This inspection took place on 28 July 2016 and was unannounced. Further phone contact was made with people using the hospices community services, whose views we were unable to capture on the day of the inspection, on 2 August 2016.

St Mary’s Hospice provides palliative and end of life care, advice and clinical support for adults with life limiting illness and their families. The hospice provides care to people from a multidisciplinary team of nurses, doctors, counsellors and other professionals including therapists. The hospice has a 16 bed in-patient unit that accepts admissions for end of life and palliative care, symptom control and respite care. At the time of our inspection there were 14 people receiving care and treatment in the inpatient unit. The day hospice service offered a range of care and treatment to people diagnosed with life limiting conditions. This included specialist clinical advice, educational courses and complimentary therapy sessions. The hospice community services supported people in their own homes through a hospice at home team and/or a clinical nurse specialist team. The hospice also provided patient transport services.

There was 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 and knew how to recognise the signs of abuse and how to raise an alert if they had any concerns. The provider ensured that there were sufficient numbers of staff on duty at all times to meet people’s needs effectively. Staffing levels were reviewed and adjusted according to people’s changing needs. There were flexible working arrangements within the hospice to provide additional staff as was required. The recruitment process operated by the provider was effective in ensuring staff employed were suitable and safe to work with people who were cared for by the service. Assessments of potential risks were clear and included the measures to take to reduce the risks identified to make sure people were protected from harm. Accidents and incidents were effectively reported, analysed and shared to ensure that action was taken to minimise the risks of recurrence. Medicines were prescribed, recorded, administered and disposed of in safe and appropriate ways.

People were well supported by staff that were well trained. The provider supplied a range of learning opportunities for staff to enhance their knowledge and levels of skills. New staff were well equipped to undertake their role through effective induction. Staff received an annual appraisal and an appropriate level of supervision, with open access to the support they needed from peers and management. When complex situations occurred reflective learning sessions or debriefs were organised. People’s consent was sought by staff before any support was provided. Records in relation to Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) were completed to a high standard, with the person’s knowledge, participation and agreement where possible. People were well supported to access the nutrition and hydration they needed and of their choice. The variety of health care professionals employed enabled people’s health and wellbeing to be responded to in a timely manner when their health needs changed.

People were supported by staff that were kind and caring. The hospice had a relaxed and homely feel with a sociable atmosphere but still had plenty of space for people to access quiet reflective time. People and their families had access to services which provided support and counselling with regards to their emotional, spiritual and religious needs. The hospice had a chaplaincy team and provided a rest room for people of all faiths, where a range of bible

We inspected the service that was provided in people's own homes, the Hospice at Home service. At the time of our visit there were five people receiving this service but over one hundred and fifty people had used it over the past 12 months.

We found that people’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Nurses and nursing assistants from the service worked with District Nurses from the NHS Community Healthcare Trust to provide end of life care for people in the their own homes.

There were sufficient numbers of staff on duty to meet people's needs. The service was staffed by Registered Nurses and nursing assistants who were supported by a manager and an administrator. The service also had flexible staffing arrangements to meet demands and people's changing needs. Staff were properly trained, supervised and appraised. They received support to deal with the challenging nature of their work providing end of life care in people's homes.

Information about the safety and quality of service that people received was gathered and scrutinised and used to improve the service. This included gathering the views of people who used the service and of other stakeholders in the service such as district nursing teams.

A family member of a person who used the service told us, "My [relative] likes them, they are very thorough and very caring...I don't know what we would do without them, they have been great."

People’s needs were assessed and care and treatment was planned and delivered in line with their care plans. People told us they were clear about the aims of care and treatment and they were very positive about their experience of the service. Before people received any care or treatment they were asked for their consent and we saw regular accounts of verbal consent from day by day discussions between people and staff in people's records. One person said, "It's very good here, very well run. If I wanted to I couldn't find anything to complain about."

There was written policy and procedures for recognising and responding to abuse of vulnerable people. People said they felt safe at the service and staff said there was an 'open culture' in which staff could raise any concerns and managers would act on them.

There were sufficient numbers of staff on duty to meet people's needs and people told us that there was always someone available when they needed them. People said that staff were competent and took time to listen to them. We found that the service was well supported with medical, care and ancillary staff and also volunteer workers.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained. We found that people's medical and care records were up to date and kept securely. Records necessary for the safe running of the service and the building were also up to date.