We saw an assessment checklist that was used by the service and noted that consent was gained to discuss prognosis, treatment and care with family members and other healthcare professionals.

The four patient folders that we saw contained an assessment checklist that was used to develop an individual plan of care. The patient liaison nurse told us, “It is very rare that people don’t meet our criteria but if they don’t we will discuss that in the multi-disciplinary meeting and then signpost them on to other services.”

The adult services manager told us, “Registered nurses have the responsibility for administering medication and we have to abide by the NMC (Nursing and Midwifery Council) code of conduct.” A senior registered nurse said, “All medication from the pharmacy and anything brought in by the patients themselves is logged into the building so we are aware exactly what is on site.”

We spoke with the registered manager in relation to funding and running costs of the hospice and were told, “We have a reserves policy that holds one years running costs. This ensures continuity of care for our patients.”

We were told of two complaints that were received in 2013; the complaints had been investigated and the findings had been shared at an internal governance meeting to ensure that the service improved from the incident. This gave assurance that complaints were taken seriously by the hospice.

The group of people that were using the service on the day of our visit were receiving treatments that meant it was not appropriate for us to obtain their direct views. However, we saw results from recent in patient surveys that showed a high level of satisfaction with the service provided.

We observed that staff provided support in a discrete and professional way; to ensure people’s privacy, confidentiality and personal dignity was maintained.

We found that a range of assessments of people had been carried out to ensure they were kept safe from potential harm and that staff knew how to deliver appropriate support to meet their individual needs.

We found that staff were very positive about their jobs and delivered support in a sensitive and encouraging manner. Staff told us they enjoyed doing their work and that management supported them with a variety of training to enable their skills to be kept up to date. One member of staff told us working for the service was a “privilege” and that they received “Tremendous support from all levels of management.”

We found the service took a positive approach to receiving comments about the service and valued feedback from people to enable the service to be further developed. We saw comments where people had stated that “The staff are fantastic” and that reassurance had been provided.

As part of our inspection we spoke with a number of people who use the service. They spoke positively about the staff and care provided and told us that staff treated them with respect. Everyone we spoke to felt they were involved in their care and in making decisions about their treatment.

We received such comments as,"Staff are helpful" and "It's better than I expected"

We undertook this unannounced inspection on the 17 and 18 March 2015. The last full inspection took place on 23 July 2013 and the registered provider was compliant in all the areas we inspected.

St. Andrew’s Hospice, Adult and Children’s Services, is situated in a residential part of Grimsby and provides supportive and palliative care services. The service can provide in-patient care to a maximum of 12; eight placements for adults and four for children. In addition, the service can provide day care for 16 adults and four children. The service is currently undergoing a new build on the same site which will replace the building used for the adult service. This will be ready for use at the beginning of April 2015 and will increase the number of in-patient placements for adults from eight to 12. The children’s service remains the same. All bedrooms are for single occupancy and the new build has ensured all bedrooms have en suite facilities with specialised beds and equipment. All bedrooms in the current and new build have access directly into the gardens and patios. There is a range of bathrooms, communal rooms and therapy facilities to meet the needs of people who use the service. The children’s unit is light, bright, colourful and appropriate for their needs.

The service has a registered manager. 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.

We found there were safeguarding systems in place, which consisted of staff training and policies and procedures to guide staff if they had concerns. This helped to safeguard adults and children from the risk of harm and abuse.

We saw staff were recruited safely and in sufficient numbers to care and treat adults and children in order to meet their assessed needs. Staff completed training considered to be essential by the registered provider and also had access to specific training relevant to their roles within the service. There were support systems for staff which included supervision and staff meetings. These measures provided staff with the skills and confidence required to support adults and children with life limiting illnesses.

We found people received their medicines as prescribed. Prescription sheets and care plans regarding medicines were correctly completed. Medicines were appropriately obtained, stored, administered, recorded and disposed of.

We found adults and children had their health care needs met and they were supported to make their own choices and decisions about treatment. When adults were assessed as lacking capacity to make decisions, best interest meetings were held with relevant people to discuss options. Assessments and care plans were produced to provide staff with guidance in how to provide care and treatment which met their preferences.

Adults and children’s nutritional needs were met. There were choices and alternatives for meals and we saw catering arrangements were flexible.

We observed staff provided care and support in a kind and compassionate way and promoted privacy and dignity. Staff provided explanations and information about treatment. There was a range of therapies and activities to support people and their family, to include them and to prevent a feeling of isolation. People confirmed this during discussions with them.

We found the service was clean and hygienic. A member of staff had been designated a lead role in infection prevention and control (IPC). Once located in the new build, they were to complete a full IPC audit and develop protocols for managing specific infections.

There was an open culture to encourage adults and children who used the service, their families and staff to raise concerns in the belief they would be addressed. There was also a quality monitoring system to ensure people’s views were listened to, lessons were learned from incidents and practice was improved.