As part of our inspection of this service we spoke with the acting manager, three members of care staff and one parent of a child who used the service. We undertook a physical examination of all key areas of the service and examined records of staff supervision, staff training, quality assurance information provided to children and families and written and electronic records relating to the provision of care by the service. We were unable to speak to the one young person present during our visit, as they were sleeping at the time, however we did observe staff providing care and support to one young person who was attending the service on the day of our visit.

Is the service safe?

CQC monitors the operation of Deprivation of Liberty Safeguards (DoLS) which applies to hospices. We spoke with the acting manager who demonstrated their knowledge of the protocols to follow. We saw evidence that all staff had been trained in safeguarding, first aid and mental capacity. We found risk assessments with clear action plans were in place to ensure people remained safe.

We saw evidence of a robust system for health and safety in respect of hygiene and infection control.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people’s care and support needs and that they had received appropriate training. People we talked with who used the service and their relatives were satisfied with the service provided. A relative said, "The staff are wonderful here. They always sit down and go through everything with you before each visit. They have always given me the time I needed to cope with the situation."

Is the service caring ?

We saw that staff interacted positively with people who used the service and people we talked with about the service told us that staff were caring and friendly. Assessments of children and young people's care, treatment and support needs were undertaken prior to using the service. Children and young people, their families and health and social care professionals involved in their care were consulted during this process. Records confirmed people’s preferences and diverse needs had been accommodated.

Is the service responsive?

The hospice provided a range of services that responded to people's needs when they had a life-limiting illness. The services included medical care, pain management, day therapy services, spiritual care, counselling, social work advice and community care. The hospice promoted a stress-free environment where people could relax and rest. A member of staff told us, "We are very aware of the need to promote a calm environment". People were encouraged to feedback on the quality of the care and services provided and their views were taken into account. The hospice maintained close links with the community. The hospice trained volunteers in the community who were active participants in some aspects of the service.

Is the service well-led?

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. We found that comprehensive policies and procedures that addressed every aspect of the service were in place.

People and their relatives or representatives were consulted about how the service was run and annual survey questionnaires were collected and analysed. Staff told us they were able and encouraged to express their views and raise any concerns they may have and said they were listened to. A member of staff told us, "We can raise any concerns and make suggestions, the management have an open door policy and they listen to us". Complaints, incidents and accidents were appropriately recorded and audited. There were audit processes in place to monitor risks, safety and wellbeing. The registered manager operated a system of quality assurance and completed audits to identify how to improve the service.

We spoke with one parent of a child who used the service. Positive feedback was given regarding the care and support provided by the hospice. They told us that the hospice was the only place they trusted to leave their child for care and respite. They said, "You can't ask for a better service."

We found that care records were detailed and updated regularly with the involvement of children and young people's families.

We found that the service was clean and hygienic throughout and that the service had robust systems in place for the maintenance of all equipment used.

The service had robust recruitment procedures in place and staff were well trained and supported.

The service dealt with complaints in an appropriate way and also learnt from the outcome of complaints.

During our visit to the service we were not able to talk with any children and young people as they were all involved with their care programmes. We were also not able to talk with their parents, guardians or family members, as there were none available at the time of our visit. However, we did read many positive comments that had been published in newsletters and thank you cards. The general opinion was that The Treehouse Hospice provided an excellent service that fully met the children, young people and their family’s needs.

This unannounced inspection took place on 25 and 29 June 2015.

The hospice services for end of life support to children, young people and their families are based both in the community and at the hospice building. The hospice is a six bedded unit, over one floor with level access throughout. This service had appropriate facilities to meet the people’s needs that used it. Ceiling track hoists were available throughout the building where personal care would be needed. There was also a suite containing family accommodation adjacent to a child’s bedroom for use by end of life care/bereavement support. There was a multi-sensory room, music therapy room, a large wooded area that was used for events and to enable the children to play outside and a hydrotherapy pool (out of use at the present time).

The newly appointed manager was awaiting the outcome of his application to become a registered manager with the commission. He has since been confirmed as registered with the CQC. 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.

People said this was a valuable resource that they had trust and confidence in to support them and their family. Everyone said staff were kind, caring and compassionate. People had confidence in the staff’s ability to respond to need. There were sufficient staff that were well trained and supported in their roles. These staff ensured children and young people were safe when using the service. Risk assessments were completed to keep people as safe as they could be and medicines were administered as prescribed.

Families were included in all aspects of assessment; planning and children were listened to with consent and choice being sought. Families described the support they received as being very child focussed and they valued the range of services, such as short breaks, bereavement support, siblings groups, specialist play, music therapy and counselling.

There was good leadership and management of the service which resulted in children’s care meeting their needs and the needs of the family. The organisations values were known by staff and embedded in practice.