Charlton Farm

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

This means we looked for evidence that the service met people’s needs.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people’s needs were met through good organisation and delivery.

This service scored 82 (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 4. The evidence showed an exceptional standard. The service was exceptional at making sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

People had care plans that clearly reflected their physical, mental, emotional and social needs. All children and young people had comprehensive, holistic care plans that captured their views, wishes and needs. Where children and young people were approaching the end of their lives, detailed advance care plans were in place, with a clear focus on maintaining quality of life. Families told us they were key partners in their child’s care and treatment.

The environment was designed to support person‑centred care. Although all bedrooms were the same, ‘bedroom bags’ based on individual characters were used to personalise each room to the child’s preferences. We saw a room with character‑themed rugs, books, soft toys and bedding. Bedrooms had direct access to the outdoor grounds and were fully accessible, enabling beds to be moved outside where this supported the child’s wishes.

The service offered a range of personalised activities to support children’s wellbeing, including music therapy, access to a craft room and a variety of sensory resources such as fidget toys and rainmakers. The soft‑play area was accessible and included a hoist. A mobile sensory unit enabled sensory experiences to be provided in children’s bedrooms when they were unable to access shared spaces. Children and young people also had access to a large outdoor area with games, slides and swings to support play and enjoyment.

Learning disability nurses were part of the multidisciplinary team, alongside carers with relevant experience who acted as advocates for the voice of the child. Children and young people were supported to use their preferred communication methods. Where appropriate, children used their own communication aids, including eye‑gaze technology, which was tailored to the individual child’s abilities and parameters. The service encouraged children to bring familiar communication aids from home.

Staff used a range of communication approaches, including personalised books, signs and Makaton, and were trained to identify and use the communication methods that worked best for each child. The service worked closely with schools to support the use of communication passports. Clear ‘crib sheets’ were in place to guide staff on each child’s preferred communication methods and needs.

The service also supported children with visual impairments. A child advocate regularly visited the site, spoke with staff and provided recommendations to help improve children’s experiences and outcomes.

We scored the service as 3. The evidence showed a good standard. The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

The service provided respite, symptom management (including step‑down care from hospital), and end of life care. Children and young people were offered up to two planned respite stays each year, totalling 6 nights. Stays were provided from Monday to Thursday or Thursday to Sunday.In addition to the planned stays families were able to attend for the day to use the facilities.

The service was established for 6 children. An emergency bed was available and staffed at all times. This enabled the service to support families in crisis and helped prevent cancellations of planned stays. Short‑notice stays were offered if there were cancellations and this did not affect families’ planned respite entitlement. Families could book planned stays using an online booking system or by contacting the service directly to discuss their needs. The service worked flexibly and collaboratively with the link nurse at the local hospital to support continuity of care.

When families were struggling and needed additional support the service could extend the length of the stay. The service also enabled families from the other 2 hospices within Children's Hospice South West to stay in their accommodation when their children had been inpatients at the local hospital to reduce costs and provide support. The service accepted children in house from other hospices for end of life care if they were too unstable to travel to their local hospice. Staff visited children in the local children's hospital when they were admitted to offer care and support to children and their families.

Provide 24/7 access so families can call in whatever the time to speak to staff or to seek advice and guidance.

A policy required staff to sit and eat with children and families during stays. This helped promote a family‑centred approach and consistent relationships. Families spoke positively about the support they received. One family member told us staff advocated for their child and provided practical help, including during hospital visits.

The service recognised it did not fully reflect the diversity of the local population of Bristol. However, the service supported families from a wider area. Leaders were working with multi‑faith leaders and a visiting chaplain to improve understanding of different cultural and faith needs and to increase accessibility of the service.

Families had access to season passes for local attractions such as the zoo, local football and rugby clubs and amusement parks.

We scored the service as 3. The evidence showed a good standard. The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The service took steps to ensure information was accessible to children, young people and their families. Translation services were available, and the service worked with interpreters when required. Families could communicate face to face or use a telephone language interpretation service. Letters and written information could be translated, and translation support was used when booking stays to ensure care pathways were understood.

The service had been reviewing its patient‑facing information to improve accessibility. Easy‑read versions of key documents were available for example the complaints policy and an easy read version of the family charter was in development.

The service supported effective communication. Children and families were encouraged to bring any communication aids they used. Staff liaised with schools to understand existing communication methods, such as picture exchange communication systems and bespoke communication tools. Communication needs were considered as part of the care planning process.For example there were sign language interpreters at team meetings and a braille machine for a patient to enable them to communicate.

Information sharing was managed safely. A Caldicott Guardian was available for advice. Photographs were not stored permanently, and secure transfer systems were used where needed. Consent was obtained before sharing any personal information.

Families could contact the service at any time for advice and support. One family member told us, “You can ring for support 24/7 and they’re very responsive.”

We scored the service as 4. The evidence showed an exceptional standard. The service was exceptional at enabling people to share feedback and ideas, or raise complaints about their care, treatment and support. They always involved people in decisions about their care and told them what had changed as a result.

Families knew how to raise concerns or make a complaint. When concerns were raised, families received feedback. The service routinely contacted families to seek feedback about their experiences. Feedback was shared with staff and discussed at team meetings. Where improvements were identified, action was taken.

There had been no formal complaints in the 6 months before our inspection. However, staff and managers responded promptly and sensitively to any negative feedback received. Families and children were involved in reviewing concerns and identifying improvements.

The service listened to feedback and made changes as a result. Families had fed back that the process for checking medicines, patient history and care plans on arrival was stressful and time‑consuming. In response, the service reviewed its practice and completed as much of the history review process as possible before the stay. This reduced delays on arrival and improved the experience for families.

Older children told the service they wanted a gaming room. Leaders were planning to convert an existing sensory room into a gaming room and improve internet connectivity. The service was in discussions with technology companies to support this development.

Families requested a keypad system for accessing medicines rather than using keys, which was implemented. The service introduced a designated area in the kitchen and dining room for families to use. This enabled families to prepare their own breakfast and increased independence during stays. The service supported wider family involvement, including a fundraising activity led by a parent.

The service held training on improved awareness of hearing loss from a team member and a specialist in teaching children and young people with vision impairment to move around as safely, efficiently and independently as possible.This enabled the team to understand what it was like to navigate the building with hearing or sight impairment or loss. Feedback from a patient led to the purchase of a braille printer for both them and staff to use.

Families described being actively involved in care planning and risk assessments. One family member told us they were involved in planning transport arrangements, including seating and equipment, which reassured them. They told us they had been involved in reviewing care plans and felt listened to. They also explained staff contacted other professionals on their behalf to resolve discrepancies between medication labels and hospital information.

Families told us they felt confident raising concerns and giving feedback. One family member said they had never needed to complain but would feel comfortable doing so and had been regularly asked for their views.

We scored the service as 3. The evidence showed a good standard. The service made sure that people could access the care, support and treatment they needed when they needed it.

The service met all waiting‑time targets for urgent and routine referrals in 2024/25. All urgent referrals received a response within 48 hours and most were accepted on the same day. The service consistently accepted children onto the caseload within expected timescales.

Once accepted, the service gathered information from other professionals involved in the child’s care, with consent. This reduced duplication and supported coordinated care planning. Families were offered a visit before their first stay, allowing staff to understand needs, address concerns and agree care at the family’s pace. Online booking and proactive communication supported access.

Care plans were completed before admission and reviewed shortly before and on arrival to reflect any changes. Decisions about accepting referrals were made through a central group, and families were allocated a care team as close to home as possible to support continuity.

The hospice environment supported access for all families, including lift access and facilities adapted for children. Cultural and religious needs were considered, including support for faith‑specific practices following death.

Families told us they were generally able to access the service when needed and said the booking process had improved. The service had taken part in a pilot to provide care in the community. Although funding for the project had ended, the service was able to provide end of life care at home if this was the family's wish, and was considering implementing this model in the future.

We scored the service as 3. The evidence showed a good standard. Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

Staff promoted a culture where children, young people and families felt able to share their views and influence their care. Staff had received training in equality, diversity, inclusion and human rights.

Leaders told us the service supported children and families with a wide range of circumstances and needs. This included families living in temporary accommodation, families from the travelling community, and families where parents had reading or writing difficulties. Additional support was provided to help families understand information and take part in decisions.

The service also supported families experiencing complex social situations. This included families involved with family courts, those affected by domestic abuse or relationship breakdown, children who were adopted or fostered following abuse, and bereaved parents in crisis. Records showed that safety and support plans were in place, with clear guidance for staff on how to respond and when to involve crisis services.

Systems ensured families received consistent support, tailored to their individual circumstances. This helped reduce inequalities and supported equitable experiences and outcomes across the service. Staff had also received training in how to care for patients living with a learning disability.

We scored the service as 3. The evidence showed a good standard. People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Staff supported children, young people and families to make decisions about current and future care. Personalised care plans were developed with families and reflected the child’s needs, wishes and feelings. Staff used the child and young person’s advance care plan to support planning at all stages.

Professionals involved in a child’s care were included in planning, particularly where needs were complex. This helped ensure care and treatment were coordinated and aligned with families’ preferences.

The service was involved in a transition pilot with an adult hospice provider. The project aimed to improve continuity for young people aged 16–18 by developing a clear transition pathway into adult services. Support included open days and opportunities for young people and families to become familiar with adult services. This work aimed to reduce gaps in support during transition.

The service supported families to visit other services during transition such as adult hospices and colleges. The sibling team also supported siblings of patients during periods of transition such as primary school to secondary school to help educate schools on the level of support that may be needed.

Each team had nominated transition leads who met regularly to monitor progress and discuss how best to support young people and their families. A social worker based at the hospice played a key role in supporting families with transition planning.