Acorns Children's Hospice in Birmingham is registered to provide care and treatment to children and young people, aged between 0 and 18 years, who have a life-limiting illness or condition. Acorns provide a range of services within its hospice; day care, short breaks for children, support into adult services, end of life care, and care after death. Specialist nursing care is provided at the 10 bed hospice. The provider; Acorns Children's Hospice Trust runs three hospices in the West Midlands. They share some staff expertise and teams, such as the hospice wide Transition Team, and Asian Liaison Officer.

This comprehensive inspection took place on 2 March 2016 and was unannounced. There were five children staying in the hospice on the day of the inspection with a further two children attending for day care.

There was a registered manager 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.

Children and young people we met were happy and relaxed in the company of staff. Parents we spoke with told us they were very happy that staff kept their child safe. Staff had been trained and knew how to recognise and report any concerns about potential harm or abuse. Within the hospice appropriate safeguards were in place to chaperone visitors to keep children safe. There was regular review of accidents, incidents and concerns to promote the safety of children and young people. Arrangements were in place to promote the safety of staff working alone within the community. Staff were aware of risks specific to each child’s care, safety and medical condition and how to manage these.

Appropriate checks had been undertaken to ensure only suitable staff were recruited to work with children and young people. Staff had the specialist skills to care for children and young people’s needs. Arrangements were in place to increase staffing levels where children and young people’s needs increased and parents had access to out of hour’s support for help in emergencies.

Staff had received training and support to manage children and young people’s medicines. The arrangements in place for managing medicines were safe.

Staff were highly trained and had the specialist skills to support children and young people. There were strong links with other organisations to ensure children and young people at the end stage of their life benefitted from high quality palliative care. Staff and external professionals expressed a high level of praise for the expertise and commitment of staff. There was a strong focus on developing and supporting staff to take on specialist lead roles to ensure children and young people had the care they needed.

Staff had been trained in and understood the importance of gaining young people’s consent to their care and treatment. We saw young people had been involved in decisions that affected their care or treatment. Parents’ consent and decisions regarding their child’s care had been sought.

Children and young people had a choice of meals and staff knew what to do if there was a concern about eating or drinking enough. Staff worked with parents and community services to maintain children’s eating and drinking if their condition deteriorated.

Where children or young people needed end of life care advanced care plans were in place. Parents were provided with explanations and choices regarding their child’s care and support needs. Wishes in relation to end of life care were discussed and planned for. These reflected personal choices and preferences about how their care and treatment should be met and included the arrangements for managing symptoms or pain.

Parents and family members support needs had been considered and met. Bereavement support,

At the time of the inspection, the service was providing care to six children. All of the children were away from the hospice and there were no relatives available for us to speak with. However, during the inspection we spoke with the Director of Care, the registered manager, a visiting general practioner, a staff nurse, a health care assistant and a community worker.

We looked at care plans for three people and found these contained guidance for staff on how to meet people’s individual needs. We saw that people’s needs had been reviewed regularly.

We found the premises were safe and suitable for children and parents who used the service. We found the provider had completed essential health and safety checks to make sure people were not put at risk.

We looked at the recruitment process in place. We saw that appropriate checks had been carried out before staff commenced employment.

People received information on how to make a complaint if they were not happy with the services they received. We saw that the provider had not received any formal complaints in the last 12 months.

There were seven people using the service on the day of our inspection. Due to their complex health care needs, none of the people using the service were able to communicate verbally with us. However, we observed the care and support they received. We spoke with three parents of people who were using the service and staff that supported them.

Parents told us that they had been fully involved in the decision to use the service and regarding decisions about the ongoing service that their children received. A parent told us “It was a hard decision for us to make to use the service, but I am so pleased we did. My daughter is happy when I say that she is going for a short stay at the hospice.”

Parents told us that staff were available at the times that they and their children needed them. They told us that staff had a good understanding of their children’s care needs and treated them with respect. A parent told us “Staff know exactly what my child likes. They always put his favourite toys in the room ready for when we arrive."

Parents told us that there was good communication between the staff team and themselves. A parent told us “If my child becomes unwell whilst at the hospice, they contact me quickly.”

Parents told us that, wherever possible, they were able to choose the times that their children used the service. A parent told us “The dates of our visits are flexible. If we can’t make the date that the hospice gives us, they send us another date that suits us.”