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Inspection carried out on 11 August 2016

During a routine inspection

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 carried out on 21 May 2013

During a routine inspection

When we visited Zoe's Place Baby Hospice we met and spoke with five members of staff, a relative and a visiting healthcare professional.

We saw that the children receiving a service appeared relaxed and content with the staff and in their surroundings. A relative told us, “He loves it here; he tries to laugh and talk. We can notice such a difference in him, he's awake and happy."

Care assessments and care plans were in place for children, which were updated regularly. Staff members were knowledgeable about children's needs and were able to tell us about them.

Equipment was in place to support the staff with providing care and play for children. This was checked by staff to ensure it was fit for purpose on a regular basis.

The hospice presented as clean and tidy, with procedures in place to reduce the risk of cross infection.

Confidential records belonging to children were accurate, up to date and stored securely. Staff records were also stored securely.

During a check to make sure that the improvements required had been made

We carried out this desk based review to assess whether or not improvements had been made following our last inspection visit to the service.

At that inspection visit we found that children were at risk of receiving inappropriate or unsafe care and treatment because there was no process in place for reviewing and analysing incidents that had the potential to result in harm.

We followed up on this area of non compliance by requesting information from the service to demonstrate that action had been taken to address these issues. We were provided with written evidence that demonstrated the provider had achieved compliance in this area.

Inspection carried out on 9 May 2012

During a routine inspection

We visited this service on 9 May 2012. The visit was unannounced so that no one who worked in the home or used the service knew we were coming.

We carried out this review to check on the care and welfare of children using this service. At the time of our visit the service had not been operating for a year.

During our visit we spoke with the manager, the deputy manager, four staff on duty and two relatives of children using the service.

Relatives we spoke with told us that they were happy with the service being provided and that they felt that they were included in their child's care. One comment made was "It has been a very positive experience so far", whilst another relative commented that the family were "over the moon with the service."

Children had care needs assessments in place.

Staff we spoke with were able to tell us about the care and support needs of the children using the service on the day of our visit.

Staff had completed training in safeguarding vulnerable children and were able to demonstrate their knowledge to us.

The systems in place for medication management on the day of our visit did not place children at unnecessary or potential risk.

Staff received regular clinical supervision from the local community children's nursing team. Staff also received six monthly appraisals from the manager.

The staff we spoke with told us they enjoyed working at the service and felt well supported by the manager. Comments made included "It's my dream job" and "It's a lovely place to work."

We were told that training opportunities were frequent and planned to ensure staff had sufficient skills and knowledge to meet children’s needs.

Relatives told us that they felt comfortable talking to the manager and staff of the service and that they would be able to raise any concerns they may have about their child's care.

Staff told us that they had good relationships with the parents, relatives and carer's of the children who used the service.

The manager told us that both she and her deputy were always available to parents, carers and relatives should they wish to talk with them.

We saw there were some systems in place which measured quality within the service. We identified concerns in relation to the management of incidents that occurred and have detailed this in the body of the report.