This inspection took place on 28 April 2016 and was unannounced.

Peace 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 holistic care through teams of nurses, doctors, counsellors and other professionals including therapists. The service provides care for people through an ‘In-Patient Unit’, Day Service, `Out- Patient Care` and `Community Outreach Team`. The out -patient services included rehabilitation, wellbeing, bereavement and counselling support. The community outreach team consisted of a single point of referral for `Hospice at Home` service and `Herts Neighbours` service which reached out to people in the community and provided a range of services offered by volunteers employed by the hospice. `Herts Neighbours ‘service did not include an activity regulated by the Care Quality Commission (CQC).

At the time of the inspection there were six people using the inpatient service and 60 people using hospice at home services. The day services called `Starlight Centre` offered a range of services to people recently diagnosed with life limiting conditions, their carers and families. The service provided specialist advice, courses, complimentary therapy sessions and clinics and aimed to empower people to be in control of their condition and achieve what was important to them. The Starlight Centre also offered counselling and bereavement service through teams of volunteers and contracted accredited counsellors to people and family carers.

Peace 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. Risks to people`s well-being were assessed by staff daily and the majority had measures in place to mitigate risks and keep people safe. Hospice at home staff communicated any risks to people`s health and well-being to health and social care professionals involved in peoples` care in the community. They followed up and reviewed risks regularly to ensure these were appropriately managed and mitigated.

People were at the heart of the service and were fully involved in the planning and review of their care, treatment and support. People told us they were fully involved in setting their priorities for care. Care plans in regard to all aspects of people`s 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.

Recruitment procedures were robust and ensured that staff working at the service were qualified and skilled to meet people`s complex needs. There were sufficient numbers of staff to ensure people received support when they needed it.

The service operated a 24 hour medical and duty manager on-call system for all the services offered by the hospice to ensure people received the same support and advice during the day as during the night. People using the inpatient service had their medical needs met by a team of doctors employed by the hospice.

People who used the Starlight Centre told us that this service enabled them to meet people with similar conditions and helped them prepare for the future. People told us that staff understood

We carried out the inspection in response to concerns raised.

During our visit, we spoke with several people and their relatives, and they were all complimentary about the service, and the care and treatment they received.

One person commented, "All the staff, from the volunteers to the care workers, nurses and doctors are fantastic and wonderful. I could not fault them."

Another person said, "The staff are always eager to help and support me. They keep me informed about my condition." The same person added, "The other night, as I got up to go to the bathroom, before I even reached the door handle, a nurse was already in my bedroom ready to assist me. I hadn't even pressed the call bell. They are all marvellous, both the day and the night staff."

People we spoke with said that medicines had been given on time, and that 'the doctors and nurses had got it right' when managing people's pain relief. One person commented, "I am very grateful to the doctors and the staff. I have not suffered in pain since admission. My medicines are given on time. I am in safe hands. All the staff are very caring. They know what to do. I now look forward to going home again."

During our visit, we observed that people were involved in their care and treatment and medicines were given on time.

People told us the standard of care at the Peace Hospice is exceptional. Not only do the staff care for our loved ones who are sick, but they extend their caring to Family members and this is appreciated greatly.