This inspection took place on the 27 and 28 September 2016. The last comprehensive inspection of the Rowans Hospice took place on 19 February, 2014. During this inspection we found the service’s systems for the storage and disposal of medicines were not safe. At this inspection we found that the provider had taken the required action to ensure medicines were stored and disposed of safely.

The Rowans Hospice (aka The Rowans or Rowans) is a charity dedicated to improving the lives of people and their families in Portsmouth and South East Hampshire living with life-limiting illness. The Rowans Hospice provides specialist palliative care to people, carers and families who are facing complex physical, emotional and practical difficulties arising from advanced progressive life limiting illness. This may be cancer or other diseases. The service delivers 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 (IPU), outpatient day service, a hospice at home service and Living Well Clinics.

There are nineteen in-patient beds, all in single room accommodation with en- suite bathrooms. At the time of our inspection there were 15 people using the in-patient service. The hospice at home service offers additional support to people and their family carers, enabling people to stay at home and receive high quality end of life care. The service is available 365 days a year and provides people and carers access to specialist advice and nursing visits on a 24 hour basis. The Rowans Hospice also has a Day Care service which provides short-term placements.

The service 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 The Rowans Hospice was the Director of Clinical Service (akaThe Matron).

People who used the different aspects of the service told us the quality of care and kindness provided by professional staff made them feel safe. Staff were able to explain their role and responsibility to protect people from abuse.

Care records demonstrated that potential risks to people’s safety were identified and plans were created to mitigate them. Risks to each person's health and well-being had been considered and assessed, for example people's mobility, skin care and nutritional needs. We observed staff supporting people to prevent any identified risks in accordance with people’s risk assessments.

There were sufficient staff to meet people’s needs. The relevant head of department completed a daily staffing analysis to ensure there were sufficient suitably qualified staff available to meet people’s needs. When people’s health deteriorated quickly we observed the staff ability to provide one to one care increased people’s safety and reduced the risks of harm to them.

The provider ensured that robust pre- employment checks were completed on all staff and volunteers as part of their recruitment. People were cared for safely because all staff and volunteers suitability for their role had been effectively assessed before they were appointed.

People were protected from harm because there were safe systems in place to ensure patients were not exposed to the risks associated with medicines.

People spoke positively about the quality of care and support they received from staff. Due to the expertise and knowledge demonstrated by staff, people were confident that they were well trained and supervised.

Staff had been trained to deliver best practice in relation to end of life care. Staff also had to complete regular training in relation to people’s clinical needs. This en

On the day we inspected there were 19 people using the service at The Rowans. We spoke with four people who were using the service, four relatives and seven staff. This included nurses, health care support workers, volunteers and senior staff.

People described the staff as "excellent", and the service as "fabulous, you could not ask for anything more". Another person said, "I heard it was good and I haven't been disappointed".

Relatives and people using the service felt involved in the decision making and the care and everyone we spoke with felt respected by all staff. People were aware of their rights and knew what their care plan consisted of and their plans for their future. Some people were too unwell to be asked about their care.

Staff felt supported and were motivated in their work and were complimentary about the management support and the teams. One person described their job as "great" "my dream job", and the staff "look after each other".

There were safe systems in place for the administering of medicines. However, there were concerns with the safe keeping of some medicines which were kept on a shelf inside the locked clinic room and the lack of safe disposal of some medicines no longer needed. We sought advice from the CQC lead pharmacist on these issues.

The quality of the service provided was monitored by an effective quality assurance processes.

We found that no one received care or treatment without their consent being given. Staff were aware sometimes people would not be able to give consent and had received training in this area. People told us the staff were respectful and treated people with dignity.

We saw that extensive efforts were made to ensure people received the care and support they needed. The holistic needs of people were taken into account. We saw that records of all care provided were maintained by all those involved.

People were provided with a clean, pleasant safe and calm environment, which met their needs.

There were enough staff to meet people's needs. People told us the staff were "marvellous and wonderful".

People told us they knew the complaints procedure and would feel comfortable discussing any concerns with any member of staff.

We spoke with eight people who use the service and also to two relatives, the Registered Manager and three of the staff on duty.

All of the people we spoke with said they felt they were treated with dignity and respect and that they were as involved as they wanted to be in how the service was run. Some of them commented on how good the communication was between the nursing staff and people using the service and their families. They told us about their experiences of the admission and ongoing care process and said that staff had the right skills and were aware of their needs and wishes.

The people we spoke with had between them used all of the services offered by the provider and all said that they had felt fully supported and also that they felt safe and secure in the hospice environment. They said that the provider asked for their views about the service and they were confident that the provider would listen to what they had to say. We observed that staff and volunteers promoted an inclusive, supportive environment for people using the service and their families.