Archived: Ellenor Dartford

Updated 24 September 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014. At our last inspection on 7 February 2013, we found the service was fully compliant with legal requirements.

This inspection took place on 19 and 20 July and was announced. The inspection team consisted of an inspector and a specialist advisor who was a children's palliative care nurse.

Prior to the inspection we looked at previous inspection reports and notifications about important events that had taken place at the service. Before the inspection, we asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. This helped us plan and inform our inspection.

We accompanied staff on two home visits and spoke with the children’s parents. We also attended a meeting with a school nurse at a special school, where the service supported three children.

During the inspection we were not able to speak to any children due to their age and level of understanding. We spoke with a visiting consultant in paediatric palliative care, six children’s nurses, one student nurse, the head of respite services, five respite support workers, a play therapist, a medical secretary, a fundraising officer, two volunteers, the chaplain, the head of ‘well-being’, the health and safety officer, the head of support services and a human resource assistant. Members of the management team we spoke with included the registered manager, the director of patient care and the head of children’s services. We also obtained feedback from four commissioners of the service.

We attended the weekly multi-disciplinary team meeting and looked at a range of records including eight children’s care records; six staff recruitment records; the staff training programme; staff rotas, medicines and safeguarding policy; health and safety records; risk assessments and audits; compliments and complaints logs and quality assurance questionnaires.

Updated 24 September 2016

The inspection took place on 19 and 20 July 2016. 48 hours notice of the inspection was given because the service was an office from which care was delivered and we needed to be sure that the manager and staff were available.

Ellenor Dartford provides a hospice at home service for babies and children from birth to young adults who have a life limiting condition. The service operates in Bexley, Dartford, Swanley, Gravesend and West Kent. Children’s nurses provide nursing care for the child in their own home and support and advice for their family members. Respite care is provided for children in their own homes to support family members. Cancer care is provided for children, who live in Dartford, Gravesend, Swanley and Bexley, so children can receive chemotherapy in their own homes, reducing the need for hospital visits. The location was used to hold meetings, children’s clubs and therapies. The service was providing services to 110 families in the community at the time of the inspection. The provider ‘Ellenor’ also operate an in-patient ward for adults with palliative care needs at Gravesend.

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.

The service recognised that some young people saw themselves as adults and had established a transitional pathway which enabled them to receive age-appropriate respite care on the in-patient ward at the providers adult hospice in Gravesend. Young people received support from nurses whom were known to them and undertook activities that they enjoyed during their stay, making it a positive and valuable experience.

The service provided end of life care in partnership with other professionals. Children and young people were enabled to experience a comfortable, dignified and pain-free death in the place of their choice. It had received a large number of compliments concerning the kind, compassionate and outstanding caring manner of the staff team.

The needs of the child or young person, their carers and siblings were all taken into consideration when staff provided them with psychosocial, spiritual and therapeutic support. This holistic approach was seen as a key to the child’s well-being. This included bereavement counselling, music and play therapies and support from the chaplain.

Children and their family members were involved in planning their care and treatment. Children and young people were supported to write their own advance care plans which contained their individual wishes with regards to their care. Staff went the ‘extra mile’ to ensure children’s wishes were realised and parents and carers were supported when they needed it.

Staff received training in safeguarding adults and children and knew how to recognise and report abuse and to help protect children and young people and keep them safe.

There were enough nursing and health care assistants available to meet the needs of children, young people and their carers. Comprehensive checks were carried out on all staff at the service, to ensure that they were fit and suitable for their role.

Assessments of risk were individual to children’s and young people’s specific needs and identified how risks could be minimised. Accidents and incidents were investigated and the results were used as opportunities to make improvements to the service to help ensure children and young people’s safety.

There were safe systems in place for the ordering, storage and disposal of medicines. Only staff who had been trained and had their competency assessed were responsible for the administration of medicines.

New staff received a comprehensive induction and training to ensure they had the skills and knowledge to support children and young people with long-term illnesses or who needed end of life care. The service promoted and encouraged staff to further their learning and development and had developed paediatric specific training days in conjunction with another children’s hospice.

Children and young people had access to the specialist health care support from medical and nursing staff. There were good working relationships and communication with other health care professionals involved in the child’s care to ensure their health care needs were effectively monitored and met.

Staff understood their roles and responsibilities in relation to the Mental Capacity Act 2005 (MCA). This provides a legal framework for making particular decisions on behalf of young people over 16 who may lack the mental capacity to do so for themselves.

Children, young people and their carers benefitted from a service that was responsive to their individual needs. The nursing service enabled children and young people with complex needs to remain at home with their family and so avoid hospital visits and /or admission. The respite service was personalised as children and young people were cared for in their own home and enabled parents and carers to have a break or spend time with their siblings.

The service prioritised building links with other children’s hospices and palliative care networks in order to develop and improve the care and support they could give to children, young people and their families. Children, young people and their families were able to make their views known and there were clear processes in place to make a complaint or raise a concern. When complaints had been received, these had been investigated and used as lessons learned to improve the service.

The service was led by a strong management team, who led by example. There was an open culture where staff felt safe and well supported. The views of families were regularly sought and used to drive forward the service. The service had a clear direction of the areas in which it intended to develop further to meet the needs of the local community. Education and research was seen as key to making improvements in the lives of children with palliative care needs.

Records were held on an electronic system so they were available to all health professionals involved in the person’s care to ensure continuity of care.