This inspection took place on 19 and 20 July 2016 and was unannounced. The last comprehensive inspection of Phyllis Tuckwell Hospice had taken place in November 2013 and was followed by a focused desk-based inspection in July 2014. During the inspection in 2013 we had found out that not all of staff caring for people had been supported to deliver care and treatment safely and to an appropriate standard. At the inspection in 2014 we found out that the provider had addressed our concerns and met all the required standards.

Phyllis Tuckwell Hospice provides palliative and end-of-life care, advice and clinical support for adults with life-limiting illnesses, their families and carers. The hospice delivers physical, emotional and holistic care with the aid of teams of nurses, doctors, counsellors, chaplains and other professionals including therapists. The hospice runs an 18 beds in-patient unit and accepts admissions for end-of-life care, symptom control and respite care. At the time of our inspection 17 people were in the unit. The hospice also provides community services designed to support people in their own homes. The hospice’s day service welcomes up to approximately 42 people per week and was being used by 10 people during our inspection.

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.

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. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow to make sure people were protected from harm.

People and their relatives told us they were very satisfied with the care. We saw that people were treated with dignity, respect and compassion. People were involved in the planning of their care which meant their care preferences and choices were identified so that they could be met by staff.

Accidents and incidents were recorded and monitored to identify how the risks of their recurrence could be prevented.

Medicines were safely stored and those requiring refrigeration were stored within their recommended temperature range. Nurses recorded the administration of medicines on prescription charts including prescribed creams applied by care workers. Staff had the skills to effectively manage people's medicines so these were available and administered safely to people.

Staff and volunteers had been suitably recruited and there were sufficient staff with a variety of skills to meet people's individual needs and to respond flexibly to changes.

People were supported by sufficient numbers of staff to provide care and support in accordance with the individual needs of people. There was a flexible approach to adjusting the levels of staff required. People who were receiving care in the in-patient unit told us the staffing numbers were appropriate and assistance was provided promptly when requested.

Staff received the training and support they needed and were highly motivated to undertake their roles and deliver sustained high quality care. People were extremely confident and positive about the abilities of staff to meet their individual needs.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least rest

During this inspection visit we spend the majority of our time on the wards observing care. We spoke with a number of staff including, housekeepers, nurses, doctors and the registered manager.

Patients and their family members demonstrated a high level of satisfaction with the care provided. One relative told us “This place is wonderful. I can’t imagine anywhere better. X is really well cared for and so are we.” Family members talked about being involved in all aspects of their relatives care. One said. “My family and I have been kept updated with any changes in X’s health. Staff are really kind and considerate and nothing is too much trouble.”

Staff at the hospice worked in collaboration with other providers to ensure that patients received continuity of care. Infection control measures were in place and patients were protected from the risk of infection.

Some of the staff were not properly supported to undertake their roles because the arrangements in place for staff supervision and appraisal were inadequate.

Patients and visiting relatives told us that they were very satisfied with treatment and care provided at the hospice. They told us staff were very good, friendly, polite and respectful. Comments we looked at showed the hospice provided sufficient information for people, one comment we saw said, plenty of leaflets-well presented and easy to read and understand.

Relatives told us that staff were very kind to their family member, they said " nothing is too much trouble for the staff, they are so kind to us" Another relative told us "the staff always treated their family member with the utmost dignity and respect" and " the care could not be bettered"

Patients spoken with told us they were involved in any and all decisions about their treatment and care. People commented they were always part of the discussion, staff always asked me what I thought. Others told us they liked attending the day hospice and enjoyed the recreational activities provided.

People spoken with told us they felt safe and they would speak to staff if they had concerns. One person said " I was given the choice of going to hospital or the hospice, no comparison really, the hospice is wonderful and I know I will get first class care, I am so lucky"

The purpose of this inspection was to look into concerns brought to our attention, and to follow up previous recommendation made as a result of our inspection of the 5 May 2011. Information was not required from people using the services in relation to the previous inspection findings. We did however; seek the opinions of a visitor in respect to the concerns raised.

Speaking with a close family member of a patient who had been in the hospice for approximately three weeks, we were able to obtain an overall favourable opinion of both her own experiences and that of her relative.

Comments made to us related to the professionalism of staff, the handling of sensitive information carefully and managing personal needs in a manner, which made the patient comfortable, less anxious and involved the family.

Patients and visiting relatives told us that they were very happy with treatment and care provided at the hospice. Staff were described as “marvellous,” “friendly and helpful.” People told us that staff were supportive, to both the patient and family members. One relative advised us that she could not fault anything and that the staff treated her mother with dignity and respect.

Patients said that they were involved in decisions about their treatment and care and that they had been given opportunities to discuss any questions, to state their preferences and to involve their families as much as possible. We were told that medication was provided regularly and that nutritional needs were met through a good range and choice of food.