This inspection for the in-patient unit took place on 17 October 2016 and was unannounced. Feedback about hospice at home and day services was obtained from people and their relatives on 18 and 20 October 2016.

St Clare Hospice is registered to provide specialist palliative care, advice and clinical support for adults with life limiting illness and their families. The service delivers physical, emotional, spiritual and holistic care through teams of nurses, doctors, counsellors and other professionals including therapists. The service provides care for people through an In-Patient Unit, Day Service, Out- Patient Care and Hospice at Home.

At the time of the inspection there were four people using the inpatient service and 230 people using hospice at home and day services. The day services offered a range of services to people recently diagnosed with life limiting conditions, their carers and families. The service provided specialist advice, courses, complementary therapy sessions and outpatient clinics. It aimed to empower people to be in control of their condition and achieve what was important to them.

St Clare Hospice 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 from abuse and harm. They knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risks to people`s well-being were assessed by staff daily and there were measures in place to mitigate risks and keep people safe. Risk assessments were reflective of people`s changing abilities and needs and measures to ensure people were as safe as possible were implemented accordingly.

People were at the heart of the service and were fully involved in the planning and review of their care, treatment and support. People told us they were fully involved in setting their priorities for care. Care plans in regard to all aspects of people`s medical, emotional and spiritual needs were personalised and written in partnership with people. Staff delivered support to people respecting their wishes and preferences.

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 recurrence.

Recruitment procedures were robust and ensured that staff working at the service were qualified and skilled to meet people`s complex needs. Staff told us they worked and trained towards their personal development plans and were happy with the support from their managers. 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 for the hospice at home service to ensure people received the same support and advice during the day as during the night. If there was a need for it, staff provided a night sitting service to people in their own homes to give their family carer time to rest. People using the inpatient service had their medical needs met by a team of doctors employed by the hospice.

People who used the day service told us that this service enabled them to meet people with similar conditions and helped them prepare for the future. People told us that staff understood their individual care needs and were compassionate and understanding. Staff told us they undertook training which enabled them to provide good quality care to people in the inpatient unit and in people`s own homes.

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

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. One person we spoke with explained that they had received a visit in their home by a nurse from the service before they were admitted. Their relative told us, “[The nurse] came, we sat and chatted. [The nurse] said we needed to come in and have an assessment.” They explained that their relative’s pain had been managed “…within a couple of days” of being admitted.

The chef told us, “I speak to patients when they come in. We don’t have set menus.” They explained that they ask people about what food they would like to eat and prepare this for them, rather than adhering to menu options. People were supported to eat and drink sufficient amounts to meet their needs.

There was an effective operation of systems in place to ensure that people were protected against the risks of a health care associated infection.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

We saw that equipment at the service was appropriately maintained and suitable for its purpose. We saw that equipment, such as hoists, mattresses and medical devises were regularly serviced and maintained to ensure that they were safe.

We met with people who were attending day services, as well as a person who was an in patient together with their relatives and another person with previous experience of the in patient unit. We received no negative comments about people’s experience of the service.

People with whom we spoke with were very happy with the services provided by St Clare West Essex Hospice. One person told us “There is a warm and friendly ambience as you walk in the door and it never stops”. Another person told us “It is a wonderful place; it feels like home, you will never find a better place.”

Everybody told us that they were fully consulted about their care and treatment. People attending day services and who had previously received in patient treatment told us continuity of care was good and supportive.

People spoke highly of the meals provided and told us they were always given choices. They praised the chef and kitchen staff and said that meals were always well presented and appetising.

People knew how to raise any concerns and were given the opportunity to provide feedback on the level of service received.

Everyone with whom we spoke with told us that the staff at the hospice were very helpful and kind and knowledgeable about their needs and “Nothing was ever too much trouble.”

They said the environment was pleasant, restful and clean.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant some were not able to tell us their experiences. Following the inspection of the service we contacted three relatives and three patients who had used the hospice.

They all gave positive feedback about their experiences at the hospice. One person told us, “St Clare’s is one of the finest places in the world…second to none. We found the staff helpful, friendly and caring. They gave X all the care and attention. I can’t praise them enough.” Another person told us that they found the hospice, “Excellent, really, really good. The treatment was first rate and the rooms were excellent with plenty of space. I felt I had perfect dignity.” Another person spoke of their experiences from feeling anxious and isolated to where, “I now want to give something back. The hospice ‘mended’ me which was very positive.”