The inspection was carried out on 20 September 2016 and was unannounced. This meant the provider and staff did not know we would be visiting. At the time of the inspection there were seven people receiving care and treatment on the in-patient unit.

Overgate Hospice provides specialist palliative care for adults in the Calderdale area. The hospice supports people with cancer and life limiting, progressive illnesses and helps people with symptom control as well as providing end of life care.

The hospice provides in-patient accommodation for up to 12 people and day hospice services. The day hospice services did not form part of this inspection.

The service had a registered manager. 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.

Everyone told us they felt the hospice was a safe place where care and treatment was delivered by kind, compassionate and competent staff. There were systems in place to make sure people were protected from harm and staff knew how to report any concerns about people’s safety and welfare.

The hospice employed a range of medical and nursing staff and health and social care professionals such as social workers. There were enough staff to ensure people received the right care and treatment in a timely way. The hospice did not employ an occupational therapist but worked closely with the community based team of occupational therapists to make sure people got the support they needed. Everyone told us staff were quick to respond to their changing needs.

New staff did not start work until all the required checks had been completed satisfactorily. This helped to protect people from the risks of being cared for by staff unsuitable to work with vulnerable people.

We found risks to people’s health, safety and welfare were well managed. People’s care records included information about individual risks and how these were managed.

The hospice was clean and well maintained and equipped to meet people’s needs. Checks were carried out on equipment and installations which helped to ensure the premises were safe for people to use. There were clear systems and processes in place to deal with emergencies, both medical and non-medical emergencies.

Incidents and accidents were recorded and reviewed and whenever possible action was taken to reduce the risk of recurrence.

People’s medicines were handled safely. However, some of the storage arrangements needed to be reviewed to make sure they were secure enough.

People told us the staff were well trained and knew how to meet their specialist needs. Staff received training on safe working practices and were supported to develop their knowledge and skills. Staff received support to cope with the emotional challenges of their work.

Management and staff demonstrated a good understanding of their responsibilities in relation to The Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. This helped to make sure people’s rights were protected and promoted.

People were offered a choice of food which took account of their ethnic, cultural and dietary needs and preferences. Nutritional assessments were carried out and people received support from dieticians and speech and language therapists where necessary.

People received support to maintain their wellbeing from a multi-disciplinary team and they spoke very highly about the nursing and medical staff. They told us how staff had helped to allay their fears and make their lives more comfortable.

Without exception people told us the staff were extremely caring and kind. They told us they were always involved in decisions about care and treatment and staff always asked for their consent before providing support.

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During the inspection we spoke with three patients on the in-patient unit, four patients in the day hospice and three people’s relatives.

We considered all the evidence we had gathered under the outcomes we inspected.

We used the information to answer the five key questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

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

Safe

We found the hospice was clean and well maintained. The two four bed bays were large and spacious, decorated to a good standard and well lit by natural light. There was plenty of room around each bed for people to receive visitors. The external doors were large enough to allow beds to be pushed onto the patio so that patients could go outside when the weather permitted. The people we spoke with said they appreciated having space and being able to go outside. We found temperature was well controlled on the in-patient unit and all the rooms occupied by patients had windows which could be opened.

We observed there was good access, space for wheelchairs and ramped corridors.

We looked at a selection of maintenance records relating to fire safety, gas, electricity, water and the lifts and hoists. The records showed the required checks were carried out to make sure the premises and equipment was safe and suitable to meet people’s needs.

We observed the day hospice was well-staffed. The staff we spoke with said the service had recently recruited new staff and there sufficient permanent staff employed at the hospice to meet people’s needs.

We observed a medication round and saw the nurses verified people’s identity before administering medication.

Effective

People receiving care and treatment on the in-patient unit told us they were involved in planning their care. One patient told us they saw the doctor every day and had been told when they could expect to be discharged home. Another patient told us they had asked to be kept fully informed about their care and treatment and were satisfied this was done; they said “They tell you straight, no trimmings”. They said their spouse was also involved in decisions about their care and treatment. A third patient told us they had seen the doctor very regularly following admission and were aware of what steps had been taken and when they would next be seen.

One relative we spoke with said they had been involved in discussions and decisions about their relatives care and treatment and had been very impressed by the way the palliative care consultant had supported them. However, another relative said they felt there needed to be a more structured approach to communicating with patients’ families. They said they had experienced problems with communication and did not feel they fully understood their relatives care and treatment plan.

People told us there was a good choice of food and it was of a good standard. One patient said the hot meals were served hot “9 times out of 10”. The also said staff were very attentive overnight and they were never short of something to drink. Another patient told they felt no compulsion to order from the menu or eat at set times; they said they felt supported but not pressured to eat. They described the food as being to “home cooked” standard and said they could give it no higher praise. Another patient told us the smoothies served at Overgate were the best they had ever had.

Caring

The patients and relatives said the nursing staff were kind and attentive. One person told us their relative was much brighter following transfer from hospital and attributed this to nurses who had time and quality of food and environment. They said the hospice "exceeds our expectations".

One person who attended the day hospice told us the staff "have got time for you". They said they attended the day hospice weekly and found it a very positive experience, they added, "You can't improve on perfection".

In the four bed bays it was impossible not to overhear some discussions about other patients care and treatment. However, we saw the curtains were routinely drawn around the beds for doctors’ consultations. A patient in one of the shared bays said they were aware of two people who had died in the bay and did not find it distressing. They said they would recommend the hospice to anyone and added it was “a wonderful way to go”.

The Chaplain told us people sometimes spoke to them about deaths occurring in the shared bays. They acknowledged this could sometimes be distressing for people but said there was also a positive aspect to not having death hidden away in side rooms.

Responsive

The Chaplain told us they also worked at the local hospital and was therefore able to offer support to patients in both environments.

One person told us they had been supported by the Chaplain to make arrangements for their funeral. They felt this had helped them to relieve their family of a considerable burden. Other patients told us the Chaplain led informal remembrance services for people who had used the service before their death.

The Chaplains engagement with people who used the service was well illustrated by her involvement in the development of outside 'pod' environments as spaces in which people could be quiet and/or receive counselling.

One patient who attended the day hospice told us there was good co-ordination of care between the hospice and the local hospital. They said this meant they were able to discuss the results of tests carried out in the hospital with the consultant at the hospice.

Well led

At the last inspection in November 2013 we identified some concerns in relation to record keeping. During this inspection we found the service had taken appropriate action to address these concerns. They had made changes to the way patients’ records were maintained and the records we looked at were up to date, accurate and fit for purpose. We looked at a number of other records relating to the management of the service and found they were also accurate and up to date.

There were systems in place to give people who used the service the opportunity to share their views. We saw action was taken in response to the feedback people provided. The manager explained they did have an informal process in place for real time patient feedback however the system in use at the time of the inspection also relied on surveys sent to people after they have been discharged. The manager explained they were looking at ways to formalise getting more timely feedback from people so that they could act more quickly to address any areas of concern.

The service had systems in place to review and respond to accidents and incidents. There was evidence of learning from these events which included actions taken to reduce risk.

The service had processes in place for dealing with concerns and/or complaints from people who used the service. At the time of the inspection the provider was updating the complaints procedures and was developing a new information leaflet to explain the process to people who used the service. We saw action was taken in response to people’s concerns and/or complaints to reduce the risk of people experiencing similar concerns.

The staff we spoke with said they were listened to and felt well supported by the management team. They said that their opinions are listened to and that since recent recruitment there are now sufficient permanent staff employed at the hospice.

During the inspection we reviewed how peoples’ care and treatment was assessed, planned, and delivered in order to ensure their safety and welfare. We spent time talking to staff and they told us they received sufficient and appropriate training to meet the needs of people who used the service.

We spoke with two in-patients and seven people attending day care. We looked at two people’s records receiving care and treatment as in-patients and three people’s records receiving day care. We saw inconsistencies and gaps in the nursing documentation within both of the in-patient records.

The people we spoke with told us they were ‘treated with dignity and respect.’ They were ‘Involved in their care’ and spoke positively about the staff and about the services they received. One person told us ‘I get better looked after here than a hotel.’ The majority of people who used the service told us they were given advice about other services available to them.

Essential building work was taking place at the time of our visit to develop a separate in-patient entrance area from the main reception. This new entrance will serve to improve the privacy and dignity of people being admitted to the hospice.

During the visit, we spoke with four people receiving in-patient care and one person attending the day hospice. They all told us the staff at the hospice looked after them very well, they were polite, courteous and cared for them in a dignified manner. We saw staff interacting with people who use the service in a polite and respectful manner.

All of the people we spoke with told us they and their families were included and involved in developing care and treatment plans. One person said, 'Beautiful service, well run, can’t fault the care'. Another person told us, ‘the support and care provided to both them and their family had been a positive experience’. ‘They were reassured by the care and treatment provided and had developed confidence in all of the staff’. Two people told us 'they never had to repeat the same information, as all of the staff were always up to date with their care and treatment’.

During the visit we spoke to two people who attend the day hospice. They told us staff at the day hospice had time to listen to them and said attending the day hospice had really helped them with all aspects of their daily lives. They told us they enjoyed and benefitted from the complimentary therapies provided. They told us they were able to see medical staff at the day hospice and said this had helped them to achieve better management of their symptoms because medical staff from the hospice worked closely with their GPs. Both people told us their main carer attended the carers support group and found this helpful.