This inspection took place on 1, 2, 8 and 21 June 2016 and was unannounced. The service was last inspected in February 2013 and at that time was meeting the regulations we looked at.

Richard House is an independent charity and provides specialist care for babies, children and young adults who have life-limiting, life-threatening or complex health conditions. In addition they provide a range of support services to parents, siblings and the wider family. This is provided through a 4 bed residential respite unit and a day play and activity unit. At the time of our inspection there were four children receiving respite care in the residential unit and approximately 350 children and young people were registered to use one or more of the services offered by Richard House.

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 and associated Regulations about how the service is run.

Children, young people and their families told us that Richard House was a happy place to be and that they enjoyed the time spent there. They and staff had fun together and there were lots of play and activities that were based on their preferences and needs.

Families told us staff understood their emotional needs and focused on their wellbeing as well as the wellbeing of their family member. There was a family support team which provided pre and post bereavement counselling for patients, friends and relatives. They also provided a children’s counselling service if needed. There was a dedicated room where families could spend time with their loved one after they had passed away to privately say their goodbyes. This was available up until the time of the child’s funeral if families wished it.

Although parts of the systems for ensuring children and young people’s safety were robust others were not and this placed them at risk of not always being safely cared for.

The provider’s recruitment process was robust and ensured that staff and volunteers were suitable to work with children and young people. Safeguards ensured that young people who were unable to make decisions about their care had their human rights protected.

Families were happy with the quality of food provided and their children’s nutritional needs were met. However, although vegetarian meals were available halal meals were not and we have recommended that catering arrangements be reviewed to facilitate people receiving meals that meet both their preferences and their cultural and religious needs.

Staff were clear about their roles and responsibilities. Children and young people received care from a multi-disciplinary staff team who received effective training and good support from the management team. A system of competency based assessments ensured staff had the required knowledge and skills to effectively meet the complex needs of those who used the service. The staff team worked closely with other professionals to ensure that children and young people were supported to receive the healthcare that they needed.

Children, young people, their families and staff were asked for their feedback about the service. There was a clear management structure and staff, children and young people and their families felt comfortable talking to the management team about any concerns. They felt that any issues or concerns they raised would be dealt with. The provider had a positive approach to using complaints to improve the quality of the service. Each complaint was investigated and, where necessary, appropriate action taken to improve the service provided.

Children and young people received a person centred, individualised service. They and their family members were consulted and involved in planning their care and supported to make decisions on h

People who used the service told us that "the hospice provided a lifeline", and that communication with staff was very good. Relatives described the staff as very accessible, including by telephone between stays. Patients and their parents had contributed to individual care plans, which were documented and acted upon at each contact.

Staff accurately described their role in managing foreseeable emergencies and in protecting the health, safety and welfare of those in their care. There were evidence based policies in place which had been reviewed and updated regularly.

There was consistency of care provided by staff with the right knowledge, experience and skills to support people.

Staff told us they were well supported in their roles and that their training and development needs were addressed in a timely manner. A range of learning and development activities had been successfully completed by staff.

Staff told us how important safeguarding was within the hospice. They had attended safeguarding training and were able to correctly describe what may constitute abuse, and their specific safeguarding role. We saw how staff had worked collaboratively with other health care professionals and agencies in managing a recent safeguarding referral.

There were a range of measures in place to monitor and report on quality, and we saw examples of where learning from incidents and patient feedback had taken place.