This inspection took place on 6 April 2016 and was unannounced.

Severn Hospice Bicton Site is registered to provide specialist palliative care and clinical support for adults with life limiting illnesses. The service provides care on their in-patient facility which catered for up to 16 people over two wards. At the time of the inspection there were 15 people using the inpatient service. The Hospice at Home service was based on site and provided a service to both the Apley and Bicton sites. At the time of our inspection two people were receiving support from the Hospice at Home team. The clinical nurse specialist team also provided expert advice, support, liaison with other healthcare professionals and signposting for people in the community.

The service provided counselling and bereavement support, day hospice care, family support, chaplaincy, out-patient clinics, occupational therapy, physiotherapy, complementary therapies and a lymphedema service (for people who may experience swellings and/or inflammation following cancer treatment).

The manager was registered with us as is required by law. 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.

Medicines and related confidential data were not always stored securely in treatment rooms and audits were not completed on the safe storage of medicines. Some medicines, requiring extra security arrangements that had past their expiry date, were not always separated from other medication. The provider had safeguarding procedures that were well understood by staff and ensured people were kept safe. Audits were undertaken to make sure all equipment and the building were checked and serviced as required. Risk assessments reflected how care should be provided to the person to minimise any risks to them; they were regularly reviewed to adapt the level of support needed in response to people’s often rapidly changing needs.

There were sufficient staff on duty to care for the needs of each individual. Ongoing learning was encouraged and staff were supported to access a variety of training courses which included communication skills, care of the dying and mentorship. The service had an education lead who was responsible for arranging training programmes to meet the needs of staff. All new staff had a thorough induction which included working alongside other disciplines both within the hospice and externally in order to gain an understanding of how the services worked together. Staff were able to access clinical supervision and were provided with an annual appraisal. Robust staff recruitment systems were in place which ensured that only applicants who met the service’s high specifications regarding qualifications, experience, character and caring abilities were employed.

The provider recognised that people's capacity to make informed decisions about their care could fluctuate, so this was reviewed at regular intervals throughout their stay. Documentation in relation to people’s decisions about resuscitation known as Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) were flexible. These could be transferred for use within the hospice and also remained valid when people were at home. People were complimentary about the food on offer; it looked appetising and people’s specific dietary needs were well catered for. The provider employed a range of healthcare professionals including a team of doctors who worked across all the services provided by the hospice to ensure all aspects of people’s health was considered.

People described the care and compassion they received from staff. Staff were motivated and showed a high level of empathy and kindness to people. Staff used warmth and caring terms when discussi

We spoke with three patients in the in-patient units and one patient in the day unit. All were very positive about the care and treatment they had received. For example, one patient described the standard of care as "Fabulous", whilst another person referred to the service as “Marvellous”.

Patients and relatives were given appropriate information and support and felt listened to. One person commented “They go out of their way to explain things. I have felt listened to and always welcomed.”

Admission assessments reflected people's individual care needs, which enabled staff to offer the support that people required, in ways that they preferred. Care plans were detailed and covered all aspects of care and treatment. This helped ensure that all the needs of patients were met.

The hospice had suitable arrangements for the safe storage, handling, administration and disposal of medication. This ensured patients got the right medication at the right time. There was a system in place for assessing and monitoring the quality of the service. This ensured patients received a service which was of high quality and met their needs.

As part of this inspection we spoke with six people who received a service at the hospice, three relatives, eight staff, one volunteer, the registered manager, the clinical standards coordinator and the ward manager. During our visit we observed interactions and reviewed the care records of two people. We also looked at other records as detailed within the report.

We found that the hospice offered excellent care to people either within the hospice its self or in people’s own homes. The service was described as being invaluable and people could not speak highly enough of the service provided at all levels.

Everyone we spoke with said that they had been consulted and involved in their care and treatment. People said that their needs and wishes were identified and staff supported them in ways that they preferred.

People told us that their privacy and dignity was always promoted and respected. Our observations supported this and we saw numerous examples of good care.

At the day hospice people enjoyed a wide range of activities and therapies. People told us that they always looked forward to visiting.

The Hospice at Home service worked effectively with other agencies to ensure that people and their families received good quality support when it was most needed. The service was flexible and responsive to people’s changing needs.

People’s needs were comprehensively assessed and care and treatment was planned and delivered in line with individual care plans. People told us that their medical, personal and emotional care needs were met. Everyone told us that they received excellent care and support from a staff team who “looked after people very well”.

People told us that they felt safe and risk assessments demonstrated how risks were identified and reduced as far as possible. Risks were regularly reviewed and people were enabled to be as independent as they could. Staff were aware of risks, people’s rights and their responsibilities in order to support people to do this.

People were supported by a knowledgeable and well trained staff team who knew people’s care and support needs well. Staff were offered a range of training opportunities that were specifically designed to meet the needs of the people that they supported. People were protected because staff were confident to recognise and report abuse.

Volunteers were seen to provide essential support to people who received a service and to nursing staff. They were knowledgeable of their roles and remit.

The hospice had systems in place to seek the views and opinions of people who received a service. Staff told us that the service was patient led.

The hospice had comprehensive quality monitoring tools in use to ensure that they maintained good quality and safe care. They effectively sought people’s views about their care.