We inspected Nottinghamshire Hospice on 28 November 2016. The inspection was unannounced.

The hospice provides care and support for people with life limiting conditions and those who are nearing the end of their lives. The provider operates a day therapy centre which can support up to 35 people each day and a hospice at home service. The hospice at home service can provide support from nurses and healthcare assistants across a 24 hour period within the county of Nottinghamshire. The hospice also provides a range of therapies and counselling and bereavement services. These services are available to people who use other hospice services and their family members and loved ones.

There was an experienced registered manager in post at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and their family members spoke highly of the compassionate and personalised nature of the hospice services. They praised staff for their warm and attentive approaches to care and support. They told us staff were knowledgeable and skilled and this inspired confidence in the services.

The emotional and social impact of life limiting conditions and palliative care was fully recognised by service managers and taken into account when planning and developing hospice services. The commitment to providing a holistic service for people and their family members was central to the organisation’s vision.

People were at the heart of the service. They were fully involved in developing and reviewing their own care packages. Family members and those who were important to them were also consulted. Care plans were personalised and took account of people’s preferences and wishes, including those related to the end of their lives.

People’s consent was sought before any part of their care package was delivered by staff. Staff were aware of how to provide support for those people who were not able to give their consent, either by following the wishes and decisions they had set out in advanced care planning discussions or by following the guidance of the Mental Capacity Act, 2005 (MCA). This meant that people’s rights were protected.

People were protected by robust systems to manage their health, safety and welfare. Staff followed detailed risk management plans when providing care and support. They demonstrated a clear understanding of how to recognise and report any situation that may put people at risk, including those situations which may be abusive in nature. Medicines were managed in a safe way and people received all of the healthcare and nutritional support they needed.

There were effective systems in place to recruit, train and support staff. This included volunteers. This meant that there were enough suitably skilled staff to provide the support and care people wanted and needed.

Strong leadership and effective management systems promoted a culture of continuous improvement, openness and inclusiveness. Learning from mistakes and listening and responding to people’s views was embedded in this culture. A programme of audits designed to monitor the quality of services supported this approach. This meant that people would benefit from services that were flexible, responsive and could be tailored to their needs.

As part of our inspection we spoke with five people who used the service. We spoke with three members of staff and reviewed five care plans.

We found that people who used the service were treated with respect and were supported in a way that protected their privacy and dignity.

We observed people during our visit and we saw they were able to move around the service freely. One person told us, “I do what I want with the day and eat what I like.”

We found that people were involved in making decisions about their care and treatment. One person told us, “I have seen my care notes. The staff update my records and ask me first if I am happy with what they do for me."

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We spoke with five people using the service and they all told us they felt the staff supported them to access different services and made referrals to other health professionals when needed.

We found there were appropriate systems in place for prescribing, obtaining, administering, storing and disposing of medicines.

People spoken with gave positive feedback about the care and support staff were delivering. They said things like, “I have worked with many staff and wish they had all been like the staff here. They work as a good team.” All of the staff and volunteers we spoke with told us they felt supported by the nurses and the management team.

As part of our inspection we spoke with seven people who used the service and two people’s relatives. We also spoke with five members of staff and reviewed six care plans.

We found that people who used the service understood the care and treatment choices available to them. People were involved in making decisions about their care and treatment. One person we spoke with told us, “Fantastic services, can’t fault it.” Another person told us, “They’re very respectful of privacy and the staff are so approachable and pleasant.”

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We also found that appropriate arrangements were in place in relation to obtaining, handling, prescribing and storing medicine.

People were made aware of the complaints system and this was provided in a format that met their needs.

Staff received appropriate professional development and were able, from time to time, to obtain further relevant qualifications. One staff member we spoke with told us, “It’s the best job I’ve ever had, every day is different and I feel privileged to look after patients here.”

Patients told us that care staff involved them in their care, treatment and support programme and they received input and treatment from other health care professionals.

Patients told us that they were encouraged to participate in a good range of social activities within the hospice and enjoyed the relaxed interactions with staff.

Patients told us that they felt safe in the hospice, they also thought the staff had the right qualifications, skills and knowledge to perform their duties safely.

Patients were provided with the opportunity to comment on the quality of service provision within quality assurance processes.