This inspection took place on 21 March 2016 and was unannounced.

Severn Hospice Apley Site is registered to provide specialist palliative care and clinical support for adults with life limiting illnesses. The service provides care on their in-patient facility which catered for up to eight people. At the time of the inspection there were five people using the service. People within the locality of the hospice could also access support from the hospice at home and clinical nurse specialist services in their own homes and or community which were based at the provider’s sister site in Shrewsbury.

The services provided included counselling and bereavement support, day hospice care, family support, chaplaincy, out-patient clinics, occupational therapy, physiotherapy, complementary therapies and a lymphedema service (for people who may experience swellings and /or inflammation following cancer treatment).

The manager was registered with us as is required by law. 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.

People were kept safe by staff who were trained in the safeguarding of adults and health and safety. They were able to fully describe their responsibilities with regard to keeping people, in their care, safe from all forms of abuse and harm. There were safe systems in place to safely manage and administer medicines to people. Medicines were prescribed, recorded, stored, administered and disposed of in safe and appropriate ways. People received their medicines in a timely manner and in line with their preferences.

Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow to make sure people were protected from harm. Recruitment practices were safe and ensured staff employed were safe and appropriately skilled to care for people using the hospice. Systems were in place to ensure records related to accidents and incidents captured the relevant information and this was considered and analysed without delay. Appropriate remedial actions were taken following such occurrences and action was taken to minimise any immediate or future risks to people.

Staffing was at a level which allowed staff to meet people’s needs in a safe, timely and personalised manner. Staff were well supported with the provision of a wide range of support in the form of training, a comprehensive induction, ongoing supervision and appraisal along with peer support and debriefs. Learning within the service including adopting and sharing best practice was highly prioritised. People were supported to access the nutrition they needed and were monitored for any changes in their dietary needs.

Management and staff understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and supported people in line with these principles. Staff established consent from people before providing care and supported people to access independent advice and support when necessary. Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) were flexible and could be transferred for use within the hospice and also applied when people were at home, thus reducing any unnecessary distress and repetition.

Staff were very caring and showed people and their families kindness. Staff demonstrated they were both motivated and passionate about their work and had a clear commitment to providing the best quality care in a compassionate way. People were encouraged to remain as independent as possible by staff. Staff acted in a way that maintained people’s privacy and dignity whilst encouraging them to remain as independent as possible.

People were fully invol

We spoke with three patients and two relatives on the in-patient unit and two patients on the day unit. All were very positive about the care and treatment they had received. For example, one patient described the standard of care as "brilliant" and told us staff were “affectionate” and said that they could not speak highly enough of staff.

Patients and relatives were given appropriate information and support and felt listened to. A relative commented “this is the one place where I have felt listened to, staff are extremely helpful.” Patients’ privacy and dignity was respected.

Admission assessments reflected people's individual care needs, which enabled staff to offer the support that people required, in ways that they preferred. The provider may wish to note however that it was not clear from the records checked how a patient and or their relatives had been consulted with when making a decision relating to resuscitation.

The hospice had suitable arrangements for the safe storage, handling, administration and disposal of medication. This ensured patients’ safety.

There was a system in place to identify and manage all clinical and non-clinical risks and for assessing and monitoring the quality of the service. This ensured patients received a service which was of high quality and met their needs.

As part of this inspection we spoke with seven people who received a service at the hospice, four relatives, three staff, one volunteer, the volunteer coordinator and the ward manager. During our visit we observed interactions, and reviewed the care records of two people. We also looked at other records as detailed within the report.

Everyone we spoke with said that they had been consulted and involved in their care and treatment. People said that their needs and wishes were identified and staff supported them in ways that they preferred.

People told us that their privacy and dignity was always promoted and respected. Our observations supported this and we saw numerous examples of good care.

At the day hospice people enjoyed a wide range of activities and therapies. People told us that there was always something to do and that they always looked forward to visiting.

People were very happy with the quality of care received at the hospice. Everyone told us that staff met all of their care and support needs in ways that they preferred. Peoples’ needs were comprehensively assessed and care and treatment was planned and delivered in line with individual care plans. People told us that their medical, personal and emotional care needs were met. Relatives told us that people received excellent care and support from a staff team who “couldn’t do enough for people”.

People told us that they felt safe and risk assessments demonstrated how risks were identified and reduced as far as possible. Risks were regularly reviewed and people were enabled to be as independent as they were able. Staff were aware of risks, people’s rights and their responsibilities in order to enable people to do this.

People were supported by a knowledgeable and well trained staff team who knew people’s care and support needs well. Staff were offered a range of training opportunities that were specifically designed to meet the needs of the people that they supported. People were protected because staff were confident to recognise and report abuse.

Volunteers were seen to provide essential support to nursing staff and were knowledgeable of their role and remit.

The hospice had systems in place to seek the views and opinions of people who received a service. Staff told us that the service was patient led.

Telford hospice had comprehensive quality monitoring tools in use to ensure that they maintained good quality and safe care. They effectively sought people’s views about their care and listened to them.