The inspection took place on 28 and 29 September 2016 and was announced. The previous inspection took place on 20 August 2013 when the service was found to be meeting all requirements reviewed.

Bolton Hospice is a registered charity operating from purpose built premises close to Bolton town centre. The hospice is set in rural grounds with a large car park.

The hospice had 14 inpatient beds, and all patients are accommodated in single rooms. At the time of the inspection renovations were being carried out to complete the work to en-suite all 18 rooms following the addition of four bedrooms add extra rooms to allow the hospice to accommodate up to 18 patients and they had updated their registration to ensure they were registered for this number.

Close family members are able to stay overnight if they wish to do so. Other services include a planned day therapy unit, outpatient clinics, bereavement support and a hospice at home service. On the day of the inspection there were nine patients in the inpatient unit which was operating at a reduced capacity of 12 beds due to the building works.

There was a registered manager employed. 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.

Relatives told us they felt their loved ones were safe and secure. Appropriate safeguarding policies and procedures were in place and staff were aware of how to report a concern.

The recruitment process was robust and the induction programme thorough and comprehensive. Training was on-going for all staff, including volunteers, clinical and non-clinical. Staffing levels were sufficient to ensure people’s needs were met.

All staff received regular supervisions and there were frequent reflection sessions to help ensure continual improvement in staff skills and knowledge. Staff and volunteers were well supported by colleagues and management.

Incidents and accidents were logged appropriately. These were audited, analysed and issues identified and addressed as required. General and individual risk assessments were in place and were reviewed and updated as required. All health and safety procedures were in place.

Systems for ordering, storage, administration and disposal of medicines were robust and the medicines room was extremely tidy and well ordered. This helped ensure medicines, including controlled drugs, were managed safely.

The service were working within the legal requirements of the Mental Capacity Act (2005) (MCA) and there was evidence of best interest decision making where it was appropriate.

People’s nutritional needs were assessed and staff ensured these requirements were addressed by the catering staff. Staff were aware of any risks with regard to nutritional and hydration issues and these were documented appropriately so that risks could be minimised.

The building was warm, clean and tidy. The premises were being extended to incorporate more beds and this work was being carried out sensitively, with the least possible disruption for patients and families. The service was in the process of trying to create a more dementia friendly environment.

Patients, relatives, staff and volunteers all described the service as caring, inclusive and supportive. We saw staff delivering the service with kindness and compassion. There was a range of literature for people to pick up explaining the services offered and how to access them.

Spiritual support and counselling was offered in a range of different ways, including multi-faith services, one to one bereavement counselling, bereavement groups and social activities and access to particular religious support. There was a multi-faith prayer and reflection room, which provided a quiet space for people to use as th

We visited Bolton Hospice on 20 August 2013 and there were eleven in patients. We saw staff caring for patients with respect and compassion.

Appropriate policies and procedures were in place and staff members were aware of how to access them and the correct procedures to follow.

We saw a sample of three patients’ records which contained relevant and factual health information. Patients’ wishes and preferences were recorded and patients were included in discussions about their care and treatment.

We spoke with two patients and one relative. One patient said “I can’t praise them enough – if I want it I can have it. They try to keep my spirits up, if I’m down they come and hold my hand.” Another patient told us “They have regulated my pain and I feel much better.” A relative said “I talked to staff about X’s condition and home versus hospice. They advised and supported me.”

We spoke with three members of staff who were aware of the safeguarding procedures and had an understanding of mental capacity issues and best interests decision making. Staff were well supported by management and told us that there was an open door policy and everyone was approachable. Staff meetings were held regularly, training and professional development was on-going and annual appraisals were undertaken.

Complaints were taken seriously and followed up appropriately and regular audits were carried out. The results were analysed and changes and improvements were made as appropriate.

We visited Bolton Hospice on 23 October 2012. We looked at a sample of three patients’ records and spoke with two patients and two visitors.

We looked at documentation and found that all appropriate policies and procedures were in place and staff members we spoke with were aware of how to access them and knew the correct procedures to follow.

We looked at a sample of three patients’ records and noted that relevant and factual information was contained within them. We saw that consent forms were signed by patients where appropriate.

We observed care being given in a respectful and inclusive manner by appropriately qualified staff members. Staff were observed to follow good hygiene practices and were aware of guidelines in place around these.

We spoke with two patients and two visitors. One patient told us “There is nothing too much trouble, they think about what is best for you.” Another patient said the staff “Put themselves out”. One visitor told us “They treat you like family.”

We looked at how records were managed and found that they were kept safely and patient confidentiality was maintained. We saw that safeguarding issues were managed appropriately and efforts were made to continually monitor, assess and improve standards in all areas.

At the time of our visit there were 11 inpatients at Bolton Hospice. We spoke with three patients, and they all had friends or relatives present who spoke with us. Comments from patients included “The care here is five star” and “I can’t find any faults at all. I wouldn’t change a thing”. One patient said “I feel that I can ask about anything if I am not sure. You could not get better treatment”. Relatives commented about how friendly staff were and how they were made to feel very welcome. One relative told us that they had been able to stay overnight, which they appreciated.