We inspected this service on 6 and 7 June 2016 and we gave short notice to the registered provider prior to our visit. This was to ensure that key people were available during the inspection.

The Hospice of the Good Shepherd provides specialist palliative care to persons over the age of 18 years. It also provides respite care for people with complex nursing needs. There is an inpatient unit with 12 beds and a day care facility with 10 places. The Hospice provides specialist palliative care through a multi-skilled and qualified staff team. They are able to offer a range of medical treatment and complementary therapies to address symptoms, enhance quality and life and meet a patient’s holistic needs which include physical, emotional, psychological, spiritual and social needs. Their end of life care provides support, dignity and comfort to those in the terminal stage of an illness. The hospice also provides complementary therapies and counselling services to families, though these services fall outside the regulatory framework of the Health and Social Care Act 2008. The service is situated in the suburbs of Chester, close to a range of local shops and other amenities. Car parking is available to the side and rear of the premises.

During the past year the hospice has provided 358 In-patient stays and had 360 day therapy attendances. There were also over 800 medical consultations in hospice out-patients and day therapy.

At the time of this inspection there were eight inpatients at the hospice.

The previous inspection was undertaken in January 2014 and the service had met the regulations in place at that time.

There was a registered manager in place at this service, who has been registered for two and a half years. 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.

We have made recommendations about the management of medicines because these were not always safe, although the management said they would follow this us this was the findings at the time of the inspection.

People told us that they received very good quality of care from all the staff at the hospice. People told us they staff were kind, patient and caring towards them and that they supported them to meet their physical, social and emotional needs. People described the culture of the service as positive and caring.

People told us they felt safe at the service with the staff team. Staff had been trained to recognise and report any signs of abuse. No safeguarding issues had arisen at the service since the last inspection.

Care plans were person-centred and kept up to date. End of life care was given in sensitive and appropriate ways that acknowledged people’s rights and preferences. The service promoted a “focus on living” approach to care which supported people and their families to enjoy the time they had together and enhance their feelings of well-being.

The staffing levels were good and sufficient staff were seen on the days the inspection took place. Staff were well trained and had access to a variety of training courses to enable them to develop their skills and knowledge base. Good support was given to staff by senior management and regular meetings and supervision sessions were undertaken.

Robust staff recruitment processes were in place which ensured that only staff who met the service’s high specifications regarding experience and qualifications, character and caring abilities were employed. This included the recruitment of volunteers.

People told us the food was very good and that they had access to snacks and drinks whenever they wanted them. Care plans showed that a nutritious diet was encouraged.

The service worked closely with other professionals and agencies to ens

People told us that they were happy with the service and felt well cared for. One person in the day care unit said "I don’t have any concerns about the service. It is wonderful and I couldn’t fault it". Patients in the inpatient unit said "It's great, I've no complaints" and "The care is fantastic".

Patients said the food was good. One patient said "The meals are very nice. You can have a three course meal for lunch if you want and you can ask for anything you fancy." Visitors also confirmed the food was good and that they were offered refreshments when they visited. They said they could have a full meal for a small charge.

We found that appropriate equipment was provided and it was properly maintained.

There were effective recruitment processes in place to ensure that staff were appropriately skilled and suitable for the job. Patients and visitors were complimentary about the staff. One visitor said "They really care and they are very supportive of all the family".

There was an appropriate complaints procedure in place, although the service had not received any complaints in over a year and CQC had not received any concerns.

Patients told us that they were happy with the service and well cared for. Records showed that care and treatment were planned in consultation with the patient and their family. The care included spiritual and emotional support for both the patient and their family.

We spoke with four people staying in the hospice who confirmed that their care had been explained to them. One person told us “they always explain what they are doing to me before they do it”. Each person we spoke to confirmed that each member of staff explained to them who they were and what care or treatment they planned to carry out.

We saw that people were being given their medicines as prescribed by their doctor.

People we spoke with were complimentary about the staff, said that their needs were met by the number of staff provided and that call bells were answered promptly. We spoke to three members of staff, who all said that they felt there were enough staff to meet the needs of the people in the hospice. One member of staff told us "It’s nice to have the amount of staff that gives you time to spend with patients”.

The premises were well maintained and there were plans to improve the bathroom facilities and accommodation for relatives who wished to stay overnight.

We spoke to a sample of patients receiving care at the hospice and two next of kin We asked their views about the service.

They told us they were receiving "very good care”; “the best”

They felt that all aspects of their care and support was of the highest standards and that the staff took all of the stress of making arrangements for them going home.

Patients told us they were asked daily about their care and that they were always asked for their consent. They felt well respected and told us they were treated with dignity.

Relatives told us they were also well looked after and made to feel comfortable and supported and encouraged to stay as long as they wanted. They were offered meals and alternative therapies and helped to stay overnight with their relative if they wanted to.

We had also contacted the infection control team before we visited the service. They had no issues of concern to report about the service.