The inspection visit at Trinity Hospice and Palliative Care Services Limited was undertaken on 13 July 2016 and was announced. We gave 48 hours’ notice of the inspection because of the sensitive nature of the service provided. We also wanted to ensure people, staff and visitors were available to talk with us.

Trinity provides palliative and end of life care for 33 children and adults with life limiting illnesses. The service supports people and their families, providing spiritual and holistic care. Furthermore, they offer a hospice at home service in the local community to assist individuals living at home. At the time of our inspection, there were eight people inpatient at Trinity. Additionally, the hospice supported approximately 500 individuals in their own homes within the Blackpool and surrounding areas. The service further employed two teams of clinical nurse specialists in the wider community who worked at the local hospital and with community services. They supported people who were inpatient and worked collaboratively with district nurses for those who lived in their own homes. The nurse specialists provided palliative care management, symptom control advice and facilitated complex treatment discussions with people and their families.

Trinity is situated in a residential area close to local amenities. The service supports people in three different units: the main hospice inpatient unit; Brian’s House (the children’s unit); and a day therapy unit. Bedrooms are for single occupancy, spacious and comfortable. Additional facilities include therapy areas, private consultation rooms and extensive gardens.

A registered manager was in place. A registered manager is a person who has registered with the Care Quality Commission (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.

At the last inspection on 20 August 2014, we found the provider was meeting all the requirements of the regulations inspected.

During this inspection, staff, people and visitors said the service was organised to a high standard and had exceptional leadership. The registered manager worked jointly with other agencies to develop best practice and foster excellent partnership relationships. For example, they conducted various research studies with the local hospital that influenced and improved best practice and national care policy-making. We saw this had a major impact upon people’s care, safety and welfare.

We found staff, people and relatives were at the heart of Trinity’s quality assurance programme. The management team set up multiple forums to involve and gain their feedback. One comment we saw stated, “Nothing needs improvement.” A relative fed back, “Fantastic support given by the hospice at home team.” The registered manager had remarkable oversight of care provision, service quality and everyone’s safety. This included multiple auditing systems, a range of different staff-level meetings and various structures to review staff, people and visitor’s views.

We observed staff provided outstanding support that had the person at the centre of their care and treatment. Without exception, people and their relatives spoke extremely highly of staff and their experiences of care. One relative said, “I really cannot praise them enough.”

We found care planning enabled staff to work in a highly personalised and holistic approach. People told us staff were efficient at responding to them and their requirements. End of life care plans were very detailed and relatives told us related support was excellent. One relative fed back, “The memory boxes have been overwhelming since my [family member] passed away.”

People and their representatives said staff worked collaboratively with them to ensure they received high standards of care. One person said sta

We spoke with a range of people about the hospice. They included the registered manager, staff members, volunteers, patients, relatives and visitors. We also asked for the views of external agencies in order to gain a balanced overview of what people experienced using Trinity Hospice.

We spent time in all areas of the hospice, including the in-patient unit, the day centre and the children’s specialist unit, Brian House. This helped us to observe the daily routines and gain an insight into how people's care and support was being managed. Staff treated people with respect and ensured their privacy when supporting them. They provided support or attention as people requested it.

We spoke with people about the care and support they received. They said they were happy with the care and support being provided. One person told us, “The care has been very, very good, couldn’t ask for anything better.”

There were systems in place to reduce the risk and spread of infection. Patients and relative we spoke with had no concerns about infection control. Comments included, "I have no concerns about hygiene.” And, “There are always cleaning staff around. The building is always so clean."

The hospice had a range of audits and systems in place to monitor the quality of the service being provided. This included taking into account people’s views and experiences. This meant the hospice effectively monitored the quality of its service provision.

People who used the service told us they understood the care and support services available to them, and that they were involved in making decisions about care and treatment.

People told us they were treated respectfully by staff and the support the hospice could provide was explained to them before they were admitted. Staff members we spoke with told us they thought it was essential to make people feel at ease when they were admitted. Also, it was equally important to keep relatives informed of care and treatment.

People we spoke with were satisfied with the care and support they received. One person told us, the changes in pain relief had made him feel much more confident to return home.

Another person told us "It’s so calm in here and the staff cant do enough for you.”

When asked people told us they felt safe using the service. One person said "There are always staff around you are never on your own, it makes me feel secure".

People told us they were happy with the service and knew how to raise issues, should they have any. People we spoke with said they didn't have any complaints or concerns.