During our inspection, we spoke with thirteen people who used the service and five relatives. We also spoke with eleven members of staff, the registered manager and two visiting health and social care professionals. People or their relatives were either receiving care and treatment from the inpatient beds at the hospice, the community managed beds at the hospice or they received care in their own homes. We also spoke with people who were receiving support from the hospice’s ambulance transport service and people who accessed the telephone help line for advice.

People told us they were involved in the planning of their care and they had choices about how they spent their time. One person told us how staff respected their choices and supported them to smoke, "The staff help me to have a smoke by taking me outside".

People told us that they or their relatives received the care they required in a professional manner that promoted their dignity. One relative said, “If we could have this standard of care everywhere, then people would die with dignity”.

We saw that people were protected from the risk of harm because staff were aware of how to identify and report abuse. Systems were also in place to check that staff were suitable to work with vulnerable people before they were recruited.

We saw that there was an effective complaints system in place and people understood how to complain because information explaining how to complain was readily available.

We carried out this inspection of the in patient unit as part of our schedule of inspections to check on the care and welfare of people using this service. The visit was unannounced, which meant that the registered provider and the staff did not know we were coming.

We spoke with four people using this service and three people visiting this service. People using the service told us they were happy with the care provided. One person said, “It’s like a five star hotel”. Another person said, “Coming here is like having a comfort blanket”.

During our inspection we observed staff treat people with care and respect. We saw that people were offered choices and that staff had a good understanding of people’s individual needs. People using the service told us how they were involved in the planning of their care and that their dignity and independence was promoted at all times.

During our inspection we observed that medications were kept safe and secure. People told us that they were regularly involved in their medication reviews.

Staff told us that they receive regular support and training to enable them to provide specialist care. People using the service spoke positively about the staff. One person said, “The staff are very willing and do everything with a smile on their face”.

We saw that the service had effective systems in place to monitor and improve the service. These systems involved consulting with people using and visiting the service.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

Our inspection was unannounced which meant the service and staff did not know we were visiting.

The Douglas Macmillan Hospice provides care and treatment to people using the 28 bedded inpatient unit, three community led beds, the hospice at home service, the domiciliary care service and outpatient clinics. People may also receive support from the hospice's ambulance transport service and a telephone advice line. All these services provide specialist palliative and end of life care to people with progressive, advanced disease and a limited life expectancy. The hospice also runs a day therapy unit that provides a service for up to 25 people per day. This service falls outside of our regulatory role, therefore we did not include this in our inspection.

At the beginning of our inspection there were 26 people using the inpatient unit, three people were using the community beds, 708 people were using community and outpatient services and 37 people were using the domiciliary care services. There were 75 people using the hospice’s transport service to access the day therapy unit, and in the two weeks prior to our inspection 175 calls had been made to the telephone advice line.

Care and support was provided within the hospice environment and within people’s own homes dependent upon their care preferences and needs.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People and their relatives told us they were very happy with the care. We saw that people were treated with dignity, respect and compassion. People were involved in the planning of their care which meant their care preferences and choices were identified so they could be met by the staff.

People were safe because there were effective systems in place to help manage the risks posed to people. For example procedures were in place to protect people from the risks associated with medicines and the risk of falling.

There were sufficient numbers of staff to meet people’s individual needs and keep people safe. Volunteers were innovatively used to help manage the risks posed to people and to improve the effectiveness of the care.

The staff and volunteers were trained to provide the specialist care people required. A holistic approach to care was used which meant the staff treated the whole person and their family rather than only treating the person’s medical condition. People’s health and wellbeing were closely monitored so they could receive the right care at the right time.

The staff worked closely with other professionals and services so that people received consistent care. The staff responded positively and inclusively to people’s changing needs and the diverse needs of the local population.

The staff worked with people on an individual basis to plan their end of life care. When people required end of life care, it was provided with the aim of achieving a private, dignified and pain free death.

The legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were being followed. The Mental Capacity Act 2005 and the DoLS set out the requirements that ensure where appropriate, decisions are made in people’s best interests when they are unable to do this for themselves.

Managers regularly assessed and monitored the quality of care by completeing audits and seeking feedback from people who used the service and the local community. The service actively engaged in project work and research to identify best practice and make improvements in care.