This inspection took place on 19 and 20 October 2016 and we provided 48 hours’ notice of our visit to ensure the registered manager would be available to facilitate our inspection. The service was last inspected in December 2013 and was found to be meeting all the regulations we reviewed at that time.

St Ann's Hospice is situated in the Little Hulton area of Salford, Greater Manchester and is registered as a charity. The hospice provides palliative and supportive care services to people with life limiting illnesses. Services provided include Hospice at Home, day therapy, inpatient care and a CSPCT (Community Specialist Palliative Care Team). An extensive garden area is available for the benefit of patients and visitors. Off street car parking is available and the location is well served by public transport routes.

St Ann’s Hospice is registered with the Care Quality Commission (CQC) to provide care for up to 18 people on the inpatient unit. At the time of our inspection there were 12 people being cared for on the inpatient Unit and approximately 250 people receiving care and support in the community. Of these 250 people, the manager told us that provision of personal care was limited.

There was a registered manager employed at the time of the inspection. 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 told us they felt safe when accessing services provided by the hospice. People who used the hospice told us staff would not hesitate to go the extra mile when caring for them. We saw the importance staff at the hospice placed on supporting families and carers of people with life- limiting illnesses in order to improve the well-being of all concerned. This included the provision of carer and bereavement support, complementary therapies and counselling.

Staff treated people with sensitivity, dignity and respect. People's emotional and spiritual needs were met by staff who were knowledgeable and confident to care for and comfort them. Families and those that mattered to the person were supported to spend quality time with them.

All staff had received training in safeguarding adults. In addition the hospice had developed a culture in which staff were supported to report any concerns, no matter how small, to senior staff.

There were sufficient numbers of staff available to provide tailored, individual support to people, both in the hospice and in the community. Staff and volunteers had been safely recruited, such as ensuring DBS (Disclosure Barring Service Checks) were in place.

People received excellent care, based on best practice from an experienced and consistent staff team. Staff were supported through training to develop the knowledge, skills and confidence to be able to meet people's needs in an individualised manner.

All staff and volunteers completed a comprehensive induction programme. Staff were expected to complete online training to demonstrate knowledge in all the topics covered. A comprehensive training programme was also in place to help ensure staff had the skills they required to communicate effectively with people who used the hospice, families and professionals.

Good systems were in place to ensure the safe handling of medicines. People were cared for in a safe, secure and clean environment. People were protected because risks were identified and managed. The risks of cross infection for people were reduced through training for staff and robust infection control procedures. There were high quality fixtures and fittings throughout the building, ensuring people’s comfort and privacy was catered for.

People had access to high quality food and their nutritional and hydration needs were met by excellent catering s

As part of our inspection we focussed on the inpatient unit at St Ann's Hospice as well as the community based services team which provided care to people in their own homes.

During our inspection, patients made positive comments about the service they received whilst at the hospice. The people we spoke with told us they were comfortable and their pain was well managed. Comments included; “The hospice is fantastic. Staff help me with personal care and keep my pain under control. The staff are brilliant and the food is fantastic” and “I have been very well looked after since I have been here. I get treated with respect and would definitely recommend it to other people and their families”.

We looked at how patients were involved in the care they received and if they were treated with dignity and respect my staff. One patient told us; “Staff treat you so well here. Thankfully I can still do things for myself but staff recognise that and allow me to have a go on my own first”.

We spent some time speaking with the lead for infection control and found the premises were clean, tidy and odour free. We also checked equipment was fit for purpose and available in appropriate quantities. We found equipment had been serviced regularly and stored safely.

We found there were appropriate systems in place to monitor the quality of service provided. This included regular auditing and the use of patient surveys which were analysed.

The hospice is registered with the Care Quality Commission to provide care for up to twenty-four people and there were seventeen people receiving care on the day of the inspection.

Throughout the course of the inspection we found that people had been well cared for and that they were comfortable, relaxed and that their pain had been managed appropriately. We also saw through discussions, how families had been made to feel at ease through the quality of service that had been provided.

As part of the inspection we spoke with four people using the service who all spoke very highly about the care that they had received during their time at the hospice. One person told us “They help me with everything, I only have to ask the staff and they will assist me with what I need. I only arrived at the hospice last week and I can’t fault it so far”. Another person who used the service said “Nothing is ever too much” and “They go over and above”.

We also spoke with five relatives who were visiting on the day of the inspection and their feedback was also positive. One relative told us “I feel so re-assured now that my ‘x’ is being looked after here” and “I had been struggling to find a specific Christmas gift recently and the staff helped to find it. It meant going out of their way, but that is just how they are here”.

We talked to a number of people who were being cared for as in-patients at the hospice during our visit on 7 March 2012. When we asked the people who use services about their experiences, we ensured that we were sensitive to their health condition. People told us that they were exceptionally well cared for and stated that they were treated with dignity and respect. One person commented that "I have been here before . They absolutely take care of me in everyway, your body, cleanliness and your health, they’re wonderful. Everything is for your comfort, they make me as comfortable as I can be. They are patient and never rush me”. Another person told us that “I'm from the old brigade - I thought hospices were still like in the olden days. I was very pleasantly surprised. Anything I ask for; it's there. I've never had food so good. ” Across the outcomes we looked at, the people who use the service gave very positive comments.