Warwick Myton Hospice

Updated 23 November 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 201

This inspection took place on 12 and 15 September 2016. The first day was unannounced. The inspection team on day one consisted of an inspector, a specialist advisor who is a nurse with experience of palliative and end of life care and an expert by experience with knowledge of end of life care. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. The inspector returned to the hospice on the second day and provided feedback to the registered manager.

Before our inspection we asked the provider to complete a Provider Information Return (PIR). The PIR is a form that asks the provider to give some key information about the service, what the service does well and what improvements they plan to make. The previous registered manager had submitted the information as we requested in January 2016. We took this information into account when we made the judgements in this report.

We checked the information we held about the service and the provider including statutory notifications. Statutory notifications include information about important events which the provider is required to send us. We sought information about the quality of service from the clinical commissioning group (CCG). We also asked Healthwatch for their views. Heathwatch is an independent consumer champion who promotes the views and experiences of people who use health and social care.

We spent time with people who were inpatients and with people who attended the day hospice on the day of this inspection and saw the care and support offered. We spoke with four people who were inpatients, two people attending the day hospice and two relatives about the care they received. We sampled the care records of five people and daily records to see how their care and treatment was planned and delivered. Consideration was given to how medicines were managed which meant we looked at medicine charts and administration records. We were present at a meeting with medical and nursing staff who met daily to share information and make recommendations about people’s treatment and care needs.

We spoke with two people and one relative by telephone about their experiences of the care they received in their own homes from staff who were part of the hospice at home team.

We spoke with the registered manager and a range of 20 staff across the inpatient, day hospice and hospice at home services. These included the day hospice sister, ward manager, doctor, sister from Myton at home, receptionist, audit and compliance manager, nurses, health care assistant, volunteers, catering manager, chaplain, art therapist and hairdresser.

We looked at a selection of documentation about the management and running of the hospice services. These included the provider's recruitment procedures, staffing arrangements, complaints and compliments received, incident reporting and results of the provider's quality monitoring systems to see what actions had been taken and plans for the future. The leadership team also sent further information to us as part of the inspection.

Updated 23 November 2016

This inspection took place on 12 and 15 September 2016 and was unannounced.

Warwick Myton Hospice provides care and treatment to people over the age of 18 with life limiting conditions who require specialist palliative care in the 24 bedded inpatient unit, day service and hospice at home service. (Palliative care is comprehensive treatment of the discomfort, symptoms and stress of serious illnesses). At the time of our inspection 10 people were using the inpatient service. Initially people attend the day hospice for one day per week over a 12 week period and on the day of this inspection visit five people attended the day hospice. People were able to access a range of care and support which included, children and family support, occupational therapy, physiotherapy, chaplaincy, counselling and bereavement support.

There was a registered manager in post who was also the director of nursing, care and education. 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 were protected from harm and abuse due to the arrangements in place to make sure risks to people were reduced. Where people were at risk due to their health and physical needs these had been identified with measures put in place to help people to manage and reduce any known risks. Staff and volunteers had been suitably recruited and there were sufficient staff with a variety of skills to meet people’s individual needs and to respond flexibly to changes.

Staff received the training and support they needed and were highly motivated to perform their roles and deliver sustained high quality care. This included staff having the skills to effectively manage people’s medicines so these were available and administered safely to people.

People were extremely confident and positive about the abilities of staff to meet their individual needs in the right way and at the right time for them. The leadership team supported staff to undertake relevant training and career development. This was one area the leadership team had focused on to ensure improvements in care when required so that it remained effective in meeting people’s palliative and clinical needs with best practice shared in end of life care.

People told us they were supported with their nutritional needs with the assistance of the catering team who actively sought and welcomed people’s feedback. There was a shared commitment between all members of the staff team to sharing how meals remained nutritious and people enjoyed these in comfort. Staff were also aware of people’s reduced appetite’s towards the end of their lives to make sure changes in people’s dietary needs could be effectively catered for and creatively met in different ways which included fruit smoothies.

Staff were kind and thoughtful to people which reflected the positive comments we received from people about how their experiences felt listened to and were valued. People told us staff spent time listening to them, did not rush them, and did all they could to meet people’s individual wishes and requests whether this was in their own homes, the day hospice and/or as inpatients. This supported people who used the hospice services and their families to make special memories which were of a comfort to both people and families especially towards the end of their lives.

People’s individual needs were assessed and staff always encouraged people to make their own choices about their care and treatment which were written down to help people’s wishes to be followed in life and death. Where this was not possible issues of consent and decisions were made in people’s best interests by people who had the authority to do this.

People were treated as individuals and staff were motivated and committed to providing people with the best possible palliative and end of life care. Staff enjoyed their work and believed the ethos of the hospice movement was about spending quality time with people. This was reflected in staff practices as they had assisted people to overcome obstacles so they could aim for their goals in life.

People were supported to receive end of life care in their preferred place of choice which met with their needs and wishes and to achieve a private, dignified and pain free death. People, their family members and staff were able to access the emotional, psychological, spiritual and bereavement support they needed.

People were at the centre of the leadership and staff teams core values of personalised palliative and end of life care aimed to provide quality of care and life to all people. To achieve this the registered manager led by example since they came into post to raise the profile and reputation of the hospice services in the local community. Close partnerships with external professionals, educators and national organisations involved with palliative and end of life care were being sought and partnerships formed. This helped to ensure people received the right care at the right time and knowledge was appropriately shared and used to influence best practice for people’s care. This included care and treatment planning which looked towards the future to make sure it was inclusive to meet the diverse and changing care needs of the local population.

People and their family members, staff, board of trustees were actively informed and involved in developing the service. There was an open culture where every person was encouraged to share their experiences of the care and treatment the different hospice services provided. This included making complaints which were fully investigated and responded to, with evidence of the leadership team using them as a learning opportunity in order to make improvements to the hospice services. The registered manager showed they were dedicated to the continual development of the hospice services so all people received palliative and end of life care which was inclusive to all and of a high quality.