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 thei

At the time of the inspection we were able to speak with two people that visited the service. We also spoke with the head of clinical services, a human resource consultant, two nurses, a clinical lead in palliative care, a diversional therapist, a health care assistant and a hospice at home team leader.

People we spoke with were very complimentary about the service they received. One person told us: “I love it and I look forward to coming here every week”. Another person we spoke with said: “I give it 11 out of ten” and: “They really care”.

We saw staff provide assistance to people when they required it and people were supported at their own pace.

Staff knew about the needs of the people they were caring for. We looked at care plans for four people and found these contained guidance for staff on how to meet these needs.

We looked at the recruitment process in place. We saw that appropriate checks had been carried out before staff commenced employment.

The provider supported their staff and made sure staff were trained to an appropriate standard to meet people’s needs. The provider encouraged staff to participate in meetings and group supervisions.

The provider had systems in place to regularly monitor and assess the quality of service that people received.

We looked at the complaints that had been received by the provider. We found these complaints had been responded to and people had been satisfied with their response.

We asked people about the care they had received. We asked whether they had been involved in making decisions about their care and had been kept informed. People and relatives told us they had been happy with the care and support they had received. Some of the responses people gave were: ''The food and drink is excellent''. ''I had no idea what to expect; I found the staff very helpful. Can't speak too highly of the service provided''.

We found the home was compliant against the five outcomes we inspected. We have asked the provider to take note that we did not see written confirmation of agreement from either the patient or carer on care documentation or do not resuscitate forms.

People told us they felt safe using the service. The staff we spoke with described the hospice as having a supportive atmosphere with senior support always available. Staff said they could access a variety of training. We saw that where shortfalls in training provision existed the manager and safeguarding lead had arranged for additional training to take place.