Acorns Children's Hospice in the Black Country

Updated 7 October 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 22 February 2016 and was unannounced.

The inspection was carried out by one inspector, a member of the CQC medicines team and a specialist advisor. The specialist advisor was qualified and experienced in working as a nurse within a hospice and the community and within the field of palliative care.

We did not request a provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. The provider had sent a PIR for one of their other locations and information from this was taken into account when we inspected the service and made the judgements in this report.

We used a number of different methods to help us understand the experiences of children, young people and families who used the service. We spoke with seven families of children and young people. We spent time with children and young people observing the care and support being delivered. We spoke with a young ambassador [YA] from Acorns; a young person who has had experience of using the services of Acorns. They represent ‘the voice’ of young people within the service with a view to influencing the services provided. We spoke with a Parent/Carer Champion; [PCC], a parent who uses the services of Acorns and has been trained to support other parents. They represent the views of parents and families in order to influence the services provided.

We talked with 18 staff. This included, nurses, healthcare assistants, physiotherapist, and team leaders from the family support team, transition team, hospice at home team, volunteer manager, volunteers, sibling support worker, quality and governance lead, safeguarding lead, head of care services and director of care services. We viewed the accommodation and facilities, six children’s care and treatment plans and medication records. We looked at a range of quality assurance audits, clinical audits, meeting minutes for different teams and departments, and staff training and development records. We also looked at the feedback from external professionals who had attended palliative care training days provided by the provider. We looked at a variety of written feedback from parents and children to include testimonies from parents, feedback from support groups and young people’s feedback from sibling groups they attended. We received written comments from external healthcare professionals and spoke with Acorns Asian Liaison Officer. We looked at a range of documents which related to the management and governance of the service to include impact statements; [reports on how the services provided had impacted upon people receiving them].

Updated 7 October 2016

Acorns Children's Hospice in the Black Country is registered to provide care and treatment to children and young people, aged between 0 and 18 years, who have a life-limiting illness or condition. Acorns provides a range of services within its hospice; short breaks for children, support into adult services, end of life care, and care after death. Specialist nursing care is provided at the 10 bed hospice or within children and young people’s own homes. The provider; Acorns Children's Hospice Trust runs three hospices in the West Midlands. They share some staff expertise and teams, such as the hospice wide Transition Team, and Asian Liaison Officer.

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.