This inspection took place on 28 and 29 September 2016. We gave the service 48 hours’ notice of the inspection because we needed to make sure that the registered manager was present.

Rossendale Hospice Integrated Health Care Centre provides care for people living with cancer and other life-limiting conditions in their own homes. They also have a day therapy service where people have access to a wide range of therapies and support. These included nurse assessment, reviews, complementary therapies, psychological support and access to a consultant clinic each week.

The service had 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. At the last inspection on 23 March 2014, we found the service was meeting the regulations that were applicable at the time.

During this inspection we found the service was meeting the requirements of the current legislation.

People who used the service told us they felt safe and raised no concerns about the care that they received. Staff had been given training in recognising the signs of abuse and how to report any possible concerns. Staff we spoke with told us the appropriate measures they would take when dealing with any allegations of abuse.

Effective recruitment systems were in place. This helped ensure the provider recruited staff appropriate for the position with which they were employed. Appropriate checks such as references, disclosure baring services checks, proof of identity and professional qualification’s had been completed. Duty rotas and staff we spoke with confirmed there was appropriate amount of suitably qualified staff to meet people’s individual needs. The rotas included assessments that identified if more staff were required and if it was the case then additional was provided.

There were systems in place to assess and manage risks. One example was supporting staff in the event of a person bleeding. The provider demonstrated their commitment to ensuring risks in the service were identified and measures had been put into place to mitigate these risks.

People who used the service and relatives were positive and complimentary about the knowledge and skills of the staff team. All staff we spoke with confirmed that there was a robust training programme in place. The clinical services manager told us online training had been introduced. We observed a staff member completing online training during our inspection. The training matrix confirmed relevant training had been undertaken by the staff team.

Staff told us the management team were approachable and supportive and operated an ‘open door policy.’ Clinical supervision was available and accessed by staff. Staff we spoke with confirmed regular appraisals of their roles took place.

It was clear the involvement of the multi-disciplinary team was an integral part of the care provided by the service. Staff and professionals who worked with the service confirmed systems were in place to ensure a seamless service. The care delivered clearly met people’s individual needs. .

There was an established befriending service that received very positive feedback about the support it offered to people who may be socially isolated.

They also offered a range of complimentary therapies and a counselling service to people who used the service and families. Complimentary therapies, aim to treat the whole person, not just the symptoms of disease. People told us they enjoyed the therapies and a relative of one person told us this was also offered to them after their loved one had died.

Relatives and people who used the service were involved in the development and planning of their care. A range of health professionals took an ac

At our visit we spoke with four people (patients) who used the services and two (family) carers. Everyone told us they were very satisfied with all aspects of the service. They said the staff were caring, sensitive and skilled, and felt involved in the planning of their support. People had the choice of some complimentary therapies and these were discussed and explained to them. Comments included: "We sign records in agreement to things", "I've had an assessment today and everything was explained to me", "Staff are very kind and are always there to talk to if you need them", "Staff are very pleasant, very helpful" and "It's (the day unit) a break for both me and my wife". Two people described the hospice at home service as being reliable, with staff being punctual and caring. One person said,"The service is fantastic; they (carers) are very considerate".

Patients attending the day unit told us there was a choice of therapies, and some told us the benefits of, for example, foot massage and exercise. One person said the day unit was 'a lovely place'. People enjoyed sitting outside on the patio, weather permitting.

All parts of the hospice we saw, including the lounge and some private rooms, were clean and decorated and furnished to a high standard. The hospice was a pleasant well kept environment to enhance patients' wellbeing.

The staff we spoke with felt well supported by senior staff and also that good training gave them the skills and knowledge to do their job.

During our visit we spoke with six people who were using the day therapy services, three of whom were also using the hospice at home service. All the people (patients) we spoke with were highly satisfied with all aspects of the service. They praised the staff for being caring, sensitive and skilled, and felt their rights to privacy, dignity and choice were respected. Comments included, "Staff are respectful and there are places to go for a private chat with staff", "I am treated with dignity and respect; staff are amazing", "The staff are very skilled communicators" and "Volunteers do a great job".

Patients told us they felt involved with planning the service they needed. One person told us, "I spoke at length with staff about what I needed and what the hospice could provide". Another said they frequently saw the 'team leader' to discuss changing needs. People had the choice of some complimentary therapies that were discussed and explained to them. Three people described the hospice at home service as being reliable, with staff being punctual and caring.

With respect to the staff employed at the hospice, the comments were very positive and complimentary. We were told staff were, "All wonderful", "Have a good bedside manner" and "All lovely from the volunteers, to the staff in the office to the nurses". Someone said, "I have nothing but praise for them".

Patients attending the day therapies unit appreciated the therapies they experienced and felt they were beneficial. They also felt they could talk to staff, or have privacy, depending on how they were feeling, and that staff were sensitive and skilled in understanding about this side of their lives. One person said, "The day unit is beautiful and provides a safe environment for expressing emotions".

People were confident they could talk to staff about concerns or worries, and also if they were not satisfied with any aspect of the service.

Patients told us they managed their own medicines that they needed to bring to the day therapies unit, and wanted to continue to do this. However we agreed with the manager that some monitoring systems needed to be developed to ensure there was no risk of medicines mishandling in the day therapies unit.