Bluebell Wood Children's Hospice

Updated 22 November 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 carried out 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 was carried out on 30 August 2016 and 1 September 2016. The inspection on 30 August 2016 was unannounced. We gave short notice to the registered provider of our visit on 1 September 2016 because we needed to be sure that key people would be available during our inspection visit. The inspection team consisted of two inspectors and a specialist advisor in palliative care.

Prior to our inspection, we spoke with stakeholders, including local NHS Clinical Commissioning Groups. This information was reviewed and used to assist with our inspection and the findings are included throughout the report. Stakeholders we spoke with told us they had no concerns about Bluebell Wood Children’s Hospice and provided positive feedback about the service.

Before our inspection, we reviewed the information we held about the hospice. This included correspondence we had received about the service and notifications submitted by the service.

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

During the inspection we spent time observing the care and support being offered to children, young people and families. We spoke with two young people and ten family members or visitors who had previously used the services of the hospice.

Over the two days of inspection we spoke with 27 hospice staff. Staff we spoke with included the registered manager/director of care, head of care, head of family support and well-being, medical director, physiotherapist, community nurse, clinical educator, counsellor, activity coordinator, sibling coordinator, nursing and medical staff, nurses on placement at the hospice and support workers. We also spoke with the chief executive officer, chairman of the board of trustees, administration staff, volunteer coordinator, facilities, catering and housekeeping staff and people who worked as volunteers at the hospice.

During our inspection we looked at the systems in place for managing medicines; spoke with five members of medical and nursing staff involved with prescribing and giving people their medicines, looked at four children’s and/or young people’s medicines charts and spoke with a young person and three family members in relation to their children’s medicines management.

We spent time looking at records, which included four children or young person’s care records, six staff records and other records relating to the management of the hospice such as training records and quality assurance audits and reports.

Updated 22 November 2016

Bluebell Wood Children's Hospice offers care and support to children and young people with life-shortening, life-threatening conditions. Children and their families receive support through regular care in their own homes, planned periods of respite care at the hospice, end of life care and counselling and bereavement support.

The hospice has an eight bed unit. All bedrooms are equipped with medical equipment, including hoists and piped oxygen; all have their own en-suite. Bedrooms also have a sofa bed or an extra bed can be accommodated, so parents have the option to sleep in their child’s room. Alternately family members who stay with their child at Bluebell Wood can have their own double bedroom, as well as use of a family lounge and kitchen.

Bluebell Wood covers a large geographical area, supporting children, young people and families across South Yorkshire, North Nottinghamshire, North Derbyshire and North West Lincolnshire.

Bluebell Wood support children and young people up to the age of 25 and provide a wide range of support services for all family members.

The hospice have a transitions team which work closely with all who are approaching young adulthood to ensure the right support is in place in a variety of ways.

Bluebell Wood are currently supporting around 250 families, both in their own homes and at the hospice.

Bluebell Wood has two end of life suites where children who have died can stay until their funeral. Both have family accommodation to enable families to stay if they wish.

The hospice sits in extensive grounds with a variety of garden areas with accessible playground and specialist play equipment. There is also the ‘Dragonfly Garden’ which is a reflective and memorial space for bereaved families.

Bluebell Wood has 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 2008 and associated Regulations about how the service is run.

Day-to-day operation of the hospice is delegated by the Board of Trustees to the Chief Executive Officer (CEO). The CEO discharges responsibilities through the Hospice Leadership Team.

Our last inspection at Bluebell Wood took place in August 2014. The hospice was found to be meeting the requirements of the regulations we inspected at that time.

This inspection took place on 30 August 2016 and 1 September 2016. The inspection on 30 August 2015 was unannounced. This meant staff at Bluebell Wood did not know we were coming. On 30 August 2016 five beds in the hospice were occupied and one child was being supported in day care.

We saw the children and young people we met were happy and very relaxed in the company of staff. Parents told us they were very happy that staff kept their child safe.

Staff were trained in how to protect children and young people from the risk of abuse and harm. They knew how to recognise signs of abuse and how to raise an alert if they had any concerns.

Staff were recruited safely to ensure that children and young people were cared for by suitable staff. There were enough staff on duty that had the specialist skills needed to make sure children and young people’s needs could be met safely. Staffing levels were increased to respond to children and young people’s rapidly changing needs.

The service had appropriate arrangements in place to manage medicines so children and young people were protected from the risks associated with medicines. Staff had received training and support to manage children and young people’s medicines. We identified some shortfalls in the record keeping, storage of medicines and staff training although there was no indication children or young people had been placed at risk.

Staff were well informed about the risks to children and young people and we saw staff were trained in managing risks specific to each child’s care, safety and medical condition.

Systems were in place to maintain the safety of the hospice. The environment was well designed, welcoming, well maintained, clean and suited children and young people’s needs. We identified some potential shortfalls surrounding fire evacuation procedures (Personal Emergency Evacuation Plan) and fire practices. There was no indication children or young people had been placed at risk but we advised further guidance be sought from the local fire and rescue service.

Staff said the training and support they received was good. However, poor record keeping did not evidence that staff received the support and training they required to ensure they had the knowledge and skills to carry out their roles and provide high quality care to meet children’s and young people’s needs.

Children and young people were supported to maintain a nutritious diet. Young people and families told us about the high quality and choice of the food.

Staff were trained in the principles of the Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguards and were knowledgeable about the requirements of the legislation. Staff worked within the principles of the Mental Capacity Act (MCA) where appropriate.

Young people had been involved in decisions about their care and treatment by staff. Parents’ decisions regarding their child’s treatment and end of life care had been sought.

Care and support was offered and provided with exceptional dignity, respect and compassion.

Families’ feedback about the caring approach of the service and staff was overwhelmingly positive and described it as “amazing, exceptional and wonderful.”

Families’ feedback surrounding the end of life care and bereavement support they received was described as “Outstanding.”

The care plans we looked at reflected the children’s or young person’s needs and gave information about their treatment regimes.

There were good links with regional NHS antenatal and children’s services to ensure families had early involvement with the hospice. The hospice staff worked closely with community-based professionals to provide an integrated service.

Children and young people had access to a wide range of activities, outings and events suited to their needs and age.

There was a positive approach to receiving and managing concerns or complaints which were used to improve the quality of the service.

Quality assurance and clinical governance systems were in place and were used to improve the service.

Management had a clear vision and strategy to improve the services on offer to children, young people and their families. They had developed a ‘service improvement plan’ to be implemented over the next three years. The registered manager and chief executive shared this plan with us.

There were strong links with specialist palliative care professionals and other providers to share best practice and expertise so that children and young people had high quality palliative care.

We received very positive comments regarding the overall management of Bluebell Wood Children’s Hospice from staff, other care professionals, relatives and people who used the service.