The inspection took place from 19 January to 28 February 2017 and was announced. Marie Curie Nursing and Domiciliary Care Service, North East Region is a well-established service that has previously been registered at a national level. In April 2016 the service was registered as a separate location and this was the first inspection.

The service specialises in providing nursing and personal care to people living with terminal illnesses in their own homes. At the time of our inspection services were being provided to 130 people across the North East region.

The service had 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.

We found the service was very effective in meeting its’ aim of enabling people to be cared for at home at the end of their lives. Relatives we contacted spoke highly of the standards of care and treatment provided and their confidence in the staff. They described the service as being “outstanding in every way”, “absolutely superb” and providing “brilliant support”. Feedback received by the service and commissioners reflected these positive views, with many relatives wishing they had known about and been able to use the service sooner.

A range of planned and reactive services were provided by skilled and experienced nurses and healthcare assistants. The staff were proactively supported to develop their learning in line with current best practice and the needs of the people they cared for. A variety of methods were used to ensure staff were appropriately supervised, had their performance and clinical skills reviewed, and were competent in their roles.

Nurses contributed to accredited initiatives, delivered end of life training to other providers and were looking forward to supporting student nurses during their placements at the service. Very good links and joint working arrangements had been made with the NHS and other healthcare providers, promoting co-ordinated care for people.

The service equipped staff to understand the standards required of them and checked that they put person-centred care into practice. Staff were mindful of upholding people’s rights to give their consent and direct how their care and support were given. Sufficient time was allowed for visits so that people’s care was not rushed.

Relatives were consistent in their praise of the kindness and compassionate approach of the staff. They felt care was given very sensitively and that staff treated people with great dignity and respect. A relative, whose family member had been cared for by the service, emphasised that, “The whole experience transformed my perspective of end of life care.”

Many comments were received about relatives’ appreciation of the comfort and emotional support that staff gave to families, including opportunities to rest and take breaks from their caring roles. The Marie Curie helper services were promoted to raise awareness of volunteers who could provide companionship and practical support.

Comprehensive information about the service, guidance and support on caring for people with terminal illnesses, and coping with bereavement was made available to people and their carers. People were encouraged to give their views and influence the service. Complaints were taken seriously and acted upon.

Care was taken to protect the safety and welfare of people using the service. Systems were in place to prevent risks and safeguard people from harm and abuse. There was enough staffing capacity to deliver the service and managers aimed to allocate regular staff for continuity, wherever possible. Support was provided with medicines by staff who were suitably trained.

Staff predominantly worked