Archived: Ellenor Dartford

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.

We saw people who use the service could be confident that their human rights were respected and taken into account because the provider had systems in place to gain and review consent from people who use services, and act on them.

We found people experienced care, treatment and support that met their needs and there were contingency plans in place to enable the service to continue safe appropriate care in emergency situations.

We found that the health and safety of people was promoted, reviewed and audited and the provider had an effective system to regularly assess and monitor the quality of service that people received.

The last inspection report recorded a shortfall under outcome 21 (regulation 20) records and set a compliance action. At this inspection we found that the shortfall had been met and the compliance action closed. We therefore found that people were protected from the risks of unsafe or inappropriate care and treatment because people's personal records were fit for purpose.

The parents that we spoke with said that they were very happy with the care that their child received. One person we spoke with told us, 'I can't fault them at all. They've been fantastic.'

We saw that the service had an infection control policy which included detailed instructions on hand hygiene.

We saw that the recruitment files contained a 'new employee checklist' that ensured that all necessary checks were taken before the person took up their new post. Documentary evidence of identity had been recorded for each member of staff.

We found that there was inconsistency in the completion of the 'care plan details' sheet within a child's record and in the way the records of the care plans were completed by staff members.