This inspection took place on 12 and 13 April 2016 and was unannounced.

Sue Ryder St John's is a hospice that also provides specialist outpatient treatments and remote, telephone advice services. Fifteen beds are provided in the accommodation facilities at Sue Ryder St John's. At the time of our inspection four people were using the in-patient facilities.

There was 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.

People felt safe. Staff had received training to enable them to recognise signs and symptoms of abuse and how to report them. People had risk assessments in place to enable them to be as safe and independent as they could be.

There were sufficient staff, with the correct skill mix, on duty to support people with their care and treatment needs. Effective recruitment processes were in place and followed by the provider.

Medicines were managed safely. The processes in place ensured that the administration and handling of medicines, including controlled medicines, was suitable for the people who used the service.

Staff received a comprehensive induction process and on-going training. They were well supported by the registered manager, director and the provider and had regular one to one time for supervisions. Staff had attended a variety of training to ensure they were able to provide care based on current practice when providing care and treatment for people.

Staff gained consent before supporting people or providing care and treatment. People were supported to make decisions about all aspects of their life; this was underpinned by the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff were knowledgeable of this guidance and correct processes were in place to protect people.

People were able to make choices about the food and drink they had, and staff gave support when required. specialist diets were catered for.

People were supported to access a variety of additional health professional when required. Alternative therapy was available including; aromatherapy, Indian head and Swedish massages, reflexology, reiki and aromatherapy.

There was an extensive support programme, manned 24 hours to provide a single point of contact for additional support. The service had a Black, Minority and Ethnic (BME) outreach worker who worked closely with the wider community.

Staff provided care and support in a caring and meaningful way. They knew the people who used the service well. People and relatives, where appropriate, were involved in the planning of their care and support. People’s privacy and dignity was maintained at all times.

A complaints procedure was in place and accessible to all. People knew how to complain.

Effective quality monitoring systems were in place. A variety of audits were carried out and used to drive improvement.

People we spoke with during our visit said things like ''staff make me feel better'' and ''it is nice and caring and thoughtful in here''. One said, ''I wouldn't change anything in here'' and another said 'they do the best they possibly can, cheery. I love the people.'' We saw staff responding promptly to requests to assist people. Staff had good records of people to ensure they were appropriately treated as either in- or out-patients. Staff told us how the teamwork for the clinic was supportive of them.

We saw that a wide and suitable menu was provided to all inpatients by the kitchen, made from fresh ingredients. In addition, people's nutritional needs were met by staff providing snacks at any time patients required them. The kitchen also provided a selection of sandwiches and other snacks for visitors or outpatients. One person commented that they always had sufficient water and juice provided.

When we visited Sue Ryder, St John's, we saw records of staff employed for the day clinic, the residential unit and the Partnership for Excellence in Palliative Support ( PEPS) service run from St John's. Records were kept to ensure that all staff were kept current in training that Sue Ryder considered mandatory for work at St John's. We saw that staff also had current training records. We saw records that showed staff were supported in achieving additional, relevant qualifications such as a foundation degree. This helped staff to provide effective care for people.

When we visited Sue Ryder, St John's we spoke with two people who had received either day care or residential care. One said they ''could not fault it''. The other said staff were 'very caring and thoughtful'. We saw that people received support and treatment appropriate to their needs, whilst being encouraged to maintain independence where possible. Staff respected people's privacy and treated them with dignity. Visitors were welcomed at St John's, enabling them to spend time with people and share mealtimes if they wished.

A refurbishment undertaken in 2011 included the provision of improved bathroom facilities, private quiet areas and good TV, radio and DVD services for people resident at St John's. All areas were bright and well maintained. A wealth of information on services, conditions and treatments was available to people.

We spoke with someone who was accompanying a person receiving day treatment at the service. They told us that they visited the service regularly, and that staff had been very welcoming. We were told that they had been made to feel at home in respect of somewhere comfortable to wait, and facilities for making drinks and snacks.

Following our visit, we spoke to the Lead Commissioner for Palliative and End of Life Care for NHS Bedfordshire, who told us that they had no concerns about the service, and that the hospice provided very good care.