This inspection took place on 21 July 2016 and was unannounced.

Rugby Myton Hospice is registered to provide personal care. Rugby Myton Hospice provides people aged over 18 who are living with life threatening and life limiting conditions with the opportunity to attend the day hospice. Initially people attend the day hospice for one day per week over a 12 week period. Rugby Myton Hospice also offers a hospice at home service to support people with palliative (Palliative care is comprehensive treatment of the discomfort, symptoms and stress of serious illnesses) and end of life care needs in their own homes. Family support is provided. The aims of the services offered include supporting people with their physical health and emotional wellbeing.

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 by staff due to the arrangements in place to make sure risks to people at the day hospice and in their own homes were reduced. Where people were at risk due to their health and physical needs these had been identified. Preventative measures were 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.

People independently managed their own medicines when they attended the day hospice, with arrangements in place if support was required to promote safe medicine practices. Nurses were on hand to support people if this was required and secure medicine storage arrangements were available if needed. When people received care at home arrangements were in place to ensure people were safely supported to take their medicines where required.

People’s specialist needs were met by a diverse volunteer and staff team who had received training and support to perform their roles and deliver good quality care. People were confident and positive about the abilities of staff and volunteers to meet their individual needs. The management team supported staff to develop their knowledge and skills to ensure best practice with on-going improvements in care.

People’s individual needs were assessed and staff always encouraged people to make their own choices about their care and treatment. Where this was not possible, decisions were made in people’s best interests by people who had the legal authority to do this.

People had built trusting relationships with volunteers and staff when they attended the day hospice. They valued the time volunteers and staff spent listening to them and how they were helped to achieve their individual wishes in their own time without any rush. Relatives of people who received a hospice at home service praised staff for their kindness and thoughtful ways whilst caring for their family members. They appreciated the service offered which meant their family members could have their wishes of dying at home fulfilled due to the support they received.

We received very positive feedback about the care provided by the volunteers and staff. People who used the service and their relatives felt staff went out of their way to support them in a kind, caring manner and went above and beyond what was expected to meet their diverse needs. Staff developed positive, respectful relationships with people and were kind and caring in their approach.

Staff were creative in supporting people to express their views so their care was personalised and involved each person in meeting their particular goals. This included staff continually striving to

On the day we visited Rugby Myton Hospice, there were eleven people using the day service and four people using the domiciliary care service. During our visit we spoke with two people who used the day services, two members of staff delivering care, the registered manager, the manager of the domiciliary care service and the provider’s audit and compliance manager. We read the care records for two people who used the day services and for one person who used the domiciliary service. We observed care practice and staff's interaction with people when they were delivering care in the day service. We telephoned a relative of someone who used the domiciliary service, after our visit.

People who used the day service were complimentary of the care they received. One person told us that visiting the day service was, “The highlight of their week.” They told us, “If I wasn’t able to come I would be very upset, it is a wonderful service.”

A relative we spoke to about the domiciliary service, told us that their family member, “Misses them when they are not there.” They told us that the care provided is, “Patient centred” and “Fantastic.”

During our visit we saw that people in the day service were involved in different activities. Several people joined in a quiz. Other people played board games and did jigsaw puzzles.

When we visited Rugby Myton Hospice, there were six people using the day service and four people using the domiciliary care service. During our visit we spoke with two people who used the day service and we telephoned two relatives of people who used the domiciliary service. We spoke with three members of staff delivering care, the housekeeper, the registered manager, the manager and the administrator of the domiciliary care service, the provider’s human resource manager and the provider’s audit and compliance manager.

We read the care records for five people who used the service. We observed care practice and staff's interaction with people when they were delivering care in the day service.

We looked at the cleanliness of the day service and found that everywhere was clean and tidy. Staff we spoke with explained how they minimised the risk of infection.

We found that the records kept by the service were fit for purpose and stored appropriately.

We found that people or their relatives had agreed to the care and treatment they received.

We found that the provider had an effective recruitment process and appropriate checks were made on staff before they began work.

When we asked one person’s relative about the service they told us, "They could not have been more caring and loving. It was a wonderful experience.”