This inspection took place on 25 April 2016 and was unannounced.

Bradbury Day Hospice offers day care to people who have an advanced progressive, life limiting illness. The aim of the service is to support people with their physical needs such as symptom and pain management, and provide social and psychological support. The service is provided by Sandwell and West Birmingham Hospitals NHS Trust.

Bradbury Day Hospice is run by a palliative care nurse specialist, (nurse manager) who oversees the daily management of the service on behalf of the provider. The hospice operates Monday to Friday 8.30am to 3.30pm, and is closed on Thursdays. The day hospice can accommodate up to twelve people daily who attend one day a week for a twelve session programme. People are then signposted to other services within the community.

People looked forward to attending the day hospice but described the range of activities as limited. The attendance rate was frequently low and people said this limited their opportunities to fully enjoy the social aspects. The availability of complementary therapeutic therapies such as relaxation or massage was also limited. The provider recognised this as an aspect of the service that needed to improve and this was part of their improvement plan to re-design the day hospice provision so that people had access to the types of support that would aid their well-being.

People had not always received a consistent service because of short notice closures of the day hospice. The nurse manager had taken effective action to ensure staffing levels were consistently reviewed to ensure people’s safety.

People were supported by staff who had been trained to recognise signs of abuse and how to report this. People told us they felt safe in the company of staff. Risks to people’s safety had been assessed and included the action staff should take to reduce identified risks.

People brought their own medicines with them to the day hospice service and there were arrangements in place to make sure they could be stored and administered safely.

New staff received a thorough induction and regular training to make sure they had the knowledge and skills to deliver quality care. Staff told us they felt supported and had regular opportunities to discuss their care practices.

People were happy that their consent was always sought before care or treatment was provided and that they had been involved in decisions about their care and treatment. People were supported to share their choices around their end of life care and preferred place of dying. Family members told us the hospice at home service provided them and their relatives with the opportunity to realise their wish to receive their end of life care at home.

People spoke in very positive terms about the quality of meals they had when at the day hospice. They were supported with their nutritional and health needs and had access to specialist nurses to support them with their symptom and pain management.

Staff had developed caring relationships with people using the service. People told us staff listened to them, and were caring and friendly. Staff treated people respectfully and promoted their dignity.

People knew how to raise concerns and were confident they would be listened to. There were opportunities for people who used the service, their relatives and other professionals to provide feedback.

The provider had benchmarked the day hospice service against local hospice community services and had a plan to develop their provision. The day hospice was in a transitional phase of redevelopment. The provider and senior managers had a clear vision for the future and demonstrated a commitment to providing people and those closest to them with a safe, quality and caring service within which they had access to the specialist care and support they needed. There was a range of auditing and monitoring systems which were shared with senior managers so they were able to look at the qu