This inspection took place on the 28 September, 5 and 7 October 2016.

St Giles Hospice has 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 provider, they are ‘registered persons.’ Registered persons have a legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

St Giles Hospice is an independent registered charity that provides specialist medical, nursing care and treatment, health diagnosis and screening; associated with specialist palliative and end of life care for people with life limiting, progressive and advanced disease or illness. The service includes a 27 bedded inpatient unit with an on-site advice and referral centre, a day hospice with on-site lymphoedema clinic and outreach service; a hospice at home service, which also supports people who may choose, to die at home. A range of other care and support services are offered for people and their families, which include bereavement and counselling, spiritual care, occupational, physio and alternative therapies, community engagement support and a transport service.

At the time of our inspection there were approximately 1380 people using the service, including 21 people accommodated on the inpatient unit at St Giles Hospice.

People felt safe and in control of their care and treatment. People’s care, treatment and medicines were consistently accounted for and safely managed. Risks to people’s safety associated with their health condition, environment or care equipment were fully accounted for. Staff understood and followed people’s care plans, which showed the care actions required to mitigate any identified risks to people’s safety from this.

People were protected from harm or abuse. People felt safe and both they and staff were confident and knew how to raise any concerns about people’s care and safety. Staffing and emergency planning measures helped to ensure that people received safe care. Equipment, environmental maintenance and cleanliness, was consistently maintained. This helped ensure people’s safety in care.

People and their families were highly satisfied and complimentary of the individualised care, treatment and support provided; and felt this made a positive difference to their health and emotional wellbeing. People’s care and treatment was consistently delivered in a way that met with their needs and wishes and often exceeded their expectations. Staff and volunteers worked as a cohesive team in consultation with external health professionals when required; to optimise people’s care and treatment options and their health and comfort. Plans to establish revised outcome measures for people’s clinical care and treatment from recent national guidance, aimed to further this.

The provider’s arrangements for staff training, development and support were comprehensive, well-resourced and service specific. This enabled effective clinical leadership, staff expertise and knowledge concerned with people’s palliative and end of life care and treatment.

Staff understood the importance of ensuring people received good nutrition and hydration; and the related support requirements at people’s life end stage of care. People accommodated on the inpatient unit were provided with quality and choice of food and drinks at times to suit them.

Staff understood and followed the Mental Capacity Act 2005 to obtain people’s consent or appropriate authorisation for their care. Manager’s checked the related assessment and decision making process to ensure this was being properly followed. This enabled people’s rights in care and helped to protect them from receiving end of life care that did not meet with their needs, wishes or best interests.

People received care from kind, caring and compassionate staff and volunteers who treated them with respect and were highly motivated to

During our inspection we spoke with three people who used the service and four relatives of people who used the service. We also spoke with two visitors who were interested in becoming hospice volunteers and five members of staff.

We found care was planned and delivered to keep people safe and which promoted their wellbeing as far as was possible. One of the relatives we spoke with told us: “This is a wonderful place to be”.

We saw that the service took appropriate steps to minimise and reduce the risk of infection. Hand gel was available in all reception areas, and at frequent intervals along corridors in clinical areas.

We found that all medicines were securely stored and that systems were in place to ensure that these were ordered and dispensed appropriately. We also met with the hospice pharmacist.

We saw evidence that recruitment processes for all staff, including volunteers, ensured that only people of suitable character were employed by the service. We saw that staff were offered tailored induction packages as part of the recruitment process.

There was information about how to raise a concern or complaint in every hospice care booklet, and a dedicated complaints leaflet. We also saw a comments and suggestions box clearly available with postcards in the reception area.

We inspected the St Giles Hospice site at Whittington in November 2012. We visited Compassus, the in-patient unit and the Day Hospice. We saw that people received ongoing information about their care and treatment. The people we spoke with had given their consent to care and treatment based on the information they received. One person said, “They explained everything”. Another person told us, “If I have a worry, they put me at ease”.

We saw that people’s care plans were personalised and detailed. They included information about people’s own priorities and preferences in respect of their care and treatment. People told us their care was, “Brilliant”. Relatives told us, “They always find time to reassure us”. People told us they felt safe at St Giles Hospice.

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 that St Giles Hospice had thorough systems in place to monitor the quality of the care and treatment provided. We saw that there was continuous monitoring of people’s views about their care. We saw evidence that suggestions people made were acted upon. Any complaints or adverse comments were responded to. Most people who used the service and their families were very positive about every aspect of their experience.

We visited St Giles Hospice over three days and spoke with people who received care and support within the day hospice setting, hospice care on Compassus and people who received care in the community. We spoke with carers and relatives and staff who were working in all areas including the Lympoedema clinic. This enabled us to get a view of all the services provided by St Giles Hospice and many of the people we spoke with, had experiences of more than one service.

People we spoke with and their carers talked enthusiastically about the care and the support they received in all areas of the service. People told us that staff were helpful and supportive and spent time explaining information to them. Comments included, “They’re absolutely wonderful to me, nothing is too much trouble”, "They’re so helpful and you can ask them for anything”, “They’re attitude is so lovely”, “They explain everything to you”, and I don’t know what I’d do without them, I didn’t know where to go or what to do before I came here.”

People valued the continuity of care and having a named person to speak to, people told us, “At hospitals we always see different doctors, but at St Giles you get continuity” and “I can ring at any time to speak, and if [the named nurse] isn’t there is someone else I know and who knows me.”

People told us they contributed to the plan of care and staff asked them how they wanted to be supported. People knew this information was recorded and people we spoke with were content for staff to manage the plans. Carers told us they were included in discussions and one person stated “They care about the carers, not just the patient”. Carers told us they knew who to contact and having access to volunteers or other support groups helped them to cope with difficult situations.