This inspection took place on 24 and 25 February 2016 and was announced.

Leicestershire & Rutland Organisation for the Relief of Suffering Limited (LOROS) is registered to provide care and support to people in relation to symptom control, pain relief, assessment and end of life care

LOROS in-patient facility caters for up to 31 people, accommodated within four bedded bays or an individual room. The hospice service provides specialist palliative care, advice and clinical support for adults with life limiting illness and their families. They deliver physical, psychological, social and spiritual care through teams of nurses, doctors, counsellors, chaplains and other professionals including therapists and social workers. The service has a team of community specialist palliative care nurses who care for people and their families within the community providing specialist advice as regards symptom control and psychological support along with other health care professionals.

The services provided include counselling and bereavement support, home visiting, chaplaincy, out-patient clinics, occupational therapy, physiotherapy, dietetics, and complementary therapies.

LOROS 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.

People told us that they felt safe at the service. The service was committed to promoting people’s safety across all levels of staff within the organisation and included advising the Board of Trustees of safeguarding concerns and ensuring staff at all levels, including volunteers received training on protecting people from potential abuse or avoidable harm.

Risks to people were assessed and where potential risks had been identified these were minimised in consultation with the person. Where accidents or incidents occurred there was a no blame culture within the service. This ensured staff reported any concerns so that they 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 from a range of disciplines to provide holistic care. People’s needs were regularly reviewed by staff from a range of health and social care disciplines and included staff that provided spiritual support and complementary therapies.

The service supported people within the community providing psychological and practical support. People in some instances accessed the day therapy facility, which offered clinics where people could review their health, which included symptom and pain management along with complementary therapies, creative therapies and social activities. People told us that the day therapy 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 that they undertook training which enabled them to provide good quality care, which supported a holistic approach to care. Reflective practice sessions were used to enable staff to discuss issues associated with their work and their welfare was supported by the chaplaincy team who provided one to one and group support.

People’s medication needs both within the hospice and the community were discussed by health professionals to manage and support people’s symptoms and pain management. Medicines were regularly reviewed and audited to ensure they met people’s needs. A pharmacy team including a specialist pharmacist and pharmacy technici

We spoke with three people who use the service and asked them for their views about the care, treatment and support they receive. People’s comments included: “Brilliant care, I am fully aware of my care package.” “My wife is an absolutely wonderful woman but it would have been difficult without the help of these people they’re absolutely wonderful.” “They tell the family everything about my treatment.” (The person told us this information had been shared with their consent). “The care is excellent; they explain everything that’s going on.” “Amazed with the care at LOROS.” (Leicestershire and Rutland Organisation for the Relief of Suffering).

People we spoke with were happy with the meals provided and told us they received the support they needed, which included support where they were unable to eat or drink and received nutrition in a different way. People’s comments included: “There’s a good choice and it’s always really tasty.” “The food is excellent, you get asked what you like and the choices are excellent. The drinks trolley regularly comes round and there’s always a jug of water by your bed.”

Staff we spoke with told us they receive the support they need from within their individual teams and through the provider. Staff told us that support came in many forms which included clinical supervision and annual appraisals. The provider encouraged staff to access services to support them which included attending reflexology sessions as well as being given information about external counselling services. Staff we spoke with told us they have good access to training and developmental sessions.

People who use the service are asked for their views about the service they receive within days of their admission to the hospice. In addition, annual surveys are also completed as part of the annual quality assurance process in place at the service. Groups involving people who use the service had been set up and met regularly to talk about their views and experiences and we saw that the outcome of these meetings was used to develop the services provided by LOROS. The provider had a robust quality assurance system in place which produced an annual report which is available on the LOROS website.

In this report the name of a registered manager Christine Faulkner appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still one of the two Registered Managers on our register at the time.

We spoke with patients and patient relatives who told us they had been provided with information about the service provided. Patients and relatives told us they were involved in all aspects of their care and treatment and that staff spent time talking and explaining to them their options. Patients and relatives said they were very happy with the service provided and their comments included: - “coming in here is fantastic. It’s like walking into a snowball and someone puts a big fluffy blanket around you and looks after you.” “Metaphorically embraces you.” “The professionalism of all the staff and their cheerfulness cannot be sufficiently highlighted.” “I can’t fault the doctors and the nurses, everything is explained to you and everyone has time for you.”

People we spoke with were able to tell us about the day to day running of the service and how they involved patients and their relatives in reviewing the service and how they listened and made changes based on the feedback they received. We looked at a range of records. All recording systems were up to date and effectively used to monitor the service.

We spoke with patients and their relatives and asked them about their involvement in their care and treatment and for their views about the care and support they received. We received positive comments from both patients and their relatives. People told us they were involved in decisions about their care and treatment and that they received care and support from staff that were able to meet their needs. Patient and relatives comments included: -

“The first time I came here I was terrified of dying, but within half an hour I was talking to a doctor. We talked about my wishes which included my views about resuscitation. They helped me look at it completely differently. It gave me a spiritual feeling, like someone putting there arms around you.”

“They have helped us talk about things, helping us make decisions and plan for the future. We were asked whether I wanted to be at home to die of whether I wanted to be at LOROS.”

“My husband was transferred from hospital, within 45 minutes of being admitted to LOROS he had had a cup of tea, been asked when he wanted for his evening meal, had a vase of flowers placed in his room, and had been seen by the doctor.”