We carried out an unannounced comprehensive inspection of this service in May 2016 when a breach of legal requirement was found. We found a breach in regulation regarding the service not having robust procedures in place to make sure patients were protected from abuse.

After the comprehensive inspection, the provider wrote to us to tell us what they would do to meet legal requirements in relation to the breaches. We undertook a focused inspection on 12 April 2017 to check that they had they now met legal requirements.

On this inspection we found improvements had been made and the service was now meeting requirements.

This report only covers our findings in relation to the specific area / breach of regulation. This covered one question we normally asked of services; whether they are 'safe'. Although ‘well led’ was rated as good at the last inspection, we looked at this domain in respect of the improvements around the management of safeguarding procedures.

The question 'was the service effective’, ‘was the service responsive' and ‘was the service caring' were not assessed at this inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Woodlands Hospice on our website at www.cqc.org.uk.

There was a registered manager in post at the time of our inspection. 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.

Woodlands Hospice is an independent charity situated in the grounds of University Hospital Aintree. Woodlands is based in North Liverpool and covers a population of 330,000 in North Liverpool, South Sefton and Kirkby in Knowsley. The hospice provides 15 overnight beds in a purpose built wing (in-patient unit).

Woodlands has a multi professional team of staff who provide specialist palliative care to people who have a life threatening illness and for people who are in the terminal stage of their disease. Palliative care is the total care of people whose illness is not responsive to curative treatment.

Other services provided by the hospice include day therapy services (well-being and support centre), community therapy, outreach and outpatient services and a hospice at home service for South Sefton patients only.

Hospice at home provides a sitting service, support for the district nurse team, accompanied transfer home from hospital or hospice and crisis intervention. This service is provided by the staff from Woodlands and is commissioned by South Sefton.

Woodlands Hospice medical staff visit people in their own home to advise the community team on appropriate management if this is needed. This is to prevent a crisis or inappropriate hospital admission if the person's preferred place of care is home.

At the previous inspection we found the service did not always follow their safeguarding policy and act in accordance with the local authority’s safeguarding procedures. At this inspection we reviewed the hospice’s safeguarding policy and procedure, looked at how incidents were reported and recorded and assessed staff. We reviewed a number of documents in respect of safeguarding procedures, reported incidents and systems and processes in place to assure safeguarding procedures were monitored effectively. This breach of regulation had been met.

This announced inspection of Woodlands Hospice took place on 17 and 18 May 2016.

Woodlands Hospice is an independent charity situated in the grounds of University Hospital Aintree. Woodlands is based in North Liverpool and covers a population of 330,000 in North Liverpool, South Sefton and Kirkby in Knowsley. The hospice provides 15 overnight beds in a purpose built wing (in-patient unit). Woodlands has a multi professional team of staff who provide specialist palliative care to people who have a life threatening illness and for people who are in the terminal stage of their disease. Palliative care is the total care of people whose illness is not responsive to curative treatment.

Other services provided by the hospice include day therapy services (well-being and support centre), community therapy, outreach and outpatient services and a hospice at home service for South Sefton patients only. Hospice at home provides a sitting service, support for the district nurse team, accompanied transfer home from hospital or hospice and crisis intervention. This service is provided by the staff from Woodlands and is commissioned by South Sefton. Woodlands Hospice medical staff visit people in their own home to advise the community team on appropriate management if this is needed. This is to prevent a crisis or inappropriate hospital admission if the person’s preferred place of care is home.

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’. The senior management team included the Chief Executive (CE), consultant in palliative medicine/clinical lead, head of income generation and registered manager.

People were very complimentary regarding the standard of care, treatment and support offered to them. Their comments included, “First class”, “An amazing place”, “Fabulous support” and “The staff just do so much for you, I can’t say any more.”

Staff told us people were at the heart of the service and that everyone worked as a team to achieve this. We received positive feedback about the management of the hospice from staff, people at the hospice and their relatives. The management structure was clearly defined and robust governance processes and systems were in place across all departments. This included the completion of audits and information collated was reviewed, actions taken to improve practice and lessons learnt shared with the staff.

Emphasis was placed on driving forward improvement for end of life care internally and via established links with other hospices and organisations. Staff attended external training events and attended conferences, including conferences run by Hospice UK to support good practice and further develop standards for end of life care.

The safeguarding process to follow in accordance with local authority protocol had not always been followed to protect people from abuse.

People using the services of the hospice were protected against the risks associated with the use and management of medicines. Medicines were audited (checked) to ensure they were managed safely.

Risk assessments were in place to ensure people’s health and safety. The risk assessments helped to help mitigate those risks and to protect them from unnecessary harm. There was a robust system in place to assess and monitor accidents and incidents.

People were supported by sufficient numbers of staff to provide care and support in accordance with individual need. There was a flexible approach to adjusting the levels of staff required.

Staff sought advice and support from health professionals to optimise people’s health and provide continuity of care. Hospice staff included doctors, nurses, physiotherapists, occupations

People told us that they had been well cared for at Woodlands and they had been asked for consent before any treatment had been carried out. People felt that the place was kept very clean and the staff had been observed to carry our regular hand hygiene.

We spoke with four people and their relatives. They were very positive about the staff and care at Woodlands. Their comments included:

"Cannot fault the place."

"Staff are absolutely wonderful."

"They are very caring and helpful."

"If I buzz the nurses they respond quickly."

"Nothing is too much trouble."

We saw systems in place for prevention and control of infectionl, the unit was clean and well maintained. Effective recruitment processes were in place and records were managed effectively and securely.

During our visit we spoke with four people who used the service and two relatives. We spoke with five members of staff.

Comments we received from people using the service included:

‘’Have a good choice of meals’’

‘’Staff are very good’’

‘’What I ask for I get’’

‘’I have no complaints’’

‘’I am kept well informed about my treatment’’

‘’Staff are very helpful’’

‘’I see a Doctor every day’’

‘’My room is very clean they do it every day’’

‘’My privacy is respected, they always knock on my door before entering’’.

During our visit, discussions we had with staff showed they had a clear understanding of the need to respect and value the people they supported. We observed staff interacting with relatives on the unit with sensitivity and compassion.

People told us they knew about their care plans and what was recorded in them.

Staff told us that they had received the support they had needed from senior staff. They also told us that they had undertaken training relevant to their role.

We spoke with two patients about their medicines and the way they were handled. Both said they had had their medicines given to them properly and they were told about any changes to their treatment.

Overall we found appropriate arrangements for the safe handling of medicines.

The provider told us that the Trustees had carried out regular spot checks to assess the quality of the services provided and seek the views of staff and service users.

We spoke with four people who were staying at the hospice. All said they were well cared for and nobody raised any concerns about the way medicines were handled.

We spoke with four patients about the way their medicines were handled and none of them raised any concerns.