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Zoe's Place Middlesbrough Good

Reports


Inspection carried out on 6 and 12 November 2019

During a routine inspection

Zoe’s Place Middlesbrough was operated by Zoe’s Place Trust, which was a registered charity, that also operated from two other locations. The service provided palliative, respite and end of life care to babies and infants aged from birth to five years, who were suffering from life-limiting or life-threatening conditions.

Opening in 2004, Zoe’s Place Middlesbrough was situated in a largely residential area occupying a converted leased building, (formerly a convent), that was wheelchair accessible and with ample off-street parking. The public reception was managed by volunteer staff with adequate seating and toilet facilities. The hospice had its own entrance which was managed by clinical staff.

The service provided respite care for the families of the babies and young children up to five years old. As part of this wrap around service, staff could offer therapy, bereavement support, (including use of private accommodation so the family could stay with their child for as long as they needed), plus support groups for the wider family.

We inspected this service using our comprehensive inspection methodology. We carried out an unannounced inspection on 6 November 2019. Unknown to us, the service was closed on this day. We re-visited on 12 November 2019 to speak to more staff and parents/carers. To gain their feedback, we also spoke, over the phone, with parents/carers.

To get to the heart of patients’ experiences of care and treatment, we asked the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rated services’ performance against each key question as outstanding, good, requires improvement or inadequate.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

Services we rate

We had previously rated this service in August 2014. At that time the service was rated outstanding overall with outstanding in the domains of effective, caring, and responsive, with safe and well-led rated as good.

At this inspection the rating went down. We rated it as Good overall.

We found good practice in relation to children and young people care:

  • The service provided mandatory training in key skills to all staff and made sure everyone completed it.

  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

  • The service controlled infection risk well. Staff used equipment and control measures to protect babies and children, themselves and others from infection. They kept equipment and the premises visibly clean.

  • The design, maintenance and use of facilities, premises and equipment kept people safe. Staff were trained to use them. Staff managed clinical waste well.

  • Staff completed and updated risk assessments for each patient and removed or minimised risks. Staff identified and quickly acted upon patients at risk of deterioration.

  • The service had enough staff with the right qualifications, skills, training and experience to keep babies and children safe from avoidable harm and to provide the right care and treatment. Managers regularly reviewed and adjusted staffing levels and skill mix, and gave bank, agency and locum staff a full induction.

  • Staff kept detailed records of babies and children’s care and treatment. Records were clear, up-to-date, stored securely and easily available to all staff providing care.

  • The service managed patient safety incidents well. Staff recognised and reported incidents and near misses. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave children, young people and their families honest information and suitable support. Managers ensured that actions from patient safety alerts were implemented and monitored.

  • Staff gave patients enough food and drink to meet their needs and improve their health. They used special feeding and hydration techniques when necessary. The service made adjustments for babies and children’s religious, cultural and other needs.

  • Staff assessed and monitored babies and children regularly to see if they were in pain and gave pain relief in a timely way. They supported those unable to communicate using suitable assessment tools and gave additional pain relief to ease pain.

  • The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and development.

  • All those responsible for delivering care worked together as a team to benefit patients. They supported each other to provide good care and communicated effectively with other agencies.

  • Staff treated children, young people and their families with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.

  • Staff provided emotional support to patients, families and carers to minimise their distress. They understood babies and children’s personal, cultural and religious needs.

  • Staff supported and involved children, young people and their families to understand their condition and make decisions about their care and treatment. They ensured a family centred approach.

  • The service planned and provided care in a way that met the needs of local people and the communities served. It also worked with others in the wider system and local organisations to plan care.

  • The service was inclusive and took account of children, young people and their families' individual needs and preferences. Staff made reasonable adjustments to help babies and children access services. They coordinated care with other services and providers.

  • People could access the service when they needed it and received the right care in a timely way.

  • It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff. The service included patients in the investigation of their complaint.

  • Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service promoted equality and diversity in daily work and provided opportunities for career development. The service had an open culture where babies and children, their families and staff could raise concerns without fear.

  • Leaders and staff actively and openly engaged with patients, staff, equality groups, the public and local organisations to plan and manage services. They collaborated with partner organisations to help improve services for patients.

  • All staff were committed to continually learning and improving services. They had a good understanding of quality improvement methods and the skills to use them. Leaders encouraged innovation.

However, we also found the following issues that the service provider needed to improve:

  • The leadership at the service had not set any key performance indicators, for example, mandatory training targets, which meant it was difficult for the leadership and staff to effectively monitor performance and drive improvement.

  • National recommendations, such as the inter collegiate guidance for safeguarding, required staff dealing with adults and children to be trained to a certain safeguarding level depending on the role staff had. We found clinical and volunteer staff were not trained to the appropriate level for adult safeguarding and for volunteer staff, children safeguarding.

  • The environment should be free of ligature risks and risks of crushing by door hinges. However, we found examples of such risks when inspecting the environment.

  • Good governance required that staff were guided by policy on how to use their risk registers, that risk registers were aligned between the local and trustee register, and that all registers reflected actual risks posed to the service. We found the local risk register and trustee risk register were not aligned and did not reflect the actual risks posed to the service. The risk management policy failed to guide staff on using the registers to record risk, its escalation, or monitoring.

  • To ensure staff and users of the service knew they were following the latest guidance, notices, policies and procedures that were displayed should have had a current version control. We found version control was not displayed on notices we saw or, when it was, they were not current.

  • To assess and address risks to health, policies should set out what staff should do if faced with a deteriorating child. We found staff had no written policy to follow for the deteriorating child.

  • A clinical audit programme was one way to ensure that staff were using the latest evidence-based practice. We found the service did not operate a clinical audit programme.

  • To support staff in identifying parents or carers who may not have had the necessary mental capacity to consent to treatment provided to their baby or child, staff should be trained in mental capacity and consent. We found staff were not trained in mental capacity and consent.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with one requirement notice that affected the service. Details are at the end of the report.

Ann Ford

Deputy Chief Inspector of Hospitals (North)

Inspection carried out on 6 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

This was an unannounced inspection carried out on 6 August 2014. We last inspected the service on 18 July 2013.

Zoe’s Place in Middlesbrough is part of the national organisation, Zoe’s Place Trust. The service 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.

The service has a registered manager. 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. The children who were at the hospice on the day of the inspection were unable to speak with us either because they were too young or they had complex needs which made communication very difficult. We spoke with the parents and carers of eight children who used the service. They described the hospice as “Brilliant”. One person said, “The staff give amazing support.” Another person said, “We couldn’t do without them now.” We also spoke with the hospice’s registered manager, acting deputy head of care, a registered children’s nurse, a support worker and two nursery nurses.

Parents and carers told us that they felt that their children were in safe hands and we saw there were systems and processes in place to protect children from the risk of harm.

Risks to children’s safety were appropriately assessed, managed and reviewed. Care records we looked at during the inspection contained a number of risk assessments specific to the needs of each child.

There was sufficient staff on duty to meet the needs of children. Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff started work.

Parents / carers told us that their children were cared for and supported by skilled and experienced staff. Parents / carers told us that the care children received was excellent. Staff who worked at the service were extremely knowledgeable about the care that children received.

Staff we spoke with had an excellent knowledge of each child’s dietary needs. A dietician was involved in providing advice for all children who used the service. This ensured that children’s nutritional needs were catered for.

Children were supported to maintain good health and had access to healthcare professionals and services. Staff at the service had open access to the paediatric day unit and ward at James Cook University Hospital. This meant that appointments did not need to be made for a child to be seen by a medical professional. If there was a problem children would be seen when needed.

Parents / carers told us they were supported by kind, caring and compassionate staff. Parents / carers could make decisions about their child’s care and daily routine.

We observed interactions between staff and children who used the service. We saw that staff were kind and respectful to children when they were supporting them. Staff were aware of the values of the service and knew how to respect people’s privacy and dignity.

Children’s care and support needs had been assessed before they used the service. 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.

At the time of the inspection the service was not providing end of life care.

We saw that parents / carers and siblings were provided with lots of support and involved in a wide range of activities. We saw that staff engaged and interacted positively with parents / carers.

The registered manager and staff were very proactive in planning children’s care and support. Any new referrals were dealt with promptly and parents / carers received the respite care they needed.

Appropriate systems were in place for the management of complaints. Parents / carers told us that the registered manager was approachable. Parents / carers we spoke with did not raise any complaints or concerns about the service.

There were effective systems in place to monitor and improve the quality of the service provided. Staff told us that the service had an open, inclusive and positive culture.

At the last inspection on 17 July 2013 the service was found to be meeting the regulations we looked at.

Inspection carried out on 18 July 2013

During a routine inspection

During the inspection we spoke with the parents of one child who used the service at Zoe�s Place. They told us, �The hospice has been brilliant, the environment is good and the staff are caring and friendly.�

We observed the experiences of children who used the service and parents visiting the unit. We saw that staff interacted and communicated well with children and their parents. We saw that the atmosphere was friendly and relaxed. The staff were attentive and demonstrated a good knowledge and understanding of the needs of the parents and children.

We saw that children had their needs assessed and that care plans were in place. We saw that there were effective processes in place to ensure safe sharing of information with other providers.

We found that children were safeguarded against the risk of abuse.

We found that medicines were administered safely.

We found that the staff received appropriate training and had regular supervision and appraisals.

We found that systems were in place to monitor the quality of the service.

Inspection carried out on 21 November 2012

During a routine inspection

We spoke with two parents of children who used the service. They told us, �The service is really good�, �The staff are great� and �They are like a second family.�

We found that parents and their children were treated with dignity and respect. We saw there was a friendly and relaxed atmosphere between staff and the children. We observed staff interacting well with children and supporting them which had a positive impact on their wellbeing.

We found the premises that children, staff and visitors used were safe and suitable and that children were cared for and supported by suitably qualified, skilled and experienced staff.

We found there was an effective complaints system in place at the hospice.

We found that staff were not always appropriately supported in relation to their responsibilities. This was because supervision, appraisals and mandatory training was not up to date. We spoke to the new manager, who had only been in post for two weeks, and she had already identified these issues and started to address them.

Inspection carried out on 18 January 2012

During an inspection looking at part of the service

The visit took place because we were following up concerns we had raised during the last in August 2011. At the time of our unannounced visit no parents were in the unit and staff were looking after 3 pre-school age children therefore we could not gather direct views on the service. Although we did concentrate on the issues that were raised in the previous visit, we also spent time with the children observing care practices. From our observations we found that staff were attentive and knowledgeable about how to meet the children's specific healthcare needs, as well as how to engage them in simulating activity. The children enjoyed painting sessions, one-to-one play and time in a paddling pool. Staff were conscious of the routines parents were trying to establish with their children so matched these routines, thus the children had their baths, naps and quiet times in line with what parents would do. Staff were also mirroring parents feeding schedules and eating regimes. Staff appeared to care a great deal about the children and we found that the children reacted with warmth towards the care team.

Inspection carried out on 6 July 2011

During an inspection in response to concerns

During our visit we spoke to parents of children who used the service. They told us they were very happy with the service. They said they felt that the staff knew their child well and they felt confident to leave their child in their care.

Reports under our old system of regulation (including those from before CQC was created)