This inspection took place on 14 and 15 March 2016 and was unannounced.

St Richard’s Hospice provides care and treatment to people using the17 bedded inpatient unit, day service, community nurses and hospice at home service and outpatients clinics. People may also receive support from the hospice’s transport and a telephone triage service. All these services provide specialist palliative and end of life care to people over the age of 18 with life limiting illnesses. (Palliative care is comprehensive treatment of the discomfort, symptoms and stress of serious illnesses). At the time of our inspection eight people were using the inpatient unit service.

There was a registered manager in post who was also known as the care director. 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 felt safe while receiving services from the staff team. Staff understood how to identify report and manage any concerns about people’s safety and welfare. There were arrangements in place to assess and manage risks to people’s safety. This included staff having the skills to effectively manage people’s medicines to ensure these were available and administered safely to people. There were sufficient staff with a wide variety of skills to meet people’s individual needs and to respond flexibly to changes in people’s identified risks.

Staff and volunteers had been suitably recruited and benefitted from an education and training programme which was well established. A strong partnership link had been made with a local university to deliver training around the subject of palliative end of life care. Staff were highly motivated and felt supported to continue with their learning. This supported staff to be effective in meeting the care and treatment of people with life limiting illnesses.

Staff and volunteers worked alongside people to enable them to live life as fully as possible. People were supported in achieving their goals with key comments from staff who held the belief of `people mattered`. People were treated with respect by staff who strived to support each person’s end of life care needs and wishes to achieve a private, dignified and pain free death. People who used the services and family members were provided with the emotional, spiritual and bereavement support they needed.

There was a strong sense of staff placing people at the heart of all the care and treatment provided. People benefitted from consistency of care and treatment due to the different services which had been developed both in the hospice and in people’s own homes. Staff understood what was important to people and worked closely with each other and family members and did all they could to meet each person’s individual wishes and requests. This included the determination to go the ‘extra mile’ when faced with adversity so people continued to receive the care and treatment they needed. Creative ways were explored to make sure food and drink were provided to a high standard and people could choose what to eat and drink and when.

People’s individual needs were assessed and staff always encouraged people to make their own choices about their care and treatment. Where this was not possible issues of consent and decisions were made in people’s best interests by a family member or a health and social care professional who had the authority to do this.

The management and staff team undertook work in the local community to promote greater awareness and understanding of end of life care. Strong relationships had been developed with local healthcare services so people received any specialist support they required. This helped people to receive seamless care and treatment through shared worki

When we visited St Richard's hospice in patient unit (IPU) we found that twelve people used the service and we met and spoke with one of these people. We spoke with three relatives of people who used the service. We spoke with four members of staff who delivered care, the registered manager and the medical director. We read the care records for four people and five care staff records.

We found that the provider had systems in place to gain the consent to care and treatment of people who used the service.

We found that staff had an understanding of the needs of people who used the service. We found that care and treatment was planned and delivered in a safe way, which met people's individual care needs. People we spoke with were positive about the care they received. One person told us, "I can't speak highly enough of this place, it's clean, really well designed and the staff are excellent."

We found that people's dietary needs were met and that people had a good choice about what they ate. We found that there was an effective recruitment process in place to ensure that staff had the skills to meet people's needs. One relative told us, "It's amazing, the food is brilliant and nothing is too much trouble for the staff."

We found that systems were in place to effectively deal with complaints. The provider monitored the quality of the service and had made improvements where needed. One relative told us, "This place has made such a difference to the whole family."

We spoke with three people who were receiving care and treatment on the Inpatient Unit (IPU) and four people who were visiting friends or relatives. The people we spoke with were complimentary about the hospice and its staff.

One person who was visiting their relative told us,” We can’t fault the experience.” A person who was receiving treatment said, “It’s fantastic. Not hospitalised. It’s friendly and lovely. The staff are fantastic, always there.” Another visitor told us, “The staff are very caring, like family.” One person said, “I’ve heard about the staff in these places, but I was amazed when I came in and saw it for myself.” They said, “It’s not just a job for them. They think about what they’re doing. It puts you at your ease.”

Staff knew about the needs of the people they were providing care to. We looked at care plans for three people who were receiving care and treatment and found that these contained guidance for staff on how to meet their needs. We saw that people’s needs were reviewed regularly to make sure the provider was meeting them appropriately.

We found that people who used the service felt safe there, that staff had received training in safeguarding, knew how to raise concerns and felt they would be supported by the provider if they did raise concerns.

We saw that staff were supported to be trained to an appropriate standard and we looked at records which showed that the provider was regularly monitoring the quality of its service.

When we visited St Richard’s Hospice we met people who were using the service and some visitors. We spent time speaking with people who used the Day Hospice. These were people who had spent time as a patient on the In-patient Unit (IPU) and we also spoke with people who were currently being cared for on the IPU. People told us that before they spent time on the IPU they ‘never knew what a hospice did. I thought you came here to die’. It did not occur to me that you can go into the In-patient Unit and come out and live a lot longer’. People said that St Richard’s is a place where ‘all they are interested in is making you feel less worried and accepting of your condition’.

People made the following comments to us about St Richard’s:-

‘I do not know what I would have done without this place’.

‘Brilliant, they do everything to make things as easy as they can do’.

‘Nothing is too much trouble’. ‘If you use your call bell two staff appear straight away. They are always smiling and there is never any negativity from them at all’.

‘They all deserve a saint hood’.

‘Very privileged to be treated here’.

‘Good volunteers’.

‘Staff and volunteers are amazing’.

‘At night if you ring the bell, you know they will come’. ‘The staff are most caring people. They are absolutely wonderful’.

‘The care is amazing’.

‘I can’t believe how good this place is’. ‘All the staff are super to me’.

‘I felt so much better after being treated at St Richard’s’

‘Coming to St Richard’s is the right place. The staff are not rushed off their feet; they listen carefully and do their best to help us’.

‘You are kept pain free’.

‘It’s very good to talk to the chaplains’.

‘I did not like sharing a room’.

‘I will live much longer due to being a patient on the IPU’.

‘The place is a god send’.

‘I feel comforted here, which is a big healer’.

‘There is a feeling of tranquillity and peace here’.

‘The food is superb’

‘The food is always superbly cooked’.

‘The food is excellent’.

We looked at the provision of care and found that people were receiving effective and appropriate care, treatment and support to meet their personal needs.

We found that people benefitted from safe quality care and support as effective systems were in place to identify and manage any risks to their health, welfare and safety. This could be further improved through closer auditing of care records to ensure that they accurately reflected the actual care being given to people.