Charlton Farm

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

This service scored 79 (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 shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

Staff understood the provider’s vision and values and described how these guided their work. At the time of inspection, the service was developing a new organisational strategy. This work involved staff at all levels, children and families, and trustees, to ensure a wide range of views were considered. Leaders recognised the importance of reviewing services in line with changes in children’s hospice care while maintaining the organisation’s values and legacy, with children and families remaining central to decision‑making.

Staff described a positive and inclusive culture. Teams worked closely together across the service to support children, families and each other. Senior leaders, including the Chief Executive and directors, attended team meetings to discuss the vision and values and used practical exercises to help embed them in practice.

Staff told us they felt valued, respected and listened to. They said they could raise concerns openly without fear of reprisal and felt supported by managers. Staff consistently told us they enjoyed working at the service.

Leaders acknowledged current challenges linked to organisational change, including aligning education provision across three sites. Staff told us these changes were being managed through regular meetings, shared leadership and collaborative working to maintain standards and staff competencies. There was an awareness of a growing need for the service and leaders were exploring ways to extend the offer in the community. Although this work was at an early stage, there was a clear vision to develop the service in the future, informed by staff input.

Families also experienced the positive culture. One family member described the atmosphere as “warm and safe”.

We scored the service as 3. The evidence showed a good standard. The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

Leaders had the skills, knowledge and experience needed for their roles. They understood the services well and explained clearly how teams worked to deliver high‑quality care. Leaders were proud of the teams and described them as being passionate and committed to making every visit for children and families count.

Leaders were visible and approachable for patients and staff. Staff told us managers were easy to contact and offered consistent support.

There were opportunities for leadership development. Staff were supported to take part in training, gain new skills and pursue areas of interest. This included support for further study, extended skills and shadowing opportunities. Nurses were encouraged to take part in shift coordination. The service was exploring nurse apprenticeships and supported staff who later returned to work on the bank. Professional development was actively promoted.

The service supported members of the care team to access qualifications and training for their professional development.

Leaders created open forums for feedback. Team meetings included dedicated sessions for questions, and a pilot process allowed staff to submit forms if they found it difficult to raise issues verbally. The senior care leadership team operated an open‑door policy. Staff felt able to raise concerns, give feedback and suggest improvements, including by email. Leaders delegated improvement projects to the care team. This supported a strong, developing and encouraging culture.

We scored the service as 3. The evidence showed a good standard. The service fostered a positive culture where people felt they could speak up and their voice would be heard.

Patients and their families had opportunities to give feedback in ways that met their individual needs. Staff received this feedback and used it to make improvements.

Staff knew who the Freedom to Speak Up Guardians were but told us they felt comfortable raising concerns directly with managers and leaders. The staff council met quarterly, with the CEO or director of care and HR in attendance. For example, concerns about shifts and breaks led to changes being made. Staff also requested a cycle‑to‑work scheme, which was then implemented.

We scored the service as 3. The evidence showed a good standard. The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them.

Managers put reasonable adjustments in place to help staff carry out their roles. Shift patterns were adapted to meet individual needs. Staff told us they felt supported and able to speak with their line managers and the senior leadership team.

All staff were required to complete equality and diversity training. Leaders took action to review and improve the organisation’s culture, with a focus on equality, diversity and inclusion.

We scored the service as 3. The evidence showed a good standard. The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They act on the best information about risk, performance and outcomes, and share this securely with others when appropriate.

The service had effective governance and management systems to support safe, high‑quality and sustainable care. There was a clear framework outlining the information to be discussed at ward, team and directorate meetings, which ensured learning from incidents, complaints and deaths was shared consistently. Staff had implemented recommendations from reviews and demonstrated learning in practice.

Staff participated in local clinical audits, supported by external audits where appropriate. These provided assurance, and actions were taken when audits identified areas for improvement. Staff understood how to work with internal and external teams to meet children’s needs, supported by formal partnership agreements and service‑level agreements that clearly defined responsibilities and governance arrangements.

There was strong oversight through quarterly quality and governance meetings. These reviewed incidents, audit findings, policy assurance, risk registers, staffing levels, sickness rates and updates from working groups. Learning from incidents was reviewed through the electronic incident reporting system, which staff were trained to use, and shared across the three houses. Key information was escalated through board and trustee meetings to ensure scrutiny and oversight.

Leaders maintained clear oversight of risks, including safeguarding, staffing, medical provision, funding and information governance. Risk registers were in place, although leaders recognised the risks associated with multiple systems and were working to maintain accuracy. Contingency plans were established for business continuity, including managing adverse weather, increased demand, staffing pressures and system disruptions. The service had robust emergency plans, including backup power, supplies, and arrangements to maintain care during severe weather or other disruptions.

Demand fluctuations were actively managed. The service used an emergency bed when required, increased staffing where possible and rearranged planned stays to ensure children approaching end of life or with urgent needs were prioritised.

Information governance systems ensured confidentiality, with clear policies for the secure storage and appropriate retention or destruction of records. Information was accessible, accurate and timely, and was used to identify risks and drive continuous improvement through dashboards and regular reporting to senior leaders and the board.

We scored the service as 3. The evidence showed a good standard. The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement.

The service worked closely with partners and the wider community to improve care and experiences for children, young people and staff. Patients and staff had regular opportunities to meet with members of the provider’s senior leadership team and commissioners to share feedback and contribute to service improvement.

The provider had developed effective partnership roles with local services to strengthen joined‑up care. Shared posts were in place, including a jointly funded role with the local children’s hospital within the children’s palliative care team, and a further role embedded within the local Community Nursing Team, fully funded by the provider. This post extended the service’s reach and enabled support to be delivered closer to families’ homes. These partnership arrangements were clearly defined through job descriptions and governance structures.

We scored the service as 4. The evidence showed an exceptional standard. The service had a strong focus on continuous learning, innovation and improvement across the organisation and local system. They always encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

The service supported learning, improvement and new ways of working. Leaders were passionate about change being the right thing to do. Staff were given time and support to suggest ideas and make improvements, which led to positive changes in how care was provided. Staff also had opportunities to take part in research and innovation.

The service tested new approaches to care for example a pilot programme, which explored providing end‑of‑life care in the community. This pilot included a family steering group so the service could use direct family feedback.

The service organised themed weekends to better meet the needs of different children and young people. These included weekends for teenagers, children with sensory needs and younger children, helping to make care more relevant and enjoyable.

Staff shared their knowledge with others. They provided tailored training to schools to help them better understand advance care plans. Staff also worked with partner organisations to deliver end‑of‑life training, supporting learning across different services.

The provider developed new roles to support learning and improvement. This included shared roles with the local Children’s Palliative Care Team and a liaison role within the local Children’s Community Nursing Team, which helped deliver care closer to home. A research role was also in place one day a week to support the use of evidence in practice.

The service used creative ways to support learning and developed training sessions with partner organisations. This helped staff explore complex end‑of‑life situations in a safe and supportive way.

Families were also involved in learning and improvement. The service held bereavement events, remembrance services and sibling days, which helped shape care and ensured services remained compassionate and responsive. Families and children sat on staff interview panels and their feedback was used in recruitment decisions.

There was an in house education team who offered support for staff and arranged site specific training. They collaborated with the local children’s hospital and children transport service and organised training simulations. Staff were able to request specific training to meet their needs to feel confident in performing their competencies. The service had an annual 3 day closure for staff to focus on education and learning.

Families shared examples of how they had been included in improvements to the service. One family member said after an incident “they called a meeting to find out how the incident could be avoided in the future, they were really invested in trying to make it better”.