This inspection took place on 9 and 10 February 2016 and was unannounced.

We had last inspected this service in July 2013. That inspection had found the service had been meeting all the legal requirements in force at the time.

Thames Hospice - Windsor is a 17 bed inpatient unit delivering end-of- life care as well as assessment, care and treatment to people with life-limiting illnesses. People receive care and treatment at Thames Hospice when their condition is too severe for outpatient treatment and the symptoms cannot be relieved if they stay in their homes. People are also provided with care on a respite basis. At the time of our inspection 15 people were using the hospice service.

The registered manager has been in post as Director of Patient and Family Services for 10 months and has been the Registered Manager from 9 December 2015. 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.

Medicines were safely stored. However, we were not assured that medicines were always stored within their recommended temperature ranges, or appropriately ordered. We did not see that people had experienced any negative outcomes as a result of these shortfalls.

People said that they felt safe receiving care from the hospice. Staff had been trained in safeguarding adults and received regular refresher courses. Staff gave clear explanations of the different types of abuse to be aware of. They also demonstrated that they knew what steps to take in the event of any suspicion of abuse.

Risks to people’s safety were assessed and managed appropriately. Assessments identified people’s specific needs and showed explicitly how the recognised risks could be minimised. Environmental and health and safety checks were carried out to ensure that the environment was safe and that the equipment was in good working order. There were systems in place to review accidents and incidents enabling relevant improvements to be made.

There was a robust recruitment process and staff had undergone induction when they commenced their employment. Checks were carried out on all staff at the service to ensure that they were fit and suitable for their role. These included interviewing applicants and undertaking criminal record/barring checks and character references. Staff told us that they received support and supervision from their line managers. They understood their roles and responsibilities, as well as the guiding values of the hospice.

People said that there were sufficient staff available to promptly attend to their needs. Staff displayed patience in their interactions with people and relatives. They did not rush people and were ready to give support to them and their family members. Staffing levels were flexible and suited people’s individual needs.

Staff had been given training in safe working practices. They were provided with any personal protective equipment such as disposable gloves and aprons that were needed to keep them safe while handling potentially harmful substances but also to stop germs being passed on . Effective systems were in place to monitor and prevent cross infection at the service.

The hospice provided a relaxing, comfortable, clean and attractive environment. There was a quiet reflective area in the sanctuary and well-maintained gardens where people could spend their time.

The legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were being followed. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do

People told us they were very pleased with the care provided at the hospice. They said staff were responsive and caring. One person told us “Staff care for me, that’s what they do best.” We were told staff communicated well and worked well as a team.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. One person told us “Staff always gain my permission for care to be given to me.” Where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

Care was planned with the involvement of the people who use the service and their

relatives. People told us they were involved in discussions about any changes to their care. We found they were provided with appropriate care to meet their needs.

The provider had an effective recruitment, interview and selection process to ensure that people who use the service were not placed at risk of being cared for by staff who were not suitable to provide their care and treatment. Appropriate checks were always undertaken by the provider before staff began work. Examples included enhanced Criminal Records Bureau checks (now called Disclosure and Barring Service checks), full employment histories and health checks.

A system of staff supervision and appraisal was in place to support workers. Staff received appropriate training and professional development to enable them to deliver care and treatment to service users safely and to an appropriate standard.

There were processes in place for recording, investigating and resolving complaints from people who use the service and their relatives. The people we spoke with were aware of who they would speak to if they had any complaints.

During our inspection we met with five people who were receiving care; three sets of visitors and eight staff working in the service. People receiving care and their visitors were unanimous in their praise for the care they received. One person said that the care and compassion was "beyond words". Another person said that the staff should be given "top marks" for the care they gave.

People receiving care told us that the food was very good as was the way that it was served. People told us that their rooms were pleasant and that the general environment was good. People also said that they felt involved in their care and that they were treated with dignity and respect.

We observed that staff working in the service were professional and kind in their interactions. We saw staff delivering personal care showed due regard for the person's dignity. People told us that the staff responded to them very quickly and that they felt able to discuss any concerns or worries with the staff.

Care plans were found to be comprehensive and enabled staff to deliver individualised care to each person.

On this occasion, we did not speak to people using the services of the hospice. The purpose of our visit was to follow up on the action plan submitted to CQC following the findings of our inspection of the 22 November 2010.

There were a number of patients in the hospice on the day of the visit and in making our decision to talk to people who use the services about their experiences, we took into account their health and wellbeing.

People using the service provided very positive comments about the hospice and told us that they had been involved in decisions regarding their care and treatment. The standards of care and treatment were described as being “excellent. The staff can’t do enough for me”. We were told that the staff take into consideration the needs of the family too and involve them in decisions. Medical staff have been mindful of the family and we were told by one relative that the doctor had undertaken a discussion about treatment and care at the home of the patient.