Last updated 8 November 2017
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked 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. At our last inspection in 2016 we found the children's service met legal requirements, but the adults' service required improvements.

This inspection took place on 25, 26 and 27 July 2017 and was announced. The inspection team consisted of two inspectors, a specialist adult nurse, a specialist children palliative care nurse, two medicines inspectors and an expert by experience. An expert by experience is a person who has personal experience of using similar services or caring for family members

Prior to the inspection we looked at previous inspection reports and notifications about important events that had taken place at the service. Before the inspection, we asked the provider to complete 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. This helped us plan and inform our inspection.

We spoke with twelve adults who used the service, seven relatives and 39 staff. We spoke with the management team including the heads of department for patient care, community services, education and research, wellbeing, human resources, quality, ward sister and children nursing. We also spoke with staff that included the pharmacist, family support worker, play therapist, seventeen nurses, four health care assistants, two housekeeping staff, cook, two volunteers, chaplain and an administrator.

Home visits were undertaken with consent to two adults who received support from the community team; and one child with their parents. We spent time on the Inpatient Ward talking to people, relatives and staff and observed medicines being administered to people. In the adult day hospice we joined some people for lunch and in undertaking an activity. We attended the children multi-disciplinary meeting, a multi-disciplinary meeting at a local GP surgery and a Schwartz round. This is where staff come together to talk about the emotional and social challenges of caring for people. We also received feedback from two children’s commissioners of the service, a commissioner and quality lead for the adult services, a paramedic and nursing home manager.

During the inspection we viewed three children’s and six adults care plans and notes to check how their care was planned and delivered. We also looked at eight staff recruitment records; the staff training programme; staff rotas; meeting minutes; six people’s medicine records; health and safety records; risk assessments and audits; compliments and complaints logs and quality assurance questionnaires.