This unannounced inspection took place on 19 and 20 April 2016. At previous inspection the hospice had been compliant with regulation and offered a quality service.

St Nicholas Hospice provides day, community and inpatient care and support to people of West Suffolk and into Norfolk. The Sylvan ward in Bury St Edmunds provides palliative and also respite care for up to 12 people. The Orchard Centre in Bury St Edmunds and the Burton centre in Haverhill provide support, care and activities for day patients and their families. The Community Hospice Team provides care, support and advice to patients in their own homes. St Nicholas Hospice also runs a Hospice Neighbours scheme - trained volunteers offer people companionship and practical support. Approximately 500 people were being supported in the community and 150 through the day centres.

There was a registered manager in place and they participated fully 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.

St Nicholas Hospice is an outstanding service. It is truly focussed on the individual needs of people that they support, giving people support at the time they need it in a way and place that best suits them and their family. 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. People viewed the healthcare clinicians as expert in their knowledge.

People spoke of a service that was tailor-made for them and their families saying that staff truly went the extra mile to offer understanding, empathy and choices that were based upon information and keeping people informed and involved. Informed consent was embodied into all work that was undertaken at the hospice. The various departments within this hospice worked well together so that people had a seamless experience of moving from one department to another as the need arose.

Staff were motivated and keen to convey to inspectors their pride in the service they worked at. Staff were involved, listened to and empowered with training and support to offer excellent end of life healthcare and support.

Management were inclusive and promoted a culture of excellence. They listened to people and involved them in the running and development of the service. They actively sought out people’s views and used criticism as an opportunity to improve and develop the service. There was a kindness and warmth about the management team that made them approachable to everyone and people knew them by their first names and told us they were visible, approachable and solved matters raised. Governance of the service was of a high standard that was benchmarked against similar services and communication was very good. The board of governors and others who needed oversight were appropriately informed of how the hospice operated. The measures of quality in place showed that people were right to have the confidence in this local hospice.

As part of our inspection we spoke with seven people who used services and three peoples’ relatives. Everyone we spoke with told us that the standard of care and support they received was high. One person told us: “I can’t fault any of the care. It is a wonderful experience and the staff here should have a halo.” Another person told us: “I find it absolutely top notch. I can walk through the door and know that it will be good.”

We found that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. We looked at nine sets of care records. People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

We inspected several aspects of infection control and found there were effective systems in place to reduce the risk and spread of infection. We also found that appropriate arrangements were in place in relation to obtaining, recording, storing and administering medicine.

We spoke with six members of staff during our inspection. One member of staff told us: “There is very much a feeling of team work. Every level of staff is involved in making this a happy place to work.” We found that staff received appropriate professional development and were able, from time to time, to obtain further relevant qualifications.

We also found that people’s complaints were fully investigated and resolved, where possible, to their satisfaction.

We spoke with 13 people using the service. This included people using the day centre, the community service and people residing on the Sylvan Ward. Everyone spoke very positively about the care and support provided. We heard many comments about how staff provided assistance that was in line with people's individual wishes. One person told us, "I am known as a person and not just a patient who is being treated for a condition." Another person explained, "I am receiving care in my own home and staff have guided me in choosing the equipment that can help me to stay as comfortable as possible." One person told us that, "Staff have been available 24/7 for me and my family to speak to. It feels better knowing that we are never alone."

We found that the service was meeting the needs of people, in a way that respected their individual wishes and their dignity. Work around improving falls and pain management was being completed in order to improve the care given to people. Staff we spoke with told us they were passionate about coming to work and that they found it rewarding to maintain high standards of care. They had received additional training in order to further their professional development and to equip them to meet everyone's needs. The ward environment was pleasant and restful. The segregation of 'dirty' and 'clean' areas provided an excellent basis for good infection control. We observed care in action and saw that staff took pride in making people smile.

We spoke with twelve people who use services. We met with people during our visit and telephoned people by arrangement to seek their feedback. The response we received was overwhelmingly positive. Everyone spoke highly of the individual treatment and respect they were afforded throughout all their contact with various aspects of the hospice service.

One person told us, “I am treated as an individual. I’m not spoken down to. I’m able to ask lots of questions”.

Another person told us, “What is extraordinary is that my nurse knows exactly the right thing to say. She knows me as an individual”.

People did have influence on how the service was run. A typical statement was: “They assessed what the patients wanted to get from the hospice by asking us as a group what we would like in terms of services and provisions”.

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. People stated that they felt their care met their individual needs in both the hospice and when they were at home.

One person told us that the care was seamless “When we met to review my medication everyone was very good. I did not need to go over everything again. The doctors, everyone was up to date with the situation”.

Another person told us that the Community Hospice Team “Were instrumental in getting me out of hospital and back home as soon as was possible. They sorted out all my new disability issues and knew just where to get all the equipment from. I felt very supported”.

All the people that were spoken with during a visit to the hospice and through telephone contact confirmed that the staff were wonderful, knowledgeable, caring and considerate. They behaved in a professional way and nothing was ever too much trouble.

One person told us, “My nurse is excellent she is highly trained and good at her job. She has a good manner about her”.

Another person told us, “They seem to know so much. They are always quick to put you on to the right person to solve a problem”.