This inspection was announced and took place on 19 and 20 July 2016. Our previous comprehensive inspection was on 29 April 2014 and was part of the pilot to test the Care Quality Commission's (CQC) new inspection methodology and so although they were rated this was not published.

At the inspection on 29 April 2014 we asked the registered provider to make improvements with regard to Regulation 12 Safe care and treatment; around the management of medicines. This action has now been completed. We revisited the service on 29 September 2014 and found the service was compliant with the regulation.

St. Leonard’s Hospice York provides a 20 bed in-patient hospice care unit (IPU) and a hospice-at-home service which are regulated by CQC. The Sunflower Centre, which is the day hospice is not regulated by CQC. These are based on one site. The hospice holds condition specific clinics, has a social work team, a bereavement support service, therapy services, an education department, a fundraising department and a team of volunteers numbering around 230. There is a hospice-at-home team who provide hospice care in the community to people. There is also a care homes education team who work specifically with care homes in the area. The hospice also has an on-site Chaplain who provides spiritual care to everyone using the hospice service.

The care provided by the hospice is for people that live in the York area of North Yorkshire and Ryedale and some parts of the East Riding of Yorkshire. The service is a registered charity with a board of trustees. Day-to-day the service is run by a senior management team drawn from all departments within the hospice.

The service was responsive and focused on providing a tailored service which people helped plan and develop. There were appropriate systems in place to ensure flexibility to people so that their care needs could be met either at home, in the hospice or in the wider community. In addition the service provided good support to relatives and carers.

Excellent leadership and management was demonstrated at the service. The culture was open and inclusive which meant that people received a tailored service which was flexible to their needs.

There was a registered manager employed for this service. 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. The registered manager was very experienced after being employed by the hospice for a number of years.

The beautiful environment was maintained by the hospice maintenance and gardening team. There were servicing agreements in place for mains services. The premises were extremely clean and tidy with appropriate adaptations in place for people who used the service. The gardens were extremely well maintained and offered people tranquil and pleasant areas in which to sit, chat and spend time with their loved ones.

Staff recruitment processes were followed with the appropriate checks being carried out. There were a high number of staff on duty to meet people's needs in a meaningful way and the service had a team of volunteers who provided additional support. The hospice had a bank of staff who they could contact if they needed additional staff. All staff received annual appraisal and clinical supervision and staff discussion groups were in place. Staff and volunteers received a thorough induction and regular training to ensure they had the knowledge and skills to deliver high quality care which they demonstrated throughout the inspection.

Staff followed risk assessments and guidance in management plans when providing care and support for people in order to maintain people's safety.

Staff were able to describe what it meant to safeguard people and told us how they would report a

St. Leonard’s Hospice is a hospice service that is located on the outskirts of York. The hospice has twenty in-patient beds and incorporates a Hospice@Home service. In addition to this, a maximum of fourteen people per day have access to day care; this part of the service is not required to register with the Care Quality Commission. However, as some people who access day care have also used the in-patient or Hospice@Home service, we spoke to them as part of this inspection. On the day of this inspection some bedrooms were being refurbished so there were only ten people using the in-patient unit.

There was a registered manager in post as the time of this inspection and they had been registered as the manager for two years. A registered manager is a person who is registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

We previously visited St. Leonard's Hospice on 29 April 2014. We had concerns about the management of medicines, particularly the disposal of medication and the recording of fridge temperatures. A focussed inspection was carried out on 30 September 2014 to check that the provider had taken action to ensure that medicines were stored and disposed of safely.

You can read a summary of our findings from both inspections below.

Scheduled Inspection of 29 April 2014

People told us that they felt safe whilst using the hospice. Staff and volunteers had been recruited following robust policies and procedures that ensured only people suitable to work with vulnerable people had been employed and there were sufficient numbers of staff. Staff had undertaken training on safeguarding adults from abuse and they displayed a good knowledge of the action they would take to manage any incidents or allegations of abuse. Staff had undertaken other training that provided them with the skills to carry out their role effectively.

People’s individual circumstances and lifestyle had been taken into account when their care or treatment plan had been devised. People who were important to the person had been consulted and their needs were incorporated into treatment plans. There were appropriate risk assessments in place that ensured people’s safety, allowed people to take responsibility for their actions and be as independent as possible, but remain safe.

There were some quality assurance systems in place that monitored people’s satisfaction with the service and that audited the systems in place. However, there was no overall clinical governance system in place and medication audits had not identified the issues that we raised.

Focussed inspection of 30 September 2014

Staff had a good understanding of the policies and procedures in place on the storage, recording and disposal of medicines. Medication was stored safely, including medication that required refrigeration and medicines that were waiting to be destroyed. Only registered nurses had responsibility for the administration of medicines and access to the medication room.

St. Leonard’s Hospice is a hospice service that is located on the outskirts of York. The hospice has twenty in-patient beds and incorporatesa Hospice@Home service. In addition to this, a maximum of fourteen people per day have access to day care; this part of the service is not required to register with the Care Quality Commission. However, as some people who access day care have also used the in-patient or Hospice@Homeservice, we spoke to them as part of this inspection. On the day of this inspection some bedrooms were being refurbished so there were only ten people using the in-patient unit.

There was a registered manager in post as the time of this inspection and they had been registered as the manager for two years. A registered manager is a person who is registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

People told us that they felt safe whilst using the hospice. Staff and volunteers had been recruited following robust policies and procedures that ensured only people suitable to work with vulnerable people had been employed and there were sufficient numbers of staff. Staff had undertaken training on safeguarding adults from abuse and they displayed a good knowledge of the action they would take to manage any incidents or allegations of abuse. Staff had undertaken other training that provided them with the skills to carry out their role effectively.

People’s individual circumstances and lifestyle had been taken into account when their care or treatment plan had been devised. People who were important to the person had been consulted and their needs were incorporated into treatment plans. There were appropriate risk assessments in place that ensured people’s safety, allowed people to take responsibility for their actions and be as independent as possible, but remain safe.

There were some quality assurance systems in place that monitored people’s satisfaction with the service and that audited the systems in place. However, there was no overall clinical governance system in place and medication audits had not identified the issues that we raised.

On this visit we looked at the Hospice@Home service provided by St Leonard’s Hospice. This provides end of life care to people in their own home. It is a small service and can currently only provide that service to a small group of people at any one time. The staff team are mainly registered nurses, though healthcare workers are also sometimes used. The professional in overall charge of the person’s care is their district nurse.

We spoke with three people by telephone and visited one person in their home. We also spoke by telephone with three healthcare professionals.

All provided very positive comments about the service and the care they delivered. Comments included “They treat my mum like their own mum.” And “The staff are all lovely. They’re very competent.” One professional said “The service works really well with the patient and their family.”

People are treated in a kind and respectful manner and are included in decisions about their care.

People receive the right care and support at the time they want it.

Medication is administered safely and appropriately by staff that are skilled, knowledgeable and competent.

Staff are provided with the training and support needed to enable safe and effective care to be delivered.

Whilst informal feedback from people using the service and from healthcare professionals indicates an effective and efficient service the provider may like to consider how they can better evidence this.

The service was routinely talking to people about care and treatment options and gaining people’s consent before these were provided. This ensured people understood why that care was needed so could provide informed consent for that care.

We could not speak with many people when we visited because of their complex needs. We did however speak with three people receiving care and one visitor. All were very pleased with the care they received. One person said “We can’t stress how nice this place is. We’re really happy with the care.” Another person said “The staff are absolutely super. The care is first class.”

The service had established infection prevention and control systems which were regularly reviewed. This ensured the risk of harm to patients, visitors and staff from a healthcare associated infection was minimised.

The service followed a robust recruitment process when employing new staff. Checks were completed before recruitment decisions were made. This ensured only staff suitable to work with vulnerable people were employed.

The service took complaints seriously. There were systems in place to enable people to comment on the service they received. Staff were open to receiving any negative comments as they recognised that all comments could be used to help improve the service they delivered.

During this visit we looked at care provided on the In-Patient Unit. We did not visit the area where Day Care is provided.

People we talked with spoke highly of the care and support they received at St Leonard’s Hospice. One person commented “I’ve been really well looked after.” Whilst another told us “Care is all that you need”, with their relative adding “I can’t fault the care. Anything we need - then we get it straight away.” A third person said “The care is excellent. I’m so impressed.”

We did not receive any negative comments about the care, the staff group or indeed how the service was being run.

People told us about the excellent meals that were served to them, and the snacks and extra drinks that were available at any time, day or night. One person said it was like a hotel and another told us how they had been offered toast and soup in the night when they couldn’t sleep, which had been very welcome.

People pointed out to us the well maintained gardens, rural outlook and also wildlife seen from their rooms. This means the outside environment was having a positive impact on their day to day lives.