This inspection visit took place on 23 and 24 November 2016. The first day of the inspection was unannounced. A further two days in February 2017 were used to speak to seven people using the service. The service was last inspected in April 2014 and was found to be meeting all the regulations we reviewed at that time.

St. Helena Hospice is a charity which provides a range of hospice services for anyone over the age of 16 with a life-limiting illness living in North East Essex and the Colne Valley area of mid Essex. St Helena Hospice provides a range of palliative care services to patients at home, through two day centres [Joan Tomkins in Colchester] and in an inpatient unit that has 15 beds. In addition the hospice offered a 24 hour telephone advice line, a range of complementary therapies, counselling, support for carers and bereavement support groups that was also available to children.

There was a registered manager in place at the time of the 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.

The service had a strong person centred approach. People's dignity was supported and staff treated people with respect at all times. Staff were exceptional at helping people to express their views. People and their families who received care, treatment and support from St Helena could not speak highly enough about the staff who supported them. People who were challenged in coming to terms with a life limiting illness or a terminal diagnosis told us repeatedly that they were enabled to manage their condition and their emotional wellbeing because of the excellent care and support received from various departments within St Helena hospice. Staff were exceptionally kind, caring and compassionate. People we spoke with were only too pleased to share their stories of compassionate appropriate care, treatment and support.

The hospice was proactive in reaching out to communities who did not traditionally access their services. Innovative methods had been used to encourage people to access the support available to them. The model of care delivered was one of inclusion and acceptance and promotion of diversity. The ‘Safe Harbour’ project provided hospice services and supported people on the fringes of society, such as those affected by homelessness, alcohol and drugs misuse.

People received excellent care based on best practice from experienced staff with the knowledge, skills and competencies to support their complex health needs. Staff were supported and coached to deliver care and support following best practice guidance. People and families received care from staff and volunteers who developed positive, caring and compassionate relationships with them. Staff worked together as a multidisciplinary team and had excellent links to community based services to provide the care people needed.

Staff had permanent support and guidance from social care professionals employed by the hospice and were trained in how to protect people from abuse and harm. Staff were proactive and knew how to recognise signs of potential abuse and how to put measures in place to overcome safeguarding issues. Risks to people`s well-being were assessed by staff daily and there were measures in place to mitigate risks and keep people safe as they could be. 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 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 respecti

As part of this inspection on the Colchester hospice site we spoke with three people in the Day Centre and three people in the Inpatient Unit (IPU). We also spoke with the chief executive and a number of managers and staff.

During our inspection we gathered evidence to help us answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well-led?

Below is a summary of what we found. The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

People all told us that they felt safe when they visited the Day Centre or IPU. One person in the IPU said: “I feel so safe here. I had all those fears and they’ve helped to allay them all.” Another person told us: “You are safe here. I was so frightened at home when I needed help.”

People told us that they felt their rights and dignity were respected and they felt in control of decisions about their care and support. There were good systems in place to protect people from poor practices or potential abuse.

Is the service effective?

People told us that the hospice service was extremely effective in meeting their needs. One person said: “My pain was so bad before I came to the Day Centre that I couldn’t get any sleep. I thought I’d just have to live with the pain. I came here, they prescribed a different pain killer and I’m now pain free.” Another person in the IPU told us: “They’ve helped all my symptoms. I didn’t think care this good was available.” A third person described their recent stay in the IPU as “immensely beneficial”.

Is the service caring?

People were extremely complementary about all the staff. One person told us: “It doesn’t matter what they are asked to do they all go out of their way to help.” Another person said: “Everyone including the volunteers and cleaners are all so caring. They all have time for me. Any concerns they can take away from me they do. They’ve given me my dignity back.”

Is the service responsive?

All the people we spoke with told us that the staff were very responsive to their needs and wishes. One person said: “Everything is a joint decision. They explained the different pain killers and asked me what I wanted.” Another person told us: “They listen to me here and that means a lot to me. They didn’t listen to me at the hospital.” A third person said: “I just ring the bell and they’re here.”

The hospice had introduced a service called ‘SinglePoint’. This provided a single telephone number and point of access to palliative care services. A team of registered nurses provided support and advice at any time of the day and night. They assessed the urgency of the support and care required and arranged for the most appropriate member of staff to respond. People we spoke with were very appreciative of the service and said that it gave them a “lifeline” when they were at home.

Is the service well-led?

One person who had attended both the IPU and day services told us: “The service is exceptionally well led. I cannot speak highly enough about all the hospice staff. ” Another person told us: “Everything is well organised. The teamwork is very good.”

The senior management team was leading collaborative work with local hospitals, ambulance services and commissioning groups. This was helping to provide a much more integrated and coordinated service for people with palliative care needs. It also helped to reduce avoidable admissions to hospital for people receiving end of life care.

Considerable changes were being made to St Helena Hospice in order to integrate services and improve quality. Since our last inspection in October 2012 the hospice had continued to develop and expand the services provided in people’s own homes. Day care services provided support for both people and their carers. Inpatient services were only provided for people with the most complex needs or for short periods of symptom control. In March 2013 the Hospice introduced a transition service specifically geared to young people from the ages of 16 to 40.

During our inspection we spoke with three people attending the day unit, three people in the inpatient unit and one relative. All the people we spoke with were extremely complimentary about the services they received. They felt fully involved in all decision making. They told us that staff and volunteers, without exception, provided an excellent service. One person said: “I’m treated with dignity. I’m not just a patient, I’m a person.” The relative we spoke with said: “They look after X very well and look after me as well.”

The hospice had a commitment to continuous quality improvement of the services, treatment and care that they provided. They provided training that enabled staff to meet people’s individual needs. There was evidence of actions taken to address the issues raised by people and their carers and evidence of improved standards within the services following audits.

During our inspection we had conversations with three people and one relative in the inpatient unit. There were no day patients on the day of our inspection on the St Helena Hospice site. All the people we spoke with were extremely complimentary about the personalised treatment, care and support that they were receiving. One person said “It’s like being in a hotel. I’d give it six stars.” Another told us “I can’t praise them enough. It’s wonderful here. The staff are all excellent. If you press the buzzer they’re here.” Another person said “They give me the support I need.” The relative we spoke with appreciated the fact that they could visit at any time and said “It doesn’t feel like a hospital.”

People described the food as “wonderful”. They told us that the fruit and vegetables were “very fresh, with lots of flavour.” They said that staff provided food especially for them if they had any problems with eating. People also appreciated the range of complementary therapies that were provided. They told us that the therapies helped them to relax and improved their symptom control.