Acorns Children's Hospice in the Black Country 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 provides a range of services within its hospice; 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 or within children and young people’s own homes. 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 22 February 2016 and was unannounced. There were four children staying in the hospice on the day of the inspection with a fifth child visiting for the day.

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.

We saw the children and young people we met were happy and relaxed in the company of staff. Parents told us they were very happy that staff kept their child safe when working with them within their own home or the hospice. 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 recruited safely to ensure that children and young people were cared for by suitable staff. There were enough staff on duty who had the specialist skills needed to make sure children and young people’s needs could be met safely. Staffing levels were increased to respond to children’s and young people’s rapidly changing needs. Separate staffing arrangements were available to ensure children and young people cared for in their own home received consistent support 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. We identified some shortfalls in the administration and storage of medicines. Corrective action was taken on the day but we found the monitoring of processes needed to be improved to ensure that medicines were administered and stored safely.

We saw positive risk taking which enabled children and young people to take part in everyday play activities that were important to them. Staff were well informed about the risks to children and young people and we saw staff were trained in managing risks specific to each child’s care, safety and medical condition. Risks had been considered and planned for which included the use of the specialist equipment children and young people needed to keep them safe.

Parents and external professionals spoke highly of the specialist skills of staff which meant children and young people received the care they needed either in the hospice or their own home. Staff were highly trained and supported in their development of specialist skills and there was a strong working partnership with other organisations to support children and young people at the end stage of their life.

Young people had been involved in decisions about their care and treatment and staff had been trained in and understood the importance of gaining young people’s consent to care and treatment. Parents’ consent and decisions regarding their child’s end of life care had been sought.

There was a choice of meals for children and young people and staff knew what to do if

We carried out this inspection as part of our scheduled inspections to check on the care and welfare of people using this service. The visit was unannounced, neither the provider nor staff knew that we would be visiting.

During the inspection we spoke with the registered manager, the head nurse, the head of governance for the service, three qualified nurses, one care assistant and one parent. Following our inspection we spoke with four parents.

Parents told us that they discussed their child's needs and when there had been any changes to their needs with the service. Parents we spoke with were positive about the care and support their child received from Acorns Children's Hospice in the Black Country (will be referred to as Acorns throughout this report). One parent said: "I don't know what I would do without the support and help I get from Acorns. They go through everything at each visit. They are absolutely brilliant ". Another parent said: "Acorns is fantastic".

The service had suitable arrangements in place to ensure that children received safe and coordinated care there was cooperation with other providers of care.

The service had suitable arrangements in place to safely and appropriately manage medicines.

We observed during our visit that staff were caring and the children responded positively to the staff". The parents we spoke with all made positive comments about the staff. One parent said; "X loves all the staff, they are all brilliant". Another parent said: "Acorns is A star. The nurses and physios are the best we come across. I could not cope without Acorns".

Staff told us that they received training and supervision to provide children with the support and treatment they needed.

Systems were in place to review and monitor the quality of the service. We saw that when needed changes to the service were made.

This was the service's first inspection by the Care Quality Commission. The last inspection of the service was undertaken in July 2008 by the Healthcare Commission.

We spoke with one family and four staff. The family told us that information for admission into the hospice was good. They also told us, “At first I was a bit nervous… but there is such positive energy here, so upbeat”, and “I would definitely recommend it, it’s great here”.

We were able to see that children and young people and their families received care and support that met their needs. Good practice guidelines were routinely followed by the service. Individual care records had been written with the children/young people and their families, identifying their likes and dislikes, choices and how they wanted to be supported.

The hospice offered a welcoming environment. There were a number of different garden areas, activity areas, and relaxation rooms available for children and their families.

The hospice had appropriate systems in place to keep children and young people safe and minimise the risk of harm to them. One family member said, "Staff here are very good, I would not hesitate leaving X with them".

Staffing levels at the hospice and the skills and knowledge of staff was suitable and appropriate to meet children's/ young people's needs.

We found that Acorn's Children's Hospice was meeting all the standards we reviewed.