This inspection took place on 17and 18 July 2017 and was announced. We gave the registered manager 48 hours’ notice of the inspection because we wanted key people to be available.

The North Devon Hospice at Deer Park in Barnstaple provides a seven bed in-patient unit (called the bedded unit), a team of community nurse specialists (CNS), a range of day services and support groups and a hospice to home team. Deer Park is situated on the hillside above Barnstaple, has beautiful views and is surrounded by well-kept landscaped gardens. The area of North Devon covers 1000 squares miles of mainly rural countryside. They work closely with community hospital facilities and the local NHS Trust.

The hospice has an outreach centre in Holsworthy, known as The Long House. This opened in September 2015 and was a specially designed building in order to aid people’s sense of well-being. From here people can see their CNS, complementary therapist and attend therapeutic support groups. This addition of this outreach centre meant that people from the lower half of the North Devon area did not have to make long journeys up to Barnstable for their care, treatment and support.

Hospice services were provided for adults over the age of 18, with life-limiting illnesses and advanced progressive conditions. At the time of this inspection 80% of services were provided to people with a cancer diagnosis and 20% were to people with non cancer illnesses. Non cancer illnesses include motor neurone disease and other degenerative neurological conditions, pulmonary and cardiac disease.

Where people’s preferred place of care was their own home they were supported by the hospice to home team, the CNS and the local community district nurses. The hospice to home team helped people to stay at home longer or to die in their own home. The service also offered respite for family carers.

The staff team included the following: doctors, nurses, health care assistants, physiotherapist, occupational and complementary therapists, counsellors and volunteers. The various services provided by the hospice worked in conjunction with people’s own GP’s, community district nurses, and other health and social care professionals.

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. The director of care was the registered manager.

At the time of the inspection the bedded unit were looking after five people and the hospice to home team were providing support to about 20 people living in their own homes.

Both parts of the service provided end of life care in the last couple of weeks or during a time when they needed care and treatment for symptom control or help during an emotional or physical crisis. The service looked after people with a cancer diagnosis (80%) and non-cancer patients (20%) but the service aimed to increase the numbers of people they were able to support with non cancer conditions. From the bedded unit 20% of people were able to go home after a short stay and may return at a later date and 80% would die in the hospice. The hospice to home service was mainly provided for people nearing the very end of their life, however they may also support people and their families during a crisis.

The service was safe. All staff received safeguarding adults training. This meant they would be able to recognise if people and children they came into contact with were being harmed and would know what to do to report those concerns. Recruitment procedures were robust and ensured that only suitable staff were employed.

Training was undertaken by all staff who assisted people to move from one place to another including the use of eq

This inspection took place on 19, 21 and 22 January 2016 and was unannounced. The service was last inspected in December 2013 and no breaches of legal requirements were found.

North Devon Hospice headquarters is in Barnstaple, it is set on a hill and has beautiful views of the surrounding area and a well-kept themed garden. It provides a service for adults with life-limiting illnesses and advanced progressive conditions, such as, motor neurone disease. About 130 people were receiving a palliative care service across North Devon when we visited. The service includes an inpatient unit (known as the bedded unit) with seven beds, a day hospice at the same location and a newly built hospice outreach centre in Holsworthy, known as The Long House, which opened in September 2015. Most people receiving palliative and end of life care in North Devon preferred to remain at home and have support in the community, wherever possible. This was in line with national findings.

The day hospice in Barnstaple opened four days a week, and included a drop in service on Fridays. The Long House opened three days a week including a drop in service on Wednesdays. This new service provided a service closer to home for people in a very rural part of North Devon.

The hospice team included specialist palliative care medical and nursing staff, an occupational therapist, physiotherapist, a team of healthcare assistants and support staff. The hospice had a supportive care team, which included complementary therapists, counsellors, bereavement care, and a chaplain. A specialist community nursing palliative care team provided physical, emotional and social support for people thought to be in their last year of life and those close to them. They also provided specialist advice to GP’s, district nursing and other staff. Local GP’s and consultants in the NHS referred most people to hospice services, and a few people referred themselves. People accessed the service in a variety of ways, via the community nurse specialist, day hospice, bedded unit or the hospice to home team.

The hospice to home service is comprised of registered nurses and healthcare assistants, who provide personal care and support to people at home approaching the end of their life. Healthcare assistants in the hospice to home team were employed by the hospice but worked under the direction of the district nurses. District nurses assessed people’s individual needs and provided care plans to inform hospice to home staff about their care. The hospice to home service was available day and night, and was flexible. This meant it could respond to people’s rapidly changing needs and provided respite for carers. The team worked closely with Marie Curie, a charity for people with terminal illness, who also provided some night sitting services for people in the area.

The hospice had about 550 volunteers who were involved in all aspects of the service such as fund raising, working in the bedded unit, day hospice, in shops, and as volunteer drivers and gardeners. They offered befriending services to people and provided respite for carers. Some volunteers also had professional qualifications and offered counselling and complementary therapies.

The service had a registered manager, who is the director of care at North Devon Hospice. 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.

Staff supported people with poor appetites who needed help and encouragement to eat and drink. People praised the food available at the hospice, although some staff had concerns about people in the bedded unit being able to have food of a consistent standard whenever they wanted it during the day. Suggested reasons for this varied but in

We spoke with someone who was receiving treatment and their family and we looked at comments from people who used the service. We saw that they were happy with the care and treatment that they had received. There were comments such as "Expert, gentle and loving care" and "I was made to feel at home". We saw that staff protected people's privacy and maintained their dignity.

Care and attention was paid to people's individual needs so that they received effective and appropriate treatment. Staff were trained to understand the specific needs of people requiring end-of-life care. Unexpected events were analysed and used as learning opportunities. The quality of treatment and care was closely monitored and the results of clinical audits were used to improve practice if necessary.

Staff were supported and managed effectively and were encouraged to up-date their skills and knowledge. Professional and organisational skills were regularly assessed and further development encouraged.

This inspection was carried out on 20 and 25 February 2013. We met 11 visitors who were visiting their relatives or attending a ‘Carers support group’. We spoke with another four carers on the phone about the support from outreach teams. Comments from patients and carers we spoke with were very positive and they praised the care, support and treatment they had received.

We interviewed 14 staff including the acting chief executive, director of care, registered manager, human resources manager, palliative lead nurse specialist, a doctor, nurses, health care assistants, receptionist and counselling staff.

People were involved in all aspects of their care, consent was obtained and we were told “they don’t tell you what you should do. They ask you what would you like?” People said highly skilled staff had been recruited who understood and met their needs. People said the building was well maintained; for example one person commented “it’s like being in a first class hotel”. None of the people we spoke with had any concerns, but if they did they said it would be dealt with. One patient summed comments we had from people, “I look forward to going there and every time I go I get a huge welcome”. The experiences families told us about were summed up in the comment “They’ve taken a huge amount of pressure off us, you couldn’t wish for a more caring place or staff”.

We (the Care Quality Commission) carried out an unannounced inspection on 02 February 2012. We spent a day at the service observing care and reading records. We also visited two people in the community and undertook telephone interviews with people and relatives who were receiving services or had recently used the service. We spoke to 11 people and 10 relatives about the in patient, day hospice and community specialist palliative care team. We looked in detail at the care of three people. We also spoke to nine staff and four volunteers about how they were trained and supported to meet people’s needs.

People and the relatives we spoke to were very positive about the professionalism and caring attitude of staff. They reported that staff treated them with dignity and respect and involved them in making choices about their care. One person said “they have done everything they can, they have been wonderful” A second person told us how they appreciated their wife being involved in the discussions about their care and how they feel they can talk to staff about anything. A third person said they were treated with “kindness” and how staff were “humorous, they keep me cheerful”. A fourth person said “it can’t be alright but they make it as good as it can be and they are there for us.”

Six relatives told us how supportive they found hospice staff. One said “they were expert, helped with symptom control and would sit and watch x to make sure they weren’t in pain”. A second relative said, “they were marvellous to all the family, helped with the children,” a third said “the nurse was a great comfort, they prepared us for the reality, I don’t know what we would have done without them”. A fourth person told us how much they appreciated the pamper days offered at the day hospice.

People we spoke to confirmed that staff knew how to provide the care they needed. Everyone we spoke to said they felt safe and were able to raise concerns and were confident they would be dealt with.

We observed staff interactions with people and family members and saw that people’s views were listened to and respected. Staff were confident to discuss options for treatment and support people making decisions about whether or not to continue with treatment. Advice and information about risks, side effects were offered sensitively as needed. All decisions about care were recorded and communicated to other members of the team.

The hospice had a range of systems in place for monitoring the quality of care and demonstrated how they improved the service following feedback from people, staff and in response to incidents. The service was managed well and provided a high standard of individualised care and support. We found that North Devon Hospice were compliant with all five outcomes we inspected.