This inspection took place on 15 March 2016 and was unannounced.

Garden House Hospice is registered to provide specialist palliative care, advice and clinical support for adults with life limiting illness and their families. They deliver physical, emotional, spiritual and social holistic care through teams of nurses, doctors, counsellors, spiritual care team and other professionals including therapists. The service provides care for people through an ‘In-Patient Unit’, Day Service, `Out- Patient Care`, `Drop-in Service`, and `Hospice at Home`. The hospice also offered a 24hour telephone advice line for people and their family carers to request help if there was a need for it.

The inpatient facility catered for up to 12 people, accommodated within a ward or individual rooms. At the time of the inspection there were six people using this service, beds being gradually reduced for refurbishment work. Approximately 10 people received support from the ‘Hospice at Home’. The service provided specialist advice with regards to symptom control and worked in partnership with health and social care professionals to ensure that people received the best possible support.

The services provided included counselling and bereavement support, family support, chaplaincy, out-patient clinics, patient clinics, physiotherapy, complementary therapies and a lymphedema outpatient clinic (for people who experience swellings and inflammation usually to their limbs post cancer treatments).

Garden House Hospice had a registered manager in post. 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.

Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow to make sure people were protected from harm.

People 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 people respecting their wishes and preferences.

Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced. Staff reported any concerns so that these could be reviewed and discussed to identify if lessons could be learnt to reduce the likelihood of reoccurrence.

People’s physical, psychological, emotional and spiritual needs were met as the service employed sufficient staff with the appropriate skills to support those needs. People’s needs were regularly reviewed and the service responded to their changing needs. Staff provided spiritual support and complementary therapies as well as caring for people`s physical needs.

The service supported people within the community providing psychological and practical support. People from the community accessed the various clinics held in the day care facilities where staff could review their health. People told us that the day care facility enabled them to meet with people in similar circumstances and was a welcome part of the community support.

People told us that staff understood their individual care needs and were compassionate and understanding and that their cheerful and friendly approach created a welcoming and relaxed atmosphere. Staff told us they undertook training which enabled them to provide good quality care, which supported a holistic approach to care.

The staff provided meals that were in sufficient quantity an

People we spoke with during our inspection who used the service were very positive about the care and support they received. One person said: “It is a wonderful place”. Another person told us they had regained their appetite and said: “The food is excellent”.

Assessments of people’s needs were centred on their preferred priorities for care and support and were completed by a multi-disciplinary team of staff trained in palliative care. The hospice had systems in place to ensure that care was planned and delivered to meet people’s needs, and the needs of those close to them, at every stage of their care.

There were effective arrangements in place to protect people in respect of the prevention and control of infection and the safe use and management of their medicines.

People who used the services were cared for in safe, accessible surroundings that promoted their wellbeing.

We spoke with members of staff from a range of roles within the staff team. They all confirmed that they received good support and appropriate training to enable them to carry out their roles effectively.

During our inspection on 5 February 2013 we spoke with four people who had experienced a service from the in-patient hospice, day hospice and hospice at home service. We also spoke with one person’s relatives. Without exception, people praised the service they, or their relative, had received. People told us that the staff understood and met their needs. One person’s relative told us, “The quality of care is excellent. All staff are very understanding and respond quickly. It’s a service they can be proud of.”

People told us that they were given information about the service and the care and treatment they received and what they could expect.

People were cared for by staff who were trained and well supported to deliver care and treatment safely and to an appropriate standard. People praised the staff saying they were, “very professional” and, “always had time to talk”. One person told us, “[The staff] have always been able to answer my questions. They’ve given me information on what help I can get and numbers to call if I do need help. They give me reassurance. They’ve talked to my [relative] and explained things to [them] too.”