This inspection was carried out on 12, 13 and 27 September 2016 and was unannounced.

Princess Alice Hospice serves the adult population of part of Surrey and West London. The Inpatient Unit (IPU) can care for up to 28 highly complex people at any one time, it does not offer long-term in-patient care. There are four elements to the Hospice at Home service. The Hospice at Home team is usually the first point of contact for people living at home. Patients are triaged and the Rapid Response team visits people who need immediate symptom relief and support; the Night Response team provides this service after hours. The Night Nursing team provides family and carers with an overnight break and will stay by the person’s side from 10pm to 7am. When a person experienced a significant change in symptoms whilst at home, which might necessitate a hospital admission the hospice implemented the Enhanced Support service. The service had a dedicated Patient and Family Support Team and Day Services.

The hospice has a large multi-professional team consisting of medical staff, nurses, social workers, therapists and chaplaincy supported by people facing volunteers. There are approximately 800 people on the community caseload at any one time and capacity to support 24 inpatients where outstanding care and holistic support was offered to those whose illness towards the end of their life necessitates admission to the hospice.

There was a registered manager in place. 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.

Princess Alice Hospice is an outstanding service. It is focussed on the individual needs of the people and families who they support, at the time they need it in a way and place that best suits them and their whole family. The hospice ensured that everyone received good quality, personalised end of life care regardless of diagnosis, age, ethnic background, sexual orientation, gender identity, disability or social circumstances.

People and carers spoke overwhelmingly of the positive support, guidance and healthcare interventions people had received. They were full of praise for the staff in terms of their kindness, compassion and knowledge about end of life matters. People and their carers viewed the staff as experts in their knowledge and skills when supporting people with complex health needs at the end of their life. The hospice was an accredited training centre and offered end of life care training opportunities for their staff and other health and social care professionals. Through this training and other service developments the hospice had enabled people to receive end of life care closer to home and reduced the need for hospital admissions.

People and carers spoke of a service that was tailor-made for them and their families saying that staff went 'the extra mile' with empathy and compassion. Throughout their end of life care people and their families were kept involved and encouraged through creative risk taking to remain living at home at the end of their life. People’s informed consent was embodied into all work that was undertaken at the hospice and people who did not have capacity to consent to their care and treatment had their rights protected under the Mental Capacity Act (MCA) 2005.

The various departments within this hospice worked well together so that people had a seamless experience of moving from one department to another as the need arose. The end of life and bereavement support provided was tailored to meet the needs and wishes of each family member with sensitivity and compassion. The hospice was supportive of family's spirituality. They strived to offer spiritual support that went beyond faith support and staff were sensitive

We visited Princess Alice Hospice to look at the care and treatment provided to people who used the service.

We spoke with four people who used the service, three family members, six staff members, the registered manager, the medical director and the Chief Executive.

All the people we spoke with were very happy with the service. One person told us “The staff are marvellous, nothing is too much trouble for them.” Another person said “The staff listen to me and what I need, and that’s important to me.”

People told us that they felt respected by staff, and were able to take part in decisions about their treatment. One person said “The staff respect how I’m feeling. If I want to be left alone I tell them to put a sign outside my door and I am left.”

We found arrangements were in place to ensure people had their nutritional needs met. Nutrition was taken seriously at the hospice and a committee had been formed to look into the provision of the meals.

Infection control procedures were followed and all staff had a good knowledge of their roles and responsibilities.

We saw that records of qualifications, criminal record checks and professional registrations were up to date.

All of the people we spoke with were happy with the service, and had never felt the need to make a complaint.

During our inspection we sought the views of people attending the day hospice and those admitted to the wards. We spoke with eight people who used the service and four members of staff including, the registered manager, the safeguarding lead and the Chief Executive of the hospice.

We asked people about their experience of using the service and received positive feedback from all people. Comments received included “As soon as you walk through the door you relax.” “When I come here it’s like coming to see your family.”

We asked people about the staff who cared for them and we were told “The doctors are always asking what would you like and what can we do for you.” We were also told “The staff always put the patients first.”

Staff were complimentary about the support they received with training. They were also supported to attend sessions every month to discuss difficult situations that may have arisen that month. Staff were able to express their feelings in a non judgemental and supportive environment.

Safeguarding vulnerable adult training had taken place and staff confirmed this. Staff were knowledgeable about the process for incident reporting.

The management carried out regular audits of their service and these reports are published.

When we visited The Princess Alice Hospice we met people who were using the service and some visitors. We spent time speaking with people who used the Day Hospice. These were people who had spent time as a patient on the In-patient Unit (IPU) and we also spoke with people who were currently being cared for on the IPU. People told us that before they spent time on the IPU they 'never knew what a hospice did. I thought you came here to die'. It did not occur to me that you can go into the In-patient Unit and come out and live a lot longer'. People said that The Princess Alice Hospice is a place where 'all they are interested in is making you feel less worried and accepting of your condition' and that 'Nothing is too much trouble' 'If you use your call bell staff appear almost straight away". I have always found the staff to be helpful and "they are always smiling and there is never any negativity from them at all'. The people who use the service also stated that in addition to the staff the "volunteers are amazing' 'I feel comforted here, which is a big healer'.’There is a feeling of tranquillity and peace here'. People also stated that it was not just the care that they received that was excellent they also felt that ’The food is superb', 'The food is always superbly cooked' and is always "excellent'.

In addition people said that they were asked to give feedback by staff about the care and experiences they have had at the hospice.

A member of staff said that all meals that are prepared by the hospice are designed to be fully balanced and meet the nutritious needs of the people who use the service. In addition the staff working in the kitchen are dedicated to making meals a pleasure to eat and benefit from the experience.