Charlton Farm

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

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

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.

Staff understood what incidents to report and how to report them. They discussed incidents with managers and demonstrated how learning and improvement actions had reduced the risk of recurrence.

Following one incident, a guide for completing documentation was developed to support safe care. The service used the patient safety incident response framework (PSIRF) to investigate incidents and prioritise learning.

Between December 2024 and December 2025, 149 incidents were reported, most resulting in no harm. There were no never events or serious harm incidents. Staff described a culture of openness, transparency and learning, and understood their responsibilities under the duty of candour.

The evidence showed a good standard. The service 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’s referral and admission processes ensured essential information about the patient was received to determine if the patient’s needs could safely be met. Staff worked closely with parents, families and other healthcare services to provide continuity of safe care during admission and after discharge. Discharge letters were redesigned to give GPs clear actions, including when medication changes had occurred.

The age range for the service was 0 to 18 years and the planning for transitioning into adult services started around 14 years, taking into consideration any individual needs and complexities.

Staff worked with acute transition leads and partner agencies to ensure risks and needs were appropriately managed, using a multidisciplinary approach. The service also provided respectful post‑death care in line with family wishes, including a separate entrance for funeral directors and a parent‑led final journey.

We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They 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 service shared concerns quickly and appropriately.

Staff were trained in safeguarding, understood how to raise concerns and did so when needed. Staff gave examples of how they protected and identified patients at risk of, or suffering, significant harm. This included working in partnership with other agencies.

There was a safeguarding lead for the service who was level 4 trained in safeguarding and the service has access to 3 safeguarding level 5 trained leads. Staff received role‑specific safeguarding training, with level 3 compliance for children and adults at 96%. Trustees also completed safeguarding training relevant to their roles.

Where applicable, staff understood the Mental Capacity Act, although most patients were below the age threshold for the legislation.

We scored the service as 3. The evidence showed a good standard. The service 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 communicated with patients so that they understood their care and treatment. This included finding effective ways to communicate with patients with communication difficulties.

Specific standard risk assessment tools were completed on admission. Staff included the parents of the child to complete risk assessments, especially for any updates on the child’s conditions in-between admissions to the hospice. These risk assessments included but were not limited to a child’s risk of skin damage, bed risk assessment, nutritional needs and bowel function. Individualised risk assessments were reviewed regularly and care was planned to reduce risks.

Staff used a nationally recognised tool to identify deteriorating patients and escalated concerns. A doctor was available on site on weekdays from 9am to 5pm and on call during evenings and weekends. Staff continually assessed patient safety and emerging risks which included the patient and family.

Staff shared care plans and risks associated with the last days of life, such as pain assessments, when handing over care to others.

Psychologists were available to support patients and their families with bereavement and other psychological impacts of having a life limiting or terminal illness. Any children or young people who displayed concerning mental ill health was discussed with either the GP or consultant in charge of their care and referrals required would be completed. If staff deemed the situation to be urgent, emergency care would be accessed.

The service did not have a policy for nightly observations, they were led by the families wishes and recommended hourly observations. However, any patients that were ventilated were monitored hourly. They also monitored patients by video stream if consent was given.

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

There were processes to ensure equipment and the environment were well maintained and safely met the needs of the patients admitted to the area. Staff gave examples of improvements that had been made following incidents, for example providing non-slip mats for bathroom floors.

The service had suitable facilities to meet the needs of the children, families and those close to them. This included a cold room (a specially designed room resembling a bedroom which was temperature controlled to enable deceased children and young people to remain in them to allow families space to say goodbye), multi faith room, games room, soft play, hydrotherapy room and sensory room. The bathrooms had Hi/Lo accessible baths, adjustable showers and hoists. All bedrooms were equipped with suitable hoists.

The service used resuscitation grab bags for adults and paediatrics and there were plans to implement resuscitation trollies. We found one item out of date in the adult grab bag which had been risk assessed. As there was a delay in supply of the item, the service felt it was important to have the out-of-date item, rather than no item at all. All equipment servicing was due in December. The service had a hydrotherapy pool for children and young people to use. The pool had a call bell alarm system, regular chlorine level checks and evacuation drills were in date.

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 well to provide safe care that met people’s individual needs.

Staffing was provided for patients according to their needs. The service was established for up to 6 children and planned their staffing based on the dependency scores of the children they had admitted or were due to be admitted. Staffing was based on a minimum 1-1 ratio with a supernumerary shift co-ordinator and duty manager. The service had their own bank of staff which could enhance staffing if the dependency indicated additional staff were required. There was a doctor on site on weekdays between 9am and 5pm and on call over the weekend.

In addition to the staffing for the inpatient children and young people, the workforce was further complimented by a social worker, a psychologist, a team who supported patients’ siblings, music therapists domestic staff and volunteers. There was an in house education that offered support to staff to help them feel confident in their competencies. Further additional staff included non-medical prescribers (non-medical prescribers are healthcare professionals such as nurses, pharmacists and allied health professionals who are authorised to prescribe medications without being doctors or dentists), children's nurses, learning disability nurses and adult nurses and carers. There was also bereavement support from within the care team as well as the sibling team.

Staff were up to date with mandatory training which was comprehensive and met the needs of the patients and staff. Data showed overall compliance was 95%.

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.

Staff protected patients from the risk of infection by maintaining the environment and equipment to ensure they remained visibly clean and tidy. There was daily surface cleaning in all areas and a full deep clean on changeover days. Each room had a record of the cleaning schedule. A family member told us “I have never seen Charlton Farm not clean, even in messy play!”.

The service had an approach for assessing and managing the risk of infection. Staff requested any details around the patients infectious status when transferring into the service to enable them to take the appropriate steps if required.

Senior team leaders were specialists for infection prevention and control (IPC) and the service had access to an IPC nurse at the children’s hospital for additional advice.

The service completed audits to provide assurance that both children and young people were provided with safe care in line with IPC standards. Environmental audit results showed compliance ranged between 94% recorded in March 2025 and 84% recorded in June 2025. Areas which were identified as not meeting the standard was in relation to staff having long nails and wearing jewellery. Handwashing compliance was between 98% in March 2025 and 96% in September 2025.

We scored the service as 3. The evidence showed a good standard. The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happen.

Staff followed safe practice in medicines management, including the use of controlled drugs (CDs). CDs were stored in a locked cupboard in the pharmacy. There were medicine cabinets in each bedroom with keypad access (this was not for controlled drugs) so parents were able to administer medication. Staff recorded when this happened. Staff had access to the cabinet in case of emergency. Medication travelled with the child when they were not in their bedroom. The medicines stock cupboard was in a locked room and at the time of our inspection a magnet lock was being used to open this, however there was a plan to change the lock. Following the site visit, the provider told us there was a plan to refit the whole of the Pharmacy to include digital locks on stock medicine cupboards.

Staff maintained records of medicines administered and remaining stock in line with national guidance. There were some poor quality paper records when photocopying syringe driver charts, but the information was legible.

Some staff had additional training and gained qualifications to become non-medical prescribers (NMP) to enhance quality of care and give better access to medicines for children using the hospice. The service had the support of a palliative care pharmacist who visited each Wednesday to provide specialist support and guidance.