This inspection took place 29 and 30 June 2016 and was unannounced.

The inspection was carried out by two inspectors, a pharmacy inspector and a specialist advisor.

Keech Hospice Care is a purpose built hospice on the outskirts of Luton. The service provides 15 overnight beds, a palliative care centre and a hydrotherapy pool. The service provides nursing care to adults and children, many of who may be experiencing physical disability, life limiting conditions and or terminal illness.

There was a registered manager in post.

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.

People felt safe. Staff had received training to enable them to recognise signs and symptoms of abuse and how to report them. People had risk assessments in place to enable them to be as safe and independent as they could be.

Effective recruitment processes were in place and followed by the service which ensured staff working at the service were suitable. There were sufficient staff, with the correct skill mix, on duty to support people with their care and treatment needs.

Medicines were managed safely. The processes in place ensured that the administration and handling of medicines, including controlled medicines, was suitable for the people who used the service.

Staff received a comprehensive induction process and on-going training. They were well supported by the registered manager, Chief Executive Officer (CEO) and their line managers. Staff had access to a range of differing levels of support.

Staff had attended a variety of training to ensure they were able to provide care based on current practice when providing care and treatment for people.

Staff gained consent before supporting people or providing care and treatment. People were supported to make decisions about all aspects of their life; this was underpinned by the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff were knowledgeable of this guidance and correct processes were in place to protect people, children and young people.

People were able to make choices about the food and drink they had, and staff gave support when required. Catering staff had good knowledge of the types of diets people had and catered for them effectively.

People were supported to access a variety of additional health professional when required. Some medical procedures were carried out in the Keech Palliative Care Centre, which cut down on hospital appointments for people. Alternative therapy was available including; aromatherapy, Indian head massages and reflexology as well as music and art therapy.

There was a support programme, manned 24 hours to provide a single point of contact for additional support.

Staff provided care and support in a caring and meaningful way. They knew the people who used the service and their relatives. People and relatives, where appropriate, were involved in the planning of their care and support.

People’s privacy and dignity was maintained at all times. People were asked for their feedback, which was analysed, and actioned if required. A complaints procedure was in place and accessible to all. People knew how to complain.

Effective quality monitoring systems were in place. A variety of audits were carried out and used to drive improvement if required.

During our visit to Keech Hospice Care on 3 July 2013, the focus of our inspection was the children's unit. We spoke with the parents of some of the children using the service at the time of our visit. The people we spoke with told us their children received a thorough assessment of their needs and staff were very good at meeting those needs. They said they felt their children were safe and well cared for at Keech Hospice Care by professional, knowledgeable and friendly staff. In general, the people we spoke with had no complaints about the service. One person said of Keech Hospice Care: "I would tell anyone in my position that it has to be Keech." Another person said: "It's fantastic and I'd highly recommend them."

We found that each person received an assessment of their needs and these were regularly updated. The assessments were used to develop support plans of how the service would meet each person's needs. We saw that arrangements were in place to deal with foreseeable emergencies, including the provision of items for use in an emergency. We found that staff were receiving supervision, appraisal and professional development relevant to their roles and were trained in and knowledgeable about subjects such as protecting vulnerable people from abuse.

We found the service had a complaints system in place and people had their complaints responded to appropriately. Information about the complaints procedure was readily available to people who use the service.

Peoples’ diversity, values and human rights were respected. People who use the service told us that staff were very good at respecting their privacy. When they needed assistance with such things as dressing or bathing they found it a dignified experience. They said that staff respected their choices, preferences and decision making and they felt very involved in their care. They said they had been given lots of information about the service.

Peoples’ needs were assessed and care and treatment was planned and delivered in line with their individual care plan. People said they had been asked about their needs and staff displayed a good understanding of their needs and of them as people. They told us there were activities arranged for them at the service which were designed to assist in their care. They said their visitors were made welcome. One person we spoke with said her religious and cultural needs were very well respected by the staff.

They told us they had no concerns about their safety and wellbeing at Keech Hospice Care and that staff were very good at responding to call alarms when they needed them. They said that a member of staff could be located when needed and were always able to do what was required of them. People said that staff appeared competent, experienced, friendly and respectful.

People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. The people we spoke with said they had never had the need to raise a concern, but if they did they would feel confident and comfortable in approaching the manager or senior staff. They told us they had been given questionnaires asking for their views on their care and the service and they had provided very positive feedback.

One person said of her experience at Keech Hospice Care: “It’s very pleasant here. I am comfortable and everyone is so nice and working hard to help me”. Another person summarised the view of the people we spoke with by saying: “I am perfectly happy with the way everything is done here. I’d rather be [cared for] here than anywhere else”.