We inspected this service on 16 and 17 August 2016 and we gave short notice to the registered provider prior to our visit. This was to ensure that key people were available during the inspection.

Willowbrook hospice offers care and support for adults with life-limiting illnesses in the St Helens and Knowsley area. The service is registered to care for up to 12 people on two in-patient wards. Willow Suite has seven beds, four of which are single rooms plus a three-bedded room. Oak Suite has five beds, three of which are single rooms, plus a double room. All rooms are en-suite, with the three-bedded room having a walk in bath. There is also a multi-sensory therapeutic bath for use by inpatients. The day therapy unit provides up to 60 day care places per week.

Willowbrook Hospice is a purpose built independent hospice opened since 1997. There is car parking available to the front of the building. There were 11 people staying at the hospice at the time of this visit.

The previous inspection was undertaken in January 2015 and the service met the regulations we assessed at that time.

There was a registered manager in place at this service, who has been registered for 15 years. 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 told us that they received very good quality of care from all the staff. People told us staff were kind, patient, wonderful, superb and caring towards them and that staff supported them to meet their physical, social and emotional needs. People described the culture of the service as positive, calm and caring.

People told us they felt safe at the service with the staff team. Staff had been trained to recognise and report any signs of abuse. No safeguarding issues had arisen at the service since the last inspection.

The management and administration of medicines was safe and staff were competent and suitably trained in this area of care.

Care plans were person-centred and kept up to date. End of life care was given in compassionate, sensitive and appropriate ways that acknowledged people’s rights and preferences. The service supported people and their families to enjoy the time they had together and enhance their feelings of well-being.

The staffing levels were good and sufficient staff were seen on the days the inspection took place. Staff were well trained and had access to a variety of training courses which enabled them to develop their skills and knowledge base. Good support was given to staff by senior management and regular meetings and supervision sessions were undertaken.

Robust staff recruitment processes were in place which ensured that only staff who met the service’s high specifications regarding experience and qualifications, character and caring abilities were employed. This included the recruitment of volunteers.

People told us the food was very good and that they had access to snacks and drinks whenever they wanted them. Care plans showed that people were encouraged to have a nutritious diet.

The service worked closely with other professionals and agencies to ensure people’s holistic needs were fully met. There was clear evidence of close and effective partnership working between the service, people, their families and carers, and external professionals.

Regular checks were made regarding the safety of the building and equipment. Staff were given training in safe working practices and provided with any necessary personal protective equipment. The building was clean, hygienic and in a good state of repair. The gardens had been developed with a “Japanese” theme which people and visitors commented positively, saying it was a peaceful and calming place to be.

We spoke with two people who were inpatients at the hospice and two people who were attending the day therapy unit. We also spoke with two relatives. All the people we spoke with were complimentary about the service provided at the hospice. Comments included, “The care is fabulous”, “It’s fantastic here. I didn’t want to come at first but now I look forward to it” and “It’s all positive here”.

People told us they were fully involved in decisions about their treatment and care. One person told us, “You can talk to the doctor about anything. They have been very good at explaining things”.

All the people we spoke with told us they felt safe and well cared for in the hospice. However, the provider might wish to note we found care plans contained limited information for staff to follow. This meant there was a risk people might receive inappropriate care.

We found appropriate arrangements were in place for the safe administration of medicines.

There were sufficient numbers of staff on duty to meet the needs of people who used the service. We saw there were systems in place to review staffing levels against the dependency levels of people who used the service.

We found suitable arrangements were in place to manage an effective process for identifying, receiving and handling complaints for people who received a service at Willowbrook hospice.

Willowbrook Hospice is a purpose built facility, with accommodation for ten people with life limiting conditions, and with facilities to provide services and treatments for people who are terminally ill, but who choose to be cared for in the community. The service had 400+ volunteers, who help in the day to day running of the facility, doing jobs such as switchboard operation and providing transport services. Volunteers also work in the charity shops which support the hospice financially. The building was bright, airy and modern with access to gardens which provide open spaces for patients to sit in when the weather allows.

When we spoke with people using the service, they said without exception that they felt safe and well cared for. Relatives spoke highly of the staff, saying how thoughtful, considerate and caring they had been to both them and their family member.

When we toured the building we were shown an activities room. Here, people had written out their Christmas wishes or anything else they wanted to say, and these were displayed on a board. We observed people sitting with volunteer staff, playing dominoes. People told us “it’s lovely here, there are really nice places to sit, the rooms are fine, and it's lovely and warm”.

Consideration had been given to relatives by the provision of spaces to sit and spend time with a family member, maintaining some measure of privacy, without feeling hurried.

We interviewed a number of people that use this service (referred to in this report as patients) and family members. We were told that they were clear about the treatment and support choices available to them. They said that that they felt involved in the decision making process, family members said they welcomed this. Some patients pointed out to us that they had been given leaflets about this. We asked about how involved they felt in the assessment and care planning and positive comments were provided by family members who wanted to participate in the care given.

Family members told us they were kept well informed of the changes in their relative’s condition. They told us that staff were kind and that it seemed like ‘Nothing was ever too much trouble for them’. Patients and their families told us that they felt supported by staff in making difficult decisions. People told us that staff made them feel welcomed and involved a number of examples for how this had been achieved were explained to us.