This inspection took place on 26, 27 and 28 July 2016 and was unannounced.

Donna Louise Trust provides care for children and young people as they become adults with life threatening or life limiting conditions. Services include specialist respite, palliative, end of life and bereavement care. The service provides support to families of children and young people both within the hospice, through the provision of respite and day care, along with support in individual’s own homes and the wider community. The hospice supports families across Staffordshire and Cheshire.

Donna Louise Trust provides a residential respite facility for up to eight children and young people at any one time, within individual bedrooms. At the time of our inspection there were four children and young people accessing respite care. The facilities provided by the hospice include, a multi-sensory room, computer room, soft play area, Jacuzzi, music room, separate lounges for children and young people, an art and crafts area and day care facility. Accommodation is also provided for parents and their families should they wish to stay. The grounds of the hospice incorporated a range of facilities for children to play, and distinctive areas of landscaped gardens, areas of interests and relaxation.

The service had a registered manager. 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.

Parents and young people we spoke with highly commended the service and staff and had confidence in the staffs’ ability to keep them safe. The provider had established direct working relationships with external agencies to share information to promote the welfare and safety of children and young people. Internal meetings were held that provided a forum for potential concerns and risks to be identified. Enabling the provider to provide timely support to families.

We found improvements were needed in the assessment of risk and the plans to mitigate risk, in some areas, which included medicine management and within the care plans that detailed areas of individuals care. The provider assured us they would take action and we received information following our inspection advising that improvements had been made.

Young people who used the service and a parent we spoke with said medicine was managed safely and staff provided support where needed. Medicine was stored securely within the service and staff responsible for the administration of medicine had their competency regularly assessed.

The provider employed sufficient qualified and experienced staff, from a range of disciplines to meet the needs of children and young people. This had a positive impact on the experience of children, young people and their families. For children and young people it presented opportunities for them to take part in activities including play. Whilst for the families of children and young people, the provider recognised the impact of a child’s health on the wider family. They had recruited a strong contingent of volunteers to support the wider family, through befriending services and the support provided to siblings, through activities and social events. Staff received regular training in areas relevant to their practice. Safe recruitment practices were followed when recruiting new staff.

The provider worked in partnership with children, young people and their families by providing opportunities for all to comment and influence the care and treatment provided. This enabled staff to deliver person centred care, with staff and volunteers supporting children and young people, both within the hospice and at home. Parents valued their relationships with staff who felt the support they received had a positive impact on t

On the day of our inspection there was one person using the service. They did not wish to speak with us but we observed the care they received and spoke to a parent. We spoke with the registered manager, four care staff and three administrative staff.

A parent told us, “The quality of the service is excellent” and, “I have been made to feel welcome here. Every time I visit the nurses give me an update of what has been going on so I am up to date with everything”.

We saw that before people received any care or treatment they, or the legally appropriate person, were asked for their consent and care staff acted in accordance with their wishes. We saw that the care, treatment and support met their needs and the needs of their family because people were cared for by staff that were supported to deliver care and treatment to an appropriate standard.

We saw that people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

We saw that the provider had an effective system in place to regularly assess and monitor the quality of the service that people received.

On the day of our inspection there were four people using the service. Due to their complex health care needs, most of the people using the service were unable to communicate verbally with us but we observed the care and support they received. We spoke with four parents of people who were using the service and five staff that supported them.

Parents told us that they had been fully involved in the decision to use the service and decisions regarding the ongoing service that their children required. One parent told us, "They explained what it would be like here before we visited but it surpassed our expectations. You get more here than they could ever say ".

Parents told us that staff had a good understanding of their children's care needs and treated them with respect. One parent told us, "As soon as I walk through the doors I feel as though a big weight has been taken off my shoulders”.

Parents told us that they felt certain that their children were kept safe at the hospice and we saw evidence that people were cared for by suitably trained and experienced staff. We observed that some care records were kept securely and that the provider had recently completed an audit of care records which had identified changes that needed to take place so that they were clearly legible.