Rowcroft Hospice serves the people of South Devon. They provide palliative and end of life care, advice and clinical support for people with progressive, life limiting illnesses and their families and carers. They deliver physical, emotional and holistic care including bereavement counselling support, a lymphoedema service which provides advice and treatment (for people who experience swellings and inflammations usually of arms and legs), an outpatient service, occupational and creative therapy, complementary and physiotherapy, chaplaincy, social workers and clinical nurse specialists and volunteer services. The hospice inpatient unit can care for up to 17 adults who require symptom control or end of life care. The average length of stay is two weeks. The service provides acute specialist palliative care for people and does not provide a respite service or have longer stay beds. The majority of people are cared for in the community.

The service continuously looked at the local community to see how best they could provide the service. This had resulted in the provision of the Hospice at Home service. Rowcroft's Hospice at Home service provides responsive end of life care and support to patients and their families in their own home or a care home in the last two weeks of life. The service operates 24 hours a day, 7 days a week with access to doctors, registered nurses and care assistants as well as ancillary staff and therapists. The Hospice at Home staff are all employed by Rowcroft and work with other health care professionals in the community. Services are free to people and Rowcroft Hospice is largely dependent on donations and fund-raising. A training centre also offers advice and support to staff in nursing and residential care settings in the community. The service had also recognised a need to provide specialist training and end of life care for people living with dementia and their carers and had established links with homeless communities.

This inspection was carried out on 11 and 14 January 2016 by one inspector, a pharmacist inspector, an expert by experience and a specialist advisor in palliative care. It was an unannounced inspection. There was a manager in post who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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. They oversaw the running of the service and were supported by a leadership team that included the chief executive and directors and department managers.

Information about the needs of the local population had been used to develop specialist support such as the expansion of the hospice at home service. The service provided outstanding end of life care and people were enabled to experience a comfortable, dignified and pain-free death.

Staff were trained appropriately and had a good knowledge of each person and of how to meet their specific support needs. Staff went that extra mile to ensure people’s needs were met in a holistic way including support for people’s loved ones.

People’s feedback was actively sought, encouraged and acted on. People and relatives were overwhelmingly positive about the service they received. They told us they were extremely satisfied about the staff approach and about how their care and treatment was delivered. Staff approach was kind and compassionate. Relatives told us, “The care was first class, the staff were all so considerate and helpful no matter the problem and what a wonderful place.” People’s feedback about the caring approach of the service and staff was overwhelmingly positive and described it as “Fantastic” and “A1”. Clear information about the service, the facilities, and how to complain or comment was provided to people and visitors.

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We inspected Rowcroft Hospice at Home service because it was an new service introduced by Rowcroft Hospice. Because of the nature of the service provided, we did not speak to any patients who were receiving care. We spoke with six bereaved relatives, three healthcare professionals, and three members of staff.

Relatives told us people had been able to choose where to spend their final days of life. One relative said "It was his wish to stay at home in his own bed. Without the hospice at home team we could not have made this happen. Another relative said "Mum had never been in hospital. Hospice at home meant she never had to be." A thank you card read "Her request was to be at home and you made that possible, for which I am eternally grateful."

Feedback about the service patients and their families received was also very good. Relatives described staff and the care as "Brilliant", "Amazing" and "Faultless". One relative told us "The help and kindness they showed was incredible, and the care they provided in the last few hours made a difficult time more bearable for us all."

Relatives said that they appreciated the seamless approach offered when more than one healthcare professional was caring for the person. One person said "At one stage we had several staff in the house at the same time. However, this did not matter. They all worked so well together so he received the best care. The Rowcroft staff just blended into the team and just knew what needed to be done."

We spoke to three health care professionals who we also very complimentary about the service. A district nurse said "They are all so very professional and knowledgeable.

District nurses told us the care records kept were their responsibility but that any entries made by hospice at home staff were written to a very high standard. We saw that the nursing staff also entered a summary of the care they had provided on the computerised system used by the hospice. However we saw that information regarding a person’s culture, faith or sexual orientation was not always recorded.

Relatives said they felt safe when Rowcroft Hospice at Home staff were in their home. One relative said "I just felt reassured by their presence." Another relative said "They (staff) were dignified, respectful and caring. They never left her bedside, making sure she was comfortable. They supported us through the hardest time of our life."

Relatives knew there were formal ways of making complaints or sharing concerns but all of those asked said they could not envisage the occasion arising such was the high level of genuine and good care from the staff.

All comments received from bereaved relatives and healthcare professionals were positive and reflected an opinion that the staff were knowledgeable, professional and kind. Staff had access to mandatory and additional training programmes, and received formal and informal supervision and support in their roles.

There were recruitment processes in place which meant that only staff who have had robust pre employment checks undertaken before they were able to work with vulnerable people.

Patients and relatives knew how to complain and were given opportunities to provide feedback about the care they had received. Effective systems, audits and checks were also in place to continually monitor the quality of the service provided.

On the day of the visit there were 11 patients at the Hospice. During the course of the inspection we spoke with five patients, eight visitors, eight members of staff and two volunteers.

All patients and relatives we spoke with were all very complimentary about the staff and the care they received. Staff and volunteers said it was a supportive and good place to work.

General comments from patients and visitors included, “ Tip Top”, “Can’t fault it”, “Beautiful setting, “Rowcroft is just brilliant – invaluable to us”, “The volunteers are lovely and like all the staff so respectful”.

Patients appreciated the care given to them and their families and were complimentary about how respectful the care was provided. One relative told us that the staff had been “fantastic” when their partner had been cared for. They went on to say “Staff really listened to us both and treated the whole family with great care.”

Staff were good at recognising the different needs each person had, which included spiritual, emotional and social care needs. Patients and relatives appreciated the complimentary therapies offered.

Without exception patients were full of praise for the choice, flavour, quality and presentation of the food. Some said that if choices on the daily menu were not to their liking they could choose something else. Patients also appreciated the pre lunch drinks trolley with a wide variety of alcoholic beverages and non-alcoholic items.

Patients knew what to do if they were unhappy about any aspect of the care they received. Patients thought the Hospice was well maintained and very clean.

Patients and their families were encouraged to give feedback either informally or formally using the survey left at the patients’ bedside.

Patients and their relatives appreciated the care and support they received both physically and emotionally. We spoke with one relative who told us they had received care and support from the community team, hospice at home team and hospice inpatient team. This relative said “They were absolutely fantastic; they were prompt, reassuring, sensitive and never took over.”

Patients were able to consent to their care and treatment but also said “They are the experts and know what is best for me”. We were told that patients were provided with enough information about their care and appreciated the staff being at the end of the call bell or telephone.

The hospice was clean and had systems in place to reduce the spread of infection.

There were sufficient numbers of skilled staff available who were popular with patients. Comments included “Everyone here is amazing, all the staff and doctors,” and, “everyone is brilliant here from the cleaners right up to the top people”. Relatives told us “There was always someone around to ask and sometimes they knew they were needed before we knew it ourselves.”

Records were well maintained, kept under constant review and reflected the care that was provided.