The East Cheshire Hospice is located in a residential area close to the centre of Macclesfield from where it provides care for adults suffering from life limiting illnesses. There are fifteen inpatient beds as well as a day care centre supporting people to continue to live in their own home. The hospice is staffed by doctors, nurses, other health professionals and support staff as well as volunteers. The services provided include counselling and bereavement support; a Lymphoedema service (for people who experience swellings and inflammations); an outpatient clinic; occupational and art therapy, physiotherapy, chaplaincy and volunteer services. Services are free to people and the Hospice is largely dependent on donations and fund-raising by volunteers in the community.

This inspection was carried out on 17 March 2016 by one adult social care inspector. It was an unannounced inspection. There were 12 inpatients at the hospice on the day of our visit.

There was a manager in post who was registered with the Care Quality Commission (CQC). 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 also the director of care and operational services and oversaw the running of the service.

East Cheshire Hospice had caring and positive staff who said that patients were at the heart of the service and were fully involved in the planning and review of their care, treatment and support.

Plans in regard to all aspects of their medical, emotional and spiritual needs were personalised and written in partnership with people. Staff delivered support to patients according to their individual plans.

Staff had received training with regard to protecting patients from abuse and harm. They knew how to recognise signs of abuse and how to raise an alert if they had any concerns.

We saw risk assessments which were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow or make sure patients were protected from harm.

Accidents and incidents were recorded and monitored so that risks of recurrence could be reduced.

There were sufficient staff on duty to meet patient’s needs. Staffing levels were calculated and adjusted according to patient’s changing needs.

There were thorough recruitment procedures in place which included the checking of references.

Staff were enthusiastic about the care they gave and said that patients were at the heart of East Cheshire Hospice and it was important to treat each person as an individual.

Patients were treated with dignity and respect and cared for by staff who knew and understood their needs. Patients and their relatives were involved in making decisions about their care and

support.

Families and friends were supported by trained bereavement councillors and all staff at the hospice.

We saw warm, caring, respectful relationships between patients and staff during our inspection.

Staff had received essential training including end of life care and were scheduled for refresher courses. Staff had received further training specific to the needs of the people they supported.

All members of care and support staff received regular one to one or group supervision and an annual appraisal. This ensured they were supported to work to the expected standards.

Clear information about the service, the facilities, and how to complain was provided to patients and visitors.

Medication was managed safely and processes in place ensured the handling and administration of medication was safe, secure and that patients received medicines when they were prescribed.

Patients were supported to make decisions about their life and trea

We spoke with people who used the service in both the in-patient and out-patient areas of the service. They told us that the service worked closely with them to ensure their needs and wishes were met. People we spoke with said staff treated them with respect and dignity and they were well cared for.

Comments included: "Customer is king without doubt"; “Staff are excellent, nothing is too much for them” and "They treat me with respect and have put me at ease.”

We also spoke with family members whose relatives used the service. They stated they considered the care to be good. Comments included: "It’s comforting to know they are here" and "I have seen an improvement (in my relative) since she has been in here.”

During our visit we looked at the care records for people who used the service. We saw that the assessment of need documentation contained information about the person's care needs and how the staff were to support them.

We spoke with two people who used the service. They told us that the service worked closely with them to ensure their needs and wishes were met. Both the people we spoke with said staff treated them with respect and dignity and they were well cared for. Comments included: "This is where I want to be at this time” and “the staff explain everything to me.”

We also spoke with two family members whose relatives used the service. Both family members said that they considered the care to be good. Comments included:” its wonderful care and they are very supportive to me as well” and “everyone is so professional.”

During our visit we looked at the care records for three people who used the service. We saw that the assessment of need documentation contained information about the person’s care needs and how the staff were to support them.

We found that systems were in place to ensure people were protected from the risk of harm and abuse. We saw evidence to show that staff were supported to attend training and educational programmes that enabled them to deliver safe and effective care to people who used the service.

We spoke to a relative of a patient who was very ill and asked if their relative’s privacy and dignity was protected. They replied “absolutely”. They said that the care that had been received was “absolutely fabulous” and “second to none”. We were told that staff were “so kind” and that the “pastoral care is such a comfort”. We were told that their relative was “kept clean” and in “no pain” and this meant that they themselves felt “safe and comfortable to go home”. We asked about the admission process and were told that in their case Macmillan Nurses had acted to liaise between the referring hospital and the hospice and that this had ensured that the transfer was successful.

We spoke to another relative and they said they had “nothing but praise” for the care their relative had received. They said that staff treated patients “as if their own” and that they were “concerned not just for the patient but concerned for everyone”. We asked about privacy and dignity and were told that “everything is done properly; they manage beautifully”, “No sense of rushing”. They further commented that when someone died everything was “managed well”.

We spoke to a group of patients using the day care facilities and all were complementary about their care. One said it was “fantastic here” and another commented that they are “the kind of staff you can talk to”, “staff are approachable”. We were told by one person that their GP or Macmillan Nurse was not always available but that the hospice was “always in” and able to give advice at all times of the day and night which was important to them in relieving anxiety. Another said that in the day unit they learnt off of each other and that the hospice was “a place to solve problems”.

We spoke to two visitors about whether they had concerns about the safety of their relatives. Both said that they would feel confident to raise concerns with staff but there had been no need to do so.