St Ann’s Hospice provides in-patient hospice care and a day hospice from one site. It is part of a wider organisation with two other sites in the Greater Manchester area providing hospice care. The hospice holds condition specific clinics, has a bereavement support service, therapy services, a fundraising department and a team of volunteers all based on-site.

The service is a registered charity with a board of trustees. Day to day the service is run by an executive management team drawn from all departments within the hospice. There was a new chief executive who had been in post for several months who had been meeting with all staff and users of the service as part of their induction into the role.

There was a registered manager employed for this service. 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 registered manager was experienced in providing palliative care and had joined the organisation within the last two years.

People and professionals spoke highly of the complementary therapies that were available to both people who used the service and relatives. The hospice provided family support, counselling and bereavement support and we saw the service helped people carry out specific wishes such as providing a Christmas party for someone with their family at the family’s request.

People told us that staff were caring, compassionate and listened to them. People we spoke with who received personal care felt the staff were knowledgeable, skilled and their care and support met their needs.

The service had recently introduced a new electronic recording tool called EMIS (Egton Medical Information System). Although this was still relatively new, staff we spoke with were positive about the training they had to support this new approach and stated it was, “useful and efficient.”

People’s health care needs were met by the in-house medical team. This included consultants, GP’s with a special interest in palliative care, an occupational therapy team, a physiotherapist, social worker, dietician and chaplain.

Care plans were personalised to include people’s wishes and views. People and relatives told us they were consulted about their care and treatment and that they regularly had the opportunity to speak to medical and nursing staff. Care plans were regularly reviewed in a multi-disciplinary framework. We observed staff caring for patients in a way that respected their individual choices and beliefs.

Staff recruitment processes were followed with the appropriate checks being carried out. There were sufficient staff on duty to meet people’s needs. The hospice had experienced some shortness of staff recently although this had not impacted detrimentally on the people using the service. The hospice had a bank of staff who they could contact if they needed additional staff. The registered manager told us they had recently tried to recruit additional nursing staff but felt the calibre of applicants wasn’t right. They were going to review their advert and recruitment process to try and attract further applicants. Staff and volunteers received a thorough induction and regular training to ensure they had the knowledge and skills to deliver high quality care and support.

Staff followed risk assessments and guidance in management plans when providing care and support for people in order to maintain people’s safety.

People were protected by the service’s approach to safeguarding and whistle blowing. People who used the service told us that they were safe, could raise concerns if they needed to and were listened to by staff. Staff were aware of safeguarding procedures, could describe what they would do if they thought somebody was being mistreated

We visited St Ann’s Hospice on 23 September 2013 at the time of our visit there were 24 in patients. At the time of our visit the manager was unavailable; the inspection was assisted by the Clinical director, Ward Manager, Training Officer and the lead for quality and audit.

We saw staff caring for patients with respect and compassion. Staff were heard speaking with patients in a calm and friendly manner.

We saw appropriate policies and procedures in place, staff we spoke with were aware of how to access them and the correct procedures to follow.

We looked at two patients’ records which contained relevant and factual health information. Patients’ wishes and preferences were recorded and patients were included in discussions about their care and treatment.

We spoke with three patients and ten relatives. One patient said “This is a wonderful place; all the staff are so kind and caring I can’t praise them enough. They make sure I am not in any pain. The food is very good and nicely presented. ” Another patient told us “The care is excellent, I am very comfortable.” A relative said “People worry about having to go into a hospice but the care here is excellent, 10 out of 10. The staff have time to talk to us and give us as much information and support we need as a family”. Another relative said, “The standard of care is first class”.

We spoke with four members of staff who were aware of the safeguarding procedures and had an understanding of mental capacity issues and best interests decision making. Staff told us they were well supported by management and told us that there was an open door policy and everyone was approachable. Staff meetings were held regularly, training and professional development was on-going and annual appraisals were undertaken.

Any complaints were taken seriously and followed up appropriately we saw evidence that regular audits were undertaken.

The hospice provided symptom management, rehabilitative and palliative care for people whose preferred place of care and choice for end of life care was the hospice and to support people to remain at home.

During our visit to the hospice we spoke to three people who were receiving care. We also spoke with the Registered Manager and other members of the staff team.

One of the people we spoke with who was using the service told us; “They do what they can to ease you, we get an allocated nurse who always sits with you and has a chat, they do so much for you mentally as well as physically, staff are friendly and calm in their approach to people”. The person also said that they enjoyed talking with the volunteers and liked the friendly banter between one of volunteers in particular.

Another person told us that the hospice had given them a safety net and that the staff, nurses and auxiliary’s could not do enough for you and were very kind. They also said that there were other resources such as occupational therapists, physiotherapists, and social workers. The person told us that the Hospice concentrated on the person as a whole rather than just their medical needs

We spoke to family members, people who used the service and members of the nursing staff team during our visit on the 22nd July 2011. The told us that they were very pleased with the service provided by the hospice.

Comments we received were;

“feel well looked after – care second to none – come straight away when press call bell – lovely with me – no impatience even though busy – they always have time for you – communication very good”;

“flexible routines – cup of tea anytime – can have anything, within reason of course”;

“as I do not have a good appetite I get something else – can have anything I fancy providing the kitchen staff have it in;” “attended day care – lovely people, go to this when at home”.

We were told by the family members and people who were using the service that they were very much involved in their treatment and were kept informed at all times. They also told us that their right to have their privacy, dignity and independence was respected at all times.

The members of staff we spoke with said that they were well supported by their managers. We were also told that there was ongoing training available to keep them up to date with all current procedures in palliative care.

No one we spoke with had any complaints about anything the hospice provided or any of the people who worked there.

The registered manager had submitted to us on the 22 July 2011 an application to de-register surgical procedures as the hospice does not carry out this regulated activity. They had also submitted a completed application form to add the ‘Neil Cliffe’ out patient centre, which is based at Wythenshawe Hospital as a location and also add the 24 hour advice line.