This inspection took place on 13 and 14 April 2016 and was announced. The previous inspection was 8 May 2014. The hospice was part of the pilot to test the Care Quality Commission's new inspection methodology and so although they were rated this was not published.

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 a

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 visited St Catherine’s hospice and carried out a scheduled inspection. We found that patients were happy with the support they received. One patient who used the service told us “We felt welcomed and staff were approachable and knowledgeable”. A relative of a patient who used the service told us “The care has been first class and we are very happy”. We tracked patient’s care and found that it was comprehensive and well carried out.

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.

We spoke with two patients and three visitors to the hospice. We also spoke with four members of staff, the Registered Manager and the Chief Executive of the hospice. Patients told us that the staff had taken time to explain things to them and had encouraged them to ask any questions they needed to. They told us that their treatment options had been discussed with them and they were confident they had enough information to make informed decisions. A visitor told us “The care is off the scale. We have had fantastic support from all the staff.” The hospice had written records of assessments and plans of care. Risk assessments were included and all care and treatment plans were kept up to date to reflect changing needs. Consultation with a multidisciplinary team was recorded and advice was incorporated into plans of care. People were protected by staff who were trained in safeguarding, abuse awareness and mental capacity. The hospice had a quality assurance system in place which ensured that procedures were audited and that people were canvassed for their opinions about the service they received. We saw plans to show that the results of quality checks were used to develop actions plans to ensure the quality of the service was maintained and improved.

We did not visit the Day Care service, but spent our time on the In-Patient Unit. We spoke with three people receiving care there and some family members. We did not speak with more people because of their particular care needs, on the day we visited.

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.”