This inspection took place on 18, 19, 20, 21 and 26 April 2016 and was unannounced. The service was last inspected in February 2013 and at that time was meeting the regulations we looked at.

Saint Francis Hospice is an independent charity and one of the largest adult hospices in the UK. A team of specialist consultants, doctors, nurses, a range of other health and social care professionals and volunteers provide care and support to people with a life-limiting illness, their carers and family members. This is provided through an 18 bed in-patient unit and a day therapy unit. There were also two community teams based at the hospice, a “Hospice at Home” team, and a “Specialist Community and Crisis Support” team and these provided support in people’s own homes. At the time of our inspection there were 17 people receiving care in the in-patient unit and approximately 120 in the community and day therapy services.

The service had a registered manager. 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 and associated Regulations about how the service is run.

The service provided outstanding care and support. Management, staff and volunteers were highly motivated and committed to ensuring that people had the best possible care. The staff provided people with positive care experiences and ensured their care preferences were met. The hospice website contained feedback from people who used the service and comments included, "Coming to the hospice is the best thing that has happened to me in a long while. I look forward to seeing my friends, having a laugh as well as discussing my problems.” “I had no idea that a hospice was anything more than a place to spend your last couple of weeks in care, but after coming here I realised it was such an uplifting experience.” “You are not made to feel like you are ill and you get to see a doctor or a nurse if you need to. It is a really great asset.”

People received a strongly person centred service. They were supported to make choices and to have as much control as possible about what happened to them both before and after their death. They and their family members were consulted and involved in planning their care and supported to make decisions on their preferred place of death. People who used the service, their families and carers, staff, volunteers and outside organisations were all involved in developing the future of the service.

Staff were clear about their roles and responsibilities. People received care from a multi-disciplinary staff team who received excellent and effective training and good support from the management team. This provided them with the knowledge, skills and confidence to meet people’s needs in an outstanding and individualised manner. There was a very proactive approach to the personal development of staff and the acquiring of new skills and qualifications. A system of competency based assessments ensured staff could demonstrate the required knowledge and skills to meet people’s needs effectively. Volunteers also received training and support to assist them in their roles in the hospice and in the community.

The services were committed to deliver excellent care and to work collaboratively with partners to deliver and inspire better care for those affected by life limiting illness. Staff worked closely and in partnership with external health and social care professionals and other organisations to improve the service within the hospice and in the local community. Staff were encouraged and supported to undertake research and act as education facilitators to share best practice and ensure high quality outcomes for people with life-limiting conditions and those closest to them.

There was strong emphasis on the importance of good nutrition and hyd

During this inspection we spoke with five people using the in-patient unit and two people using the day therapy unit. Two of these people had used the community services provided by Saint Francis Hospice and told us about their experience. We also spoke with the relatives of two people, and members of the nursing and management teams.

All of the people using the service said they were pleased with the quality of care. One person said, "the staff are lovely. They are faultless and show kindness and care." Another person told us, "this is a wonderful place and their crafts room is second to none. I cannot believe that care can be this good." People told us they were involved in the planning of their care and the staff understood their needs and wishes.

During our inspection we saw that people were consulted and asked for their verbal consent. The care plans showed that consent was gained to discuss prognosis, treatment and care with family members and other healthcare professionals.

We saw that people were offered individualised support and choices in order to meet their nutritional needs.

The nursing staff told us they received good training and support. One person using the service told us, "I can talk about any problems and the nurses know how to support me. They have all the right skills."

The people using the service and the relatives we spoke with knew how to make a complaint and believed the service would fully investigate any concerns.

Patients told us the service had met or exceeded their expectations. Relatives felt supported and told us that "nothing was too much trouble" and that they were kept well informed. There was a range of patient and carer information booklets clearly displayed and accessible.

We saw the service focussed on supporting people to achieve their individual aims and expectations and to maintain their independence. This was reflected in individual patient records throughout the organisation. People felt that they were treated with dignity and respect and welcomed the range of activities and facilities provided.

Staff told us they felt supported by management and that their individual training and development needs were identified through annual appraisal and acted upon. Attendance at staff training had increased. Staffing levels were consistent and staff were available to provide individual patient care according to the care plans.

We saw that there were safeguarding measures in place including policies and training. All staff we spoke with had attended the training and described their safeguarding responsibilities and what may constitute abuse.

People who use the service and staff were supported to give feedback in a variety of ways. The quality of the service was monitored at local level through service user gorups, ongoing surveys, audits, and risk assessments and gaps were acted upon and communicated to relevant staff.