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 w

When we visited Warwick Myton Hospice, we saw there were 19 people using the inpatient service. We spoke with two people who used the service and one relative. We spoke with the registered manager, the director of nursing and the provider's compliance and audit manager. We spoke with six members of staff delivering care, including a doctor, a deputy sister, a senior staff nurse, two staff nurses and a nursing assistant. We also spoke with the housekeeper and a senior chef.

We read the care records for three people who used the service. Many of the people were not able to tell us about their care because of their complex needs, so we observed care practice and staff's interaction with people when they were delivering care.

During our last inspection of this service in January 2013, we found the provider did not always maintain accurate and appropriate records. During this inspection, we found that some improvements had been made, however there were still areas of concern regarding incomplete records.

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

We found that there was an effective procedure in place for recording and resolving any complaints about the service.

When we asked one person about the service they told us, "The staff are 11 out of 10, the care is excellent, I can't fault them.”

We spoke with two patients and their relatives, eight staff, the registered manager, medical director and hospice policy lead. During the inspection we observed that staff were kind and respectful towards patients. Comments made by patients and their relatives reinforced this. We were told, ‘’Turned my life around since I came in. The girls are lovely. The volunteers bring a lot to the job’’ and ‘’X is very happy here.’’

Systems were in place allowing patients and their relatives communicate their experiences of the hospice. Positive feedback had been given through patient surveys about the staff and care patients had received. The patients and relatives we spoke with confirmed they had been kept informed and had been given information about what to expect during their hospice stay. We saw a number of information leaflets and booklets available for patients.

We saw patients’ needs had been assessed, risks identified and personalised plans of care developed. We observed that full assessments of some patients’ needs and risks had not always been completed. This could put the patient at risk as the necessary actions to manage or monitor the situation had not been identified.

We saw that healthcare professionals supported patients in managing their ongoing healthcare needs. The staff and patients we spoke with said there had been sufficient staff available to accommodate patients' needs. People told us that they felt safe.