The inspection took place on 31 May and 2 June 2016 and was unannounced. At our last inspection the registered provider was meeting all the regulations that were assessed.

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 Hospice of St Mary of Furness is registered to provide specialist palliative care, advice and clinical support for adults with palliative care needs, life limiting illness and also their families. The hospice delivers physical, emotional, spiritual and social holistic care through teams of nurses, doctors, counsellors, a chaplaincy/ spiritual care team and complimentary therapists. The hospice worked with the palliative care consultant for the local NHS Trust to try to make sure the team provided seamless holistic care. The service provides care for people through an In-Patient Unit, a Day Service, and Hospice at Home. The hospice also offered a 24 hour telephone advice line for people and their carers to request help if there was a need for it.

The inpatient facility accommodated up to nine people and they were all within individual rooms. At the time of the inspection there were seven people using this service. The hospice at home service provided specialist advice with regards to symptom control and worked in partnership with health and social care professionals to ensure that people and carers received the best possible support whilst the person remained at home.

The Hospice of St Mary of Furness is located in a residential area of the market town of Ulverston. It is an older detached stone building with modern extensions to accommodate patients in individual rooms. The hospice has undergone substantial external and internal refurbishment to extend and improve facilities. The addition of an orangery has provided a place where patients and their carers and family can spend time together; staff can also use the orangery as a place to relax. Although built on a hillside, the hospice has level access for those with impaired mobility. The internal refurbishment has provided improved assisted bathing and showering facilities for patients and facilities for carers and family have also been improved.

People told us they felt safe while receiving services from the staff team and that “I have total confidence in the staff; they’re all highly skilled and know their jobs". We found during the inspection that the people using the hospice services were placed at its centre and were treated very much as individuals and with respect and compassion. People and their relatives told us that staff understood their specific needs. A person who had used the service told us “I certainly felt well rested after my stay and would recommend the Hospice to anyone”. We were also told "I am so at ease here" and how coming into the hospice was like "Being amongst friends".

Care plans in regard to all aspects of people’s medical, emotional and spiritual needs were personalised and written in partnership with people so their preferences were made clear. Staff delivered support to people respecting these wishes and preferences about their care and life choices. The catering team spent time with people to make sure the food and drink provided to people was of a high standard and that people could choose what to eat and drink whenever they wished to. We were told, “The food is absolutely excellent, better than a five star hotel and beautifully presented".

We saw staffing numbers and skills mix were planned to respond to changing needs and provide a high standard of care and to keep people safe. There were experienced palliative care nurses, health care assistants and nurse practitioners working on the inpat

We did not receive any negative comments about the nursing, medical or personal care received, the food served, the cleanliness of the hospice or the staff approaches and support.

We found that care plans were written in a person centred and holistic way and were based on a comprehensive assessment. People's physical and emotional care were being frequently reviewed in conjunction with other health and social care professionals. There were sufficient nursing, medical and care staff on duty on the day we visited with appropriate skills.

We saw that staff encouraged people to maintain their independence and control over their lives and be supported to make their own informed decisions. We saw that people were comfortable and confident with the staff on duty.

The hospice had a complaints procedure and reporting system in place. People told us they had not needed to make a complaint and had confidence in the nurses to support and help them if they did. We found that appropriate service records were kept and these were securely stored.

The provider had effective recruitment procedures in place and had carried out relevant checks on the staff they employed. This helped to make sure that staff and volunteers were suitable for working with the people using the hospice.

We received positive feedback from the people we spoke with and observed good interactions between people and staff when we inspected. We found that people who used the service were given appropriate information and support regarding their care or treatment. When we looked at care plans, and observed people in the hospice, it was evident that staff were skilled at supporting people throughout their illness. We saw that relatives were also supported and were included in the discussions regarding care and treatment.

People we spoke with said 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 we spoke with told us:

“Staff are very nice, they know what they are doing. They are excellent and wonderful.’

“Staff listened to and act upon my wishes.”

“The doctor tells me what is going on and visits me everyday.”

A relative told us:

“Staff let you know everything. Couldn’t be better, the care is terrific. Staff keep us well informed and the doctors tell us everything.”

When we inspected we found that the service had a quality assurance procedure and policies in place and evidence of an established, systematic and verifiable quality assurance and monitoring system in operation.