we looked at staff files for three people most recently employed to ensure this is being followed. We found evidence of satisfactory criminal records bureau checks, satisfactory references, work histories and proof of identification. By following the procedures the home will help to ensure that only people who are suitable will be employed. For nursing staff, a list of pin numbers is maintained with updates to ensure their suitability. Jospice provides induction training for new staff and regularly reviews staff training for long term employed staff to ensure they have the skills to support the complex and changing needs of people who use the service. Training records showed us that staff receive mandatory training updates, specialist training specific to the health and emotional needs of service users and undertake ongoing National Vocational Qualifications in care. The policies in place to guide staff in best practice and procedure are reviewed every year to ensure their quality and keep them up to date with any changes. The promotion of peoples rights and equality was evident in procedural guidance and records written in the home. Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Jospice is managed in the best interests of the people who live there. Evidence: The manager of Jospice has care/management degrees and over ten years managerial experience. There is a clear management structure in the home and two team leaders are employed who have NVQ4 management qualifications and directly supervise staff. This is to ensure staff are given the support they need to fulfill their roles and responsibilities properly and safely. A number of systems are in place for monitoring the quality of service. The manager carries out monthly service audits to ensure that standards will be maintained and improved. Records showed us that in addition to ongoing care plan reviews, regular audits of the medication system and environment (such as stairs, bed rails and equipment) are carried out and a dignity audit was recently undertaken to ensure peoples rights are protected in care giving. Annual questionnaires are given to service users and their families and where improvements are identified the outcomes are acted upon, and positive comments are Care Homes for Older People Page 21 of 25 Evidence: valued and built on. Following a recent survey, people now have flat screen televisions in their bedrooms. Also, work to phase out the remaining double rooms is in the planning stage as people said they would prefer single accommodation. We checked safety certificates for the building and equipment and they were up to date and satisfactory. Health and safety records showed us there are good systems for assessing and minimizing risks and for incident and accident reporting. Records showed us that staff receive health and safety training and have clear procedural guidance on how to follow safe working practices. Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 12 Staff should ensure that activities are regularly reviewed in accordance with changes in peoples needs to ensure they are provided with the lifestyle and stimulation they need and which will benefit them. Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 25 of 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!