St Luke’s Hospice, Turnchapel serves the people of Plymouth, South West Devon and East Cornwall. They provide palliative symptom control and end of life care, advice and clinical support for people with progressive, life limiting illnesses and their families and carers. They deliver physical, emotional and holistic care including bereavement counselling support, a lymphoedema service which provides advice and treatment (for people who experience swellings and inflammations usually of arms and legs) and an outpatient service. They offer occupational therapy, complementary therapies and physiotherapy, chaplaincy and spiritual support, as well as social workers, clinical nurse specialists and volunteer services. The hospice inpatient unit at Turnchapel was purpose built can care for up to 12 adults. The average length of stay is two weeks. The service provides acute specialist palliative care for people and does not provide a respite service or longer stay beds. The majority of people are cared for by hospice community specialist nurses in the community, currently around 300 people on the active caseload.

There was a manager in post who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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. They held the post of head of quality and compliance and were supported by a leadership team that included the chief executive and directors and department managers.

The registered manager was open and transparent in their approach. They promoted the service mission of ‘Hospice without walls” providing and promoting high quality end of life care accessible to anyone. Staff demonstrated this vision in their practice and gave person centred, individualised care. All staff felt valued by the leadership team and supported to provide high quality care throughout the service.

The service provided outstanding end of life care which enabled people to experience a comfortable, dignified and pain-free death. The environment was accessible for people with disabilities. It was welcoming, well maintained and suited people's needs. Clinics, therapies and support groups were held in the unit and people, in wheelchairs or beds could enjoy the view looking out over Plymouth Sound. There were well maintained grounds which were also accessible for people to enjoy.

The service continuously looked at the local community to see how best they could provide the service and had done excellent work in identifying the needs of the local population developing services to meet those needs. This had resulted in the provision of a Crisis Team service in 2014. It was identified that at times people experienced unnecessary hospital or hospice admissions when they would have preferred to remain at home. As part of the service mission to provide a “Hospice without Walls”, the Crisis Team aimed to respond within an hour to provide a short 72 hour intervention to enable people to stabilise their symptoms and facilitate rapid discharge home from hospital or hospice.

The team of registered nurses and health care assistants operated 24 hours a day, 7 days a week. This assisted and supported families and carers to respond to people’s rapidly changing situations to enable them to continue supporting their loved one. The Crisis Team staff were employed by St Luke’s and worked closely with other health care professionals in the community.

St Luke’s Hospice staff also worked at Derriford Hospital, Plymouth where they provided a specialist palliative care service for any hospital patient with a progressive life limiting illness and working closely with an extended multidisciplinary team. Services included assisting hospital staff with people’s complex discharge arra

We spoke with four people who were receiving inpatient care and one family who were visiting at the time of our inspection, six members of staff, the ward matron, the ward sister, a staff nurse, a doctor and the registered manager. People’s comments included “It’s brilliant here, wonderful – there are enough staff and they look after you very well”, “Staff couldn’t be better, they are seeing to me grand”, [staff] “appear to know what they are doing”, and “Fantastic…the quality is so high”.

Everyone said they were involved in their treatment plan and asked for their consent. People who were not able to make their own decisions were assured of being properly identified and assisted to make decisions in their best interest.

People's treatment needs were assessed carefully, and treatment was provided effectively by experienced and qualified staff. There were systems in place to ensure that information was shared appropriately between different agencies and organisations to provide continuity of care between providers, and that people were kept safe.

We found that measures were being put place to ensure staff were deployed effectively in sufficient numbers with the right knowledge, skill, qualifications and skills to support people.

The provider notified the care Quality Commission in a timely manner of any important events affecting people's welfare, health and safety.

We spoke to two people who used the service. Both people reported that they felt fully informed about treatment options and that their care was personalised to their individual needs. One person stated that " They listen to me here." Another said "They explain everything." We found that care plans reflected the individuals needs and were updated as a persons needs changed. Care plans incorporated the mental well being of the individual using the service.

We reviewed the arrangements for medicines at the hospice. Appropriate arrangements were in place in relation to the obtaining, recording and storage of medicines. The hospice has systems in place which monitor the administration of medicines.The hospice has an effective system of monitoring the quality of the service it provides. This includes questionnaires, suggestion boxes as well as formal audits undertaken in a number of areas. We saw that action was taken to address any deficits arising from these audits.

The provider has systems in place to provide support and training to staff. The hospice chaplain and an external consultant provide staff with the opportunity to discuss issues with them. A formal appraisal system is in place for all staff and training is offered to staff.