Zoe's Place Baby Hospice

Updated 26 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 11 August 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 a paediatric nurse, qualified and experienced in working within a hospice in the field of palliative and end of life care.

Before the inspection, the provider completed 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. Questionnaires were sent to 17 community professionals seeking their views about the hospice services. Five questionnaires were returned to us. We took the responses we received into account when we made judgements in this report. We looked at the information held about the provider and the service including statutory notifications and enquiries relating to the service. Statutory notifications include information about important events which the provider is required to send us. We used this information to help us plan this inspection.

We sought information about the quality of service from the clinical commissioning group (CCG). We also asked Healthwatch for their views. Heathwatch is an independent consumer champion who promotes the views and experiences of people who use health and social care. We did not receive information back from the CCG and Healthwatch had no information to share with us.

We used a number of different methods to help us understand the experiences of children and families who used the services. We spoke with three parents on the day of our inspection and a further three parents by telephone. We spent time with children and saw the care and support provided by the staff team at different parts of the day. We looked at three children’s care, risk and treatment plans, advance care planning and medicine records.

We met and spoke with the deputy head of care, two care assistants/support workers, a qualified nurse and a housekeeper. Two healthcare professionals also shared their views and experiences of being involved with the care and support provided to children and parents by staff at the hospice.

We looked at a range of quality assurance audits, clinical audits, incident and accident records, meeting minutes for different teams and departments, and staff training and development records. We saw a variety of written feedback from parents and children including testimonies from parents. We also looked at the results of the provider’s quality monitoring systems to see what actions were taken and planned to improve the quality of the service and plans for the future. The registered manager also sent further information to us as part of the inspection.

Updated 26 October 2016

This inspection took place on 11 August 2016 and was unannounced.

Zoe’s Place Baby Hospice is registered to provide care and treatment to children aged between 0 and five years, who have a life-limiting or life threatening condition. Zoe’s Place provides a range of services within its hospice from; short breaks for children, day care, support into children’s services after the age of five and care after death. Support is also provided to parents and siblings through groups and events held at the hospice. Since the hospice opened in 2011 the services offered to children including the opening hours have gradually developed and increased. In January 2016 the hospice extended its opening hours to seven days a week. Specialist nursing care is provided at the six bed hospice. The provider Zoe’s Place Trust runs another two children’s hospices which are situated in Middlesbrough and Liverpool.

There was a registered manager in post who is the head of care. 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.

There were procedures in place to make sure children were kept as safe as possible. This included the reporting and following through of incidents and accidents to make sure actions supported each child’s needs being met in the safest possible way when these had occurred. We found the procedures in place for following through incidents needed to be strengthened to further promote children's safety and wellbeing. The register manager immediately took action to ensure the incident procedures were as robust as they could be.

Staff had received training to support them in administering medicine to children to support their health needs. We identified some improvement to be made in the development of the risk assessment arrangements to support staff if a child experienced a severe allergic reaction. This was important to make sure staff had information to follow so children’s safety was consistently managed and met.

Children showed through their facial expressions and body language they were happy and looked comfortable when staff supported them with their needs and during play. Parents had no concerns about their child’s safety and were confident all staff knew their child’s particular needs and what may place them at risk in order to keep them safe. Staff had received training in how to protect children from abuse. Staff knew how to recognise and report possible harm or abuse and would have no hesitation in speaking out if they witnessed abuse. Recruitment checks had been carried out to make sure staff were suitable to work with children and their families before staff started to work at the hospice.

Staffing arrangements made sure children’s specialist care and needs were met at different times of the day and during the night. Children’s needs were met in a timely way and there was ample time for staff to spend with each child as the numbers of staff were based on one to one support for each child. Parents were very appreciative of how staffing levels were managed and reviewed as it had a positive impact upon the flexibility of their child’s needs being met either on a day and/or respite care basis.

Children were supported by staff who had been provided with the specialist training they required before there was an agreement by the management team to make sure a child’s needs could be effectively met. Staff practices reflected they were knowledgeable in the care they provided to each child during our inspection. Children’s healthcare needs were further promoted by the sharing of learning experiences and the joint partnerships with external healthcare professionals so care and treatment remained effective for each child. Parents were appreciative of how staff made sure their child’s needs were met which included staff knowing their child well and their little ways so parents felt confident to leave their child in the care of staff.

Parents were involved in the care and treatment of their child and they gave their consent to their child’s care and treatment due to the young age of their child. This was in line with current laws around parents being legal guardians due to the age of the children the hospice services were provided for.

Children’s feeding routines were followed by staff so their nutritional needs were met. Staff monitored children’s health needs when they spent time at the hospice. They involved and worked in partnership with external healthcare professionals when required to make sure children’s health needs were consistently met.

Staff felt supported in their roles and consistently remarked how privileged they were to be able to care and support children with life threatening and life limiting conditions as well as their parents. Children responded to the fondness and warmth of staff and this was also replicated by the relationships between staff and children’s parents. Reassurance and comfort was provided to children and parents with children supported to have moments of fun and stimulation to enhance their time at the hospice. Staff were mindful of children’s individual ways of expressing themselves so their activities of play were enhanced and their needs could be responded to in the right way for each child.

Staff understood the importance of their responsibilities in caring for each child with respect for their privacy and dignity. Staff practices reflected their commitment to closing doors when assisting a child with their personal care and bathing routines. Other staff knew not to enter closed doors without knocking and their colleagues inviting them in.

Parents were grateful of the support staff provided them and how staff responded to the difficult times they experienced with offers of day and respite care. Staff were motivated in encouraging parents to attend outings and events where they were able to share their experiences with other parents and make memories.

Parents were aware of how to raise any issues if they needed to and felt comfortable to do so. We heard from both parents and healthcare professionals who were complimentary about children’s care and treatment.

Parents and staff believed there was a culture of homeliness, warmth and friendliness at the hospice where parents had complete trust in the management and staff team to care for their child. Parents and staff recognised improvements had been made which had had positive impacts for children with palliative and end of life care needs. These had been driven through by the management team who had arrangements in place to check and monitor the quality of the services offered to children and parents.

The registered manager was supported by the deputy manager, trustees and registered managers at the providers other two hospices. They were open and responsive to the issues we found and shared with us how they planned to make the required improvements in the light of our findings. The registered manager and deputy manager showed they were constantly striving to make continual improvements. One of the examples provided was the extension of the opening hours of the hospice so children with life-limiting and life threatening conditions and their families’ end of life care preferences could be met if they wanted hospice care.