This inspection took place on 12 May 2016 and was announced. We contacted people and their relatives for feedback about the service on 18 May 2016.

Rennie House is registered to provide specialist palliative care, advice and support for adults and children with life limiting illness and their families in their own homes. They deliver physical, emotional and holistic care through teams of nurses, counsellors and other professionals including therapists.

At the time of the inspection there were 180 adults and 52 children using this service. The service provided specialist advice with regards to symptom control and worked in partnership with health care professionals to ensure that people received the best possible support in their own homes. There was a counselling, pre- bereavement and bereavement support offered to families and relatives.

Rennie House 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 and children from abuse and harm. They knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Staff assessed the risks involved in delivering a service in people and children`s own homes. Staff communicated any risks to people and children`s health and well-being to health and social care professionals. 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. Plans in regard to all aspects of their medical, emotional and spiritual needs were personalised and written in partnership with people. Staff delivered support to people respecting their wishes and preferences. The children services team from the hospice worked closely with children`s parents and social and health care professionals to ensure the best possible outcome for children with a life limiting illness.

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 service and on-call system to ensure people received the same support and advice during the day as during the night. This gave people great confidence and comfort. People told us they valued this service and they felt reassured to know they could talk to a member of staff any time during day and night. The children services team was not providing a 24 hour on-call service, however when a child`s condition deteriorated the staff worked on a rota system and provided support to the children, parents and families over a 24 hour period.

People told us that staff understood their individual care needs and were compassionate and understanding and that their cheerful and friendly approach gave them reassurance and made them feel safe. Parents of the children who used the service were appreciative of the support they received had confidence and trust in the staff. They all felt the service was very safe. Staff told us they undertook training which enabled them to provide good quality care to people and children in their own homes.

People’s medicines were administered by trained and qualified staff who had their competency assessed regularly by their manager. Any changes in peop

People who used the service were very positive about the standard of care, support and treatment they received. "Just amazing" was one comment.

Other healthcare professionals who worked with Rennie House staff said they were caring, professional and communication between them was good. They told us they worked together to make the care experience for people as sensitive and effective as possible.

We found the standard of assessment, planning and delivery of care was very high. Systems and records in place were accurate and up to date. This meant staff and people who received a care service were supported by the systems in place to provide appropriate and reliable care.

We found staff were supported by supervision and training to develop and maintain their skills. This meant people received care from staff who had the knowledge, skills and experience to meet their needs.

We saw there were procedures in place to obtain feedback from people about the service they had experienced. Where improvements could be made, these were identified and wherever possible action was taken. This showed Rennie House sought comments about the service they provided, listened to those comments and made efforts to learn from them where applicable. This enabled the service to improve and become more effective, which benefitted all those who received care, support or treatment.