This inspection took place on 6 and 7 April 2016 and was unannounced.

Treetops Hospice is registered to provide palliative care and support to people within their own home that have a life limiting illness, and includes providing a respite service for people’s relatives and carers. The aim of the hospice at home service is to enable people to remain at home as their preferred choice, to be cared for and to die at home, thus reducing unnecessary admissions to hospital. The services offered by Treetops Hospice supplement and complement existing service provision. At the time of the inspection there were 109 people using the hospice at home service. Treetops Hospice as part of its service provides counselling to people with life limiting conditions and those bereaved. And in addition provides complementary therapy and day care.

Treetops Hospice 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 who used the service and their relatives or carers told us they felt they received safe care from the staff employed by Treetops Hospice; which was confirmed by information gathered from questionnaires we had sent to those using the service.

The provider and staff were committed to promoting people’s safety across all levels of staff within the organisation and included, the meeting of a health and safety committee to review incidents. Policies and procedures were in place to promote the safety of its staff when working alone within the community.

Staff within the hospice at home service followed the risk assessments developed by health care professionals with primary responsibility for the provision of the persons care. Staff when visiting a person at home observed for potential risks. Where these were identified these were shared with the health care professionals who were responsible for assessing and minimising risk. So that people’s plans of care and risk assessments could be reviewed and updated.

Staff spoke positively about their induction and on-going training, which enabled them to meet people’s needs; this was confirmed by the completed questionnaires we had sent to staff. Staff had the opportunity to develop their skills through reflective practice when they met to discuss people’s care. This enabled them to further develop their understanding and awareness to improve the quality of the care they provided.

People’s physical, psychological and emotional needs were met as the provider employed sufficient staff from a range of disciplines to provide holistic care, which included the provision of the hospice at home service, day care and complementary therapies. People’s needs were regularly discussed and changes to people’s health and welfare were raised with health care professionals who had overall responsibility for managing people’s care. People we spoke with told us this was managed effectively so that information was shared amongst all those involved in their care.

The frequency of people’s support was planned by the hospice at home co-ordination team and led by a nurse with the involvement of people using the service and their relatives. The support provided was based upon people’s individual needs and took into account changes to people’s health in order that the service provided was effective.

The service supported people within the community providing psychological and practical support. People in some instances accessed the day care facility, which included complementary therapies, art therapy and social activities. People told us the day care facility enabled them to meet with people in similar circumstances and was a welcome part of their support.

People told us staff understood th

We spoke with people who used the service and staff at the Day Unit of Treetops Hospice. People told us staff were friendly and treated them with dignity and respect. One person told us “They do respect you; the care is extra special from the volunteers and staff.” People told us staff encouraged them to be as independent as possible and they were involved in decisions about their care and support.

People felt the service provided care that met their needs and they were involved in planning and reviewing their care. One person told us “They are very good here; they bend over backwards for you.” A second person told us “I don’t know what I would do without this place.”

People told us they felt the service was clean and had no concerns regarding control and prevention of infection. They told us staff were well trained and motivated and had the skills to deliver care that met their needs. This was confirmed by our observations on the day.

We saw that the provider had appropriate systems in place to monitor the quality and safety of the service and that people who used the service and staff had the opportunity to give feedback about their experiences of the service.

We spoke to people using the day care service. They told us they felt care staff always treated them with dignity and respect and were friendly and approachable. One person told us “They treat you equally, as an adult; they explain everything and don't talk down to you”. Another person told us “we are all treated with respect. They look after people splendidly”.

People told us they were happy with the care they received and felt involved in planning and reviewing their care. One person told us “the nurse in charge will come and look through the folder and ask if you have any problems, if you are better or worse than before”.

People told us they felt safe at Treetops and had never seen anything that caused them concern. People felt there were enough staff to meet their support needs and could raise an issue or give feedback about their experiences. One person told us “there are so many staff and volunteers there is always someone around to help us”. Another person said “ I have not had to make a complaint, but I could speak to my care worker and she would be happy to deal with it”.