Acorns Children's Hospice in the Black Country

This comprehensive inspection took place on 22 February 2016 and was unannounced. There were four children staying in the hospice on the day of the inspection with a fifth child visiting for the day.

There was a registered manager in post. 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.

We saw the children and young people we met were happy and relaxed in the company of staff. Parents told us they were very happy that staff kept their child safe when working with them within their own home or the hospice. Staff had been trained and knew how to recognise and report any concerns about potential harm or abuse. Within the hospice appropriate safeguards were in place to chaperone visitors to keep children safe. There was regular review of accidents, incidents and concerns to promote the safety of children and young people. Arrangements were in place to promote the safety of staff working alone within the community.

Staff were recruited safely to ensure that children and young people were cared for by suitable staff. There were enough staff on duty who had the specialist skills needed to make sure children and young people’s needs could be met safely. Staffing levels were increased to respond to children’s and young people’s rapidly changing needs. Separate staffing arrangements were available to ensure children and young people cared for in their own home received consistent support and parents had access to out of hour’s support for help in emergencies.

Staff had received training and support to manage children and young people’s medicines. We identified some shortfalls in the administration and storage of medicines. Corrective action was taken on the day but we found the monitoring of processes needed to be improved to ensure that medicines were administered and stored safely.

We saw positive risk taking which enabled children and young people to take part in everyday play activities that were important to them. Staff were well informed about the risks to children and young people and we saw staff were trained in managing risks specific to each child’s care, safety and medical condition. Risks had been considered and planned for which included the use of the specialist equipment children and young people needed to keep them safe.

Parents and external professionals spoke highly of the specialist skills of staff which meant children and young people received the care they needed either in the hospice or their own home. Staff were highly trained and supported in their development of specialist skills and there was a strong working partnership with other organisations to support children and young people at the end stage of their life.

Young people had been involved in decisions about their care and treatment and staff had been trained in and understood the importance of gaining young people’s consent to care and treatment. Parents’ consent and decisions regarding their child’s end of life care had been sought.

There was a choice of meals for children and young people and staff knew what to do if there was a concern about eating or drinking enough. Staff worked with parents and community services to maintain children’s eating and drinking.

Young people and their families were fully involved in the planning and reviewing of their care so that their choices, preferences and goals were known and planned for. This included the arrangements for medicines and equipment to manage symptoms and pain. Medical support was planned and provided without delay at the hospice or in the child’s own home.

Everyone we spoke with described staff as kind, patient, good listeners and always keen to help. We saw many examples of compassionate care, thoughtfulness and respect. There was a clear commitment to providing the best quality care to the child and young person and their extended family. Parents said they were involved in decisions and provided with explanations and choices regarding their child’s care and support needs. Wishes in relation to end of life care were discussed and planned for. Parents and family members valued the bereavement and support services offered to them. There was an excellent awareness of children and young people’s spiritual, religious and cultural needs so that they and their families had the support they wanted, before, during and after death. Families had additional practical and emotional support via the use of trained volunteers and befrienders.

The management team had consistently developed its services to increase the options available to families. We saw families had greater choices of the services they wished to use with access to specialist staff in either the hospice or their own home. Young people approaching adulthood had been well supported with their transition into adult services. There were excellent links with antenatal services so that care and treatment could be planned without delay for babies who had life-limiting or life threatening conditions.

Parents reported their children enjoyed a range of activities, outings and events at Acorns. They were happy that access the jacuzzi and specialist equipment meant their child had pleasurable experiences.

A complaints procedure was available and there was technology for children to communicate feedback on their experiences. These were monitored by the management team to ensure any learning could take place.

Everybody we spoke with was consistently positive about the way Acorns was managed and run. We saw they had actively engaged with parents, children and young people to ensure they shaped their services in the way people wanted and needed them. There were strong links with other specialist organisations to share learning and expertise and this had led to developing their services further. We saw they had been creative, innovative and had positively increased the number of families they had reached. The systems in place to check the quality of the service were consistently applied. These included checking their service against recognised standards for end of life care for children. Management and staff were highly motivated and committed to continual improvement to meet the changing needs of children and families.

During the inspection we spoke with the registered manager, the head nurse, the head of governance for the service, three qualified nurses, one care assistant and one parent. Following our inspection we spoke with four parents.

Parents told us that they discussed their child's needs and when there had been any changes to their needs with the service. Parents we spoke with were positive about the care and support their child received from Acorns Children's Hospice in the Black Country (will be referred to as Acorns throughout this report). One parent said: "I don't know what I would do without the support and help I get from Acorns. They go through everything at each visit. They are absolutely brilliant ". Another parent said: "Acorns is fantastic".

The service had suitable arrangements in place to ensure that children received safe and coordinated care there was cooperation with other providers of care.

The service had suitable arrangements in place to safely and appropriately manage medicines.

We observed during our visit that staff were caring and the children responded positively to the staff". The parents we spoke with all made positive comments about the staff. One parent said; "X loves all the staff, they are all brilliant". Another parent said: "Acorns is A star. The nurses and physios are the best we come across. I could not cope without Acorns".

Staff told us that they received training and supervision to provide children with the support and treatment they needed.

Systems were in place to review and monitor the quality of the service. We saw that when needed changes to the service were made.

We spoke with one family and four staff. The family told us that information for admission into the hospice was good. They also told us, 'At first I was a bit nervous' but there is such positive energy here, so upbeat', and 'I would definitely recommend it, it's great here'.

We were able to see that children and young people and their families received care and support that met their needs. Good practice guidelines were routinely followed by the service. Individual care records had been written with the children/young people and their families, identifying their likes and dislikes, choices and how they wanted to be supported.

The hospice offered a welcoming environment. There were a number of different garden areas, activity areas, and relaxation rooms available for children and their families.

The hospice had appropriate systems in place to keep children and young people safe and minimise the risk of harm to them. One family member said, "Staff here are very good, I would not hesitate leaving X with them".

Staffing levels at the hospice and the skills and knowledge of staff was suitable and appropriate to meet children's/ young people's needs.

We found that Acorn's Children's Hospice was meeting all the standards we reviewed.