This inspection took place on 9 and 10 August 2016 and was announced. At the last inspection of this service on 17 June 2013 there were no breaches of regulation.

Francis House Family Trust is a charitable trust registered to provide hospice services to 14 children, teenagers and young adults. The service provides children and young adults with life limiting conditions with respite accommodation and end-of-life care. They also provide care and support for children and their families within the local community. The service is within one building but is separated into two areas. Francis House provides seven single bedrooms for children and accommodation for their families. Francis Lodge has seven bedrooms for teenagers and young adults. In addition there are facilities for their friends and siblings to stay with them.

The service accepted children from birth to 16 years old at the time of referral. They then remained patients of the hospice for as long as they required services.

There was a manager registered with CQC working at the hospice. 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.

People and their relatives told us that they felt safe at the service and we saw that there were sufficient staff on duty that had been recruited safely. Where there had been issues with staff conduct these had been dealt with through the services disciplinary procedures which mirrored employment law requirements.

Staff were aware of what was meant by abuse and could tell us who they would report any incidents to. The environment and equipment was risk assessed and serviced to maintain people’s safety. There were emergency plans and disaster recovery plans in place in the event of a major event such as a fire.

Medicines were managed safely. Infection control measures were in place to prevent the spread of infection.

Staff were well trained and knowledgeable. They received good support through supervision and appraisal.

Children, young people and their families sat together with staff to eat where possible. This gave a family feel to meal times. Where children received their nutrition by other means staff were well trained. The meals were well presented and nutritious.

Staff worked within the principles of the Mental Capacity Act 2005. Where it was appropriate the service had applied for deprivation of liberty authorisations for young adults.

The environment supported the needs of children and young adults in separate units. There were toys and media available which were age appropriate. There were areas within the service for play and therapy. There were two minibuses, one adapted vehicle and two cars available for trips out and to support families when attending appointments with their children.

Positive relationships were developed at the hospice. Children, young adults and their families were involved in decision making about their care.

Care plans were person centred, contained risk assessments and management plans. These were reviewed regularly.

End of life care was supportive and took account of peoples wishes. Following a child’s death support was provided in the form of practical and spiritual support by staff.

There was a clear management structure at the service and a clear vision was held by the management team.

There was an open culture where mistakes were acknowledged and learning took place.

Continuous improvement was a theme at the service. There were links with the local community through fundraising events and families.

There was an effective quality assurance system in place at the service which used audit tools to identify areas for improvement.

We talked with a number of relatives of children and young people who were being cared for at Francis House Children's hospice and received email comments from one parent. We talked with two young people and one relative of a person who were being cared for at Francis Lodge during our visit. When we asked the people who used the service about their experiences, we ensured that we were sensitive to their health condition and their age.

People told us that they were exceptionally well cared for and stated that they were treated with dignity and respect. One person commented that "I love coming here”. Another person at Francis Lodge told us that “It's really good - it gives me a rest from my mum and dad".

One parent told us that: "[My child] gets a lot of opportunities to do things [they] wouldn't be able to do at home". Another said in writing: "My child] gets one to one quality care.... and is the main reason I feel confident in leaving [them]. [My child's] days are busy ....and each day is different... As a family, we all LOVE Francis House, and to be honest I don't know what we would do without it".

Across the outcomes we looked at, the provider was meeting the standards expected of them including for involving people in their care and treatment, ensuring the care and welfare of the children and young people, cleanliness and infection control, ensuring sufficient staffing levels and the management of healthcare records.

We talked with a number of children and young people who were being cared for at Francis House Children's hospice and Francis Lodge during our visit. When we asked the people who use services about their experiences, we ensured that we were sensitive to their health condition and their age.

Children and young people told us that they were exceptionally well cared for and stated that they were treated with dignity and respect. One person commented that "Everyone has a laugh. I like playing on the computer. There is lots of things to do”. Another person at Francis Lodge told us that “They give me the support I need ”.

We spoke with three parents or guardians during our visit. One parent told us that the hospice staff were: "Lovely, not one bad word I could say about any of them." Another said: "Everyone’s amazing” and “It’s like our second home".

Across the outcomes we looked at, the people who use the service gave very positive comments.

People who use services at Francis House Children's Hospice (Rainbow Family Trust) and Francis Lodge said that they felt the care was excellent. Comments included 'You can tell them anything.' 'The staff are brilliant.' 'My child trusts the staff.'

We reviewed written feedback for both services which the provider had collected. This was all extremely positive. Most comments said that the provider could do nothing better.