This inspection took place on 25 April 2016 and was unannounced.

Acorns Children's Hospice in The Three Counties is registered to provide care and treatment to 10 children or young people, aged between 0 and 18 years, who have a life-limiting illness or life threatening condition. Support is also provided for families of the children and young people who use the service. There were five children staying in the hospice on the day of the inspection with a further one child 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.

Staff had received training to support children and young people in receiving their medicines. We identified some shortfalls in the management of medicines although there were no indications children or young people had been placed at risk. The registered manager and staff were responsive to the medicine issues we found.

Children and young people were happy and relaxed in the presence of staff. Parents told us they had no concerns about their child’s safety and were confident staff had the knowledge to keep their child safe. Staff knew how to recognise and report possible harm or abuse and would have no hesitation in speaking out if they witnessed abuse.

The leadership team had arrangements in place to make sure the planning of the numbers and skills of the staff team were effective and safe in meeting the specialist needs of children and young people. When children and or young people’s needs changed and or there was an emergency there were contingency arrangements to be able to increase the staffing numbers.

Children and young people received personalised care to meet their specialised needs from a staff team who had access to on-going training and support.

There was a strong focus to source initiatives in helping the staff team to be the best they could be in their varying roles. This included individual staff taking on specialist link roles to ensure best practice guidance was implemented and specialist skills were shared amongst the staff team. We heard how these initiatives had had significant impacts upon children and young people as their complex medical needs, symptoms and pain were well managed and staff were trained to meet these specialist needs. The medical arrangements and support was provided without delay at the hospice or children and young people’s own home.

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 there was a concern about eating or drinking enough. Staff worked with parents and community services to maintain children’s eating and drinking.

We saw staff cared for children and young people with compassion and kindness which was a pattern which was consistent in the how services had been developed. Staff consistently reported they felt proud to work at the hospice and had formed supportive and caring relationships with children, young people and families. Parents told us how amazing and fantastic the different groups of staff had been in helping them through the tough times as well as sharing moments of happiness.

Advance care plans around end of life care were used to make sure good preparation where choices could be made with consideration of the support families would need to share their views. Parents and family members appreciated the bereavement and support services offered to them. We saw the different servic

At the time of the inspection, the service was providing care to a limited number of people. We were told that three families were visiting people who used the service, however it would not have been appropriate to speak with them at this time.

We saw staff treated people with dignity and respect, protected their privacy and rights to make decisions for themselves with what they wanted to do. Staff provided assistance to people when required and politely suggested ways they were able to help them.

We saw records that showed people and families expressed their views on how they wanted to maintain their independence. Staff we spoke with told us how they supported people in their choice.

Staff knew about the needs of the people they were caring for. We looked at care plans for two people and found these contained guidance for staff on how to meet these needs. We saw that people’s needs were reviewed regularly.

The provider supported their staff and made sure staff were trained to an appropriate standard to meet people’s needs. The provider encouraged staff to participate in meetings, staff forum groups and supervisions.

The provider had systems in place to regularly monitor and assess the quality of service that people received.

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

We found that the hospice had been designed with the needs of the children and families who use it at the heart of that design. The spaces and rooms used throughout the hospice promoted privacy and dignity.

We spoke with two parents of children who used the service. Both parents told us that they felt involved in the care that was provided to their child when they were at the hospice. We found that children's likes and dislikes were known by staff and that their choice and independence were supported where possible. We also found that the provider promoted inclusion and diversity.

We found that staff were aware of children's needs from moment to moment and we found that care plan records and assessments were accurate and current.

We found that the provider raised awareness around child protection issues and that staff had an understanding of their responsibilities. The provider also had systems and processes in place to monitor and effectively manage any child protection concerns.

One parent told us "staff are always visible, my son is always well attended and cared for". Another parent told us that their child always received one to one care. We found that staff roles were attributed daily based on the dependency needs of the children who used the service.

We found that records were stored securely and confidentially while remaining accessible when necessary.

One parent said that their teenage son was "always happy to go there, which speaks for itself".