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Claire House Children's Hospice Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 11 December 2019

Claire House Children’s Hospice is operated by Claire House. Claire House has a range of services to support children and families, both at the hospice or at home. Claire House provides planned and emergency respite for babies, children and young people. There are 10 beds split into two distinct areas for younger children and older children.

The hospice accepts referrals for symptom management and step-down care (help to leave hospital) after a long hospital admission or complex surgery.

The service provides family support and one-to-one counselling, and many of the services can be accessed as a planned day case. Other services include hydrotherapy, complementary therapy, music and play therapy.

Claire House provide end of life care at the hospice or home for both symptom management and emotional and practical support. The service is underpinned by a 24 hour rapid response team of nurse specialists. Families can stay with their child throughout.

Claire House have two ‘butterfly bedrooms’ where a family and their child can stay after they have died, and the team assist families with emotional and practical support.

We inspected this service using our comprehensive inspection methodology and the inspection was unannounced. The inspection was 8 and 9 October 2019.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

Inspection areas

Safe

Good

Updated 11 December 2019

Our rating of safe went down. However, this was because the Care Quality Commission’s inspection’s methodology changed following the previous inspection in 2015. It was not a reflection that the care deteriorated.

We rated it as Good because:

  • The service provided mandatory training in key skills to all staff and made sure everyone completed it.

  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse, and they knew how to apply it.

  • The service controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean.

  • There was a proactive approach to anticipating and managing risk and this was embedded across all staff levels. Staff identified and quickly acted upon patients at risk of deterioration.

  • The service had enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Managers regularly reviewed and adjusted staffing levels and skill mix, and gave bank staff a full induction.

  • The service used systems and processes to safely prescribe, administer, record and store medicines.

Effective

Good

Updated 11 December 2019

Our rating of effective stayed the same.We rated it as Good because:

  • The service provided care and treatment based on national guidance and evidence-based practice. Staff protected the rights of patients in their care.
  • Staff gave patients enough food and drink to meet their needs and improve their health. They used special feeding and hydration techniques when necessary. The service made adjustments for patients’ religious, cultural and other needs.
  • Staff assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely way. They supported those unable to communicate using suitable assessment tools and gave additional pain relief to ease pain.
  • The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and development.
  • Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent. They knew how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health. They used agreed personalised measures that limit patients' liberty.

Caring

Outstanding

Updated 11 December 2019

Our rating of caring stayed the same. We rated it as Outstanding because:

  • Children, young people and their families were valued as individuals, and empowered as partners in their care. There was a culture of inclusivity and staff made sure all care was tailored to the individual.
  • Feedback about the service was continually positive. Staff went the extra mile and the care and support exceeded expectation.
  • Staff were committed to working in partnership with people. Staff empowered people who used the service to have a voice. Children, young people and their families’ individual preferences and needs were always reflected in how care was delivered.
  • For example, we saw a child friendly ‘contract’ which described the child’s preferences for treatment, which everyone signed. The contract had pictures and clear descriptions with a treat listed at the end.
  • There were two butterfly suites available for families to use. Families could stay with their child after they had died for up to a week; staff provided extensive emotional and practical support during this time.
  • Staff made sure rooms had items that were important to the child and family. For example, the service purchased bedding in the same theme children liked.
  • Play therapists noticed the needs of siblings and could arrange activities in a timely manner.
  • The counselling team could support the child and all different members of the family including grandparents.
  • Staff tried hard to help families make memories with their child. For example, they took photographs and put together booklets and cards.
  • Staff went the extra mile for families of children who were near the end of their life. For example, staff would change their shifts and co-ordination of activities responsively.


Responsive

Outstanding

Updated 11 December 2019

Our rating of responsive stayed the same. We rated it as Outstanding because:

  • Meeting the needs of local people was central to the delivery of tailored services. The service provided person-centred pathways of care for children and young people with multiple and complex needs and involved other service providers.
  • There was a proactive approach to understanding the needs of the children, young people and families that used the service. Provision was made to meet the spiritual and cultural needs of children, young people and their families.
  • The service had a commitment to equality and diversity and adapted to meet cultural, religious and dietary needs.
  • There was an active outreach service to reach as many families as possible and identify those in need at an early stage.
  • Children, young people and their families could access the service in a way and time that suited them.
  • Staff forged innovative approaches to provide person centre pathways of care, involving other service providers.

Well-led

Outstanding

Updated 11 December 2019

Our rating of well-led stayed the same. We rated it as Outstanding because:

  • There was compassionate, inclusive and effective leadership at all levels. Leaders had high levels of experience, capacity and capability needed to deliver excellent and sustainable care.

  • The strategy and objectives were challenging and innovative, while remaining achievable. Strategies and plans were aligned with the wider health economy and leaders demonstrated commitment to system-wide collaboration and leadership. Plans were consistently implemented and had a positive impact on quality and sustainability of services.

  • Leaders had an inspiring shared purpose and motivated staff to succeed. There were high levels of satisfaction across all staff.

  • Leaders operated effective governance processes throughout the service. Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service.

  • Leaders and teams used systems to manage performance effectively. They identified and escalated relevant risks and issues and identified actions to reduce their impact. They had plans to cope with unexpected events. Staff contributed to decision-making to help avoid financial pressures compromising the quality of care.

  • The service collected reliable data and analysed it. Staff could find the data they needed, in easily accessible formats, to understand performance, make decisions and improvements. The information systems were integrated and secure. Data or notifications were consistently submitted to external organisations as required.

  • There was consistently high levels of engagement with staff and the people that used the service. Managers sought feedback from families to help hold the service to account and improve.

  • All staff were committed to continually learning and improving services. They had a good understanding of quality improvement methods and the skills to use them. Leaders encouraged innovation.

Checks on specific services

Hospice services for children

Outstanding

Updated 11 December 2019

We rated this service as outstanding overall.

The domains of caring, responsive and well led were rated as outstanding, and the domains of safe and effective were rated as good.