This inspection took place in 22, 23, 24 and 25 August 2016 and was announced. When we last visited the hospice on November 2013 we found the service met all the regulations we looked at.

North London Hospice Day Care Services provides a range of outpatient therapeutic and community based services for adults with life limiting illnesses and specialist palliative care needs who are residents of Barnet, Enfield and Haringey. At the time of the inspection there were 100 people using the outpatient services and 200 people were using the community service.

The hospice had a registered manager. 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 were supported to make choices about how their needs were met. People and relatives were involved in decisions about their care. Where people were unable to make decisions about their care best interests decisions were made on their behalf.

People were kept safe. Risks to people were identified and staff took action to reduce those risks. Staff were available and had the necessary training to meet people's needs. Staff responded to people’s needs promptly.

There were systems in place to ensure that people consistently received their medicines safely, and as prescribed.

People were supported effectively with their health needs.

Care was planned and delivered in ways that enhanced people’s safety and welfare according to their needs and preferences. Staff understood people’s preferences, likes and dislikes regarding their care and support needs.

People who used the outpatients service were provided with a choice of food, and were supported to eat when this was needed. There was a strong emphasis on the importance of good nutrition and hydration and a commitment to providing people with what they wanted to eat and drink in a flexible manner.

People and their relatives told us that staff were caring, kind and compassionate. The hospice provided people with multi-professional and person centred care that helped to ensure their physical, emotional, psychological, spiritual and social needs were met.

People were treated with dignity and respect. People and relatives told us they consistently received care that met their individual needs.

There was an accessible complaints policy which the registered manager followed when complaints were made to ensure they were investigated and responded to appropriately.

People using the service, relatives and staff said the registered manager was approachable and supportive. Systems were in place to monitor the quality of the service and people and their relatives felt confident to express any concerns, so these could be addressed.

Before patients received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Patients told us that their views and preferences were respected by staff. One patient said, "staff are very caring, they make you feel important."

Patients were very positive about the care and treatment they had received. One patient told us, "they really do care about you here." Another patient said about the way care was provided by staff was, "warm and loving." We looked at three care plans. These reflected the needs of patients and were linked to risk assessments.

There were effective systems in place to reduce the risk and spread of infection. One patient said, “It’s always kept very clean here.” Clear guidance was provided on how the risk of infection should be addressed. Regular audits of infection-control procedures had been carried out. Any improvements identified in these audits had been addressed.

There were enough qualified, skilled and experienced staff to meet patient’s needs. Patients told us that staff knew how to care for them and understood their needs. One patient’s comments were typical when they told us, “everything the staff do, they do well.” Patient's personal records including their care plans were accurate, and had been reviewed and updated at regular intervals. Care records gave an explanation of how patient's needs were to be met.

We were unable to speak with patients or their carers during our visit as our visit was on a day when no patients attended. We looked at patient surveys and feedback comments and saw positive responses about the therapies on offer, the welcome that people had been given, and the kindness and helpfulness of the staff and volunteers.

Staff we spoke with told us patients and their carers were treated with dignity and respect and showed us quiet rooms and a rest room that were separate from the main activities area, that provided the patients with a choice. They gave examples of how they met people's diverse needs.

Patients and carers were encouraged to participate in decision making and their suggestions were acted upon. Care and treatment was based on individual needs and supported by evidence based policies which took account of national research and evidence.

Staff had an annual appraisal and access to a range of ongoing learning and development relevant to their roles. They described communication with managers as open and told us their suggestions were followed up.

Safeguarding policies and training were in place. Staff accurately described their specific safeguarding role and responsibilities. They told us how they would manage emergency situations and showed us that emergency equipment was clearly accessible, labelled and checked daily.

We saw a range of ways in which quality of the service was measured, reported and acted upon.