We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service

This was an unannounced inspection carried out on 6 August 2014. We last inspected the service on 18 July 2013.

Zoe’s Place in Middlesbrough is part of the national organisation, Zoe’s Place Trust. The service provides care and support for up to six children who have life limiting illnesses, with special and complex needs to varying degrees. The service offers respite, palliative and terminal care to children aged from birth to five years.

The service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. The children who were at the hospice on the day of the inspection were unable to speak with us either because they were too young or they had complex needs which made communication very difficult. We spoke with the parents and carers of eight children who used the service. They described the hospice as “Brilliant”. One person said, “The staff give amazing support.” Another person said, “We couldn’t do without them now.” We also spoke with the hospice’s registered manager, acting deputy head of care, a registered children’s nurse, a support worker and two nursery nurses.

Parents and carers told us that they felt that their children were in safe hands and we saw there were systems and processes in place to protect children from the risk of harm.

Risks to children’s safety were appropriately assessed, managed and reviewed. Care records we looked at during the inspection contained a number of risk assessments specific to the needs of each child.

There was sufficient staff on duty to meet the needs of children. Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff started work.

Parents / carers told us that their children were cared for and supported by skilled and experienced staff. Parents / carers told us that the care children received was excellent. Staff who worked at the service were extremely knowledgeable about the care that children received.

Staff we spoke with had an excellent knowledge of each child’s dietary needs. A dietician was involved in providing advice for all children who used the service. This ensured that children’s nutritional needs were catered for.

Children were supported to maintain good health and had access to healthcare professionals and services. Staff at the service had open access to the paediatric day unit and ward at James Cook University Hospital. This meant that appointments did not need to be made for a child to be seen by a medical professional. If there was a problem children would be seen when needed.

Parents / carers told us they were supported by kind, caring and compassionate staff. Parents / carers could make decisions about their child’s care and daily routine.

We observed interactions between staff and children who used the service. We saw that staff were kind and respectful to children when they were supporting them. Staff were aware of the values of the service and knew how to respect people’s privacy and dignity.

Children’s care and support needs had been assessed before they used the service. Care records we looked at detailed individual needs, preferences, likes and dislikes and play. Care records had been reviewed and evaluated on a regular basis.

At the time of the inspection the service was not providing end of life care.

We saw that parents / carers and siblings were provided with lots of support and involved in a wide range of activities. We saw that staff engaged and interacted positively with parents / carers.

The registered manager and staff were very proactive in planning children’s care and support. Any new referrals were dealt with promptly and parents / carers received the respite care they needed.

Appropriate systems were in place for the management of complaints. Parents / carers told us that the registered manager was approachable. Parents / carers we spoke with did not raise any complaints or concerns about the service.

There were effective systems in place to monitor and improve the quality of the service provided. Staff told us that the service had an open, inclusive and positive culture.

At the last inspection on 17 July 2013 the service was found to be meeting the regulations we looked at.

During the inspection we spoke with the parents of one child who used the service at Zoe’s Place. They told us, “The hospice has been brilliant, the environment is good and the staff are caring and friendly.”

We observed the experiences of children who used the service and parents visiting the unit. We saw that staff interacted and communicated well with children and their parents. We saw that the atmosphere was friendly and relaxed. The staff were attentive and demonstrated a good knowledge and understanding of the needs of the parents and children.

We saw that children had their needs assessed and that care plans were in place. We saw that there were effective processes in place to ensure safe sharing of information with other providers.

We found that children were safeguarded against the risk of abuse.

We found that medicines were administered safely.

We found that the staff received appropriate training and had regular supervision and appraisals.

We found that systems were in place to monitor the quality of the service.

We spoke with two parents of children who used the service. They told us, “The service is really good”, “The staff are great” and “They are like a second family.”

We found that parents and their children were treated with dignity and respect. We saw there was a friendly and relaxed atmosphere between staff and the children. We observed staff interacting well with children and supporting them which had a positive impact on their wellbeing.

We found the premises that children, staff and visitors used were safe and suitable and that children were cared for and supported by suitably qualified, skilled and experienced staff.

We found there was an effective complaints system in place at the hospice.

We found that staff were not always appropriately supported in relation to their responsibilities. This was because supervision, appraisals and mandatory training was not up to date. We spoke to the new manager, who had only been in post for two weeks, and she had already identified these issues and started to address them.

The visit took place because we were following up concerns we had raised during the last in August 2011. At the time of our unannounced visit no parents were in the unit and staff were looking after 3 pre-school age children therefore we could not gather direct views on the service. Although we did concentrate on the issues that were raised in the previous visit, we also spent time with the children observing care practices. From our observations we found that staff were attentive and knowledgeable about how to meet the children's specific healthcare needs, as well as how to engage them in simulating activity. The children enjoyed painting sessions, one-to-one play and time in a paddling pool. Staff were conscious of the routines parents were trying to establish with their children so matched these routines, thus the children had their baths, naps and quiet times in line with what parents would do. Staff were also mirroring parents feeding schedules and eating regimes. Staff appeared to care a great deal about the children and we found that the children reacted with warmth towards the care team.

During our visit we spoke to parents of children who used the service. They told us they were very happy with the service. They said they felt that the staff knew their child well and they felt confident to leave their child in their care.