Hospiscare is a charity which was founded in 1982 as a community service which expanded to include the building of a purpose built inpatient unit in 1992. Hospiscare serves the people of Exeter, Mid and East Devon. In 1995 Hospiscare appointed a specialist nurse to work at the Royal Devon and Exeter Hospital to visit patients and provide education and this has grown to a small specialist team. Hospiscare provide palliative and end of life care, advice and clinical support for people with progressive, life limiting illnesses and their families and carers. They deliver physical, emotional and holistic care including counselling and bereavement support, outpatient clinics, occupational and creative therapy, complementary therapy, chaplaincy and volunteer services. The hospice inpatient unit at Searle House Hospice is registered to provide care for up to 12 adults who require complex symptom control or end of life care. The average length of stay is two weeks. The service provides acute care for people and does not provide a respite service or have longer stay beds. In 2006 a new visitor accommodation was opened allowing families to stay close to the ward. The majority of people are cared for in the community, currently around 770 people. Last year Hospiscare cared for 2,225 people, their families and loved ones. The service also has sister charities which provide community care for people in Exmouth, Budleigh Salterton and Sidmouth and three day centres, a Wellbeing Suite in Exeter and day centres in Tiverton and Honiton.

The service continuously looked at the local community to see how best they could provide the service. This had resulted in the expansion of day service provision and the Hospice at Home service in Seaton, East Devon. This comprised of a team of registered nurses, community nurse specialists and health care assistants working closely with local GPs. This meant that people in Seaton benefitted from a holistic service from the Hospiscare Hospice at Home team who could also provide district nursing support in people’s homes therefore maintaining consistency and reducing the number of professionals visiting their homes. The Hospiscare Hospice at Home service started in July 2015 and provides responsive end of life care and support to patients and their families in their own home or a care home. The service operates 24 hours a day, 7 days a week with access to doctors, registered nurses and health care assistants as well as ancillary staff and therapists.

The Hospice at Home staff were all employed by Hospiscare and worked with other health care professionals in the community. Services were free to people and Hospiscare was largely dependent on a large team of volunteers, donations and fund-raising. A comprehensive training centre in Exeter also offered advice and support to Hospiscare staff and external health professionals such as those in nursing and residential care settings in the community. The service had also recognised a need to provide specialist training and end of life care for people living with dementia and their carers, recently employing a specialist dementia care nurse, and had established links with the local prison service. The service was outstanding in the way they explored and maintained close partnerships with a wide range of external services providing end of life care such as other charities, community health professionals, hospitals and on-call out of hours services, agencies and care providers. The service worked in partnership with other organisations to drive improvements at national level for the benefit of people who used hospice services as a whole .

This inspection was carried out on 21, 22, 24 March and 11 April 2016 as it was a large service covering Exeter, East and Mid Devon. It was carried out by a lead inspector, a bank inspector, a pharmacist inspector, an expert by experience and a specialist advisor in palliative care. It was an unannounced inspection. There was a manag

We spoke with one of the patients and two family members.. All spoke very positively about the hospice. One person said "There is absolutely nothing to criticise here. It is excellent". Another told us "They all show such loving care and compassion"

We observed that people's privacy and dignity were respected and that they were included in making decisions about their care. They were encouraged to be as independent as possible and their families were encouraged to spend time with them. One relative commented "The children have seen grandpa every day".

The grounds and buildings were well designed and maintained. Relevant safety precautions were in place and specialist equipment and engineering systems were regularly tested.

There was a team of skilled and committed staff who provided a sensitive and caring service. The staff were supported and managed effectively and were encouraged to update their skills and knowledge. They demonstrated a good understanding of the needs and wishes of patients and their families and created a friendly, safe and welcoming environment.

We spent a day at the service observing care and reading records. We spoke with three people and five relatives about their experiences of care and treatment. We looked in detail at the care records of five people, two of people having day care services and three in patient records.

People and relatives we spoke with were very positive about the professionalism and caring attitudes of all staff. They said staff knew how to provide the care they needed, treated them with dignity and respect and involved them in making choices about their care. One person said, I’d give this place 101% for the care they give to the patient and the carer” another said “I’d give them five stars”. A third person told us, “I couldn’t wish for any better, the treatment and care her is absolutely amazing, nothing is too much bother, day or night”. One relative said, “I don’t think they could improve on anything”, whilst another said, “It’s fantastic, they also care for the relatives here”.

We spoke to 21 staff which included the registered manager, chief executive, doctors, nurses, support staff and volunteers who worked at the hospice. Staff demonstrated they were confident about discussing options for care and treatment and supported people to make decisions. We saw evidence of good communication and multidisciplinary working between all members of the team.

We found that Hospiscare was compliant with the six outcomes we inspected.