We inspected this service on 21 and 22 March 2016 and we gave short notice to the registered provider prior to our visit. This was to ensure that key people were available during the visit.

St Luke's Hospice provides specialist care for people with advanced life limiting illnesses, including day and inpatient services to people over the age of 18 years. There are 10 inpatient beds at the service. During the last year the hospice supported 182 people in the inpatient unit and 140 people in the day services. The hospice delivers physical, emotional and holistic care through teams of nurses, doctors, counsellors, chaplain and other professionals including social workers, benefits advisors and therapists. The service provides specialist advice and input, symptom control and liaison with healthcare professionals.

The services provided include counselling and bereavement support, a Lymphedema service (for people who experience swellings and inflammations), an outpatient clinic, occupational and creative therapy, physiotherapy, chaplaincy and volunteer services that include approximately 1200 volunteers. The service is situated in Winsford, close to the shops and other local amenities. Car parking is available to the side of the premises.

The previous inspection was undertaken in August 2013 and the service had met the regulations in place at that time.

There is a registered manager in place at this service, who has been registered for three months. 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.

People told us that they received a good quality of care from all the staff at the hospice. They staff were kind, patient and caring towards them and supported them to meet their physical, social and emotional needs. People described the culture of the hospice as positive.

People told us they felt safe at the service with the staff team. Staff had been trained to recognise and report any signs of abuse. No safeguarding issues had arisen at the service since the last inspection.

The staffing levels were good and sufficient staff were seen on the days the inspection took place. Staff were well trained and had access to a variety of courses to enable them to develop their skills and knowledge base. Good support was given by senior management and regular meetings and supervision sessions were undertaken.

End of life care was given in sensitive and appropriate ways that acknowledged people’s rights and preferences. The service promoted a “focus on living” approach to care which supported people and their families to enjoy the time they had together and enhance their feelings of well-being.

Robust staff recruitment processes were in place which ensured that only staff who met the service’s high specifications regarding experience and qualifications, character and caring abilities were employed. This included the recruitment of volunteers.

The management of medicines was safe. We noted some areas for improvement which the management team agreed to implement following the inspection process.

People told us the food was good and that they had access to snacks and drinks whenever they wanted them. Care plans showed that a nutritious diet was encouraged.

The service worked closely with other professionals and agencies to ensure people’s holistic needs were fully met.

There was clear evidence of close and effective partnership working between families, carers, and between the service and external professionals.

Regular checks were made regarding the safety of the building and equipment. Staff were given training in safe working practices and provided with any necessary personal protective equipment. During a tour of the building we noted it was clean, hyg

Patients told us that they were happy with the care they received. Comments included: "I can't fault it, they look after me very well"; " I get the care I need and more. I was apprehensive about coming in, but within a couple of hours they had allayed all my fears"; "I'm very pleased with it, I couldn't get any better care"; "The care is marvellous, it's proper nursing care". A relative said "They're fantastic, my relative is very well cared for."

Patients told us that the food was very good and they could have whatever they wanted to eat or drink at any time. One person said "The food is really nice. You can have whatever you like and I've never been refused anything I've asked for".

There were effective recruitment procedures in place and patients were extremely complimentary about the staff. "Nothing is too much trouble for them. I'm amazed how much they care"; "They must be really well vetted because they're marvellous".

The premises and gardens were suitable and well maintained. One person told us how much they appreciated the pleasant surroundings. They said "The gardens are beautiful to sit in or look at and I like to go to the reception area and look at the lovely cards and gifts for sale."

There were systems in place to help people raise concerns and have them investigated and addressed.

We spoke with three patients and two relatives. They said that the support the service intended to provide was agreed with them on admission, including decisions about resuscitation. They said that any changes in treatment were discussed with them and any changes to the care plan were always agreed before being implemented. They also said that doctors and nurses were always available and willing to discuss any aspects of their treatment at any time. One patient said "I was amazed at how much they explained everything to me and gave me time to decide what treatment I wanted, and what I didn't want".

Patients told us that they were happy with the service and well cared for. One relative said "They're marvellous" and another said "It's brilliant. Both my relative and I are so well cared for. They can't do enough for you".

Records showed that care and treatment were planned in consultation with the patient and their family. The care included spiritual and emotional support for both the patient and their family.

People we spoke with said that their needs were able to be met by the number of staff provided and that call bells were answered promptly, "within seconds". People were extremely complimentary about the staff and made comments such as; "The staff are all very kind", "I can't fault any of the staff", "They always come quickly when I call, even at night".

We spoke with three patients and three relatives in the inpatient unit and two patients in day care.

Two of the people in the inpatient unit said they had been able to visit and see what facilities were available before being admitted.

Everyone said that they were happy with the service and well cared for. They said that staff were always careful to maintain their privacy and dignity. They told us staff always consulted them about their individual needs, explained what was happening and involved them in decisions about their care and treatment.

Comments included: “They treat you as an individual”; “Everyone’s treated equally”; “They’re lovely people, they can’t do enough for you”; “I’m quite happy with the care and they keep me comfortable”; "The staff are very kind, they look after me very well”.

People we spoke with told us that they felt safe in the hospice, and would know who to speak to if they had any concerns.