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

We carried out an unannounced comprehensive inspection of this service in August 2016 when five breaches of legal requirements were found. 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 service. We asked the provider to take action to address these concerns.

After the comprehensive inspection, the provider wrote to us to tell us what they would do to meet legal requirements in relation to the breaches. We undertook a focused inspection on 19 December 2016 to check that they had they now met legal requirements. This report only covers our findings in relation to the specific area / breach of regulation. This covered three questions we normally asked of services; whether they are 'safe', ‘responsive’ and ‘well led.’ The question 'was the service effective' and ‘was the service caring' were not assessed at this inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Zoe’s Place Liverpool on our website at www.cqc.org.uk.

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.

Zoe's Place in Liverpool is part of the national organisation, Zoe's Place Trust. The service 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 organisations' 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-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. At the time of the inspection the hospice was not providing end of life care. Three children were receiving in patient care during our visit with a further admission later that day.

At the previous inspection in August 2016 we found medicines were poorly managed and medicine practices at that time put children at risk. At this inspection we found improvements had been made. This included verifying what medication a child was taking before being admitted to the service, the administration of feeds via a stomach tube and lessons learned from medicines incidents being fully recorded and discussed with staff to minimise the risk of re-occurrence.

This announced inspection of took place on 8 & 9 August 2016.

Zoe’s Place in Liverpool is part of the national organisation, Zoe’s Place Trust. The service 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 next work and sibling groups. The organisations’ website states, ‘Zoë’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.

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 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-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. At the time of the inspection the hospice was not providing end of life care.

During our inspection we found a number of breaches in our regulations.

We looked to see if there were systems in place to ensure the proper and safe handling of medicines. We found medicines were poorly managed and current practices put people at risk.

Staff had a good knowledge of what constituted abuse and how they would report an alleged incident. Safeguarding policies and procedures were in place along with local authority guidelines for staff to follow. We found on inspection however that the safeguarding process had not always been followed to protect individuals from abuse. Incidents that affected children’s welfare had also not always been reported to us in accordance with our regulations. This showed a lack of governance over monitoring around risk.

Although systems were in place there appeared to be a fragmented approach in respect of identifying and controlling risks to children’s safety and concerns, reporting on incidents, lessons learnt and actions taken. This had the potential to place children at risk.

Children’s care files contained a number of documents relating to their assessment and care. We found a number of anomalies in respect of the care files we reviewed. Some care plans we saw described children’s care though these were not always consistent or inclusive of all care needs. Care plans had not always been reviewed on every visit to reflect current care. There was a risk therefore that the staff did not always have the information they needed to provide care and support to children in accordance with their individual need.

We saw a number of quality assurance systems and audits to monitor performance and to drive continuous improvement. The concerns we identified at our inspection had not been picked up by the current governance system and auditing arrangements. This meant the governance was not as robust as it could be to assure a safe effective service.

Children were supported by sufficient numbers of staff to provide care and support in accordance with individual need. We saw that children received care and treatment from

During our inspection visit we used a number of different methods to help us understand the experiences of the children who had used the service. This was because children who used the service had complex needs which meant they were not able to tell us their experiences. We spoke with four parents of children who used the service and we observed care and support being provided by staff. We looked at the care records belonging to six children who used the service and we spoke with five members of staff.

Parents told us that staff treated them with respect, were excellent at communicating information, had a clear understanding of their child's needs and had involved them in care and treatment decisions. All the parents spoke positively about the care and treatment their child had received. Comments included, "Staff are outstanding, the facilities are great," and "The service is brilliant, we are really happy with the care," and "The staff are really dedicated."

Care files we reviewed contained information about each child's needs as well as the care and support they required. Care plans and risk assessments were up to date and had been regularly reviewed in partnership with parents. Prior to each respite stay an admission assessment was undertaken. This allowed parents to communicate any changes to their child's care and treatment. One parent told us, "They always have a handover, it's really thorough."

We found there were sufficient numbers of staff to meet the needs of the children who used the service. Parents told us that they saw the same regular staff and that staff understood the needs of their child. We observed staff providing care and support. They had a clear understanding of each child's needs and care and treatment was delivered in a respectful, warm and friendly manner. Staff were quick to respond to requests for help or support and did not appear rushed. Staff we spoke with had received training appropriate to their role and told us they had felt supported to access additional training to enhance their knowledge and skills.

We used a number of different methods to help us understand the experiences of the children who had used the service. This was because children using the service had complex needs which meant they were not able to tell us their experiences. We spoke individually with four parents of children and we spent time observing the support provided by staff.

Parents told us staff had always treated them politely and with respect and had involved them in the care and treatment of their children. They said at the beginning of each stay they had been asked to check information about their child’s health and welfare to make sure it was current and up to date and any changes they reported had been updated in their child’s care records.

Parents told us that staff had been good at communicating with them for example if their child had become unwell during their stay at Zoë’s Place or if staff had been unsure about something relating to the child’s care, treatment or welfare.

Parents said they thought the staff were good at their jobs and they had no doubt that their child had always been well cared for by all staff.

Comments made by parents included:

“I have no criticism at all, my child loves staying there and the staff love him.”

“It is like home from home.”

“I am so happy with the care they give my child.”

“The manager and staff are fantastic I couldn’t praise them enough.”

“I check everything is up to date at the beginning of my son stay at the hospice”.

We spoke with parents during our inspection. They told us that staff had included them in the assessment of their child’s needs on admission and they were satisfied with the overall level of care given. However we were told that on-going daily communication with staff could be improved.