Derian House Children's Hospice

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment the rating has remained good.

Good: This meant people were safe and protected from avoidable harm.

People were safe and protected and safeguarded. Where people raised concerns about safety, the primary response was to learn and improve. However, the service did not have a formal agreement for NHS Trust consultant care oversight of end of life patients and environmental cleaning risk assessments were out of date.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We scored the service as 3. The evidence showed a good standard. The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The service had an incident reporting policy which described the type of incidents that should be reported and that incidents should be reported on their electronic reporting system. Incidents were reviewed by staff with the appropriate level of seniority who had the responsibility for ensuring that learning was identified and actions taken. At the time of our assessment there had been 59 incidents reported on the electronic reporting system. Of the 59 incidents, 11 incident investigations were showing to be in progress, and there was 1 incident being investigated in line with the Patient Safety Incident Response Framework (PSIRF). There was evidence that changes had been made because of the learning from clinical incidents. For example, there had been a significant reduction in medication errors over the last 12 months following additional medicines management training for staff. However, some incidents were categorised under headings where learning could be missed. For example, similar incidents were occasionally reported under different categories.

Staff told us that they felt able to raise concerns about patient safety and that concerns raised would be welcomed.

Senior leaders contributed to the learning from incident sessions that were then cascaded to staff. Staff reported that this process was not always effective as they did not get to find out about all learning. A staff survey undertaken in July 2025 reported further work was required in this area and work was underway to address this.

The service had a duty of candour policy. Staff were open and transparent and gave families and patients a full explanation when things went wrong. Staff could provide examples when they followed duty of candour principles in their communication with patients and their families.
 

We scored the service as 3. The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The service worked with families and health and social care partners so that children and young people being admitted could have their needs met safely.

Referrals into the service could be made by families directly or by health and social care professionals. There were processes in place to review referrals and assess that the service could meet the young person's care needs and requirements. Staff did have access to some young people’s electronic summary care records which included GP consultations. Where more medical information was needed, staff could contact the child or young person's normal care provider.

Prior to a baby, child or young person being admitted for respite or end-of-life care staff would visit the child at home or in hospital to assess their needs and get to know the family and understand their routines. This would enable staff to provide a smooth transition from care at home to hospice care.

The service collaborated with an adult hospice locally to provide continuity of care between services for young people making the transition between child and adult services.

We scored the service as 3. The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Staff had a clear focus on improving people’s lives whilst protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoid able harm and neglect.

The service had a safeguarding reporting structure to protect children and adults from abuse. Information about safeguarding services was readily available for staff enabling them to access safeguarding teams easily and escalate concerns quickly.

Staff were trained in safeguarding to the appropriate level for their role. Compliance with overall training for Children and Adult Safeguarding was 97%. Safeguarding training was provided internally as part of induction and mandatory training which included refresher training. Staff received regular safeguarding briefing and professional development sessions delivered by the in-house safeguarding lead.

All staff that we spoke with could give examples of safeguarding risks relevant to the children, young people and the families. Staff could describe their responsibility for safeguarding those using the service and every member of staff could name the safeguarding lead as a point of contact for support.

The service had established multiagency links with the local authorities. Staff attended external meetings such as Child In Need meetings, Children Looked After reviews, Health Needs Assessments, and Best Interest Meetings. The safeguarding leads received local and national safeguarding updates and alerts from external agencies which were shared with staff for information and learning.

Staff provided support for completing benefit forms, charitable grant applications, and housing issues. We received positive feedback of the impact this advice provided.

We scored the service as 3.The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Staff provided care that met people’s needs and was safe, supportive and enabled people to do the things that mattered to them.

Prior to a planned admission a member of staff from the service would meet with the child and young person and their family to complete a needs assessment care plan. The needs assessment care plan was valid for a period of 6 months for a baby and 12 months for a child or young person. The needs assessment care plan was reviewed and updated if a care need changed. Wherever possible, the care provided by the service would mirror or complement the care provided at home.

Potential risks when caring for children and young people were documented and captured in care plans. For example, risks posed to the child or young person with feed tubing, vent tubing and unpredictable movements were documented.

We scored the service as 3. The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The service had suitable facilities to meet the needs of the children, young people and families. A canteen provided hot and cold meals. A lounge room, music room and snug with designated areas to allow for different activities were available for people to use. A sensory room was equipped with a wide variety of multi-sensory technology and soft play flooring. A swimming pool offered an opportunity for hydrotherapy and swimming lessons.

The service was divided into two age ranges, with specific bedrooms to meet the needs of children aged 0 – 16. All bedrooms were fitted with rail and track hoist systems. There was a range of safe space beds and cots. These were specially designed sleep spaces for children who might have additional requirements, for example children who needed a bed with soft sides to prevent injuries. 

Each bedroom had patio doors opening onto the reflective gardens and outdoor spaces. The gardens led to a range of outdoor spaces such as a play area, woodland walk and greenhouse.

The service had two bathrooms with hoist systems and walk around baths.

The Sunflower suite within the main building provided temperature-controlled rooms which allowed children and young people to remain at the hospice after death. Family rooms were located adjacent to the Sunflower rooms for bereaved relatives.

There were processes to ensure equipment, and the environment were well maintained to safely meet the needs of those using the services. However, the service had identified the ceiling track hoist system did not have a protocol for checking hoist function and charging. Plans to install a new ceiling track hoist system were being explored.

Access to the Sunflower suite was controlled was via keypad access and CCTV installed for monitoring purposes.

We scored the service as 3. The evidence showed a good standard. The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together to provide safe care that met people’s individual needs.

The service operated a nurse-led model of staffing with nurses and clinical support workers providing care and treatment. An acuity tool was developed by the service to assess individual care needs to ensure appropriate staff were on duty. There was General Practitioner (GP) cover on an on-call basis for medical care needs.

NHS trust paediatric consultants provided oversight of end-of-life care for children and young people. Formal agreements between the hospice and NHS trusts were not in place. Staff described having good relationships with the consultants but in the absence of a formal agreement it was not clear what the contact arrangements were. The service told us they had taken action to address this following the assessment and an agreement was now in place with an NHS Trust.

At the time of our assessment, the service was open 4 nights a week for respite care and the nights open varied. Additional staff were on stand-by 7 days a week, and available to open the service for any length of time for end-of-life care requests.

The community nursing team offered a 7-day respite-at-home care and end-of-life care service. Staff told us they worked in partnership, with other care providers, to deliver care services in the community.

Staff received mandatory training relevant to their roles and the patient group they worked within the service. The overall training compliance rate was 91%, which was above the services 90% target. Basic life support had a rate of 91%. Sepsis training compliance was 98%, and clinical staff completed training on recognising and responding to children with mental health needs, learning disabilities and autism.

Assurance papers reported to the board noted that short term sickness rates had improved, however workforce data was not available due to a staff vacancy.

We scored the service as 3. The evidence showed a good standard. The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The service had measures in place to prevent outbreaks of infection. When children become unwell with communicable infections, they were isolated from other service users in their rooms until their parents collected them. There had been no confirmed outbreaks of communicable infections during the last 6 months.

The service had an Infection Prevention and Control (IPC) Lead who was accountable for the IPC policy and processes, and managers were responsible for reviewing and actioning findings of IPC Audits. Outcomes of audits and identified IPC issues were discussed with staff at monthly care team meetings. Infection Prevention and Control updates were also communicated to staff verbally, whilst working at the service.

Staff completed IPC training both on line and face-to-face training sessions. The IPC lead had undertaken IPC lead training and staff had completed IPC training relevant to their role.

Weekly and quarterly IPC audits of the facilities and environment were undertaken and actions taken in response to the findings.

An annual IPC report was presented to the executive committee to ensure they had oversight of findings and actions.

There was a system in place to ensure equipment and devices were cleaned and fit for use. The service had dedicated housekeeping staff for cleaning of the general environment. However, the risk assessments for cleaning the environment that housekeeping staff followed were a year out of date and had not been reviewed since 2024.

Often patients brought their own equipment for use during admission which staff would clean before use. Staff cleaned equipment after patient contact to reduce risk of cross infection.

There were signs for use to indicate when areas had recently been cleaned and some equipment, such as baths had an individual cleaning document situated in the bathroom.

The swimming pool had a regular maintenance program carried out by an external contractor. The external IPC audit highlighted areas of maintenance needed in the swimming pool area which were completed after the audit. Regular water-testing was undertaken by an external provider, which included testing for Legionella.

We scored the service as 3. The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

We reviewed medicines records for 3 people and spoke with the registered manager, clinical director, nursing staff and nursing associates. Records demonstrated people were given their medicines safely and at the right time. Medicines were reviewed when people came to stay at the service and allergies were recorded.  People were supported to self-administer their medicines where they were able and wished to do so.  

Medicines were stored safely and there were processes to manage use, including controlled drugs.  Records of controlled drugs (CDs) were accurate and made in line with legislation and best practice. We saw evidence that staff who gave medicines were trained and assessed as competent to ensure this was done safely. 

Medicines incidents were identified, reported and analysed. Learning from these incidents was shared across the service and there was a good safety culture that encouraged staff to report these. 

Medicines audits were completed monthly to identify issues and drive improvement.