This inspection took place on 28 September and 12 October 2016 and was unannounced. The service last had an inspection on 5 March 2014 and found that the regulations we checked were met.

Greenwich and Bexley Community Hospice provides specialist palliative care and support within the Greenwich and Bexley Boroughs. We refer to the service in this report as the Hospice. The Hospice has a 19 bedded inpatient ward and provides a community hospice service to people in the London boroughs of Bexley and Greenwich. It also provides a day hospice service, a rehabilitation service, hospital based palliative care service, care homes support service and a counselling service.

On the first day of our visit there were 17 people using the inpatient ward. The provider informed us that 543 people were receiving a service from the hospice at the time of the inspection. This number included people under the care of the inpatient unit, day hospice, community services, hospital palliative care team, counselling team, rehabilitation and the social worker.

At the time of the inspection the service did not have a registered manager. A new manager had been appointed and they had applied to become the registered manager. 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.

Staff were recruited carefully so people could be confident that the staff who cared for them were suitable to do so. The hospice had a number of volunteers who were also appropriately recruited and who received relevant training to fulfil a range of duties.

People were cared for by sufficient numbers of staff to meet their needs promptly. Staff were caring and understood people’s and their relatives’ concerns. People’s privacy, dignity and confidentiality were protected. Staff were well supported and trained for their jobs and people benefitted from their care.

Hospice staff worked well with other health professionals and people benefitted from the coordinated healthcare. Staff promoted the importance of good nutrition and hydration. They supported people to eat meals they enjoyed, to drink enough and to maintain a balanced diet where possible.

Staff were trained in the principles of the Mental Capacity Act 2005 (MCA) and knew when to apply these. People's rights were respected and when necessary decisions were made in people’s best interests.

Care planning took people’s needs and preferences into account and advance care plans were created as required according to people’s wishes and preferences. The provider arranged for a number of social and recreational activities to take place in the day hospice which people using the Hospice services, including in-patients could access.

The Hospice had various initiatives to encourage people with end of life care needs to use their services. These could be people who might not have been referred to or thought of using the hospice’s services and included people with dementia, older people within the community and people with diverse needs.

People and relatives had the opportunity to give their views about the quality of the service. They were listened to by staff and managers and people’s feedback was used to improve services. The provider had an effective complaints process that people using the service were aware of.

Managers carried out regular audits and made reports to senior managers so they could monitor the quality of the Hospice’s services and make improvements where they were judged necessary.

The Hospice was involved in various projects and was part of various groups and initiatives to advance the provision of and improve the delivery of quality end of life care to people.

On this occasion, we did not speak with people using the service as part of our inspection.

At our visit we found that the provider had made improvements to ensure that care records and documents related to significant decisions were up to date.

People and family members we spoke with told us they were very satisfied with the care provided at the hospice. Comments we received included, "I am very well looked after here, I have no complaints,” "the care here is excellent.”

At our inspection we found that people received care based on an appropriate assessment of their needs. Staff were well supported and worked with other health and social care professionals to ensure people using the service received safe and effective care.

However, we also found that people’s care records were not up to date in all cases.

Patients and relatives we spoke with told us that the care on the ward at the hospice was "second to none" and that staff were "always at hand". We were not able to speak to patients or staff from the day care facility which was closed during our visit. However,we saw that the same policies, governance arrangements and training apply throughout the hospice.

People we spoke with told us that communication was good amongst staff and patients, and between the hospice service and the outreach services in the community. Patients said they felt secure and well cared for. We saw that people were treated with respect and involved and supported in decisions about their care and treatment. Quiet rooms were readily available for patients and relatives, and we saw that individual needs had been assessed with patients and recorded in their care plans.

Patients were protected from abuse and staff respected their human rights. The hospice had made suitable arrangements to ensure that people are safeguarded from the risk of abuse, including policies and guidance, meeting with local safeguarding boards and training for all staff.

Patients at the hospice are cared for by staff with the right knowledge, qualifications and skills to support people. There is work in progress for further training during 2013.

The hospice has systems in place to monitor the quality of the service and has shown how patient, relative, and staff feedback has informed and developed practice.

People we spoke with told us they were happy and satisfied with the service. They told us they were well looked after and the staff were friendly and supportive. One person said, “the staff work really hard here.”

People told us that they were happy with the care at the hospice. They said that they were well cared for and "felt very supported."