During our inspection we spoke with three patients and asked them to tell us how they felt they were being cared for. They told us, “You cannot get better care than here” and “I feel safe and well cared for”.

Patients’ care records showed that staff provided the care and support that people needed.

The patients were provided with a choice of suitable and nutritious food and hydration to ensure their nutritional needs were met.

Patients were protected against the risks associated with medicines because the provider was ensuring that appropriate arrangements were in place to manage medicines.

There was sufficient suitable equipment to meet the needs of the patients that was properly maintained.

Arrangements were in place to ensure the patients were cared for by skilled and experienced staff that were recruited appropriately to ensure people’s safety.

All the patients said that they had understood the treatment or reason for which they were at the hospice.

Patients said that, before admission, there was a full assessment of their needs, ”It was all talked through with me” commented one patient. Patients were very pleased with the quality of the care that they had received. They said staff were, “very attentive and re-assuring and experienced” and “nothing is too much trouble”.

The hospice was clean and free from noxious smells. It was light and bright. There was a large garden with quiet areas set aside for contemplation.

We found that there were sufficient trained and experienced staff.

There was a complaints system that patients were aware of and which was effective.

People told us that they were happy with the care and support they received and that their needs were being met in all areas. They said that the staff treated them with respect, listened to them and supported them to raise any concerns they had about their care. People told us that the service responded to their needs quickly and that their Doctor talked to them regularly about their plan of care and any changes that may be needed.

People told us they were able to make decisions about their care and day to day lives. Several people spoken with said they were happy with the care given and had no concerns. One man said “very good excellent” another said when referring to staff “They are looking after us well here, staff are very nice”.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to  pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

Pilgrims Hospice Ashford is one of three hospices provided by the Company, Pilgrims Hospices in East Kent. It provides specialist palliative care, advice and clinical support for people with life limiting illness, their carers and families. The hospice has a 16 bed in-patient unit and a day therapy hospice with various clinics and drop-in centres.  There is a bereavement counselling service.  Services are provided by health professionals and volunteers. The service was providing services to 336 people in the community and in the hospice at the time of the inspection.

The hospice provides a very relaxed, comfortable, clean and attractive environment. This includes facilities for families to relax in during the day and to stay overnight. There are quiet reflective areas including a chapel; and beautifully maintained gardens for people to spend time in – either helping with the gardening, or wandering quietly in the memorial gardens or wildlife  area. People said it was very important to them that they were able to receive care and support in such a peaceful environment.

The hospice is run by a registered manager, who was present on the day of the inspection visit. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law, as does the provider.

People said that they felt safe receiving care in the hospice. Many commented that they felt safe for the first time “in a long time”, because they “knew that their care and treatment was being managed effectively.” One person said “It only took me ten minutes to realise I was going to be safe and comfortable here.”

All of the staff had been trained in safeguarding vulnerable adults, and received regular refresher courses. Staff gave us clear explanations of the different types of abuse to be aware of; and explained that they knew the action to take in the event of any suspicion of abuse.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The manager told us that they had not found it necessary to apply for a Deprivation of Liberty Safeguard for anyone to date.  Where people were unable to make complex decisions for themselves the service had considered the person’s capacity under the Mental Capacity Act 2005, and had taken appropriate action to arrange meetings to make a decision within their best interests, if this was applicable.

The hospice had a wide range of risk assessments in place for the environment, and for each individual person who received care. Some people had restricted mobility and we saw that individual risk assessments had been implemented and were in use for different pieces of equipment. General risk assessments were evident for each room or area in the hospice, the gardens, maintenance activities and company vehicles.

Without exception, everyone spoke very highly of the staff, and patient surveys reflected this too. People’s comments included phrases such as “The service has been outstanding”; “The consultation was conducted in an excellent manner”; and “The doctors and staff could not have been more helpful and understanding.”

We saw that staff had a kind and gentle manner with people. They spent time listening to people, did not rush them, and did all they could to meet people’s individual wishes and requests.  The staff had suitable training and experience to meet people’s assessed needs; and always encouraged people to make their own choices and promoted their independence. We found that it was a hallmark of the service that ran through every aspect of the hospice, that people were treated as individuals, and were provided with the support they needed to enable them to meet their ‘wish’ lists.  A visiting health professional told us, “The care here is second to none. The staff really care about people and look after them extremely well.”

Staff files showed there were safe recruitment practices, which included Disclosure and Barring checks. These were included for volunteers who came into contact with patients.

We inspected medicines management and found that there were clear procedures in place to provide safe storage and administration of medicines.

People said that the food provided was “excellent”, and we saw that this included variety, suitable nutritional content, and was in accordance with people’s expressed wishes. The chef and catering staff were innovative in providing specific items requested by people, and in preparing and presenting food in an attractive way.

People told us that they were fully involved in every part of their care planning and treatment, and were confident that staff explained everything to them clearly. Care plans were stored electronically, and those for in-patients were reviewed and updated on a daily basis. The hospice employed their own consultants and doctors, as well as nurses, healthcare assistants, physiotherapists and other therapists to provide on-going treatment and support.

There were robust systems in place to obtain people’s views, which included formal meetings and the use of questionnaires. However, we found that it was a feature of the hospice to ask people for their views in relation to every aspect of their care, so that they were treated as individuals. The manager explained that the staff always tried to pick up on any little frustrations that people expressed and dealt with these immediately, so as to make people feel as comfortable as possible.

Patients, relatives and staff said that the manager was always available, and provided reliable and helpful support with any concerns or difficulties.