During the inspection we spoke with people and relatives who used the services at Hartlepool Hospice. One person told us, "It’s wonderful here just like a hotel. I was terrified about coming in at first but I am amazed it’s so good. "A relative we spoke with told us, “This is a place of peace and calm near home.”

We observed the experiences of people who used the service and relatives visiting the unit. We saw that staff interacted and communicated well with people and their relatives.

We saw that the atmosphere was friendly and relaxed. The staff were attentive and demonstrated a good knowledge and understanding of people’s needs.

We saw that people had their needs assessed and that care plans were in place. We found there were effective processes in place to ensure safe sharing of information with other providers.

We found that medicines were administered safely.

Staff had received appropriate training and support in respect of their job roles.

People were confident about the care, support and therapy provided within the service and had no concerns, but would raise them if they did.

We spoke to one person who used the service. They told us, "The service is excellent. I didn't know you could come in here for respite, but it is so much better here, rather than going into a hospital. It is very homely." They also told us, "The staff are excellent. They talk to me about my care. I feel informed and involved." We used a number of different methods to help us understand the experiences of people using the service, because some people who used the service were too unwell to speak with us during the inspection. This included reviewing the feedback from people who used the service gathered by the provider.

We found that Hartlepool and District Hospice had in place effective processes to monitor and manage the quality of the service. They also had in place effective recruitment and selection procedures. People were safeguarded from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

The inspection took place on 23, 26 and 27 March 2015. The first visit was unannounced and the other visits were announced. The service was last inspected on 21 November 2013 and was found to be meeting the regulations we inspected.

The registered provider operates Hartlepool and district hospice and its trading subsidiary Alice House Trading Limited from the same location. The hospice is a ten bed consultant led service providing specialist palliative and end of life care.

Both Hartlepool and district hospice and Alice House Trading Limited had the same registered manager. 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.

People said they received excellent care and treatment from kind, caring and respectful staff. People and family members told us they were re-assured and supported on admission to the hospice. One person said, “I was worried about coming to a hospice but the staff have been great and explained everything to me and showed me around which made me feel much better.” One family member described the hospice as, “A lovely place with kind, caring and considerate staff. They are very attentive and caring to all the patients and to families.”

People were actively in control of the care and treatment they received. They were encouraged to make choices and staff respected their preferences. One person told us, “I do prefer a bath to using the shower and there is plenty of bathrooms in here. The staff are happy to help you and will always ask me first before they do anything for me.”

People and family members told us the hospice was a safe place to stay. One person said, “There is always staff around if I need anything even during the night which is good, as sometimes I don’t sleep so well. The staff will come and sit by my bed and keep me company and make sure I am comfortable.” People had been assessed to protect them from a range of potential risks and assessments had been reviewed regularly. We found medicines were administered safely and appropriately.

Staff demonstrated a good understanding of safeguarding adults and whistle blowing. They knew how to report concerns. Previous safeguarding concerns had been reported to the local authority and investigated as required. The registered provider had effective recruitment and selection processes to ensure new staff were suitable to work with vulnerable people. The registered provider also had robust procedures to support managers should they need to take any disciplinary action.

The hospice was well maintained and clean. One person said, “They clean my bedroom twice a day.” One family member told us, “They [staff] are always cleaning the place, the standards here are impeccable.” People were encouraged to bring important items from their home to personalise their room. There were systems in place to check the hospice was a safe place to stay and that equipment was safe to use.

The registered provider delivered a dynamic and constantly evolving training programme. Training available to staff included person-centred care, palliative care and specialist training relating to specific health conditions such as Lymphedema, lung cancer and heart failure. The registered manager told us the provider had invested in providing three days leadership training to all staff within the organisation. This was designed to ensure people received care from an effective, cohesive and skilled staff team. Staff told us they received excellent support from their colleagues and managers. One staff member said, “We work as a team.”

People were always asked for permission before delivering any care. Staff said they would respect a person’s right to refuse care and treatment. Staff had a good understanding of the Mental Capacity Act (MCA) 2005. Where required DoLS applications had been made to the local authority in line with the requirements of MCA.

People told us staff went out of their way to provide meals at a time which suited their needs. We also saw feedback from people which described how their meal preferences were valued and delivered. People were assessed when they were admitted into the hospice to identify any potential concerns with eating and drinking. Staff told us they were able to cater for people’s special dietary requirements.

The registered provider was forward thinking in its approach and committed to empowering people to take control of their own health. For example, the registered provider ran a unique innovative pilot ‘breathlessness programme’ to support people including those in the local community to self-manage their health condition. The hospice was a consultant led service providing people with quick access to specialised treatment for complex conditions and symptoms from a wide range of health professionals.

There was a strong focus on people’s social and psychological wellbeing. People could access day services, social activities and therapeutic support in the purpose built holistic wellbeing centre. People and family members were able to access the hospice’s helpline for advice and support 24 hours a day every day.

Care was focused around what was important to each person following a ‘holistic assessment.’ The assessment was the basis for person-centred care plans which clearly highlighted people’s preferences. People were involved in discussing their life history. Care plans were up to date and identified specific interventions based on people’s particular priorities. Staff discussed with people their plans for the future including their preferred place of care and their future care needs.

People were encouraged to remain independent and continue with their everyday things. One person said they went out to bingo in their local community every Monday. People said they were listened to and staff responded to their wishes. They could choose to take to take part in organised activities. Staff said they spent one to one time with people watching a movie or playing card games and dominoes.

People knew how to complain. None of the people we spoke with raised any concerns with us about their care. The registered manager told us they usually received very few complaints. People and family members had opportunities to give their views. Feedback from the last consultation in 2014 was positive.

The registered manager and staff were very knowledgeable and enthusiastic about the service. They were passionate and enthusiastic as they spoke about the service and believed in the philosophy and values of the registered provider. Similarly people and family members spoke positively about the service.

The registered provider was pro-active about delivering it’s values. We found excellent examples of innovation, such as the breathlessness group, the 24 hour helpline, the wellness centre, contributing to the development of a nationally recognised care pathway and development of a community based service including additional long stay beds within the hospice. The registered provider was pro-active about sharing good practice to improve care for people at the end of their lives. The hospice had developed and was running a specific competency based training programme aimed at improving the skills and knowledge of care home staff employed by other providers.

The registered provider had an effective quality assurance programme in place. Audits were effective in identifying areas for improvement and ensuring action was taken to improve the service. The registered manager told us they looked for opportunities to learn and improve practice and procedures. The hospice had clear aims and objectives for its future development.