This inspection took place on 10 and 11 March 2016 and was announced. We gave the registered manager 48 hours’ notice of the inspection because we wanted key people to be available. The Hospice at Home service provided short-term care for people with a rapidly deteriorating condition in the last three months of life. The service supports people in their own homes, or the place where they live and works in conjunction with GPs and community based nurses.

The service also runs a day therapy service, an outpatient service and a counselling service for people who have life limiting or life threatening conditions. These services do not come within the scope of registration with the Care Quality Commission. We have however spoken with some people using the day therapy service in order to gain a broad view of “people’s experience of using Longfield”. Longfield is a purpose built facility, has a pleasant and relaxing atmosphere and surrounded by beautifully maintained gardens.

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. They have at times helped up to 25 people at the same time. The criteria for receiving this service was the person was in the last three months of their life. The average length of time people received support from the hospice at home team was seven days in 2014/15. Health and social care professionals referred people to the service for support and the district nurses were the key workers. Hospice at home staff worked in partnership with the district nurses.

People who used the service were safe. This was because the nurses and healthcare assistants were trained on how to safely use any moving and handling equipment and had received safeguarding adults and children training. Risks to people’s health and welfare were well managed. 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.

People were safe because the staffing levels were sufficient. The service offered to support people at the end of their lives only when there was sufficient staff available to meet their needs. The service had a flexible workforce in order to be able to accommodate demand for the service.

All staff completed a programme of essential training to enable them to carry out their roles and responsibilities. New staff completed an induction training programme and there was a programme of refresher training for the rest of the staff. Staff received palliative and end of life training and had the necessary skills and qualities to provide compassionate and caring support to people and their families. Bereavement follow-up is an opt-out service. They automatically follow up all families and carers of people who have died and been supported by Longfield .

People were supported to make their own choices and decisions where possible. Staff understood the principles of the Mental Capacity Act (2005). Where people lacked the capacity to make decisions because of their condition or were unconscious they worked within assumed consent but checked with healthcare professionals and family members before providing care and support.

Where identified as a care need people were provided with the assistance they needed to eat and drink. Staff liaised with the district nurses and the person’s GP when needed. Staff worked in partnership with healthcare professionals and families to be supportive and provide an effective service.

Because of the nature of the work the hospice at home team undertook t

We spoke with people who use the service, family members, staff, the head of care and chief executive. People who attended the hospice told us that it was a "fantastic place" and would be "sad when their therapy ends." People receiving hospice at home care said the service was "wonderful, my saving grace" and it "gives me a breather." Staff said they "loved their job" and the chief executive said that they "enjoy coming to work every day." One staff we spoke with said they felt privileged to help people to "pass away with dignity and respect."

We looked at people's individual files which incorporated their personal profile, care plans and risk assessments and found they encompassed the safety and well-being of people who use the service. Family members, people who use the day service and staff told us that they knew how to raise a concern or complaint and felt confident in doing so. People and relatives said if they had any issues or concerns they could "talk to staff" or their "key worker."

There were policies and procedures in place providing guidance and all staff had received relevant training which was identified on the training schedule. We looked at the cleanliness and infection control and found that the provider had adequate systems in place to ensure the safety of the people who use the service.

We looked at the quality of the service and found the provider had systems and procedures in place to monitor and evaluate the quality of the service provided.

We spoke with nine people, staff, the head of care and chief executive.

People attending the hospice were happy and pleased with the service. One said they looked forward to attending and spoke about the benefits of the service. They told us they only had to wait a short time between referral and provision of service.

People receiving a service at home were pleased saying “we couldn’t have better treatment”, “a remarkable service” and I am really pleased as it gives us time for a rest”. One person who was recently bereaved told us “they were perfectly wonderful, a great help to my partner and great support for me”.

Staff were enthusiastic. The chief executive said it was a “great place to work”. One staff we spoke with said it’s a “great thing to be involved in, it means that there are more opportunities for families to have their relative at home”.

We saw compliments. We read some of the comments people made about the service. They included “Thank you so much to every one of you who provide such a wonderful place to come and relax, laugh and cry and give us such support. Without you, I would never have got my ‘life’ back and become ‘me’ again"

People said staff obtained consent before assisting them or their relatives. Staff confirmed that they only supported people in taking medicines. Staff and volunteers who had been subject to rigourous checks. People knew how and to whom they should complain. We saw that complaints were investigated fully.

We visited Cotswold Care Hospice in Minchinhampton, near Stroud, Gloucestershire, on 9 February 2012 and spent the day at the service. The hospice was established 25 years ago, and now operated from a new purpose-built building that was opened in 2008.

The hospice offered people with life-limiting conditions a 12-week programme of nursing care and support, art and complementary therapies, group sessions, and out-patient services. Families and carers were offered bereavement support and counselling.

People were also able to receive care and support from a 'hospice at home' service. Healthcare professionals and care staff offered patients end-of-life palliative care in their own homes. The hospice worked with the palliative care team from Gloucestershire Royal Hospital and facilitated other support groups such as a pulmonary rehabilitation group and a multiple sclerosis group.

During our visit to the hospice we met and talked at some length with seven patients. They told us that the hospice had "surpassed expectations" and "when I came here, everything seemed to fall into place". One person who we met in the art therapy room said of the service: "it's been a life saver." A person who was new to the service said "I have been made so welcome. It's first class and I don't see how it could be better." We were told "I really look forward to coming" and "this means so much to me."

We met and talked with members of the senior management team, including the head of care services. We talked with administration, nursing and therapy staff, observed care and support, and reviewed some patient notes. We observed a feedback session at the end of the day between clinical and therapy staff, and joined an art therapy session to talk with people. We also toured the premises and met a number of the volunteer staff.