The Shakespeare Hospice

Updated 10 August 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory function. 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 2014.

This inspection visit took place on 6 and 8 April 2016. The provider was given 48 hours notice of our visit. This was because we needed to be sure that the appropriate people would be available when we visited.

The inspection team consisted of two inspectors, a pharmacy inspector, a specialist advisor with experience of palliative and end of life care (palliative care is specialised medical care focusing on providing people with relief from symptoms and stress of a serious illness) and an expert-by-experience. An expert-by-experience is a person who has personal experience of using or caring for someone who has used this type of service.

Before our inspection visit we asked the provider to complete a Provide 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 improvements they plan to make. We found the information in the PIR was an accurate assessment of how the service operated. The provider also sent us a list of people who used the service, their relatives, community professionals and care staff. We sent questionnaires to a selection of those people to find out what they thought of the service provided. We looked at the information people had shared when responding to our questionnaires.

We reviewed other information we held about the service. We looked at information received from relatives and other statutory notifications the manager had sent us. A statutory notification is information about important events which the provider is required to send to us by law. We spoke with local health authority commissioners responsible for contracting or monitoring people's care at the hospice.

At our inspection visit we spoke with a range of people about the service. They included five people and four relatives. We spoke with the Chair of the Board of Trustees, registered manager, human resources manager, medical officer and the head of clinical services. We also spoke with nine members of staff which included nursing staff, health care assistants, therapists and a counsellor. We also spoke with one volunteer. We looked at three people's care plans to see how their support was planned and delivered. We looked at a selection of medication documents to check medicines were managed safely. We accompanied a nurse and health care assistant on two visits and spent time observing them interacting with people and their relatives. We looked at policies and procedures and the service's governance structure. We reviewed management records of the checks made to assure people received a quality service.

Updated 10 August 2016

This inspection took place on 6 and 8 April 2016 and was announced.

The Shakespeare Hospice is a registered charity providing 24 hour nursing and personal care services to people who are suffering from a life limiting or terminal illness. The hospice at home service supports people with a terminal illness who choose to die at home. The service provides treatment and care for the physical symptoms during people's final weeks of life and supports their emotional, spiritual and social wellbeing. They also provide support to families and carers during this period and following bereavement. The hospice provides a day service from its building in Stratford upon Avon. The services provided include counselling and bereavement support for adults and children, occupational therapy, physiotherapy, complementary therapies and chaplaincy. There is a specialist transitional service for young people moving between children's and adult's hospices.

The service had a registered manager in post. 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. The registered manager was also the chief executive and is referred to as that in our report.

The provider had a vision that put people at the heart of the service offered. This vision was shared by the staff team who were enthusiastic and motivated to provide high quality care in a compassionate way. Staff ensured people were at the centre of everything they did and made to feel they mattered. Staff gave people and their relatives time to discuss their feelings and listened to what they had to say. Staff were responsive to requests for support outside scheduled visits and stayed with people to support them and their families during a crisis or as they approached death.

People and their relatives spoke highly of the kindness of staff who advocated on their behalf whilst leaving them empowered to make their own decisions. Staff supported families to retain their role in providing care, stepping back and allowing relatives to respond to their family member’s care needs when they wished to.

There was a holistic approach to providing care and support which involved the service’s occupational therapist, physiotherapist and complementary therapists. The hospice at home team worked closely with other organisations to provide care that was responsive to people's needs. Collaborative working ensured people received the support they required and kept them pain free. Staff worked flexibly and people and their relatives told us they received support when they needed it from staff who knew them well.

Staff understood their responsibilities to protect people from harm and were encouraged and supported to raise any concerns. Staff worked with their partner organisations to identify and manage risks associated with people’s health and care needs. The service had policies and procedures for the safe management of medicines.

People received care from a multi-disciplinary staff team who were qualified, supported and trained to meet their needs. Staff knowledge was shared in clinical education meetings so people received effective care based on up to date practice. Staff had formal and informal opportunities for reflective practice to discuss the demands of their role and their training and developmental needs. Staff told us they were extremely well supported by the management team and each other and had the resources required to carry out their roles.

The Mental Capacity Act 2005 (MCA) provides legal safeguards for people who may be unable to make decisions about their care. Staff demonstrated a clear awareness of the importance of supporting people to decide for themselves about their care and treatment. People and their families were supported to talk about their wishes and that these were constantly reviewed as part of care delivery. Staff understood the importance of asking for consent to care and waiting for a response.

The chief executive and senior managers had the responsibility for running the service with direction and support from a Board of Trustees. The trustees and senior managers worked closely together so there was an open and transparent system which reviewed all aspects of the service provided. Staff were aware of the roles of the management team and knew who to go to for support and where to seek advice.

People and their relatives were asked for their views which were used as a source of information to provide a service that was founded on what was important to the people who used it. The provider monitored the quality of the service which included checks of medicines management, clinical notes and documentation. Accidents, incidents and complaints were investigated and actions taken to minimise the risks of re-occurrence. The provider shared learning with staff to improve care provision.

There was a strong emphasis on continually striving to recognise, promote and implement innovative systems to improve the service in response to the changing needs of the local community. The provider had researched and identified areas where there were gaps in service provision for palliative and end of life care locally and acted to fill those gaps. The provider was a member of several good practice initiatives where they worked in partnership with other organisations to make sure they were following current best practice and providing high quality care through the sharing of knowledge. People from the community were encouraged to visit the hospice, work as volunteers and be involved in its on-going development. The hospice had received various recognition of good practice awards during the last 12 months, for the quality of care and support provided for people using the service.

The provider was aware of the importance of forward planning to meet the needs of the community and ensure the quality of service they provided could continue to develop. Staff were involved in formulating the strategic plan and committed to developing the service so people could receive the support they needed at the end of their life.