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Inspection Summary

Overall summary & rating


Updated 14 October 2017

At the previous announced comprehensive inspection of this service in August 2016 we found five breaches of legal requirements. We found a breach in regulation regarding the safe management of medicines and we took enforcement action in respect of this breach. We served the provider with a statutory Warning Notice regarding medicines not being managed safely. We found a breach of regulation as the service had not followed agreed protocols for reporting allegations of abuse to the local authority and to us, the CQC (Care Quality Commission); there was a lack of monitoring of potential risks to children's safety; care needs were not planned effectively to meet the needs of the children; and there was a lack of an effective system to assure the safe management of the hospice. We asked the provider to take action to address these concerns.

We undertook a focused inspection on 19 December 2016 to check that the service had now met legal requirements. This report only covered our findings in relation to the specific area / breach of regulation and we found improvements had been made and the breaches of regulation had been met. While improvements had been made we did not revise the rating at this inspection. To improve the rating to 'Good' would require a longer term track record of consistent good practice.

At this announced comprehensive inspection of 20 & 21 September 2017 we found the breaches met and there was evidence of continued improvement and development within the hospice. We were therefore able to change the rating to ‘Good’.

Zoe's Place in Liverpool is part of the national organisation, Zoe's Place Trust. The hospice provides care and support for up to six children who have life limiting illnesses with special and complex needs to varying degrees. The service offers respite, palliative and terminal care to children aged from birth to five years. Families also receive support through the parent support network and sibling groups.

The organisation’s website states, 'Zoe's Place offers our parents and carers a chance to recharge their batteries or to spend time with their other children'. Registered children’s nurses and support staff (carers) look after the children during their stay. The organisational structure included a board of trustees and clinical lead manager who oversaw the three services, Zoe's Place Liverpool, Zoe's Place Coventry and Zoe's Place Middlesbrough.

The hospice offered an in-patient palliative and respite care to children up to the age of five who had life limiting or life-threatening conditions. There was also the provision of a day service from 10am to 6pm during the week and a sibling support group. Referrals to the service were made from families, health professionals, hospitals or by contacting the hospice direct. Referrals to the service were dealt with promptly and parents were provided with a minimum of two nights respite care each month for their child.

A registered manager was 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.’

Safeguarding policies and procedures were in place and discussions with staff confirmed their knowledge around child protection.

Each child had a personalised plan of care; any risks associated with their care were recorded and observations/checks completed in respect of their care and wellbeing. Risk assessments reported on actions to keep each child safe.

Care records we looked at detailed individual needs, preferences, likes and dislikes and play. Care records had been reviewed and evaluated on a regular basis.

The children at the hospice were of very young age and therefore consent to care and treatment was obtained from the parents. During our inspection we observed staff gaining assent from the children before carrying out care and treatment. Staff talked with children about day to day activities such as, what they would like for lunch, arts and crafts and also about the care they were providing to ensure their inclusion.

Parents informed us they were involved in all decisions round their child’s care and that the staff work closely with them.

Children received care and treatment from a multi-disciplinary staff team which included a registered manager, registered children's nurses, play leaders, local doctors, paediatric palliative care consultant, physiotherapist, health care assistants and ancillary staff. Advice from external health and social care professionals was sought at the appropriate time.

Medicines were administered safely to each child. The staff had implemented a clinical decision form for assessing medicines and feeds; this was completed if any risks were identified in respect of medicines prior to admission. Staff received medicine training and their competencies were checked to ensure they administered medicines safely.

Environmental risks assessments were in place and maintenance work of the building was completed. Safety checks of the premises and equipment were undertaken, including fire safety.

We found the premises to be clean and there was good adherence to infection control.

Recruitment was robust to ensure staff were suitable to work with children.

Sufficient numbers of skilled and experienced staff were employed. New staff received an induction and staff had access to a good training programme, including specific training to meet the clinical needs of the children they supported.

Play leaders oversaw a programme of social activities for the children staying at the hospice. The hospice offered good recreational facilities including a hydrotherapy pool, light sensory room and soft play area.

Staff told us they received supervision and good level of support from the management. Staff appraisals were also completed.

Mealtimes were family orientated with hospice staff and children eating together. Many of the children who attend the hospice are unable to eat or drink and therefore receive enteral feeding which is the delivery of nutritionally complete food via a tube directly into the stomach, duodenum or jejunum.

The staff team knew the children they were supporting in respect of their health and social care needs. Each child was allocated specific member of staff to oversee their care and treatment. Staff were able to provide us with details of each child’s care, treatment and tell us about the families. Staff approach with the children was warm, empathetic, respectful and sensitive.

Information was available regarding the hospice included care following the death of a child and a service user guide which provided information around the eligibility criteria, staffing, health and safety, care, accommodation, complaints and practical advice relating to respite visits.

Parents were provided with accommodation on the first floor of the building should they wish to stay overnight. Parents and staff had access to a chapel on the first floor of the building.

A complaints policy and procedure was in place and displayed for easy referral. Concerns and complaints were logged and investigated.

Feedback from parents regarding the care and treatment provided by the staff was sought. Satisfaction surveys sent out earlier this year were complimentary regarding the service provision.

Staff and parents told us the overall management of the hospice was good and the registered manager provided good leadership.

Quality assurance processes and systems were in place to monitor and improve the service. This included the completion of clinical and environmental audits. Where appropriate actions plans were drawn up and actioned completed in a timely manner. An external auditor undertook a review of the service as part of the governance arrangements for the hospice.

The hospice worked in partnership with other organisations at regional and national level and were keen to forge links with other hospice services to help monitor and develop the service provision.

Inspection areas



Updated 14 October 2017

The service was safe.

Medicines were managed safely by the hospice staff.

Staff knew how to keep children safe. Staff followed agreed protocols for reporting allegations of abuse to the local authority and received on-going training around the safeguarding of children (protecting children from abuse).

Risks to children's safety and well-being for their care and treatment were recorded and monitored by the staff.

Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff commenced work at the hospice.

There were enough staff on duty at all times to meet the diverse needs of the children they supported.

Environmental risks were monitored and checks were undertaken to ensure the premises and equipment were safe.

The hospice was clean and we observed good standards of infection control adhered to by the staff.



Updated 14 October 2017

The service was effective.

Mealtimes were family orientated with staff and children eating together. Children's nutritional needs were monitored and children were supported to eat a healthy diet.

Children received care and support from staff who were skilled and experienced. Staff told us they received a good training programme, supervision and appraisal of their job role.

Decisions were made with the consent of the parents and where possible staff gained assent from the children they supported in respect of their care, treatment and support.



Updated 14 October 2017

The service was caring.

Parents told us the staff were very kind, polite, compassionate and supportive of them and the needs of their children. This we observed during the inspection.

Each child was allocated to a specific team of staff who built up a relationship with the child and their family.

Families could come and go during their child's stay if they so wished and were fully supported by the staff team.

Following the death of a child family support continued by the staff for as long as needed, or for as long as the family wished.



Updated 14 October 2017

The service was responsive.

Children's care needs had been assessed prior to admission and their care documents provided a good over view of their care needs, preferences, choices and likes and dislikes. Care reviews took place to report on any changes and to evaluate care.

Staff had a good understanding and knowledge of children's care and treatment and how they and the parents wished them to be supported.

A process was in place for managing complaints. Any complaints/concerns were logged and responded to.

Arrangements were in place to seek the opinions of parents, so they could share their views and provide feedback about the hospice. This included the use of feedback cards and surveys.



Updated 14 October 2017

The service was well led.

Quality assurance processes and systems were in place to monitor and improve the service. Where appropriate actions plans were drawn up and completed in a timely manner. An external auditor undertook a review of the service as part of the governance arrangements for the hospice.

The hospice had a registered manager in post. The registered manager had relevant and up to date experience and expertise to lead the service.

We received positive feedback from parents regarding the management and leadership of the hospice.

There was a clear management structure and staff told use service had an open, inclusive and positive culture.