This inspection took place on 10 and 11 January 2017 and was announced. The service was last inspected in November 2013 and at that time was meeting all the regulations we looked at.

Charlton Farm offers a service to children and young people who have a life limiting condition and their families. They are able to offer short break ‘respite’ care and emergency care for up to eight children or young people at any one time in their accommodation facilities. Children can be referred by a family member or a health and social care professional at any time from initial diagnosis to a point when end of life care is required. Charlton Farm generally provides a service to the entire family who are accommodated at the time of the short break. This allows the young person to be cared for by staff so if required the family are able to enjoy time away from their caring responsibilities.

At the time of our inspection, Charlton Farm were offering a service to approximately 200 children and young people and their families, the majority of whom received up to 14 days of care annually. Parents were able to negotiate with Charlton Farm as to when shorts breaks could be provided. This was managed by Charlton Farm, to ensure fairness so that families received an equitable allocation of popular periods such as weekends and school holidays.

In addition to the short breaks, Charlton Farm offers a range of other services. This includes a dedicated sibling’s team. The team was established in response to the recognition of the impact of having a sibling with a life limiting condition. Activities are arranged for siblings during the families’ stay at Charlton Farm which enables them to have some fun. They are also encouraged to express their views and feelings of having a sibling that is unwell and the impact this has on them.

Charlton Farm also offers end of life care. Families can stay in the accommodation provided so they can be near their child. They are arrangements in place to provide bereavement support to families when the needs are identified. The hospice also offers ‘remembering weekends’, which are open to all bereaved families and allows people to support each other and remember their child.

There are approximately 70 active volunteers who augment the work of the paid hospice staff. In addition, there are 28 shops in the community which are involved in fundraising for the three children’s hospices run by Children’s Hospices South West.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

People told us staff at Charlton Farm were kind and compassionate. They felt staff had a shared vision of providing care that was of the highest quality. The provider supported staff to achieve this through an extensive training programme and support from colleagues and line managers.

Children and young people had their health needs met either by medical staff employed by Charlton Farm or by accessing community health and social care professionals. The provider ensured children received their medicines as prescribed and good nutrition.

Parents felt their children were safe at Charlton Farm. There were a number of pre-employment checks to ensure that as far as possible only suitable staff and volunteers were recruited. Staff we spoke with knew how to keep children and young people safe, and what to do if they had any concerns. Staffing levels were sufficient to meet the needs of children and young people staying at the hospice.

Care that was offered to children and young people was personalised and reflected their needs. The needs of children and young people were reviewed prior to every short break visit and during their

On the day of our inspection there were six young people staying at the service. Four of these people had their families staying with them and there was one family who were receiving support due to a recent bereavement. We spoke with one family and one young person who used the service and a family who were receiving support due to a recent bereavement.

All the people we spoke with told us that they were fully involved with the care and treatment provided at the service. We saw that care plans were person centred and were signed by the parents and where possible the child or young person.

We found that care plans were up to date and reviewed during every visit that the person made to the service.

The serviced liaised closely with people’s GP’s and health professionals involved in the person’s care to ensure consistent care and support for people.

The service ensured that people were provided with food and drink that met their individual needs. People we spoke with told us that they liked the food and had access to food and drink at any time of the day or night.

Staff told us they received regular support and training that enabled them to carry out their roles effectively.

The service had a robust complaints policy and procedure in place. People told us that they knew how to complain but had not had reason to do so. We saw that where people had made comments to improve the service these had been acted on.

We spoke with two families who had children at the service and one family who had been recently bereaved. We spoke with the registered manager, the sibling worker, five other staff and one doctor; the cook who had been working that day, along with a volunteer.

All people spoken with were positive about their experience of the service. The parents were clear that they had received good consistent care and support. One told us, "The care is wonderful and very good" and "It's very natural and I feel able to leave my child here to be cared for".

The parents also told us that they had been consulted and included in caring for their child. This had ensured that the child had received the same level of care at the service as at home. One parent said, "The staff instilled confidence; we knew that could care for our loved one".

The sibling worker told us of the work that had taken place with the siblings of children using the unit. This had been designed to help them to enjoy life, to talk about what is happening and to support them. We saw three siblings playing in the messy room. The parent said, "It's great they do so much here and have such fun, they all enjoy it".

We saw in the staff records and it was confirmed through discussion with staff that they had been supported. The records also confirmed that they had received up to date training. One staff member who had worked at the service for about two weeks said, "The best induction I have ever had".

We visited Charlton Farm and met with a number of children and their parents who were visiting or staying at the service. We were told that Charlton Farm was “a really excellent service”, “there’s nothing that they will not do for the children” and “we feel at the centre of everything”.

One parent said how important it was that the family had found a service that was able to manage the medical care for their child, as well as personal care. The service cares for all the family and sibling care was “very important, and the sibling team do just as much for the other children as the care team do” and “the service recognises the holistic needs of the family”.

We were told that members of staff were supportive of one another and worked as a team. Members of staff were respectful and allowed families to maintain their privacy and dignity. Families were also given enough time and space and members of staff would recognise when this was important, but also when they needed to increase support.

We were told that children and families have lots of activities. This includes outings and visits to local attractions. Children are able to play with a range of toys, create artwork, get messy, enjoy the garden and play area. The service has created a soft play room and also an indoor garden for children that are not able to access the garden or when the weather does not permit. Teenagers have their own room for which others have to have permission to enter.

The service has a hydrotherapy pool, a faith room, and facilities to look after a child’s body after death and while the family plans the funeral arrangements. Families are able to stay at the service during this time if they wish, and can contact the service at any time in the future.

There is a large, light, airy, and busy dining room and kitchen, with a number of sitting rooms and a conservatory. Parents can use the kitchen facilities whenever they wish and can prepare their own food and drinks, or the service has full catering facilities and will provide food and drinks for all members of staff visitors.