This inspection took place on 19 and 20 June 2017 and was unannounced.

We had found three breaches of the regulations at our previous inspection in March 2016. Quality assurance systems in place were not effective in assessing, monitoring and improving the quality and safety of services provided. The registered person did not report notifiable safety incidents. Staff did not always receive supervision to enable them to carry out the duties they are employed to perform. At this inspection we looked to see what measures had been taken to improve the quality of the service and whether these had been effective. The provider told us that all the actions required to meet the regulations had been completed by the end of March 2017 as scheduled in the actions plans. During our inspection on 19 and 20 June 2017 we found that most of the required actions to improve the service had been completed.

Katharine House Hospice provides palliative and end-of-life care, advice and clinical support to adults with life-limiting illnesses, their families and carers. The hospice delivers physical, emotional and holistic care with the aid of teams of nurses, doctors, counsellors and other professionals including therapists. The hospice runs a 10-bed in-patient unit and accepts admissions for end of life care, symptom control and respite care. At the time of our inspection six people were in the unit. The hospice also provides community services designed to support people in their own homes. At the time of the inspection the hospice was providing support to 160 people in their own homes. The hospice’s day service welcomes up to approximately 30 people per week and was being used by six people during our inspection.

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 service did not have a business continuity plan. Although some emergency cases had been taken into account in different risk assessments, there were no contingency plans to address such issues as a data breach, adverse weather conditions or a pandemic. Staff we spoke with did not know who to contact in case of an emergency if the registered manager was not available.

A range of audits were in place to monitor the health, safety and welfare of people. However, relevant actions were not always taken to address the issues identified by the audits. Therefore, we were not confident that the quality monitoring system was effective and provider could act on the findings of the audits in a timely manner.

Staff told us they received regular supervision, but the supervision meetings were not recorded by the provider. As a result, we were not able to determine how effective the supervision meetings were. We couldn’t find out whether appropriate action was taken to act on issues raised at the meetings either.

Medicines were safely stored and those requiring refrigeration were stored within their recommended temperature range. Nurses recorded the administration of medicines on medicine administration charts including prescribed creams applied by care workers. Staff had the skills needed to effectively manage people's medicines and ensure they were administered safely to people.

People said they felt safe receiving care provided by the hospice. Staff had been trained in safeguarding adults and received regular refresher courses. Staff gave clear explanations of the different types of abuse to be aware of and knew what steps to take in the event of any suspicion of abuse.

Risks to people’s safety were assessed and managed appropriately. Assessments identified people’s specific needs and showed explicitly how the risks could be minimised. The service carried out environment

This inspection took place on 10 and 11 March 2016 and was unannounced. Katherine House Hospice provides specialist palliative care to people in North Oxfordshire, South Northamptonshire, and South Warwickshire. The hospice is set amongst fields with secluded areas for the enjoyment of people and their visitors.

They provide inpatient services, day hospice facilities, specialist community nursing and bereavement support. There were six people receiving care on the day of our visit. The inpatient service can accommodate up to 10 people. A registered manager was 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.

People and relatives were complimentary about the care provided. One person said “It’s a wonderful place; my family member was cared for here and was treated with the utmost respect and dignity”. Staff we spoke with had a good understanding of safeguarding. However, we found that appropriate referrals had not been made to the local safeguarding team as required.

Risks assessments had been completed to monitor people’s health and safety, however, not all completed risk assessments reflected consistent information regarding risks to people.

Medicines were not always managed safely within the service. We were aware of several errors that took place prior to our visit related to nursing interventions with syringe pumps. There were also pharmacy errors within the service. The errors had been reported to the services accountable officer, but had not been reported to the local authority as a safeguarding incident.

There was safe recruitment of staff and all staff had Disclosure and Barring Service checks completed prior to commencing employment.

People receiving support told us that staff were kind and caring, treated them with respect and protected their dignity. Staff told us they always asked for people’s consent before providing support and care, however discussions with people regarding consent to care and treatment were not documented in all people's records.

Staff were supported in their job role through induction, supervision and appraisal, as well as regular training to ensure they had the knowledge to meet people’s needs. However, one member of staff who had worked at the service for over one year told us they had never had supervision.

Most care files we viewed were detailed and specific to the person, reflecting their wishes, choices and preferences. However, we found that not all care plans contained sufficient detail regarding people’s needs.

Processes were in place to gather feedback from people and listen to their views. People had access to a complaints procedure which was provided to people when their support was arranged.

Feedback from staff regarding the management of the service was contradictory. Some felt supported with the management structure whilst others did not share this view.

Staff were aware of the company’s whistle blowing policy and told us they would not hesitate to raise any issues they had.

The building had a history of movement and minor cracking. The engineers report stated that the building is structurally sound and does not represent a major cause for concern.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the full version of the report.

At our last inspection we found some people’s care records, risk assessments and care plans were incomplete. This meant that people were not always protected against the risks of unsafe or inappropriate care and treatment arising from a lack of proper information about them. The provider sent us an action plan and told how they would make improvements to peoples care records. A single inspector carried out this inspection to check the improvements had been made.

We found that following our last inspection all clinical staff had attended record keeping training. Members of the multi-professional team had worked together to review the format of care plans and risk assessments. On the day of the inspection there were eight people staying at the hospice. We looked at care records for five people. We found improvements had been made and people were now protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records about them were maintained.

Katharine House Hospice provides specialist palliative care to people in North Oxfordshire, South Northamptonshire and South Warwickshire. They provide inpatient services, day hospice facilities, specialist community nursing, and bereavement support. On the day of our visit there were six people staying at the hospice, the focus of our inspection was the inpatient unit. We spoke with 3 people, 4 peoples relatives and 10 staff. These included medical, nursing, domestic and support staff. We observed care and treatment and looked at 7 care records.

The inspection team who carried out this inspection consisted of an inspector, a pharmacist inspector and an advisor who specialised in end of life care. During the inspection, the team worked together to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

There was no evidence that care was not safe. However, we found people’s care records, risk assessments and care plans were incomplete. This meant that people were not always protected against the risks of unsafe or inappropriate care and treatment arising from a lack of proper information about them.

Procedures for dealing with emergencies were in place and staff were able to describe these to us.

We found there were effective systems in place to reduce the risk and spread of infection. We saw that infection control policies and procedures were in place and adhered to. We observed staff wearing disposable gloves and aprons when carrying out care tasks to minimise the risks of cross infection. We saw that the hospice was clean and well maintained. One person told us, “It’s spotless”.

We found that medicines were handled safely and securely. Appropriate arrangements were in place for obtaining and disposing of medicines safely and suitable records were kept regarding medication administration.

Systems were in place to make sure that managers and care workers learnt from events such as accidents, incidents and complaints. This reduced the risks to people and helped the service to continually improve.

The provider understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

Is the service effective?

The service was effective but improvements were required. Because record keeping was not always complete it was not possible to assess if planned care was always effective. People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people’s care and support needs and that they knew them well. One person told us, “the staff could not do any more than they do. They seem to know what [name of person] needs and provide it quickly and with a smile. They are so kind, they are remarkable and this goes for the doctors and nurses. You read a lot about homes but this place is absolutely five star and we both feel safe here”. We found that staff had received training to meet the needs of the people living at the hospice.

Is the service caring?

The hospice was caring. People we spoke with were complementary about the service. People spoke openly about the care they had received and what it meant for them. One person told us, “this is a very special place with very special people, the patients and the staff. I have been to a lot of hospitals but the care here is better than in any of them and by a long mile. We are so grateful; we cannot express how grateful we are. There just are not the right words.” A relative said, “I do not know what we would do without this place, it is an oasis and whatever we ask for it is done. Sometimes it is little things but nothing is ever too much trouble”. Another relative said, “what the staff have in spades, the doctors as well, is empathy, not all health staff have it and some not at all but it makes such a difference. They are not afraid to show they care and that is so unusual”.

Throughout our inspection the atmosphere was calm and pleasant. We observed the way in which nursing staff spoke with people was warm, friendly and polite. We saw doctors interacting with people. They were respectful and unhurried with them.

Is the service responsive?

The hospice was responsive. People’s needs had been assessed before and on admission to the unit. We saw evidence that staff recognised when a person’s condition changed or their health had deteriorated and sought the help and advice of the medical team or other professionals.

Is the service well-led?

The service was well led. There was a registered manager in post who was visible and available for people and staff to raise any concerns. We saw that the provider took account of complaints, comments and feedback to improve the service. During our inspection we looked at the quality assurance systems that were in place. The information reviewed demonstrated that the service was monitored on a consistent basis to ensure that people experienced safe and appropriate support, care and treatment.

On the day of our visit we spoke with four people and two relatives. One person told us their stay had been “wonderful”. Another person told us “I cannot speak highly enough of the staff, these people care. They are so friendly and we have a bit of a laugh”. A relative told us “the staff are superb; it’s the best thing we ever did coming here”.

The hospice employed a range of healthcare professionals to ensure people's care and welfare needs were met. The team were supported by a range of volunteers. People we spoke with were very complimentary about the staff and volunteers. One person told us the volunteers were “thoughtful and proactive”.

People told us they had their medication reviewed and that their symptoms had been well controlled during their stay. We observed nurses responding promptly to peoples requests for as required (PRN) medication. People were not fully protected against the risks associated with medicines. The provider could not be fully assured that all medicines were kept at the correct temperature, and records relating to administration were not always completed.

People’s health, safety and welfare were protected when more than one provider was involved in their care and treatment because the provider worked in co-operation with others.

The provider monitored the quality of the service it provided and undertook checks, risk assessments and audits to monitor the safety and welfare of people using the service.

During our visit we noted everywhere was very clean, well presented and decorated. There were lots of separate areas for people to be with their families. A separate play room was also available for visiting children to use as necessary. During our visited we spoke to three people who used the service. We also spoke to one relative of a person who used the service. We looked at four care records for people. These files were found to be up to date. Care plans were in place and reflected each person’s individual needs. Risk assessments had also been completed and reviewed regularly. Medical and daily notes were comprehensive.

One person we spoke to told us, “this place is exceptional, from the cleaning staff to the volunteers that bring me a cup of tea, everything is focused on me and I can’t praise them enough”. Another person told us, “it’s far too good here, you get the feeling they actually want to look after you”. Another person told us, “I was reluctant to come here at first, because I associated it with death, but its so lovely here and full of life”.

We spoke to three people using the service. The people we spoke to said they had been happy with the care they had received. They said they had been involved when agreeing their care and individual preferences had been taken into account. One person said he felt ‘in control’; whilst another person said ‘this place has given me my life back!’

All the people we spoke to said their pain had been managed well. People said they had been involved in agreeing the pain medication they had been prescribed. One person said he had been given the choice of tablet or liquid options prior to pain relief being administered.

Staff were described as ‘very supportive’. People said there had been sufficient staff to care for their needs and they had no concerns about staffing levels at the hospice. People said that when they had rung their bedside bell staff had attended to them immediately.

One person said that staff had listened to his views. Two people said they would approach nursing staff with any concerns. One person said that a complaints box was located in the hospice main reception area which she could post comments into.

People said they had been given sufficient information about the hospice and their treatments. This information had been explained and additional meetings arranged when requested.

One person said they had completed hospice patient surveys. She said that outcomes resulting from the survey had not been fed back. One person said that people’s suggestions had been taken on board by the hospice. One example given was that roast dinners are now provided on Wednesdays.

The people we spoke to said they had been given a daily choice of foods and should the available options not be to their liking they could arrange an alternative meal with the hospice. The food at the hospice was described by the people we spoke to as ‘very good’. People said that their relatives could also obtain meals at the hospice should there be a need.

One person said that as an inpatient she had been able to access an onsite hairdressing service and the Macmillan nurse had helped her apply for her benefits. Another person said that if he wanted to become engaged in activities all he had to do was ask.