Christopher’s Children’s Hospice is provided by Shooting Star Chase, which is a registered charity caring for babies, children and young people with life-limiting conditions, and their families. Christopher’s Children’s Hospice provides support from babies to young people up to the age of 21, they support families from diagnosis to end of life and throughout bereavement with a range of nursing, practical, emotional and medical care. Their care service includes overnight short breaks, Hospice at Home, day care, symptom management, end-of-life care, bereavement care and a comprehensive range of therapies and support groups for the whole family.

The hospice is a nurse led service and children and young people's health needs are met by a range of health professionals during their stay. This includes specialist children’s nurses, adult learning disability nurses, occupational therapists, physiotherapists, social workers and the care team. A local GP practice provides daily medical cover for the hospice to review children’s medicine and respond to any health needs. A children’s palliative care consultant oversees the symptom management and end of life care.

This inspection was carried out 28 and 29 July 2016 and was unannounced. Christopher’s Children’s Hospice is registered to provide bed based care for up to nine children at a time. At the time of our visit six children and young people were using the bed based unit and the hospice service had around 700 families registered as qualifying for the service.

There was a registered manager in place. 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.

Christopher’s Children’s Hospice is an outstanding service. It is focussed on the individual needs of the children, young people and parents who they support, at the time they need it in a way and place that best suits them and their whole family. Parents spoke overwhelmingly of the positive support, guidance and healthcare interventions their children had received. They were full of praise for the staff in terms of their kindness, compassion and knowledge about end of life matters. Parents viewed the staff as experts in their knowledge and skills when supporting children and young people with complex health needs.

Staff were playful, full of energy and maintained a high level of engagement with children, young people and their parents and parents consistently told us how much they valued the normality of the service and the effort staff made to ensure their children had the same experiences as other children.

Parents and professionals spoke of a service that was tailor-made for children and their families saying that staff went ‘the extra mile’ with empathy and compassion. Throughout the end of life care of children and young people parents were given information and kept involved to enable their children to continue to receive parent led care. Informed consent was embodied into all work that was undertaken at the hospice. The various departments within this hospice worked well together so that people had a seamless experience of moving from one department to another as the need arose.

The end of life support provided was highly personalised and tailored to meet the needs and wishes of each individual child, young person and their family with sensitivity and compassion. The hospice was supportive of family’s spirituality. They strived to offer support that recognised spirituality as that ‘which connects us to each other and includes whatever gives each person meaning, purpose, value, self -worth and hope’. Staff were sensitive to parents’ individual spiritual needs and thought of ways to meet these needs when they experienced difficult times.

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We found children and their families were provided with information and were involved in the assessment process and planning of their care. Children and their parents were treated with dignity and respect. Comments included, “I was nervous initially but it’s a sanctuary here where you feel totally accepted.”

We found children’s nutritional needs were assessed and planned. Menus provided choice and alternatives to ensure nutritional needs were met. Comments from parents and children included, “The food is lovely. He has it pureed and they make sure all the food is pureed separately so that he has a taste of everything”, “I know he will get three lovely meals here” and “Sometimes I don’t want what is on the menu so they will do pasta for me and some nights they send out for pizza.”

We found the service was clean and tidy and there were systems in place to prevent the spread of infection.

We found the whole environment was calm and relaxing but there was also a feeling of fun and homeliness for the children. The environment was spacious, secure and had appropriate equipment to meet children’s needs.

We found there were sufficient staff on duty to care for children and to provide support to parents. The staff had access to clinical supervision, support, training, development opportunities and annual appraisal to ensure they had the required skills and knowledge for their roles. Comments from children and parents regarding the staff team included, “The staff are lovely – really friendly; they always ask how we are and they know what they are doing”, “Staff are very caring; there are lots around and they look after us as parents. They are kind and knowledgeable and I trust them” and “I love going there; it’s brilliant. The nurses have been helping me to be independent with my medication. They watch me and test me.”

We found the service had a complaints process and parents and an older child spoken with told us they felt able to complain.

The parents we spoke with said their children were well cared for. They said the staff were friendly and responsive, and tried to make their child's stay at the hospice as enjoyable as possible. For example " we are always very pleased with our stay at Christopher's. We always feel welcomed. The staff are very friendly, caring and professional. The facilities are first class" , "The support our family has received has been extremely good and all your staff are very highly skilled and professional. They are very much valued by us", "The care my child receives at Chase is outstanding thank you".

We observed that the hospice was decorated in a bright and child-friendly way. There were various activity areas which included a sensory room, music room, hydrotherapy swimming pool, art room and a 'chillout room' for teenagers. There were age-appropriate toys, games and books for both teenagers and younger children. We saw photographs on the wall of children taking part in activities.

The families we spoke with said that the staff were very skilled and supportive. The interactions we observed between staff and children were positive and where able children responded well.