This inspection took place on 15 June 2016 and was announced.

The provider for Kemp Hospice provides personal care to older people with life threatening and life limiting conditions at the later stages of their lives who live in their own homes in the Wyre Forest and surrounding area. The provider also provides a day hospice service within the same building as the home care service. This service is not regulated by the Care Quality Commission [CQC]. At the time of our inspection two people were using the hospice at home service.

There was a manager who was also known as the head of care and was currently applying to become the registered manager at the time of our inspection. 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.

Potential risks to people and staff were assessed with preventative measures put in place. This was done in consultation with people and health professionals who were already involved in providing care to people who live in their own homes. Staff knew how to recognise and report any concerns to keep people safe from harm. People who needed staff assistance to take their medicines were supported by staff who had received training to do this safely.

Staffing resources were managed with care to make sure people received the support at the right time and in the right way for them. Arrangements were in place to ensure potential new staff were only recruited once essential background checks had been completed to show they were suitable to provide care to people who lived in their own homes. Staff had the knowledge, skills and experience required to meet people’s individual end of life care needs effectively and were actively supported with on-going updates to meet people’s specialist needs. The manager provided staff with supervision and support including gaining feedback from people who used the service around staff member's practices in delivering the care people required to promote best practice.

People were at the heart of the service as staff worked closely with other professionals to promote people’s wellbeing and enable people’s wishes to die at home to be fulfilled. Staff saw themselves as part of the community palliative care team which supported people in receiving a seamless service at the end of their lives. People were actively involved in deciding upon their choices and preferences which were detailed in their advance care plans so people received effective care and support as they wished. Relatives told us the care and support they received provided them and their relatives with the opportunity to realise their wish to receive their end of life care at home.

Staff promoted people’s wellbeing by working in close partnership with health professionals so where required they could effectively respond to people’s eating and drinking needs. Staff shared information when they had supported people with district nurses to make sure people’s changing needs, symptom and pain management was responded to.

Staff showed they cared about people they supported and felt privileged to be part of people’s lives at such an important time. Relatives consistently felt staff were there for them and showed kindness when they required comfort as well as their family members. Staff were proud of their caring roles and treated people respectfully and promoted their dignity. The provider sought people’s opinions on the quality of the service and encouraged people to raise any concerns or suggestions.

The leadership team showed they were committed to continual focus upon improvements to make sure the services offered reflected the needs of people who lived in the local community. A five year action plan was in place which showed the ar

When we carried out our inspection a service was provided to a small number of people who required palliative care. The hospice at home provided day and night sitters. We spoke with the registered manager and five health care support workers. Due the illness of people who used the service we were not able to speak with anyone. We did speak with two relatives of people who used the service. We also spoke with three medical professionals to gain comments from them about the level of care provided.

People we spoke with were complimentary about the care provided. One relative described the staff as: “Lovely genuine people”. Another relative said they are: “Brilliant. More than happy with the service.”

Professionals we spoke with told us: “Very happy with the service” and: “A good and special service”.

We found that staff were pleased with the level of training and support they received from the provider.

Staff had been recruited in an appropriate way and checks had been undertaken to make sure that they were suitable to care for people in their own homes.

The provider had systems in place to enable them to monitor the quality of the service provided. This was to make sure people received appropriate care

On the day of our inspection there were five people who used the day hospice service and during the day we spoke with four people, the manager and some staff. We also looked at the comments that had been received from people who had used the hospice at home service and their families.

We saw that people were supported by a multidisciplinary team of health and social care professionals to ensure they had care tailored to meet their individual needs. One person told us that they were consulted about the day hospice and what it could offer them before they attended and they said “Fully involved in every aspect of their care.”

One member of staff that we spoke with told us they were happy working at the hospice and felt well supported by their colleagues and the manager. We saw that there were regular planned training opportunities to ensure staff had sufficient knowledge to meet people's needs. This included training which helped staff to recognise and report any allegations of abuse so that people were protected from the risk of harm.

We found that the manager had systems in place to monitor the quality of the care and treatment provided. For example, there was continuous monitoring of people’s views about their care so that these could influence improvements. One family member stated in a survey, “The night sitters were professional, gave caring attention and helped my husband to have his wish to end his days in his own home with peace and dignity.”

We carried out a visit on 1 and 12 March 2012, observed how people were being cared for, looked at records of people who use services, talked to staff, and talked to people who use services.

We spoke with six people who used the day service, three volunteers and four members of staff. People told us that nursing staff kept them well informed of the care and treatment they needed. People told us that their treatment had been discussed and agreed with them.

People told us how they had access to a range of complementary therapies that helped them with their needs. They were very complimentary about the service, “It took a while for me to decide to come, I didn’t know what to expect, I suppose I feared the worst, but I’m so glad I came”. “The staff are so kind and caring, will answer any questions, the food is just great”.

People told us that they were aware that they could speak with staff if they had any concerns or complaints; they felt confident that they would be listened to and any action would be taken.

Staff told us how they would deal with any issues or incidents that may place people at risk of harm. Staff confirmed that they had had specific training in the protection of vulnerable adults.

All people we spoke with were extremely complimentary about the staff. , “The staff here are excellent that includes them all; nurses, support workers and volunteers. I really love the companionship I have from people in a similar situation to my own, it really helps”. We saw staff were very attentive to the people using the service.

Staff told us about the platforms for communicating with all the professionals involved in supporting the person. This ensured a full overview of the service being provided to the individual so as to ensure people benefitted from care tailored to their needs.

People using the service can be assured that systems are in place for assessing and monitoring the quality of the service.

Kemp Hospice provides palliative care and support to people living with life limiting illnesses throughout the districts of Wyre Forest and Tenbury Wells. The hospice premises are situated in the district of Kidderminster and the services provided to people include a day hospice, hospice at home and family support. The evidence in this report relates to the hospice at home as this is the only service that is regulated by the Care Quality Commission.

At the time of our inspection there was a registered manager who was enthusiastic about the hospice services and the subject of palliative care. Staff were complementary about the leadership style of the registered manager. Staff felt that if they ever needed support due to the nature of the service they provided the registered manager would welcome them at any time for discussions.

The hospice at home service complemented other services people received at home which included a home care service from community agencies, Macmillan nurses and district nurses. This supported people to receive effective care and treatment that was personalised and co-ordinated by a group of professionals that understood people’s palliative care needs. It also enabled people’s deteriorating health to be responded to in their homes so that they had the necessary symptom and pain relief to enable them to be as comfortable as possible and their choices to die at home fully respected.

The hospice at home service had a team of health care support workers who had experience of providing end of life care and had received training in palliative care.

Relatives told us they were happy with the support they received and from the comments that we received it made a difference to people’s lives. This was because relatives could take some rest from their caring roles and get some sleep in the knowledge that their family members were safe and cared for. In addition to this, relatives told us that their family members were treated with respect and that staff maintained their privacy and dignity when they provided care. This included providing time and support to relatives with their immediate feelings of grief if their family member died whilst staff were in their home and bereavement support offered.

The registered manager was involved in different groups that were involved in palliative care and where improvements could be made in the future to meet people’s end of life treatment and care. This included advanced care planning so that people had opportunities of expressing their interests, hopes and fears when they received end of life care in community and health settings.