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Inspection Summary

Overall summary & rating


Updated 18 June 2016

We inspected Butterwick House on 24 February and 9 and 15 March 2016. The first day of the inspection was unannounced which meant that the staff and registered provider did not know we would be visiting. We informed the registered provider of the dates of our other visits.

Butterwick House provides care and support for babies, children and young people with life limiting and complex healthcare conditions. The services include specialist care, short breaks and respite care, end of life care, and family support before or after death. There are six beds within the hospice, four of which are for children and there is also a transitional unit, with two single bedrooms, to provide care and support to young adults between the ages of 13 to 25 years. The service is purpose built and situated in the grounds of the University Hospital of North Tees. Within the hospice there is a day room, sensory room and a hydrotherapy pool. There is accommodation for parents / carers on the first floor. At the time of our inspection there were three children who used the service.

Butterwick House had a registered manager in place. 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 systems and processes in place to protect children from the risk of harm. Staff told us about different types of abuse and the action they would take if abuse was suspected. Staff were able to describe how they ensured the welfare of children was protected through the organisation’s whistle blowing and safeguarding procedures.

There were enough qualified and experienced staff to meet the needs of the children and young people who used the service. Staff received regular training in areas relevant to their practice. Safe recruitment practices were followed when recruiting new staff and new staff had a structured programme of induction training.

Staff awareness and understanding of risk was good. Staff shared with us how they had dealt with children’s needs changing or dealt with a medical emergency. Risks to children’s safety were appropriately assessed, managed and reviewed. Care records contained a number of risk assessments specific to the needs of each child. The risk assessments had been reviewed and updated regularly.

Parents and carers told us they had been fully involved in drawing up the plan of care and making decisions. Children had been assessed and personalised care plans had been developed which were specific to the individual needs of each child. Evidence of likes and dislikes and what was important to the child was recorded within the plan of care.

The service had medicine management policies and procedures. Appropriate systems were in place for the management of medicines so that children received their medicines safely. The Hospice had developed an excellent pain tool that was personalised to each child. Pain charts provided specific details of any changes the child may demonstrate to indicate their level of pain and a variety of pain relief was available for different types and levels of pain. This helped to ensure that children and young people’s pain was managed effectively

Checks of the building and equipment were completed to make sure it was safe. However, fire drills were not taking place as often as needed. After the inspection the management team contacted the fire authority for advice. They told us they had updated the fire policy in line with the recommendations and fire drills were to be arranged making sure that all staff took part in two fire drills a year.

The hospice employed two doctors who worked during the day Monday to Friday. They were able to review children if they became unwell or deteriorated during

Inspection areas



Updated 18 June 2016

The service was safe.

Checks of the building and equipment were completed to make sure it was safe. However, fire drills were not taking place as often as needed. Action was taken by the registered manager following the inspection to address this.

Staff could explain indicators of abuse and the action they would take to ensure children’s safety was maintained. This meant there were systems in place to protect children and young people from the risk of harm and abuse.

Staffing numbers and skills mix were sufficient to provide a good level of care to keep children and young people safe. Robust recruitment procedures were in place to make sure staff were suitable to work with children.



Updated 18 June 2016

The service was effective.

Children’s healthcare needs were carefully monitored. Information on children and young people was shared with relevant health professionals.

Staff told us they felt supported by the management team, however formal supervision sessions had not taken place. The management team had recognised this and supervision was to be introduced in April 2016

Staff received regular training to ensure they had the knowledge and skills to deliver high quality care. Staff had a structured programme of induction training.

Mealtimes were family orientated and all meals were freshly cooked on the premises.



Updated 18 June 2016

The service was extremely caring.

Parents and carers told us that staff at Butterwick House were extremely caring. They told us the hospice cared for the whole family not just the child or young adult receiving care. Ongoing care and support provided was invaluable to families. Staff had developed excellent relationships with children, young people and their family which was based on trust.

The views and preferences of children, young adults and parents were central to the care provided. Parents and carers made decisions about the care and support their children received.

There was a beautiful chapel and spiritual support was available to the whole family. The chapel was used by people of all faiths. The hospice often went the extra mile by loaning out equipment to a families in the community and allowing children and young people who died elsewhere to use the Sunflower Suite.



Updated 18 June 2016

The service was responsive.

Butterwick House provided a flexible service to children, young adults and parents and carers. There was a wide range of activities and outings for everyone to enjoy where memories were created.

Parents and carers told us they felt confident expressing any concerns or complaints about the service they received.

Excellent support was available from the family support team. There were numerous groups available to support everyone whilst children and young adults received care and after death.

Parents and carers were fully involved in developing care plans which were person centred and clearly described the care and support needed. The hospice had developed an excellent pain tool which was individual to each child or young adult.



Updated 18 June 2016

The service was well led.

The management team gave strong and effective leadership and provided a clear strategy for the long term development of the service.

There were clear management structures and lines of accountability. Staff told us the service was well managed, that they were treated with respect and were actively involved in decision-making.

Systems were in place to monitor the quality of the service provided to ensure the service was run in the best interest of people.

All staff shared the commitment to excellence in every aspect of their work.