This inspection was carried out on 29 and 30 October 2014 and the inspection was unannounced. We previously visited the hospice on 19 September 2013 and we found that the provider met the regulations that we assessed.

The service is registered to provide nursing care, including transport services, triage and medical advice provided remotely. The hospice has 16 in-patient beds and we were told that occupancy levels were usually between ten and 12 patients. Accommodation is provided in eight single rooms and two single-sex, four-bedded bays.

The provider is required to have a registered manager in post and on the day of the inspection there was a manager who had registered with the Care Quality Commission (CQC) in January 2011. 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 told us that they felt safe whilst using the hospice. There were sufficient numbers of clinical and non-clinical staff on duty and staff were well supported by doctors and consultants. Staff had been recruited following robust policies and procedures that ensured only people suitable to work with vulnerable people had been employed. Staff had undertaken training on safeguarding children and adults from abuse and other training that provided them with the skills to carry out their role safely and effectively.

The management of medicines was safe and people told us that their pain was being well managed. Patient’s nutritional needs were met and they told us that they were offered choices and that they could have snacks outside of meal times and during the night.

People’s individual circumstances and lifestyle had been taken into account when their care or treatment plan had been devised. In addition to this, people who were important to the patient had been consulted. Relatives and friends were able to visit the hospice at any time; they told us that they were always made welcome.

People told us that their privacy and dignity was respected by staff and that they felt staff really cared about them. Relatives also told us that they were also well supported; this included the bereavement counselling service. Health care professionals who we spoke with described the bereavement counselling service provided by the hospice as being very effective.

Liaison with other health care professionals was described as being effective, including the plans for patients to be discharged home.

There were clinical governance systems in place that monitored people’s satisfaction with the service and ensured that the policies, procedures and practices in place were followed so that people received the service they needed. Staff told us that they were well supported by the hospice and that their views were listened to.

The service was responsive to people’s needs and continually looked for ways to improve. They had taken part in pilot schemes that were aimed at improving care and treatment for people with chronic illness or who were recovering from illness, and had introduced a variety of support groups for people and their relatives / carers.

At the time of our inspection there were seven people using the service. We spoke with two people and four of their visitors to gain their views of the service. People told us all the staff communicated with them well so they understood the care and treatment choices available to them. One person explained: “The staff talk to us about my care and give us options. We can ask questions and the staff explain things.” A visiting relative told us: “The care here is good. I have no worries and nothing negative to report.”

We spoke with the Registered Manager and five staff members from a variety of roles working within the hospice about the care and treatment of people who used the service. All staff had a good understanding of the importance of promoting people’s independence, and recognising and respecting people’s individuality. They spoke knowledgeably about the needs of the people in their care. Staff told us they worked well together as a team.

We reviewed four people’s care records which documented multi-disciplinary discussions and communication with other agencies, such as people’s GP, hospital consultants, community based specialist nurses and social workers. We saw the records were fit for purpose and contained accurate assessments of people’s needs.

We saw people’s care records, staff files and other key documents were stored securely and could be located promptly by staff when required.

We spoke with four people who were using the service and two relatives. They all spoke positively about how the staff involved people in decisions about their treatment and care and how they acted in accordance with their wishes. For example, one person explained; “Staff always explain things and check out if it’s acceptable. I never feel coerced.” A relative told us; “They explain the choices and involve us in decisions about care.”

We reviewed three people’s care records and found they were comprehensive, clearly written and maintained to a good standard. The records contained information about multi disciplinary team meetings and discharge planning. A person told us; “The care is very good. There are social workers, therapists, nurses and doctors and lots of others in the team and they all play their part very well.”

We looked inside the room where medication was stored and saw this was done securely in locked cupboards. Two nurses were observed dispensing a controlled drug and saw this was carried out appropriately.

At the time of our visit we saw there were enough staff on duty to meet the needs of the people using the service. We also reviewed staff rotas which showed there were sufficient numbers of staff to meet people’s needs.

We saw there was an effective complaints system available. However low level complaints which meant it would be difficult to audit particularly in relation to trends and patterns for service improvement.

During the visit we spoke to two people using the service and two relatives. They told us they were very happy with the care and support they received at the hospice. People told us they were involved in decisions about their care and treatment and one person said they felt they were “part of the team”. They said the staff were “wonderful” and nothing was too much trouble. People told us there were enough staff to meet their needs and said that when they used the call bell staff answered quickly. People said the food was very good and said alternatives were always available if they didn’t want the meals on the menu.