This announced inspection of Queenscourt Hospice took place on 31 May and 1 & 2 June 2016.

Queenscourt Hospice is a local charity that provides ten beds for acute specialist palliative care and support for the people of Southport, Formby and West Lancs. At the time of our inspection nine people were receiving specialist palliative care and support as an in-patient. The service also provides support for families, friends and carers of people using the services of the hospice. Palliative care means the hospice cares for people with serious illnesses, enabling them to achieve the best possible quality of life at each new stage. The in-patient unit had two wards (Woodside and Lakeside) and two single en-suite rooms. The service provision included Queenscourt at Home service, an in-patient unit and Queenscourt Connect. Queenscourt Connect provides day care and also a therapy service.

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’.

The organisational structure included the director of clinical services (DCS) who was also the registered manager, the medical and education director (MED) who held the position of consultant in palliative medicine and there was a director of non-clinical services (DNCS). The organisation had a responsible individual who was the main point of contact with us, the Care Quality Commission, (CQC).

People we spoke with, family members and staff spoke positively regarding the overall management of the hospice and the leadership qualities of the senior management team. A person told us, "The staff team are brilliant."

Family and carers’ support was seen as important part of the overall care provision and feedback from relatives we spoke with was very positive. A relative said, “The support we have all had has been wonderful, I could not ask for more.” Formal feedback included the provision of surveys and feedback was very positive across all hospice departments.

The quality of the service was assessed and monitored regularly by a series of audits (checks) on the service provision to help monitor standards and drive forward improvements. We saw there was emphasis on working in partnership with external organisations, including other hospices and taking part in research based work and projects to evidence best possible outcomes for people who need end of life care.

Staff had a good knowledge of what constituted abuse and how they would report an alleged incident. Safeguarding policies and procedures were in place along with local authority guidelines for staff to follow.

People using the services of the hospice were protected against the risks associated with the use and management of medicines. Medicines were audited (checked) to ensure they were managed safely. Symptom control including pain management was seen as a priority.

Risk assessments were in place to ensure people’s health and safety. The risk assessments helped to help mitigate those risks and to protect them from unnecessary harm. There was a robust system in place to assess and monitor accidents and incidents. Incidents were analysed to minimise the risk of re-occurrence.

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

Staff sought advice and support from health professionals to ensure people received the support they needed it and when requested to optimise their health. Hospice staff included doctors, nurses, physiotherap

At our last inspection in August 2013 we found patients were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines safely. Action was needed for this essential standard.

Following the inspection we received an action plan from the provider (owner) and this addressed the issues raised. On this inspection we looked to see if these standards had been maintained.

We found appropriate arrangements for the recording and safe administration of medicines. Medicine records were completed and we observed nursing staff safely administering medicines to patients during our visit. Safely administering medicines helps ensure people's health and well-being is not placed at risk. Nursing and medical staff had received medicine training, to ensure they had the skills, expertise and knowledge to administer medicines to patients.

Arrangements were in place for monitoring and auditing (checking) medicine handling and administration. These audits (checks) were completed by members of the medical and nursing team and reported through the system of clinical governance. Clinical governance is a process through which health care organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care.

We spoke with three patients at the hospice to find out their views about the care, support, treatment and support they received. Their comments included, "Such lovely staff", Everyone is helpful", "You could not have better care and help", "The attention to detail is first class", "Everyone is very polite" and "The ward layout is lovely".

Patients told us their care, treatment and support was discussed with them by the staff, their views were respected and they were advised of any changes when needed. They told us communication was good and they were able to talk with the staff at any time.

Patients had a plan of care and this provided information about their individual needs and how staff supported them to ensure their safety, health and well-being.

We looked at how medicines were administered to patients and found improvements were needed to ensure they received them safely.

Staff received training and support so they had the skills, knowledge and expertise to provide care and support to patients. Staff told us they had access to a good training programme which helped them with their job role. This also included formal qualifications in care as part of their professional development.

Systems were in place to evaluate information about the quality and safety of the service provision. Patients had access to a complaints' procedure should they wish to raise a concern about the hospice.

We spoke with four patients about how the staff involved them and respected patients' individual choices about their care and treatment. Patients' comments included, "I have had everything explained to me."

Patients we spoke with confirmed they were pleased with the standard of care they received from all the staff. Patients told us the nursing staff and medical staff were available at all times for support and to answer questions they had. The care documents we looked at recorded patients' health and social care needs and staff had the information they needed to provide care, treatment and support in accordance with individual need.

We observed the staff caring for patients during our visit. The care and support they provided was carried out in a dignified and calm manner.

We did not ask patients directly about staff training, however patients told us the staff were kind, helpful and and considerate in their approach. We observed this during our visit. A patient commented on the excellent communication skills of the staff and their effective team approach.

Infection control procedures were in place to ensure good standards of hygiene.

We looked at a number of records regarding the ongoing management of the hospice to ensure patient safety. Records seen were kept secure, accurate, fit for purpose and managed effectively to protect the safety and well being of the patients and others.

On the day of our visit we were only able to talk to one patient and two family members. We were told they were clear about the treatment and support they were receiving. Family members told us that they were well supported by nursing and medical staff. We were shown a patient information folder and the patient we spoke to said she found this information useful as she had never visited the hospice before. We were told that patients were given good food choices every day and all of their food preferences had been accommodated.

Family members told us they were kept well informed of the changes in their relative’s condition. They spoke highly of the care their relatives were receiving. We were told that medical and nursing staff were available at all times for support. When a patient’s condition had deteriorated family members had been called to the hospice and were supported by staff.

We noted in the patient survey results for September 2011 that one patient had said ‘There is so much love from staff, you feel safe and there is a lot of support from the doctors’.

The inspection was carried out by an adult social care inspector. This was an unannounced inspection of Queenscourt Hospice. The inspection set out to answer our five questions:

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with patients, nursing and medical staff and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

The environment was safe and well maintained. Fire prevention equipment, for example, was serviced regularly therefore patients were not put at unnecessary risk.

Systems were in place to make sure the managers and staff learnt from events such as accidents and incidents and complaints. This reduces the risks to patients and helps the service to continually improve.

The hospice protected the rights and welfare of the people in accordance with the Mental Capacity Act [2005]. The Registered Manager advised us that nobody was subject to a Deprivation of Liberty Safeguard [DoLS] application or plan. DoLS is part of the Mental Capacity Act [2005] and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests. The Registered Manager was familiar with DoLS as a DoLS plan had been in place for a patient at the hospice.

Sufficient numbers of skilled and experienced staff were available to provide treatment, care and support to the patients. This was evidenced by our observations, talking with patients and staff and reviewing the staffing rotas.

Is the service effective?

Patients told us they were pleased with the treatment, care and support they received and their needs were met.

Patients’ needs had been assessed on admission. Patients informed us they were involved with setting out their plan of care and were fully involved with any decisions made. We found a number of care documents lacked detail around patients’ care provision. This meant there was a risk the staff did not have the information they needed to support patients in accordance with their individual needs. We have asked the provider to tell us what improvements they will make around recording care needs to help support staff with the care.

Is the service caring?

Patients told us the staff were attentive and helpful at all times. Throughout the day of the inspection we observed the staff engaging with people in a positive, respectful and individualised way. Support was given in a patient and kind manner and there was warmth and familiarity in the staff approach. Staff had a good knowledge of patients’ needs and how they wish to be cared for.

Patients told us the staff offered plenty of support to family members and the staff respected their wishes around having ‘private time’ and receiving visitors in private.

Is the service responsive?

Patients said they knew how to raise a complaint if they were unhappy and had confidence their concerns would be listened to and addressed. Complaints received had been dealt with and responses had been thorough and timely. Patients were therefore assured that complaints were investigated and action taken if needed.

Medical and nursing support was available 24 hours a day for the patients. Patients told us calls for assistance were answered promptly and staff were on hand to help and provide the necessary support.

Is the service well-led?

The hospice had systems in place to regularly monitor the quality and safety of the service provided. Records we looked at demonstrated that action plans were developed to address any identified shortfalls in a timely way. This meant the quality of the service was continuingly improving.

Patients and their carers had the opportunity to provide feedback about the hospice by completing a survey. The feedback seen was very positive.

Staff we spoke with said they felt well supported by management. They told us they received good quality training and support. Staff were clear about their roles and responsibilities and had a good understanding of the ethos of the hospice. This helped to ensure the patients received a good quality service at all times.

The service worked well with other agencies and services to make sure the patients received their care in a joined up way.