This inspection took place on 24 and 25 May 2016 and was unannounced.

Hospice of St Francis is registered to provide palliative and end of life care, advice and clinical support for people with progressive, life limiting illnesses and their families and carers. They delivered physical, emotional and holistic care including bereavement counselling support for children as well as adults, an outpatient service, occupational and creative therapy, complementary and physiotherapy, spiritual support, social workers, clinical nurse specialists and volunteer services.

The hospice inpatient unit cared for up to 14 adults who required symptom control or end of life care. They delivered physical, emotional, spiritual and holistic care through teams of nurses, doctors, counsellors and other professionals including therapists. The service provided care for people through an ‘In-Patient Unit’ and the `Spring Centre` which included the community service.

The Hospice at Home service provided palliative and end of life care and support to people and their families in their own home during the day, six days a week with access to doctors, registered nurses and care assistants. They worked closely with a partner hospice to ensure if a person needed support during the night this was accommodated.

At the time of the inspection there were 12 people using the inpatient service. The Spring Centre community service reached out to 400 people. The Spring Centre offered a range of services to people recently diagnosed with life limiting conditions, their carers and families. The service provided outpatient clinics, specialist advice, courses, complementary therapy sessions and many other opportunities for people and their families to learn to cope with their illness or their loss.

Hospice of St Francis had a registered manager in post. 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 received excellent care, based on best practice from experienced staff with the knowledge, skills and competencies to support their complex health needs. Staff were trained in how to protect people from abuse and harm. They demonstrated a strong sense of responsibility and in -depth knowledge about safeguarding issues and were confident in the procedures they had to follow in reporting any concerns or potential abuse internally and externally.

Risks to people`s well-being were assessed by staff daily and they discussed with people the measures needed to mitigate these risks. Staff respected and recorded people`s choices if they agreed or not to have measures in place to mitigate the risks.

Staff from the community services communicated any risks to people`s health and well-being to health and social care professionals involved in people`s care in the community and also in the regular multi-disciplinary (MDT) meetings they had daily in the in-patient unit. Staff followed up and reviewed risks regularly to ensure these were appropriately managed and mitigated.

People and families received outstanding care from exceptional staff and volunteers who developed positive, caring and compassionate relationships with them. The service promoted a culture that was caring and person centred. Staff worked together as a multidisciplinary team to provide seamless care for people.

People and their relatives were overwhelmingly positive about staff`s approach, kindness and devotion they showed towards meeting people`s needs. People told us staff helped them to live their life in comfort and pain free which improved the quality of their life. Staff anticipated how people felt when planning their care and support so people felt valued and understood.

People were partners in their care, and

We inspected The Hospice of St. Francis and found that the Hospice was currently undergoing refurbishment and redecoration. We found the staff to be caring and compassionate towards people who used the service and their families. We saw that each person’s wishes had been respected by staff and there was excellent communication between them. When we spoke with relatives they told us that staff were 'just so caring'. People told us that St. Francis was 'a completely different world' and was like 'utopia' for them. We were told that staff and doctors communicated with people daily and kept them informed of any changes and that 'every level of staff, from the chef, nurses, volunteers and doctors were willing to help', and 'they make us feel lucky to be here'.

We found that the home was meeting the regulations. People were well cared for and their care plans reflected the care and support that had been provided to them. People had a choice of nutritious meals and staff were aware of peoples preferences. The provider had a detailed infection control policy in place and regularly carried out audits and cleaning checks in the home. There were sufficient numbers of qualified staff at the service to provide care to people and to support their families. The provider had a detailed complaints procedure in place and all complaints received had been recorded along with the outcomes.

During our inspection on 26 February 2013 we found that people were provided with information about the treatment they were to receive, and people were spoken to with patience and respect. We found that where people were unable to provide consent, the hospice acted in accordance with legal requirements. One person who used the service told us that, “They ask my permission for everything they do to me, and they are wonderful.”

We found that people were cared for and treated individually, one member of staff told us that, “Through our daily handovers, team meetings, knowledge of the person, and support from the doctors, we constantly review a person’s condition. It depends entirely upon that person who needs the care.” Records relating to people who used the service were clearly written, free from jargon, and focused on the person's individual needs. We saw that records were accessible to all staff and were stored and destroyed safely and securely.

The building was purpose built and suitable for the type of service operating. People were adequately protected because the provider had taken steps to ensure the building was safe. The grounds, decoration of the building and equipment in the rooms were sufficient for people's needs.

We found that appropriate checks were carried out when recruiting staff, and that staff were sufficiently qualified and knowledgeable to perform their role.

People we spoke with during our visit on 05 January 2012 overwhelmingly told us of the excellent care they received at the hospice. People told us they felt involved in their care and treatment, and that staff asked their permission and gave explanations before carrying out care interventions. People told us that staff were respectful and attentive, and that they felt staff listened to their wishes. People told us they felt safe at the hospice, and that they could speak to the staff if they had any concerns, and did not have any worries about the staff’s ability to care for them appropriately. People told us they were able to give their feedback to staff about their wishes, and felt that staff listened and responded to their comments. People’s feedback from the questionnaires given to them following discharge showed that people were extremely happy and grateful for the care they received at the hospice, with people referring to the staff as ‘angels’ and ‘superb’.