This inspection took place on 28 October 2016 and was announced. We gave the registered manager 48 hours’ notice of the inspection because we wanted key people to be available.

The service provides a hospice at home service and a day hospice service. For some people ‘out-patient’ appointments were made for them to attend Great Oaks to see complementary therapists, nutritional therapist, a social worker, a nurse or to attend a clinic with doctors or specialist nurses. Other service providers within the Gloucestershire area provide in-patient services. The service is for people with a life-limiting illness. This includes malignant diseases (cancer) and chronic disease management, such as heart and lung failure and progressive neurological conditions. The service was not bound by strict criteria and people were not excluded from a service if they did not have the right condition. There was also an out-reach service where practical help from a volunteer or referral onto other services may be made and various support groups, including bereavement support.

Great Oaks is a purpose built facility, has a pleasant and relaxing atmosphere and is surrounded by beautifully maintained gardens. The service employs nurses, health care assistants, social care and allied health care professionals, complementary therapists and business managers. A team of committed volunteers support the day hospice, maintenance of the gardens and visit people in their own homes for companionship.

There was 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.

At the time of the inspection the hospice at home team were supporting seven people. Their care was delivered by trained health care assistants or qualified nurses. This number varied from one week to the next. The criteria for receiving a service was the person was living with a life limiting illness. The majority of service provision was delivered overnight in order to provide relief for families. Health and social care professionals referred people to the service for support and whilst a hospice at home service was provided, the district nurses remained the lead health care professional. Hospice at home staff worked in partnership with the district nurses.

A day hospice service was provided on two days a week and people were allocated a place for 12 weeks on a Tuesday and Friday and on other days the premises were used by a variety of support groups. Examples of these groups included carers support, family support, friendship groups, drop-in coffee mornings, a breathe easy group, MS and MND support groups.

People who used the service were safe. Risks to people’s health and welfare were well managed. Staff were trained on how to moving and handling equipment and had received safeguarding adults training. Safe recruitment procedures were followed to ensure that only suitable staff were employed. The appropriate steps were in place to protect people from being harmed.

Staffing levels were sufficient and adjusted as and when necessary, to ensure people’s needs were met. The hospice at home service had a flexible workforce in order to be able to accommodate demand for their service.

New staff completed an induction training programme and there was a programme of refresher training for the rest of the staff. Staff had the necessary skills and qualities to provide compassionate and caring support to people and their families. Families were assisted with bereavement support by the service where this was needed.

Staff understood the principles of the Mental Capacity Act (2005) and supported people to make their own choices and decisions. Where people lacked the capac

We spoke with one person about how they had been asked for consent to the care they received from Great Oaks. They told us that staff always asked before giving care and said they felt in control of the service they received. They said, “Pretty much everything we have asked for has been done. They listened to what we wanted.”

Our review demonstrated that the provider worked exceptionally well with other providers and agencies. This began at the ‘outreach visit’, which was the service’s first contact with the person and continued throughout the person’s care.

A person who used the service said, “They appear to be very much on the ball with hygiene and cleanliness.” They told us that staff washed their hands before and after attending to them. The service had an infection control lead who had begun a whole service infection control audit and review of policies.

A mandatory training programme was in place and regular team training updates were held. Staff had access to specialist training and forums and told us they were well supported.

We found that without exception, all staff we spoke with were committed to ensuring the quality of the service and to putting people who used the service first. This was evidenced by the following comments: “The service can always be improved, none of us are complacent”… "It’s a fantastic place to be and it’s lovely to see our patients benefitting”… “It’s very person orientated, it’s about the whole person… it’s their day”.

People's diversity, values and human rights were respected. People’s wishes including their spiritual and religious views, and who they were happy to share their information with were clearly documented. In a letter to the provider one person said “My mum and I had a look at the website, read the newsletter and arranged an appointment. How amazed was I? It was nothing like I had feared.”

The provider worked actively with the NHS, County Council and other independent providers, to make sure that people’s needs were met as seamlessly as possible. Our conversations with staff demonstrated that they were well informed of the national guidance and of issues in end of life care. In the annual survey one person said, "I look forward to my visits to Great Oaks every Friday. I feel safe and I enjoy the love received". Another said, "I visit the hospice every Monday and I find it a wonderfully comforting and happy environment".

There were effective recruitment and selection processes in place. One person said, “The staff nurse responsible for my care was and is outstanding. I am so impressed with her. She goes above what I need and therefore I can relax in her presence”. The provider took account of complaints and comments to improve the service. The manager welcomed all types of feedback to assist them to improve and develop this relatively new service.