Acorns Children's Hospice in Birmingham

Updated 1 October 2016

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, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 2 March 2016 and was unannounced.

The inspection was carried out by one inspector, a member of the CQC medicines team and a specialist advisor. The specialist advisor was a Paediatric Palliative Care Liaison Nurse, qualified and experienced in working within a hospice within the field of palliative care.

We reviewed information the provider had sent to us which included notifications of significant events that affect the health and safety of children/young people who used the service.

We used a number of different methods to help us understand the experiences of children, young people and families who used the service. We spoke with six families of children and young people. We spent time with children and young people observing the care and support being delivered. We spoke with a young ambassador [YA] from Acorns; a young person who has had experience of using the services of Acorns. They represent ‘the voice’ of young people within the service with a view to influencing the services provided. We spoke with a Parent/Carer Champion; [PCC], a parent who uses the services of Acorns and has been trained to support other parents. They represent the views of parents and families in order to influence the services provided.

We talked with 15 staff. This included, nurses, healthcare assistants and team leaders from the family support team, transition team, Asian Liaison Officer, volunteer manager, volunteers, sibling support worker, quality and governance lead, safeguarding lead, head of care services and director of care services. We viewed 11 children and young people’s care and treatment plans and medication records. We looked at a range of quality assurance audits, clinical audits, meeting minutes for different teams and departments, and staff training and development records. We also looked at the feedback from external professionals who had attended palliative care training days provided by the provider. We looked at a variety of written feedback from parents and children to include testimonies from parents, feedback from support groups and young people’s feedback from sibling groups they attended. We received written comments from external healthcare professionals and looked at a range of documents which related to the management and governance of the service to include impact statements; [reports on how the services provided had impacted upon people receiving them].

Updated 1 October 2016

Acorns Children's Hospice in Birmingham is registered to provide care and treatment to children and young people, aged between 0 and 18 years, who have a life-limiting illness or condition. Acorns provide a range of services within its hospice; day care, short breaks for children, support into adult services, end of life care, and care after death. Specialist nursing care is provided at the 10 bed hospice. The provider; Acorns Children's Hospice Trust runs three hospices in the West Midlands. They share some staff expertise and teams, such as the hospice wide Transition Team, and Asian Liaison Officer.

This comprehensive inspection took place on 2 March 2016 and was unannounced. There were five children staying in the hospice on the day of the inspection with a further two children attending for day care.

There was a registered manager in post. 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.

Children and young people we met were happy and relaxed in the company of staff. Parents we spoke with told us they were very happy that staff kept their child safe. Staff had been trained and knew how to recognise and report any concerns about potential harm or abuse. Within the hospice appropriate safeguards were in place to chaperone visitors to keep children safe. There was regular review of accidents, incidents and concerns to promote the safety of children and young people. Arrangements were in place to promote the safety of staff working alone within the community. Staff were aware of risks specific to each child’s care, safety and medical condition and how to manage these.

Appropriate checks had been undertaken to ensure only suitable staff were recruited to work with children and young people. Staff had the specialist skills to care for children and young people’s needs. Arrangements were in place to increase staffing levels where children and young people’s needs increased and parents had access to out of hour’s support for help in emergencies.

Staff had received training and support to manage children and young people’s medicines. The arrangements in place for managing medicines were safe.

Staff were highly trained and had the specialist skills to support children and young people. There were strong links with other organisations to ensure children and young people at the end stage of their life benefitted from high quality palliative care. Staff and external professionals expressed a high level of praise for the expertise and commitment of staff. There was a strong focus on developing and supporting staff to take on specialist lead roles to ensure children and young people had the care they needed.

Staff had been trained in and understood the importance of gaining young people’s consent to their care and treatment. We saw young people had been involved in decisions that affected their care or treatment. Parents’ consent and decisions regarding their child’s care had been sought.

Children and young people had a choice of meals and staff knew what to do if there was a concern about eating or drinking enough. Staff worked with parents and community services to maintain children’s eating and drinking if their condition deteriorated.

Where children or young people needed end of life care advanced care plans were in place. Parents were provided with explanations and choices regarding their child’s care and support needs. Wishes in relation to end of life care were discussed and planned for. These reflected personal choices and preferences about how their care and treatment should be met and included the arrangements for managing symptoms or pain.

Parents and family members support needs had been considered and met. Bereavement support, complementary therapies and sibling support had been highly complimented. There was an excellent awareness of children and young people’s spiritual, religious and cultural needs so that they and their families had the support they wanted, before, during and after death. Families had additional practical and emotional support via the use of trained volunteers and befrienders.

There was a clear commitment to providing the best quality care to the child and young person and their extended family. Parents and external professionals told us staff were always keen to help, thoughtful, considerate and kind. We saw many examples of compassionate care and staff treating children, young people and their family with respect.

We saw children and young people enjoyed a variety of play and activities during their respite stays at the hospice. They had access to a hydrotherapy pool, specialist sensory room and computer technology. A variety of outings and events had been arranged to ensure children and young people had fun and stimulating opportunities.

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A complaints procedure was available and there was technology for children to communicate feedback on their experiences. These were monitored by the management team to ensure any learning could take place.

Everyone we spoke with was consistently positive about the way the hospice was managed. The experiences of children, young people and parents had been used in a positive way to develop the support services available to them. Families had access to specialist staff in the hospice and support within their own home. Young people approaching adulthood had been well supported with their transition into adult services. There were excellent links with antenatal services so that care and treatment could be planned without delay for babies who had life-limiting or life threatening conditions.

There were strong links with other specialist organisations to share learning and expertise and this had led to developing their services further. We saw they had been creative, innovative and had positively increased the number of families they had reached. The systems in place to check the quality of the service were consistently applied. These included checking their service against recognised standards for end of life care for children. Management and staff were highly motivated and committed to continual improvement to meet the changing needs of children and families.