We inspected St Barnabas Hospice – Specialist Palliative Care Unit on 29 March 2016. The inspection was unannounced. St Barnabas Hospice is a registered charity covering the county of Lincolnshire.

St Barnabas Hospice – Specialist Palliative Care Unit provides a wide range of services for people who have advanced, progressive illnesses and where the focus is on palliative and end of life care. The services are provided within four settings; an in-patient unit, a day therapy centre, hospice at home services and a palliative care co-ordination centre. Holistic services are delivered by a team of medical, nursing and social work staff, occupational and physiotherapists, counsellors, and chaplains.

There was a registered manager in post at the time of our inspection. 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.

CQC is required by law to monitor the operation of the Mental Capacity Act, 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of the inspection no-one using the services had any legal restrictions placed upon freedom. We saw that where this had been a necessary action prior to the inspection the provider had acted in accordance with legal guidance in order to protect people’s rights.

People were unanimously positive about the services they received from St Barnabas Hospice – Specialist Palliative Care Unit. Without exception they praised the staff for their personalised and caring approach.

People were the focus of and at the heart of the service. They were central to the planning and reviewing of their care packages and those who were important to them were fully consulted. Support for people’s spiritual, cultural and emotional needs was an integral part of their care package.

People privacy and dignity were respected in all of the hospice care settings. Their consent was sought before any care was provided. Their views and those of people who were important to them were respected and used to help improve the quality of the services people received.

Staff understood people’s needs, preferences and wishes and provided support that took all of these things into account. Staff were well trained and supported to provide care and treatment that was sensitive, warm and respectful. They were knowledgeable about their specialist field of care and took account of how a person’s wider medical needs impacted upon their life limiting diagnosis. They were supported to keep up to date with current good practice and research within their specialist field of care

People were supported to stay safe by staff who knew how to recognise and report signs of abuse. Staff also knew how to assess and manage risk in a way that did not limit a person’s lifestyle.

People received all of the healthcare support they required. Doctors and therapists who specialised in palliative and end of life care provided support alongside people’s GP, community nurses and NHS Trusts. People’s nutritional needs met in a personalised way that took account of their preferences and wishes.

People who used the service and those who were important to them praised the way the service was run. Effective leadership and management systems supported a culture of openness and close team working. There was a strong emphasis on providing care that was based on current good practice guidance and relevant research. There was also an emphasis on continuous service improvement which was supported by effective quality assurance systems, close li

One person spoken with told us that, "The staff are very kind and helpful and I cannot speak too highly of the care that l have received here.” This and the other evidence reviewed demonstrated to us that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

Everyone spoken with told us that the meals provided were very good and that they could choose whatever they liked or fancied at each mealtime. This and the other evidence seen showed us that people were protected from the risks of inadequate nutrition and dehydration.

Those medicines administration records seen were completed appropriately and provided an audit trail of medicines in use. This demonstrated to us that people received their medicines as prescribed.

Staff spoken with told us they were well supported by senior staff and that systems were in place to provide ongoing clinical and professional support. This was particularly valued by staff due to the specific pressures of their professional role. This showed us that there were enough qualified, skilled and experienced staff to meet people’s needs.

The records reviewed were accurate and were reviewed and updated regularly to reflect the delivery of specialised palliative care. This meant that people were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

We inspected the St Barnabas Hospice site at Lincoln. We visited the in-patient unit and the day therapy unit. We saw people received ongoing information about their care and treatment. One person we spoke with described how staff carefully explained everything to them and made sure they understood all their treatment and care options.

Patients and relatives expressed great satisfaction with the care and support they received at St. Barnabas Hospice. One person told us, ”The staff are brilliant, so experienced and supportive. My symptoms are managed much better now. The whole experience has exceeded my expectations.”

Staff we spoke with told us about their high level of job satisfaction. They said they felt well supported by their managers and teams. They described the range of training available to them which enabled them to develop their knowledge of caring for people with a life limiting illness.

We found people were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. People told us they felt safe at the hospice.

We saw the service had effective systems in place to monitor and improve the service. These systems involved consulting with people using and visiting the service. 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.