We saw that there were appropriate systems in place to obtain consent and review decisions made. People we spoke with said, ''the staff are very respectful and ask me about everything.'' There was information for people using the service to help inform their decisions about the care they received and this included the provision of alternative options.

People we spoke with appeared relaxed comfortable and well cared for. We spoke with peoples relatives in their presence who said, ''the doctors and nurses talked everything through with us they explained everything. We have been given different options about what care and treatment is available.'' Another relative we spoke with said, ''the staff know all his likes and dislikes. We are so happy everything is so clean and it’s lovely to have somewhere that is quiet and he can get some rest.''

Medicines were observed to be handled safely, securely and appropriately. Staff were trained and observed to administer and record medicines correctly.

The provider was able to demonstrate that there were sufficient numbers of staff with the right skills and competencies and that they carried out a daily analysis of staffing needs based on the patient’s level of dependency.

Records including patient and staff records were fit for purpose and stored securely to ensure confidentiality. Protocols existed to enable secure information sharing about people using the service.

There were arrangements and facilities in place that ensured peoples privacy and dignity were respected. One person we spoke with said "I can do whatever I like, when the weathers nice I can go out in the gardens for some fresh air". There was detailed information available to people and their relatives about all aspects of care and services available.

People's needs were fully assessed prior to provision of care in a person's home or admission to the hospice. People we spoke with said" I could happily stay longer, everyone is so kind, they always have time for you". There were effective communication systems in place to ensure continued awareness of each persons changing needs. Care and treatment plans reflected the choices of the people we spoke with.

Staff were recruited using effective systems to check that they were qualified and appropriately skilled to provide safe care.

There were suitable arrangements to ensure people using the service were safeguarded and protected from abuse or the risk of abuse. Peoples concerns were responded to and acted upon.

People we spoke with said "If something isn't right they don't mind you telling them, they soon put things right". There were systems to monitor record and evaluate the quality of the service provided and people's feedback was actively used to make improvements.

We heard from the manager and staff that the care delivered by Trinity Hospice staff was unique to each individual using the services.

All of the patients and visitors spoken with were complimentary of the service, "it is a wonderful place, you feel like you are coming home when you come here for respite, people value you and know your name", were the comments from a patient.

Another patient spoke of her decision to become an inpatient, she said, “I was at home but chose to come into the Hospice as my illness advanced, my symptoms are well managed, and spending my days here makes my illness less challenging, I am looked after by genuine people that have the best interests of the patient at heart, the service is first class”,

“I have come to Trinity Hospice where I am surrounded by love and kindness, the excellent reputation it has is richly deserved, myself and my family are truly grateful”, was the comment received from another patient.

A relative spoken with described Trinity Hospice as an excellent role model of what quality care should look like, he said, “The facilities here are so well designed and comfortable, the staff employed show that they really care about the patients as demonstrated in their good practice”.

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.

We undertook an inspection on 13 and 14 August 2014 to Trinity Hospice. The first day of the inspection was unannounced and we informed the registered manager that we would be returning on the second day to complete our inspection.

Trinity Hospice provides care and treatment for people with long term, chronic or terminal illness. The service supports people in their own homes, through an outpatient service and at an inpatient centre in Clapham, South London. At the time of our inspection the service was supporting 495 people. The inpatient service can accommodate up to 28 people. At the time of our inspection 15 people were using the inpatient service. At the time of our inspection many of the people using the service were too unwell to speak with us and were being supported with their end of life care.

At our last inspection on 20 January 2014 the service met the regulations inspected.

The service’s registered manager was their inpatient service manager. 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.

Processes were in place to identify any risks to people who used the service and preventative measures were put in place to keep people safe and free from harm. One to one nursing was provided to further support people and maintain their safety when required. Staffing numbers were regularly reviewed and adjusted according to the needs of people using the service.

Assessments were undertaken to identify people’s physical, social and psychological needs and these were reviewed regularly to ensure they were in line with people’s current care, treatment and support needs. When required referrals were made to healthcare professionals to access specialist care that was not available at the service. People were transferred to hospital for further treatment in line with their wishes and preferences. People were able to have a dignified and pain free death.

People were involved in decisions about their care, and the service was responsive to their requests and individual requirements. People’s religious, cultural and spiritual needs were met.

People’s privacy and dignity was maintained and the staff ensured information was kept confidential and conversations could not be overheard.

Medicines were managed safely. The service was clean and there were processes to protect people from the risk of development and spread of infections.

Staff were aware of what to do if they suspected someone was at risk of abuse and followed safeguarding adults and children procedures. Staff were aware of their requirements under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff had the skills and knowledge to support people using the service. Training needs were regularly reviewed and staff passed competency tests before being able to undertake any tasks unsupervised. Systems were in place to support staff and reflect on practice and service delivery.

The service regularly reviewed their performance and where further improvements were identified appropriate actions were taken. The service had systems for obtaining the views of people who used the service and there were processes in place to respond to and investigate complaints.

The service followed best practice guidance and were working with other health care providers to share and develop good practice.