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Inspection carried out on 8 and 11 August 2014

During a routine inspection

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 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

Julia's House provides a respite service for 69 children and young people with life limiting or life threatening conditions. They are cared for in the hospice or in their own homes and are supported to access their local communities. Up to four children and young people can stay overnight at the hospice and up to eight children or young people can access day sessions at the hospice. Julia’s House also supports the families of the children and young people who use the service.

The inspection was announced and took place on 8 and 11 August 2014. We told the provider three days before our visit that we would be coming.

There was a registered manager at the service who had worked at the service for many years. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

Most of the children and young people we met and visited had complex needs and were not able to tell us their experiences because of their complex ways of communicating. We observed how the staff interacted with the children, young people and their families.

Parents told us their children were safe in the care of Julia’s House. Children and young people sought reassurance from staff and were relaxed with them. This indicated they felt comfortable and safe with staff. Staff knew how to recognise any signs of abuse and how they could report any allegations.

We saw children and young people received care and support in a personalised way. Children and young people had good links and access to the specialist healthcare support they needed whilst using the service. All parents and professionals were happy with the care provided by Julia’s House. Staff knew children and young people well and understood their complex needs.

Staff were very caring and showed children, young people and their families kindness and compassion. One parent told us: “When my son is in hospital they offer to go and sit with him and that makes a big difference, they just offer I don’t ever have to ask”.

Throughout our inspection we saw examples of creative personalised care that helped make the service a place where children and young people felt included and consulted about how they wanted to spend their time. Staff treated children, young people and their families with respect and dignity. Children and young people’s privacy was maintained at all times during the inspection.

Any risks to children and young people’s safety and health needs were assessed and managed to minimise them.

We saw children and young people were supported to learn, play, develop and take part in and try new activities and experiences in the hospice, their homes and in the community. One parent said: “They do so much with him and so much more than we ever imagined he was able to do. They champion him it’s amazing”.

Children and young people were supported and cared for by their own specialist teams of staff. They were supported by at least one member of staff during sessions at their home or in the hospice.

Parents and professionals gave positive feedback about the qualities, skills and knowledge of the staff. Staff were recruited safely and received an induction, core training and specialist training so they had the skills and knowledge to meet children and young people’s needs.

There were safe systems in place to safely manage and administer medicines in both the hospice and in children and young people’s homes. Children and young people were protected from the risks of infection by the systems and equipment in place.

We found the hospice and equipment was well maintained. The hospice was designed and decorated to meet the specialist needs of the children and young people.

There was a children, young people and family focused culture at the service. Children, young people and families were involved and consulted about all aspects of the service. There was a clear management structure and staff, children and young people and their families felt comfortable talking to the managers about any concerns and ideas for improvements. There were systems in place to monitor the safety and quality of the service provided.

Inspection carried out on 30 November and 2 December 2013

During a themed inspection looking at Children's Services

As part of this announced inspection we spoke with two young people who used the service and three relatives. We also spoke with seven staff including the manager.

Young people we spoke with were happy with the service provided by Julia’s House. One young person told us, “It’s a really nice place, they treat everyone really well, how they want to be treated”. Another young person said, “Everything’s fun”.

Parents we talked with spoke highly of the service. They told us they were happy to leave their children in the care of Julia’s House. They said, “We feel our life is back again” and, “Julia’s House is family orientated”.

People expressed their views and were involved in making decisions about their care and treatment.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

People’s health, safety and welfare were protected when more than one provider was involved in their care and treatment, or when they moved between different services. This was because the provider worked in co-operation with others.

People who used the service were protected from the risk of harm because the provider had taken reasonable steps to identify the possibility of abuse and prevent it from happening.

Staff received appropriate professional development.

People who used the service, their representatives and staff were asked for their views about their care and they were acted on.

Inspection carried out on 16 November 2012

During a routine inspection

People using the service and their relatives told us that they were happy with the care and support they received.

For each person there was a detailed plan of care in place that included people's individual needs and wishes. The plans also detailed physical and emotional health care needs.

People were protected from risk of abuse or harm by there being safeguarding policies

and procedures in place and by staff knowing how and when to use them.

Evidence we saw showed us that people were supported by a caring, experienced staff

team. The staff team were well supported and trained.

There was a regular cycle of quality audits undertaken to ensure that the home was kept

under review. Records showed us that people using the service, families and professionals

involved in people's care were consulted.

Inspection carried out on 13 December 2011

During a routine inspection

At the time of our visit the hospice supported in total 94 children.

On the day of our visit there were pre school children using the service, they were not able to give us their views.

We spoke with the parent of one child, who told us that staff were very focused on their child's needs and how they liked and needed to be supported.

The children's routines were clearly documented such as when they preferred to eat lunch, when they had a nap and when they needed support with personal care. Staff understood the needs of the children well and were knowledgeable about their routines and preferences.

We spoke with parents of children who used the hospice and they told us they knew their children were safe.

Parents of children who used the hospice told us that staff were wonderful.

Parents we spoke with told us they had been asked their views of the service.