We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by Care Quality Commission (CQC) which looks at the overall quality of the service.

This was an unannounced inspection. This meant the provider did not know we were visiting. At our previous inspection on 17 May 2014 the provider was found to have met the requirements of our Regulations.

Isabel Hospice provides an inpatient hospice service for symptom control and specialist palliative care, and a community service for people moving towards the end of their lives.

At the time of our inspection a registered manager was employed at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People and their relatives told us they were happy with the services provided by the hospice. They felt the staff understood their needs and they felt safe. The service only commenced care for people if it was safely able to meet their needs. People’s wishes and preferences were taken into account and recorded in care plans. Risk management procedures were in place to ensure people’s health risks were identified and plans were in place to manage those risks.

Staff demonstrated a good understanding of the needs of people with an end of life illness. Staff had received good training and support to meet people’s needs.

The service worked well with other health and social care providers to ensure people’s needs were met.

There were appropriate policies and procedures in place to support people should they ever have a need to complain or raise concerns. When concerns had been raised, they had been dealt with effectively.

There were systems in place to assess and monitor the quality of support provided for people.

We found that there were systems in place to ensure people were asked for consent about their care and treatment. We found that people were involved and supported to make decisions about their care, and that staff gained their consent before carrying out care and treatment. One person told us, "Staff ask permission all the time and don't overstep the boundaries."

People we spoke with during our inspection were very happy with the care and treatment they were receiving. People told us that staff were very attentive to their needs, and carried out their care in a very caring and considerate manner. One person described the care as, "Brilliant. I've only got to say what I want and it's there." Another said the care was, "Excellent, I couldn't fault it." Care plans we saw reflected people's individual needs and included detailed assessments and reviews.

We found that the provider had systems in place to prevent the risk and spread of infection. Staff had received training in infection control to promote this and we saw them carrying out good practice to prevent the risk and spread of infection. We saw that audits were undertaken to monitor the effectiveness of infection control procedures. Equipment used was maintained and repaired as required, and was available to ensure people's needs could be met. Staff felt supported in their roles, had received mandatory training, and had reviews of their performance to support them in meeting people's needs.

People we spoke with during our inspection told us they were very happy with the care they received from the staff at the hospice. They felt they were treated with respect and dignity, and that staff involved them in their care. People told us they were able to make decisions about their care and that they were given information about the service and their treatment. People we spoke with couldn't speak highly enough of the caring and attentive nature of the staff looking after them. They said they felt staff knew what they were doing, and that staff came quickly when they needed them. People told us they felt safe with the staff caring for them, and did not have any concerns about the service. People told us they felt able to raise any concerns that they may have, and were very happy with the standard of care they were receiving.

This inspection took place 25 and 26 January 2016 and was unannounced.

Isabel Hospice provides care for people with life limiting illnesses through its inpatient unit, hospice at home service, day care unit and its specialist community palliative nursing care service.

There was a manager in place who was in the process of registering with the Care Quality Commission (CQC) to be the registered manager. 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.

People felt safe. Staff had received training to enable them to recognise signs and symptoms of abuse and how to report them. People had risk assessments in place to enable them to be as independent as they could be.

There were sufficient staff, with the correct skill mix, on duty to support people with their needs. Effective recruitment processes were in place and followed by the service.

Medicines, including controlled medicines, were managed safely. The processes in place ensured that the administration and handling of medicines was suitable for the people who used the service.

Staff received a comprehensive induction process and ongoing training. They were well supported by the management team and had regular one to one time for supervision. Staff had attended a variety of training to ensure they were able to provide care based on current practice when supporting people.

Staff gained consent before supporting people and ensured their choices were acted on. People were supported to make decisions about all aspects of their life; this was underpinned by the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff were knowledgeable of this guidance and correct processes were in place to protect people.

People were able to make choices about the food and drink they had, and staff gave support when required.

People were supported to access a variety of health professionals when required.

Staff provided care and support in a caring and meaningful way. They knew the people who used the service well. People and relatives, where appropriate, were involved in the planning of their care and support.

People’s privacy and dignity was maintained at all times.

People were supported to follow their interests and join in activities.

A complaints procedure was in place and accessible to all. People knew how to complain. Effective quality monitoring systems were in place. A variety of audits were carried out and used to drive improvement.