Chestnut Tree House

Updated 1 June 2015

We visited the hospice on 20 August 2014. We looked at care records for four children and young people who use the service. We also looked at records relating to the management and running of the service, which included records of complaints, governance meetings, audit checks, and analysis reports of surveys of children and young people, and their families.

We spoke with seven staff about their work and looked at staff training and supervision records as well as staff duty rosters. We also spoke to the registered manager, a member of the administrative team, the chef, a Trustee and the Chief Executive officer for the provider.

The inspection team consisted of an Inspector, who was accompanied by a specialist advisor, a pharmacy inspector and an Expert by Experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.

The service met all of the regulations we inspected against at our last inspection on 12 September 2013.

Before the inspection the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some information about the service, what the service does well and improvements they plan to make.

During the visit, we spoke with three children and young persons living at the hospice and two parents. We also observed staff working with children and young people and their families. We observed a staff meeting where children and young people’s needs were discussed. Following the inspection we spoke to 15 parents of children and young people who received a service from Chestnut Tree House. We spoke with two social workers from children’s disabilities services from different local authorities who have worked with the hospice regarding children’s welfare and safeguarding. We also spoke with a consultant paediatrician and a local authority social services’ commissioner who monitored the service they purchased on behalf of children and young people.

Updated 1 June 2015

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.

The inspection was unannounced.

Chestnut Tree House is a hospice which provides residential and nursing care for up to ten children and young people who have a life threatening condition including care for those at the end of their life. Respite care and day time activities are also provided at the hospice and care and support is also provided to children and their families in their own homes. A range of other services are provided by Chestnut Tree House including specialist support to family members of children. Community support to children and their families includes access to an out of hours ‘on-call’ service and sessions with trained family counsellors. The service is provided to children from birth, including new-born babies and to those in early adulthood. At the time of the inspection there were a total of 275 children and young people who received a service from the hospice, eight of whom resided in the hospice. This included children and young people with a physical or learning disability.

The service had 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.

Staff working in the hospice understood the needs of the children and young people. We saw care was provided with kindness and compassion. Children, young people and their families told us the standard of care was good. We saw examples of creative care and where children and young people were able to express themselves. Staffing was provided at levels where children and young people were safe.

Staff were well trained, motivated and skilled to provide care to children, young people and their families. There was a comprehensive training programme for staff. Training was provided to staff in the Mental Capacity Act 2005 and there were policies and procedures for this. The registered manager and staff, however, were not clear about arrangements for gaining consent for providing care to children and young people, or of the requirements of the Act, such as the use of the Deprivation of Liberty Safeguards (DoLS) for those over the age of 18 years.

Medicines were safely handled and administered.

Children and young people’s needs were assessed and each person had a care plan of how care was to be provided. Children and young people and their families said they were consulted about their care. The quality of care was regularly reviewed and families of children and young people were asked to give their views on the service they and their children received so any improvements could be made. Two of the staff were ‘dignity champions’ with the specific role of promoting a good standard of care for children, young people and their families.

There were systems to review any accidents or incidents so that any improvements could be made to prevent any reoccurrence.

There was good management oversight of the hospice with a registered manager and team leaders to guide and support staff. Nursing practices were monitored by a system of clinical governance.