This inspection of St Michael’s Hospice took place on 5, 6, and 7 July 2016. The service provides specialist palliative care, advice and clinical support for adults with life limiting illness and their families. They deliver physical, emotional, spiritual and holistic care through teams of nurses, doctors, counsellors and other professionals including therapists. The service provides care for people through an Inpatient Unit, Day Service and a Hospice at Home service.

At the time of the inspection there were six people using the inpatient service and 102 people using the Hospice at Home services. The day services provided in the `Wellbeing Centre` offered a range of services to people diagnosed with life limiting conditions, their carers and families. The service provided specialist advice, courses, complementary therapy sessions and clinics. St Michael’s Hospice also provided a counselling and bereavement service for people and their families if required.

St Michael’s Hospice had a registered manager in post. 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 at St Michael's Hospice was the Director of patient Services (DPS)

People were protected from abuse because staff were trained and understood the actions required to keep people safe. Staff had completed the provider’s required safeguarding training and were able to explain their role and responsibility to protect people.

Potential risks to people had been identified and managed appropriately. Risk assessments were completed with the aim of keeping people safe yet supporting them to be as independent as possible. The Hospice at Home staff knew people’s needs and proactively managed risks to people being supported to live with their illness at home, in accordance with their wishes.

The registered manager (DPS) told us department heads completed a weekly staffing analysis to ensure there were sufficient staff available to meet people’s needs. Rosters were completed a month in advance and demonstrated that the required number of staff to meet people’s needs was provided. Staff working within the inpatient unit told us that staffing levels were sufficient to ensure people received their care safely. People and relatives told us they had no concerns regarding the staffing levels.

Staff had undergone robust pre- employment checks as part of their recruitment, which were documented in their records. These included the provision of suitable references in order to obtain satisfactory evidence of the applicants conduct in their previous employment and a Disclosure and Barring Service (DBS) check. People were safe as they were cared for by staff whose suitability for their role had been assessed by the provider.

All staff involved in medicines administration had regular training and had undergone competency checks. Medicines were stored safely and securely. There was a system to check that all medicines were within date and suitable for use. There were medicines available for use in an emergency and these were being checked regularly.

Staff described effective processes for the supply of medicines on discharge from the hospice. We were told by staff that people going on leave were supplied with their medicines in unlabelled dosage boxes. No adverse incidents had been reported in relation to this practice because staff had ensured that people knew all of the information required to manage these medicines safely. The registered manager (DPS) and quality and governance officer ensured this practice ceased before the conclusion of our inspection.

People received effective care, based on best practice, from staff who had the necessary skills and knowledge to do so. The

We found that St Michael’s Hospice (North Hampshire) provided a range of services to people with life limiting illness.

The care was good and people were complimentary about the support provided by staff. We found that care records were not as co-ordinated as they could have been and paper and computerised systems were used in parallel to try to ensure that all relevant information was available. People were properly consulted about their care or that of their relative and involved in decision making.

Patients were provided with a varied and nutritious diet and had a range of options at each meal. They could also request individual items if desired. Specialist or adapted diets were provided when necessary.

The majority of staff recruitment records were in accordance with requirements and the manager was going to request a review of records to identify and address any shortfalls.

Staff and volunteers received appropriate training according to their role. An annual programme of core training was provided to all staff. Qualified staff could attend clinical group supervision led by the in house psychologist. Staff could also obtain personal support from the chaplain. Volunteers were provided with a mentor when they started with the organisation.

The provider had a range of management monitoring and audit systems in place and reported regularly to the board of trustees. The views of patients and their families about the service were sought and acted upon.

The people who used the service we spoke with told us that staff were kind and caring and they were given support to be independent, to learn new skills and manage their disease.One relative told us ''it is just like a first class hotel, and they look after me so well''. Others users told us how much they relied on their attendance at the day care centre, they had treatment and therapy services and had made new friends.

The facilities provided a safe environment for patients, relatives and staff. The facilities include accommodation for relatives,a quiet room, and a faith area.

Peoples needs were assessed and support plans put in place ensuring that people were provided with safe and effective care. Staff with appropriate qualifications and experience were available during each working day to provide the required level of care and support to people using the service.