This report aims to raise awareness of the need for good palliative and end of life care in all care homes. Palliative care is about ensuring a good quality of life for both residents and their families at every stage of a life limiting illness which can be from diagnosis onwards. One part of palliative care is care given towards the end of life, that is, care given in the last few months, days and hours of a person's life. This report reflects findings between April 2007 and the end of March 2008 during 1,036 inspections and three investigations into complaints. The report focusses on whether staff in care homes have an understanding of what palliative and end of life care is, and how well they are delivering palliative and end of life care to residents and their families. Inspections showed that 587 (57%) of the care homes in the sample understood the importance of providing palliative and end of life care. Examples of good practice are given throughout the report. However the report found many care homes had fallen short of best practice. Recommendations are made.