This unannounced inspection took place on 10 October 2016. We announced two further days of inspection that took place on 12 and 14 October 2016. We had last inspected this hospice on 22, 29 January and 5 February 2014. At that time we reported that care records were not consistently maintained. On this inspection we found that this had improved.

St Elizabeth Hospice is located on the outskirts of Ipswich and is owned and operated by a local charity. It provides palliative and end of life care for adults and young people aged 14 years and above. Based in Ipswich there are eighteen inpatient beds. The aim is for short stays to manage symptoms of illness, pain management, respite or to receive a specific treatment or end of life care. The hospice also runs and supports out-patient day services. The principle day service is run from the main site in Ipswich where there is a five day a week service. Another site is Ditchingham, ran on a Monday. A variety of therapies are available at these day centres as well as medical support from doctors and nurses. The hospice provides support to the majority of people through help at home. This is through the Clinical Nurse Specialist (CNS) Team and Community Healthcare Assistants. The CNS team work with people and those that support them in the community such as GP and District Nurses. They offer specialist advice on symptoms and end of life care as well as a link to all that the hospice offers. Community health care assistance at home provide personal care support to enable people to remain in their homes longer. The service as a whole was used by 844 people last year. The hospice also run a telephone advice line that gives access to expert advice and access to a CNS. 16700 calls were made last year.

There was a registered manager in place who participated in the inspection process. 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 service was extremely caring and focused on providing a tailored service which people helped plan and develop. There were appropriate systems in place to ensure flexibility to people so their care needs could be met either at home, in the hospice or in the wider community. People were able to seamlessly transition through different parts of the hospice. Young people were effectively supported to transition from children’s hospice services into this adult environment. In addition the service provided excellent support to relatives and carers. People spoke overwhelmingly of the positive support, guidance and healthcare interventions they had received. People were full of praise of the staff in terms of their kindness, compassion and knowledge about end of life matters.

Staff followed risk assessments and guidance in management plans when providing care and support for people in order to maintain people's safety. Medicines were safely and effectively managed within all the hospice departments.

Staff were able to describe what it meant to safeguard people and told us how they would report any suspected abuse. There were policies and procedures for staff to follow and there was an embedded culture of learning. Staff worked within the principles of the Mental Capacity Act where appropriate. People had choices about their care and their consent was sought by staff. They told us they were involved in all decisions about their care.

Excellent leadership and management was demonstrated at the service. The culture was open and inclusive which meant that people received a tailored service which was flexible to their needs.

Staff were involved, listened to and empowered with training and support to offer excellent end of life healthcare and support.

Staff and volunteers shared simila

The service had clear policies and procedures in place to meet the needs of the people who used the service.

We spoke with four people who used the service and they told us that staff always asked permission or consent before they performed any part of their care or treatment. One person told us, “They explain everything, sometimes twice.” Another person told us, "The staff are very kind and make me feel comfortable." Another person told us, “The nurse tells me what is happening and answers my questions.”

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. In all the records seen during our visit we saw clear evidence of the input from the multidisciplinary team. For example, nurses, physiotherapist, occupational therapist, dietician, support staff and medical staff.

The service had appropriate policies, procedures and staff practices in place to safeguard all the people, including young people from the age of 14 years and their families who used the service. There was sufficient qualified, skilled and experienced staff to meet the people's needs for the 24 hour period.

All the people that were spoken with during a visit to the hospice confirmed that the staff are wonderful, knowledgeable, caring and considerate. They behave in a professional way and nothing is ever too much trouble.

During a visit to the hospice people who use the service confirmed that their care was well planned and supported by the experts in the multidisciplinary team. Some people stated that they felt their care met their individual needs in both the hospice and when they are at home.

We found a service that was cherished by all who used it. People were enthusiastic about their praise for the service and the kindness and compassion shown by all who worked and volunteered at this service. We spoke with 10 people who had recently or were currently receiving a service. One person typically said, “I was overwhelmed with their kindness and help. All the staff were lovely. They were skilled and well trained. They made such a difference. They explained everything. They were able to read the situation and provide the needed answers”.

We found that the care and support people needed was appropriately provided and what people wanted, but we also found that there was a potential through incomplete records that care may be unsafely delivered. Care records seen did not always support the care that was delivered.

We found an environment that was suitable and well maintained and ensured the safety of people who used it. We found a staff group that was well trained and very well supported to complete their role at the hospice.