We inspected St Peter and St James Charitable Trust on 15 December 2014. This was an unannounced inspection. The Trust provides specialist palliative care for people with a life-limiting illness and continuing care for people where longer-term palliative care is necessary. It also offers day care and support for people in their own home.

There was a registered manager in place. 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 and associated Regulations about how the service is run.

The hospice accommodated 23 patients. On the morning of our inspection there were 14 people, which had increased to 17 by the afternoon. The registered manager described the three categories within the service: the hospice (where end of life was imminent), continuing care (end of life but not imminent) and short term respite care. In addition, the hospice offered support services for 220 people living in the local community. The hospice had also recently developed and implemented a new ‘Wellbeing Centre’ called Beacon View, which had replaced the existing day care unit.

People were treated with respect and dignity by the staff. They were spoken with and supported in a sensitive, respectful and professional manner and were supported to express their views and wishes about all aspects of their care. Staff had a good understanding of people’s individual needs and the support they and their family members required. Each person had comprehensive care and support plans, including risk assessments, tailored to their individual needs. The personalised plans highlighted any additional areas of support required and were developed from a range of physical and psychological assessments, undertaken on referral, prior to admission and during ongoing treatment.

People told us they felt safe and well cared for. One person told us “I feel very comfortable here. I’ve always been quite shy, but here I feel confident and this is just another part of my life.” Another person told us “It’s so friendly and welcoming, I can’t imagine being anywhere else, it’s not like a hospital. I wouldn’t want to go home now, I’d rather be here.” Relatives said they felt confident and reassured that their loved ones were safe and their medical needs were well met. They were also confident in the staff and spoke positively about the care and support provided. One relative told us “When I go home I know I don’t have to worry.”

Some concerns were raised regarding the recording systems for medicines and also the process for allocating link nurses and health care assistants.

The visions and values were shared with patients, relatives and staff at the hospice and there was a culture of compassionate care, knowledge and understanding. The management team used a variety of methods to assess and monitor the quality of the service provided. These included regular audits, satisfaction surveys and care reviews. People, relatives and staff spoke positively about the management. They were aware of the complaints procedure and confident that any concerns raised would be taken seriously and acted upon.

During our visit we spoke with two patients, two of their relatives and ten members of staff. This included the registered manager, chief executive, operations manager, human resources administrator, chef, housekeeper and three members of the nursing team. We looked at computerised care records for six patients who used the service, the service's policies and procedures, the complaints register and six sets of personnel files.

Staff were able to demonstrate a good understanding of the needs of the patients using the service and were able to show us that they received the training and support they needed. They prioritised the privacy and dignity of people, and supported people to be independent. We spent time observing the care and saw that staff had a good rapport with patients, understood their needs and spent time talking and listening to them. There was a friendly, happy atmosphere in the hospice.

We found that patients’ needs were fully assessed, associated risks were identified and well managed. Care plans were well written, reviewed and continuously updated. Patients were involved in decisions about their care with the involvement of advocates available when appropriate.

We found that the food was prepared in clean safe surroundings to meet the needs of patients. Patients told us that catering staff took care when helping them to choose their meals and encouraged them to eat and drink. One patient told us “Nothing is too much trouble and staff will always do something special for me if they can.” A member of the catering team told us “We speak with each patient every day to find out what they would like to eat, use the freshest ingredients and pride ourselves on the quality of our meals.”

There was information provided to staff about the procedures to follow if there were any concerns that people were at risk of abuse. Staff had undertaken appropriate safeguarding training and were knowledgeable about the correct procedures to follow if they had concerns.

We looked at records related to the employment of staff and clinical practitioners that worked at the hospice. The provider was able to provide evidence that staff were appropriately qualified and competent to carry out their roles and meet the needs of patients using the service. We found that the provider had undertaken appropriate checks on staff and ensured that references and documentation were in place as required under Schedule 3 of the Health and Social Care Act 2008.

The provider had a system in place to respond to comments and complaints made by patients about the service.

One person who used the service told us "I, definitely, feel respected here. The staff can't do enough for you." A relative told us "They're absolutely marvellous, I know she's in safe hands here." It was clear that the service had thought carefully about how to ensure that people who used the service and their relatives were fully informed about choices and outcomes, in a sensitive manner which left no room for ambiguity.

One of the care plans we examined was for a person who had been placed on the Liverpool Care Pathway, with the agreement of the relatives. It was clear that the latest research and guidance was being followed and that great care and thought had been given to ensure that everyone felt assured the approach was appropriate and proportionate.

"I know there are various sorts of abuse" one member of staff told us "it's never happened, in practice, but there's a folder in the nurses' room which has the local arrangements and details for contacts."

"We have a very structured programme here for making sure staff can work safely and effectively." one member of staff told us. Another member of staff told us "It's a good staff team here and we all know that working for the people here is what we're doing."

It was clear from the documentation we reviewed that the feedback, from people who had used the service, together with reviews of complaints and incidents had been taken seriously and changes in service made as a consequence.