The inspection took place on 13 and 14 April and was unannounced. Wisdom Hospice is one of a range of services provided by Medway Community Healthcare. The hospice offers specialist palliative care, advice and clinical support for adults with life limiting illness and their families. They deliver physical, emotional and holistic care through a multi-disciplinary team of nurses, doctors, counsellors, social workers, occupational therapists, physiotherapists, spiritual leaders and a range of volunteers. The service cares for people in four types of settings: at the hospice in a 15 bedded ‘In-Patient Unit’; in the ‘Hospice day service’; in people’s own homes; and in hospital, where people received care from the hospital palliative care team, based at Medway Foundation Trust. The service was providing services for 392 people in the hospice and the community at the time of the inspection.

A registered manager was 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 said that they felt at ease receiving care from the service and relatives reported that people were in safe hands. Ensuring that staff understood how to safeguard adults and children was central to the running of the service. Staff received training and regular updates throughout the year and demonstrated that they knew how to recognise and report potential abuse.

Assessments of risk were individual to people’s specific needs and identified how risks could be minimised. Environmental and health and safety checks were carried out to ensure that the environment was safe and that equipment was in good working order. There were systems in place to review accidents and incidents and make any relevant improvements.

Checks were carried out on all staff at the service, to ensure that they were fit and suitable for their role.

People said that there were enough staff available to promptly attend to their needs. The numbers of staff and volunteers available meant that staff had time to give people one to one attention.

Safe systems were in place for the ordering, storage, administration, recording and disposal of medicines.

New staff received a comprehensive induction and received effective support from a mentor. Training was provided which was necessary to their roles and included specialist training in bereavement and end of life care to make sure that they had the right knowledge and skills to meet people’s needs effectively.

People’s health, medical, nutritional and hydration needs were assessed and closely monitored. People’s needs were individually discussed and effectively communicated when the staff team changed on the in patient unit. People were supported by a multi-disciplinary team and referrals were made to other professionals to seek their advice and input when it was required.

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 so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes, hospitals and hospices are called the Deprivation of Liberty Safeguards (DoLS). The service manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The service

We found that consent was sought from people about all aspects of their care and treatment and where people were unable to make decisions best interests meetings were held involving relatives and the health and social care professionals.

People experienced effective and safe care which met their needs and promoted their rights. Care was person centred and delivered by a skilled multi-disciplinary team. People told us that the staff and the services offered were “Superb, there’s no other word for it”.

We found that people were supported to receive food and drink that they chose, whenever they wished. One person told us “The food is excellent”.

We found that the risks of infection were reduced, because staff had received training in infection control and were knowledgeable about the actions they should take to reduce risks. Robust policies and procedures were also in place.

People using the service were protected from risks associated with inappropriate staff, because effective recruitment procedures were in place.

There were effective systems in place for monitoring the quality of the service. The systems were sufficiently detailed to ensure the service was fully complaint with the regulations we inspected. We found that there was strong leadership which helped continuously improve the service.

We spoke with people who used the service and relatives of people. We spoke with nursing and administrative staff as well as members of the management team and the Consultant in Palliative Medicine.

People told us that communication between them and the staff was excellent. People told us they were fully involved in decision making about their care. People received personal care in a way that promoted and protected their privacy and dignity. People told us that the staff were friendly and welcoming.

There were a range of activities and complementary therapies available for people, including massage, physiotherapy, sensory treatments, as well as arts and crafts.

People and relatives we spoke with said that the care and support they or their loved one received was outstanding. One person said “I can’t praise them enough” another said “You couldn’t wish for a better place”.

People said they felt safe and well cared for at the hospice and were confident that if they were unhappy with anything their concerns would be listened to and acted upon.

Staff told us that they received the training and support they needed to carry out their roles.

The service had a broad range of quality assurance processes in place which ensured compliance and maintained standards.