The inspection took place on 16 May 2016 and was unannounced. At our last inspection the registered provider was meeting all the regulations that were assessed.

Eden Valley Hospice is located in the outskirts of Carlisle. It is registered to provide palliative and end of life care for up to12 adults and five children. The hospice has a 12 bed adult in-patient unit with eight single ensuite rooms and one four bed room. Care and support services for children and young adults with life limiting conditions are provided within a separate unit on the site called Jigsaw. Adults and children may be admitted for care during the last weeks and days of their life, symptom control, and assessment and / or respite care. There is a Day Hospice that provides care and support for up to 15 people a day, four days a week. The hospice provides bereavement support, complimentary therapies, counselling and carer support services and wellbeing programmes. There is a multidisciplinary team who are all experienced and trained in palliative care. Medical cover is provided by dedicated doctors who are supported by a Palliative Care Consultant.

At the time of our inspection there were 10 people using the adult inpatient unit and two children in Jigsaw.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run.

The management team demonstrated a desire to learn about and implement best practice throughout the service. There was a clear organisational structure and a visible management presence throughout the service. Feedback from people and families using the service, health and social care professionals and visitors was very positive and people praised the care and compassion of the staff and volunteers.

The hospice environment was calm and it was open to families to visit and stay 24 hours a day. Hospice staff facilitated pre and post bereavement support for children, young people and adults through the hospice’s family support team. Those offering bereavement support and counselling had specific training for this role in line with ethical practice.

We saw people had been able to discuss with staff their spiritual and cultural beliefs and how they wanted these to be met. There was a well established chaplaincy team to offer pastoral and spiritual support whatever a person’s individual beliefs.

Hospice nursing and medical staff spent time with people and planned ahead to find out what people’s needs and goals were. A holistic approach was used to help make sure people’s emotional, spiritual and social needs were met as well as their physical needs. This meant people approaching end of life or with life limiting conditions were supported to lead a full and meaningful life. People told us they could speak openly about what they wanted and how they felt about their illnesses and were given the information needed to help them make their own treatment decisions.

Records we looked at demonstrated that staff took a lot of time working with people and giving them the time and information they needed to make decisions about their care and treatment. We saw that this process was led by the adult or child’s family.

There was a safeguarding policy in place that included information about the protection of adults and children. The safeguarding policy covered both adult services and Jigsaw and referred to relevant policies and national guidelines.

There were policies and procedures in place covering all aspects of the management of medicines within the adult inpatient unit and the Jigsaw unit. Medicines were stored in appropriate cabinets and fridges and were administered in accordance with the prescriber’s instructions. Controlled Dr

People expressed their views and were involved in making decisions about their care and treatment. One young person we spoke with told us: “When I arrive we go sit in a room, go through any changes and updates and talk about what I would like to do, I am fully involved.”

We observed staff supporting people in ways which maintained their dignity. Staff communicated clearly with people, asked prior to carrying out any tasks and ensured people were in private if they required personal care.

People we spoke with in the adult unit told us: “I couldn’t get any more benefit from being here,” “They are kind, do what I ask, absolutely brilliant,” and “Staff check on you all the time to make sure you are okay, everyone is willing to help.”

We looked at care records for both children and adults and saw people’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

People's health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services. This was because the provider worked in co-operation with others.

The staff were able to demonstrate clear understanding of their roles and responsibility to safeguard children and adults from abuse and to keep the environment safe.

The provider had an effective system to regularly assess and monitor the quality of service that people received.

The people we talked with, who were using the services of the Eden Valley Hospice, all expressed satisfaction with the support and services they were receiving. People told us that the staff looked after them well and their needs were being met. We observed staff engaging with people in ways that demonstrated that they were trained and experienced to deliver appropriate and sensitive support.

People told us:

“Staff listen to and act upon my wishes.”

“I have a choice to become involved, or not involved, with activities.”

“I am spoken to in a polite and pleasant manner.”

A relative told us:

“They don’t just care for the person they care for the whole family.”

In the patient satisfaction survey regarding how people found staff, one person had recorded; ‘no comparison with the hospital. Staff are very nice, they know what they are doing. They are excellent and wonderful.’