This inspection was carried out by one inspector on 16 and 18 January 2017 and was announced to ensure the Hospice at Home staff we needed to speak with would be available.

Phyllis Tuckwell Hospice Care (PTHC), also referred to as ‘the hospice’ throughout the report, serves the adult population of West Surrey and part of North East Hampshire. Services are provided from two locations; the Hospice in Farnham (In-Patient Unit, Community Services, Day Hospice, Out-Patient appointments and through Patient and Family Support) and at the Beacon Centre in Guildford. This inspection looked at the services provided at the Beacon Centre which included an Outpatient service, Day service; Community team and the Hospice Care at Home Team. In 2014 a joint proposal was submitted by PTHC and another local provider to their four Clinical Commissioning Groups (CCG) to integrate the EOL community services across the area. A new service contract was drawn up and the Beacon Centre was incorporated into PTHC in 2015. The PTHC has a large multi-professional team consisting of medical staff, nurses, social workers, therapists and chaplaincy supported by people facing volunteers.

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 2008 and associated Regulations about how the service is run.

The Beacon Centre provided an outstanding service that creatively enabled people to have the choice to receive end of life care (EOL) at home, if this was their preference, and responded promptly to clinical deterioration in times of need. People spoke of a service that was tailor-made for them, highly personalised and focussed on their individual needs and that of their families. PTHC had developed their community service innovatively with local agencies to ensure their local population would receive the support they needed at the time they needed it and in a way and place that best suited them.

People, their relatives, staff and professionals spoke overwhelmingly of the positive support, guidance and healthcare interventions people had received. They were full of praise for the staff in terms of their exceptional kindness, compassion and knowledge about end of life matters. Staff went out of their way to ensure people were involved in decisions about their care and used technology creatively to stay in touch with people. The day service used gardening interventions creatively as a therapeutic activity to entwine spirituality with rehabilitative palliative care. People told us this had brought them and their families hope and peace through the rhythms and cycles of life seen within nature and horticulture.

Managers showed outstanding leadership and they recognised, promoted and implemented innovative ways of working in order to provide a high-quality service. This forward thinking approach had resulted in a creative provider led commissioning arrangement to ensure people received high quality integrated community care to support their preference to receive end of their life care at home. The integration of the Beacon Centre into PTHC was managed creatively ensuring staff and people were involved in the development of the values and vision of the service. Governance of the service was of a high standard and robust quality assurance systems were in place that showed people were right to have confidence in this local hospice.

The hospice offered end of life care training opportunities for their staff and other health and social care professionals. Through this training and other service developments the hospice had enabled people to receive end of life care closer to home and reduced the need for hospital admissions. Staff were involved in the development of working practice, listened to and supporte