Little Harbour is a children’s hospice. The hospice supports babies, children, teenagers and young adults up to the age of 21 with life limiting or life threatening conditions and provides accommodation for respite (short breaks), and end of life care. The service is registered to accommodate up to a maximum of six children and their families. On the day of the inspection two families were staying at the service and one family was visiting the service for the day.

We carried out this unannounced inspection on 12 December 2016. 95 families were actively being supported with 20 bereaved families receiving support from Little Harbour. The hospice can accommodate up to six children or young people and there are additional facilities and suites to enable parents and siblings to stay at the hospice with the child.

There was a registered manager 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.

The children we met during the inspection had complex needs and were not able to tell us their experiences because of their complex ways of communicating. We observed how the staff interacted with the children and their families.

We identified two areas that needed further development at the service. The registered manager told us following a recent staffing restructure and staff leaving there were a number of posts that were to be recruited to. Some practice specific posts were particularly difficult to recruit to. Due to this it had impacted on the number of families the service could support at any one time. For example on the day of our inspection only two families were able to be supported on a 24 hour basis due to staffing levels. This was to ensure that the staff ratio would meet the child and family’s needs safely. We found that due to the strategies the management team had put in place they were able to provide a safe service to the families they supported, however, they were not able to use their resource to its full potential.

We found that the fridge temperature was not monitored consistently. This could mean that medicines were not stored at their correct temperature and could affect the medicine. We recommend staff should monitor and record the temperature of the medicines refrigerators daily.

Our findings were that children, young people and their families were being cared for by competent and experienced staff. Staff were caring and showed children and their families kindness and compassion. Staff were very motivated and demonstrated a commitment to providing the best quality care to children, young people and their families.

Children received care and support in a personalised way. Children and young people had good links and access to the healthcare support they needed during their stays at the hospice. All parents were happy with the care provided by Little Harbour. Staff knew children well and understood their complex needs.

Parents told us their children were safe in the care of Little Harbour. One parent told us "The staff are fantastic. When I come here I can rest, I know that my son is in safe hands and so I can sit and have a cup of tea and not worry.”

Children were relaxed and comfortable with staff. Staff knew how to recognise any signs of abuse and how they could report any allegations.

Any risks to children and young people's safety and health needs were assessed and managed in order to minimise the risk.

Children and young people and their families including siblings received a responsive service. Their needs were fully assessed, planned for and met. Children, young people and families were involved in developing care plans and keeping these under review.

Children and young people were supported to play, dev

We saw a consistent and respectful approach from all staff in the way they communicated with the young people and their families. We observed that the staff were warm, friendly and showed kindness and understanding to those they cared for. People were positive in their comments about the staff.

Young people were encouraged and supported to make their own decisions and their wishes were respected. One parent told us full explanations had always been given to them regarding the treatment and care plan for their child and they were able to question and discuss any concerns they had.

Care and treatment was planned and delivered in a way that was intended to ensure young people's safety and welfare, and the care and treatment met their needs and protected their rights.

The catering arrangements at Little Harbour met the individual nutritional needs of the young people and their families.

There was sufficient equipment available to meet the care and treatment needs of the young people and records showed this equipment was safe to use and maintained appropriately.

There were enough qualified, skilled and experienced staff to meet the young people's needs. Parents told us they were able to contact the staff at any time and that the service was well organised and able to respond to their child's or families changing needs at any time.

We spoke with the families who were staying at Little Harbour with their children. They told us they were very satisfied with the care their child received and the support provided to themselves by the staff who they found to be kind, helpful and polite.

We looked at the care documentation, including care plans, for four children who used the service. We saw evidence of individualised care planning that took into account the child’s preferences and likes and dislikes.

The staff worked closely with other professionals and / or carers involved with the child. One parent was positive about the reduced number of hospital admissions their child had experienced, as visits were carried out by professionals to their child at Little Harbour, whenever possible.

The premises were modern, well decorated, warm and homely in nature. We saw there were different communal areas that could be used by children and their families. For example, there were two lounge areas, a dining room, conservatory, ‘messy’ arts and craft / play room, toy cupboards, and a computer and games room. During our inspection we observed that the environment was clean, tidy and hygienic in appearance.