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Inspection Summary


Overall summary & rating

Good

Updated 26 October 2016

This inspection took place on 11 August 2016 and was unannounced.

Zoe’s Place Baby Hospice is registered to provide care and treatment to children aged between 0 and five years, who have a life-limiting or life threatening condition. Zoe’s Place provides a range of services within its hospice from; short breaks for children, day care, support into children’s services after the age of five and care after death. Support is also provided to parents and siblings through groups and events held at the hospice. Since the hospice opened in 2011 the services offered to children including the opening hours have gradually developed and increased. In January 2016 the hospice extended its opening hours to seven days a week. Specialist nursing care is provided at the six bed hospice. The provider Zoe’s Place Trust runs another two children’s hospices which are situated in Middlesbrough and Liverpool.

There was a registered manager in post who is the head of care. 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.

There were procedures in place to make sure children were kept as safe as possible. This included the reporting and following through of incidents and accidents to make sure actions supported each child’s needs being met in the safest possible way when these had occurred. We found the procedures in place for following through incidents needed to be strengthened to further promote children's safety and wellbeing. The register manager immediately took action to ensure the incident procedures were as robust as they could be.

Staff had received training to support them in administering medicine to children to support their health needs. We identified some improvement to be made in the development of the risk assessment arrangements to support staff if a child experienced a severe allergic reaction. This was important to make sure staff had information to follow so children’s safety was consistently managed and met.

Children showed through their facial expressions and body language they were happy and looked comfortable when staff supported them with their needs and during play. Parents had no concerns about their child’s safety and were confident all staff knew their child’s particular needs and what may place them at risk in order to keep them safe. Staff had received training in how to protect children from abuse. Staff knew how to recognise and report possible harm or abuse and would have no hesitation in speaking out if they witnessed abuse. Recruitment checks had been carried out to make sure staff were suitable to work with children and their families before staff started to work at the hospice.

Staffing arrangements made sure children’s specialist care and needs were met at different times of the day and during the night. Children’s needs were met in a timely way and there was ample time for staff to spend with each child as the numbers of staff were based on one to one support for each child. Parents were very appreciative of how staffing levels were managed and reviewed as it had a positive impact upon the flexibility of their child’s needs being met either on a day and/or respite care basis.

Children were supported by staff who had been provided with the specialist training they required before there was an agreement by the management team to make sure a child’s needs could be effectively met. Staff practices reflected they were knowledgeable in the care they provided to each child during our inspection. Children’s healthcare needs were further promoted by the sharing of learning experiences and the joint partnerships with external healthcare professionals so care and treatment remained effective for each child. Parents were appreciative of how staff made sure their child’s needs were met which included staff knowing their child well and their little ways so parents felt confident to leave their child in the care of staff.

Parents were involved in the care and treatment of their child and they gave their consent to their child’s care and treatment due to the young age of their child. This was in line with current laws around parents being legal guardians due to the age of the children the hospice services were provided for.

Children’s feeding routines were followed by staff so their nutritional needs were met. Staff monitored children’s health needs when they spent time at the hospice. They involved and worked in partnership with external healthcare professionals when required to make sure children’s health needs were consistently met.

Staff felt supported in their roles and consistently remarked how privileged they were to be able to care and support children with life threatening and life limiting conditions as well as their parents. Children responded to the fondness and warmth of staff and this was also replicated by the relationships between staff and children’s parents. Reassurance and comfort was provided to children and parents with children supported to have moments of fun and stimulation to enhance their time at the hospice. Staff were mindful of children’s individual ways of expressing themselves so their activities of play were enhanced and their needs could be responded to in the right way for each child.

Staff understood the importance of their responsibilities in caring for each child with respect for their privacy and dignity. Staff practices reflected their commitment to closing doors when assisting a child with their personal care and bathing routines. Other staff knew not to enter closed doors without knocking and their colleagues inviting them in.

Parents were grateful of the support staff provided them and how staff responded to the difficult times they experienced with offers of day and respite care. Staff were motivated in encouraging parents to attend outings and events where they were able to share their experiences with other parents and make memories.

Parents were aware of how to raise any issues if they needed to and felt comfortable to do so. We heard from both parents and healthcare professionals who were complimentary about children’s care and treatment.

Parents and staff believed there was a culture of homeliness, warmth and friendliness at the hospice where parents had complete trust in the management and staff team to care for their child. Parents and staff recognised improvements had been made which had had positive impacts for children with palliative and end of life care needs. These had been driven through by the management team who had arrangements in place to check and monitor the quality of the services offered to children and parents.

The registered manager was supported by the deputy manager, trustees and registered managers at the providers other two hospices. They were open and responsive to the issues we found and shared with us how they planned to make the required improvements in the light of our findings. The registered manager and deputy manager showed they were constantly striving to make continual improvements. One of the examples provided was the extension of the opening hours of the hospice so children with life-limiting and life threatening conditions and their families’ end of life care preferences could be met if they wanted hospice care.

Inspection areas

Safe

Good

Updated 26 October 2016

The service was safe.

The registered manager took immediate action to ensure the safety measures in place for reducing similar incidents from happening again were strengthened to promote children’ s safety and wellbeing.

Children were protected from abuse by a staff team who were able to recognise and report possible and/or actual abuse.

Children had the care, support and supervision they needed to meet their needs in a timely way due to the continual assessment of the numbers of staff requiring to be on duty.

Children received their medicines from staff who were knowledgeable and competent to be able to do this so children’s wellbeing was not placed at risk.

Effective

Good

Updated 26 October 2016

The service was effective.

Children were provided with care and treatment from staff who received regular training to ensure they had the skills and knowledge to meet their specialist needs.

Parents’ decisions regarding their child’s treatment and end of life care had been sought.

Children’s feeding routines and the support they required was well known by staff to make sure their nutritional needs were met.

Children’s healthcare needs were met by staff who worked in partnership with parents and involved external healthcare professionals when required.

Caring

Good

Updated 26 October 2016

The service was caring.

Children were supported by staff who were caring and knew the importance of their roles in making sure their caring practices respected each child’s privacy and dignity.

Parents were complimentary about how staff were thoughtful and how they valued their mutual support as it meant they felt comfortable and at ease in their child staying at the hospice.

Staff were committed in providing the best care to each child during their life and at the end of their life which supported each child’s individuality.

Responsive

Good

Updated 26 October 2016

The service was responsive.

Children needs were responded to by staff in a personalised way and very much involved parents so choices, preferences and goals could be met.

Children were supported by staff to have fun and enjoyment through age and need appropriate resources to enhance each child’s time spent at the hospice.

Links were being made with community resources so the services offered at the hospice continued to expand and be responsive to children’s palliative and end of life care.

The spiritual and religious needs of children and their families were supported. .

Parents knew how to raise any concerns and/or complaints they had and had confidence the management team would take action to resolve these.

Well-led

Good

Updated 26 October 2016

The service was well-led.

Parents were complimentary about how the management team was making on-going improvements and how they felt there was an inclusive and homely culture at the hospice.

Staff were proud of their work, achievements and felt supported by the management team to make sure the care each child received the best care.

Quality and monitoring checks together with the views of others were used to reflect continuous improvement and development of palliative and end of life care offered to children and families.