The inspection was carried out on 6, 7 and 12 October 2016 and was done by one inspector. The service was given 48 hours’ notice because the location provides a domiciliary care service and we wanted to make sure someone would be available to speak with us. The last inspection took place on 18 October 2013 and the provider was compliant with the regulations we checked.

Rainbow Trust Children's Charity 9 provides support to children who have life threatening or terminal illness. The charity provides support to the children and their families in their own homes, in hospital and in the community. The regulated activity is personal care but this is provided only when needed, for example, changing a baby's nappy when providing support. At the time of inspection there were 112 children being supported by the service and two received occasional support with personal care.

The service had an experienced 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.

Procedures were in place to safeguard children against the risk of abuse. Staff understood the importance of keeping children safe and of reporting any concerns.

Risks were assessed so action could be taken to minimise them.

Staff recruitment procedures were in place and being followed. Staff were available to meet the needs of the children using the service.

Staff received the training and supervision they needed to provide them with the knowledge and skills to care and support children and their families effectively.

Staff respected the rights of children and their families to make choices about their care and support and knew to act in their best interests.

Staff were able to support children with their nutritional needs when they required it.

Staff knew children’s healthcare needs and supported families to attend appointments. Staff knew the action to take in an emergency to summon help and support children and their families.

Parents were very happy with the service their child received and felt the whole family was well supported by the service. Staff understood the importance of providing person-centred care and support to each child and their family.

Staff understood the end of life care and support children and families needed and provided an ongoing service to support the family through their bereavement.

Care records reflected the care and support children and their families needed, including any personal support needs for children using the service. Records were reviewed periodically to keep the information current.

Procedures for raising complaints were in place and parents were aware of how to raise a concern so it could be addressed.

Families could contact the service easily and were happy with the way the service was run. Staff said the provider and the registered manager were very supportive and accessible.

Systems were in place for monitoring the service being provided and to identify areas for improvement so this could be achieved.

During our inspection we spoke with the manager, three support workers and four people using the service. We viewed five care records and three staff files. People told us that they were happy with the support their family received. One person told us "the charity is very supportive, it's like having an extra pair of hands." Another said "they are always there when you need them, they take so much pressure off."

We viewed comment cards people using the service had completed. Comments included "Thanks so much for last week, you are incredible with my child" and "thank you so much for all your help and support, I really appreciate it."

All the families we spoke with had a high opinion of the charity. People told us they were given support that was tailored to their needs and they had been involved in all the decisions relating to their care and support. People said they were given all the necessary information before their care and support commenced. Staff told us that they were provided with adequate support and training to carry out their job role effectively and meet the needs of people using the service.

The charity had systems in place to gain people's views of the service and monitor the quality of service provided. A complaints procedure was in place and people were aware of the steps to take if they needed to make a complaint.

During our inspection of Rainbow Children’s Trust we spoke with the manager and one staff member. Due to the sensitive nature and circumstances that families and children using this service were going through, we used feedback that people had sent to the agency to get views from people. We saw a number of thank you cards that had been sent to the agency by families. Amongst messages sent were, “we are grateful for the help and support we have received”. We were shown a compliment letter that another family had written to the agency thanking them for their support.

Staff told us that they were offered appropriate support by the provider and this included non - managerial supervision with a counsellor which helped them debrief on some of the situations they were dealing with and bereavement of children they would have cared for.

You can see our judgements on the front page of this report.