At the previous announced comprehensive inspection of this service in August 2016 we found five breaches of legal requirements. We found a breach in regulation regarding the safe management of medicines and we took enforcement action in respect of this breach. We served the provider with a statutory Warning Notice regarding medicines not being managed safely. We found a breach of regulation as the service had not followed agreed protocols for reporting allegations of abuse to the local authority and to us, the CQC (Care Quality Commission); there was a lack of monitoring of potential risks to children's safety; care needs were not planned effectively to meet the needs of the children; and there was a lack of an effective system to assure the safe management of the hospice. We asked the provider to take action to address these concerns.We undertook a focused inspection on 19 December 2016 to check that the service had now met legal requirements. This report only covered our findings in relation to the specific area / breach of regulation and we found improvements had been made and the breaches of regulation had been met. While improvements had been made we did not revise the rating at this inspection. To improve the rating to 'Good' would require a longer term track record of consistent good practice.
At this announced comprehensive inspection of 20 & 21 September 2017 we found the breaches met and there was evidence of continued improvement and development within the hospice. We were therefore able to change the rating to ‘Good’.
Zoe's Place in Liverpool is part of the national organisation, Zoe's Place Trust. The hospice 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. Families also receive support through the parent support network and sibling groups.
The organisation’s website states, 'Zoe's Place offers our parents and carers a chance to recharge their batteries or to spend time with their other children'. Registered children’s nurses and support staff (carers) look after the children during their stay. The organisational structure included a board of trustees and clinical lead manager who oversaw the three services, Zoe's Place Liverpool, Zoe's Place Coventry and Zoe's Place Middlesbrough.
The hospice offered an in-patient palliative and respite care to children up to the age of five who had life limiting or life-threatening conditions. There was also the provision of a day service from 10am to 6pm during the week and a sibling support group. Referrals to the service were made from families, health professionals, hospitals or by contacting the hospice direct. Referrals to the service were dealt with promptly and parents were provided with a minimum of two nights respite care each month for their child.
A registered manager was 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.’
Safeguarding policies and procedures were in place and discussions with staff confirmed their knowledge around child protection.
Each child had a personalised plan of care; any risks associated with their care were recorded and observations/checks completed in respect of their care and wellbeing. Risk assessments reported on actions to keep each child safe.
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.
The children at the hospice were of very young age and therefore consent to care and treatment was obtained from the parents. During our inspection we observed staff gaining assent from the children before carrying out care and treatment. Staff talked with children about day to day activities such as, what they would like for lunch, arts and crafts and also about the care they were providing to ensure their inclusion.
Parents informed us they were involved in all decisions round their child’s care and that the staff work closely with them.
Children received care and treatment from a multi-disciplinary staff team which included a registered manager, registered children's nurses, play leaders, local doctors, paediatric palliative care consultant, physiotherapist, health care assistants and ancillary staff. Advice from external health and social care professionals was sought at the appropriate time.
Medicines were administered safely to each child. The staff had implemented a clinical decision form for assessing medicines and feeds; this was completed if any risks were identified in respect of medicines prior to admission. Staff received medicine training and their competencies were checked to ensure they administered medicines safely.
Environmental risks assessments were in place and maintenance work of the building was completed. Safety checks of the premises and equipment were undertaken, including fire safety.
We found the premises to be clean and there was good adherence to infection control.
Recruitment was robust to ensure staff were suitable to work with children.
Sufficient numbers of skilled and experienced staff were employed. New staff received an induction and staff had access to a good training programme, including specific training to meet the clinical needs of the children they supported.
Play leaders oversaw a programme of social activities for the children staying at the hospice. The hospice offered good recreational facilities including a hydrotherapy pool, light sensory room and soft play area.
Staff told us they received supervision and good level of support from the management. Staff appraisals were also completed.
Mealtimes were family orientated with hospice staff and children eating together. Many of the children who attend the hospice are unable to eat or drink and therefore receive enteral feeding which is the delivery of nutritionally complete food via a tube directly into the stomach, duodenum or jejunum.
The staff team knew the children they were supporting in respect of their health and social care needs. Each child was allocated specific member of staff to oversee their care and treatment. Staff were able to provide us with details of each child’s care, treatment and tell us about the families. Staff approach with the children was warm, empathetic, respectful and sensitive.
Information was available regarding the hospice included care following the death of a child and a service user guide which provided information around the eligibility criteria, staffing, health and safety, care, accommodation, complaints and practical advice relating to respite visits.
Parents were provided with accommodation on the first floor of the building should they wish to stay overnight. Parents and staff had access to a chapel on the first floor of the building.
A complaints policy and procedure was in place and displayed for easy referral. Concerns and complaints were logged and investigated.
Feedback from parents regarding the care and treatment provided by the staff was sought. Satisfaction surveys sent out earlier this year were complimentary regarding the service provision.
Staff and parents told us the overall management of the hospice was good and the registered manager provided good leadership.
Quality assurance processes and systems were in place to monitor and improve the service. This included the completion of clinical and environmental audits. Where appropriate actions plans were drawn up and actioned completed in a timely manner. An external auditor undertook a review of the service as part of the governance arrangements for the hospice.
The hospice worked in partnership with other organisations at regional and national level and were keen to forge links with other hospice services to help monitor and develop the service provision.