This inspection took place on 18 May 2016 and was unannounced.

Primrose Hospice is registered to provide personal care. Primrose Hospice provides people in the local community with opportunities to attend the day hospice, receive a hospice at home service and family support.

There was a registered manager in post who was also known as the director of care. 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 assessed any potential risks to people and preventive measures were put in place where required. Staff knew how to recognise and report any concerns to keep people safe from harm. The provider had lone working arrangements to ensure staff who worked in the community were safe. Accidents and incidents were recorded and practice improved upon so the likelihood of these happening again were reduced to ensure people’s safety.

The provider had staff and volunteer recruitment procedures to ensure new staff were suitable to provide care to people who used the day hospice service and the hospice at home service. There were sufficient staff to meet people’s needs and volunteers complemented the support provided.

People brought their own medicines with them to the day hospice service and there were arrangements in place to make sure they could be stored and administered safely.

New staff and volunteers received a thorough induction and regular training to make sure they had the knowledge and skills to deliver high quality care. The management team provided staff with support to inform their care practices and opportunities to share experiences.

People had choices about their care and their consent was sought by staff during the support and treatment offered. There was a strong focus upon advance care planning so people were supported to share their choices around their end of life care and preferred place of dying. Family members consistently told us the hospice at home service provided them and their relatives with the opportunity to realise their wish to receive their end of life care at home.

People were supported to receive a nutritious lunchtime meal when they attended the day hospice. There was a choice of menu and drinks and snacks were available. People enjoyed their meals and by people having a lunchtime meal it provided an opportunity for staff to assess and monitor people’s nutritional needs. This enabled staff to seek assistance from other healthcare professionals where required so people kept well.

People were at the heart of the day hospice and hospice at home service. Staff and volunteers understood what was important to each person and worked closely with each other and other professionals to promote their well-being and happiness. This included people having access to a physiotherapist, occupational therapist and chaplain so people had support for their physical, social and spiritual needs whether they received a service at home or at the day hospice.

People told us staff were caring and they enjoyed friendly banter with staff who they had good relationships with. Staff supported people in making memories about things which were important to them. People had access to a range of bereavement services which were provided to, people of all age ranges including children, before the death of a person and afterwards.

Staff had arrangements in place to ensure people’s changing needs were responded to which included holding meetings with community healthcare professionals so people’s needs were met at the right time and in the right way. This included people receiving help with symptom control and management at the day hospice and in the community.

People were confident about expressing any concerns to staff and when complaints

We spoke with two of the eight people who were receiving care and treatment in the hospice on the day of our inspection. We also spoke on the telephone with a relative of a person who received palliative care services in their own home. The people we spoke with were complimentary about the hospice, its staff and the services provided.

One person told us: “They’ve been especially pleasant here.” Another person said: “It’s a wonderful support. You feel you can talk to someone who understands. I’d be lost without them.” A relative of a person who received care at home told us: “It’s very reassuring. I’ve been able to go shopping and I know that X is being looked after.”

We spoke with the registered manager and two members of staff, including nursing and care staff. The staff knew about the needs of the people they were caring for. We looked at care plans for two people and found that these contained guidance for staff on how to meet their needs. We saw that people’s needs were reviewed regularly.

People received coordinated treatment and support where their care was shared with another provider.

We found that the equipment that was used in the hospice was maintained appropriately and that staff had been trained in its use.

We saw that there were enough staff available to support people to meet their needs in a way that they wanted.

There was a system in place for people to make complaints if they were not happy with any aspect of the service.

We spoke with three people who were receiving care and treatment in the hospice. The people we spoke with were complimentary about the hospice and its staff.

One person told us,” The staff are lovely. They can’t do enough for you,” and another said, “I enjoy coming here and just being with people who are in the same boat. The staff are very friendly and the volunteers are very helpful too.”

A third person told us, “I didn’t want to come here at first but everyone was so nice and friendly. They went out of their way to reassure me and we have a talk every time I come in.”

We spoke with the Registered Manager and two members of staff. The staff knew about the needs of the people they were caring for. We looked at care plans for three people and found that these contained guidance for staff on how to meet their needs. We saw that people’s needs were reviewed regularly.

People told us that they felt safe at the hospice and knew who to speak to if they had any concerns. Staff had been trained how to recognise signs of abuse and knew how to report concerns.

We saw that staff were supported to be trained to an appropriate standard and we looked at records which showed that the provider was regularly monitoring the quality of its service.