Demelza, Hospice Care for Children - Kent

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 meant we looked for evidence that safety was a priority for everyone, and that leaders embedded a culture of openness and collaboration. We checked that people accessing the service were safe and protected from bullying, harassment, avoidable harm, neglect, abuse, and discrimination. We also checked people’s liberty was protected where this was in their best interests and in line with legislation.

At our last assessment we rated this key question good. At this assessment, the rating has remained good. This meant babies, children and young people were safe and protected from avoidable harm. We assessed all quality statements in this key question.

The service provided care and treatment in a way which made children, young people and their families and carers feel safe, supported, involved, and listened to. The service had a good learning culture and people knew how to raise concerns. Managers completed full investigations of patient safety events. Staff knew how to safeguard children and young people effectively. Staff understood and managed risks. The facilities and equipment met the needs of babies, children, young people, and their families. The environment was well-maintained, visibly clean, and tidy. There were enough staff with the right skills, qualifications, and experience.

Managers made sure staff had up-to-date necessary training and regular appraisals to maintain high-quality care. The service had systems for prescribing, administering, and handling medicines.

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.

The evidence showed a good standard. The service had a proactive and positive culture of safety, based on openness and honesty. Staff recognised and reported incidents in line with policy.

The service aligned its approach with NHS England’s, Patient Safety Incident Response Framework (PSIRF), enabling deeper analysis of themes and trends and driving improvements in patient safety and care quality. PSIRF sets out the NHS’s approach to developing and maintaining effective systems and processes for responding to and learning from patient safety incidents.

The service used the System Engineering Initiative for Patient Safety (SEIPS) model to investigate patient safety events. The SEIPS model is a simple way to understand how everything in a healthcare setting fits together and influences patient safety.

Staff investigated patient safety events thoroughly and identified themes and trends. The services’ annual incident report showed health and safety and medicines errors as the most frequently reported. It also showed an increase in non-clinical incident reporting, which leaders attributed to improved reporting systems and more accurate documentation.

We reviewed the 10 most recent learning responses. We saw that each patient safety event, had been thoroughly investigated with learning outcomes that were proactively shared with all staff. For example, a patient safety event relating to a medicines error, we saw the service responded with transparency, immediately informing the child’s family. Staff involved took part in reflective practice, and leaders promptly communicated learning to all colleagues, including a recirculation of the medication chart checking procedure to reinforce best practice. Reflective practice is the ability to reflect on one's actions so as to engage in a process of continuous learning.

Leaders promoted continuous learning by sharing incident outcomes and lessons through emails and team meetings. Actions and learning were shared at every handover. Staff understood how to report patient safety events and near misses and did so in line with their policy. The service collaborated with other hospices and partnership agencies to share wider learning and benchmark performance.

Staff and leaders understood duty of candour. They were open and transparent and gave patients and families a full explanation if and when things went wrong. Staff involved families in the patient safety investigations and gave them the opportunity to ask questions. They told them what action had been taken following the investigation. We spoke with families who told us they knew how to raise concerns and felt confident doing so.

Staff reported a strong learning culture across the service. One team member shared that they had “never seen an organisation so keen to listen, learn and continuously improve.” This reflected a broader commitment to openness, reflection, and growth, which was evident in how patient safety events were handled, and learning was shared.

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. Staff made sure there was continuity of care, including when people moved between different services.

Staff provided a comprehensive approach to planning and coordinating children and young people’s move to other services, which was done at the earliest possible stage. Arrangements fully reflected individual circumstances and preferences. Staff, teams, and services were committed to working collaboratively and had found efficient ways to deliver more joined-up care and support to people.

Staff told us how they worked in partnership with multiple services to meet the needs of the children. The service made sure babies, children and young people had access to appropriate support and placements. They worked closely with partner agencies to ensure care was in the best interests of the baby, child, or young person.

Families told us they understood and were involved at every stage of their child or young person’s care plan. One relative shared that their child and family played an active role in planning care, including making meaningful contributions to end of life decisions. Another family felt supported to remain at home during their child’s end of life, in line with their wishes, thanks to the round-the-clock support provided by the service.

There were clear processes and pathways for patient transfers, and collaborative arrangements with other local services to ensure safety and continuity of care. Staff could access other professional services when needed such as speech and language therapists and physical therapists.

The service had appropriate data sharing policies and arrangements. Leaders told us staff had access to patients’ electronic care records, allowing relevant staff to access patients’ care records from multi-disciplinary teams.

The service had systems to care for children and young people in need of additional support, specialist intervention, and planning for transition to adult services. Young people and adults aged 14 to 24 could access this pathway. The framework was based on early planning and full involvement with young people and their families/carers. The service had developed a transition steering group, which involved essential stakeholders such as parents, care team leaders, and representatives from an adult hospice to develop the framework. The transition team also supported the smooth transition between hospice and community care.

The service, ensured a gradual, supported transition to adult services. Young people were given the chance to engage with adult services, meet new staff, and become familiar with new routines well before the move. This reduced anxiety and created a sense of security, paving the way for a smooth, confident step into adult care. Each decision upheld the independence and dignity, empowering young people with strength and self-assurance.

The hospice offered a ‘step down’ service where they could support smooth transition from hospital to hospice, hospice to home or hospital to home. The service worked collaboratively with families, carers, and other health professionals. They provided advice and training to build confidence and competence for carers.

Leaders and staff worked closely and proactively with healthcare partners to ensure babies, children and young people were cared for in the most appropriate environment in line with their wishes. There were clear communication arrangements with both community and NHS acute services.

The service had a policy for deteriorating babies, children, and young people. When a baby, child or young person became unwell or there were significant changes in their presentation, staff obtained observations. This was to monitor and support transfer of care to emergency serviced and hospital settings. They had appropriate recording documents in line with their policy. Staff completed competencies to support early recognition and escalation of deteriorating patients.

The pre assessment team carried out risk assessments prior to admission to the service, for both inpatients and patients receiving care at home. These were reviewed prior to each admission and adjusted accordingly in line with their policy.

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. 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 service shared concerns quickly and appropriately.

The service was clear that safeguarding was everyone’s business. Leaders maintained clear safeguarding systems, processes, and practices. The service had clear structures for sharing concerns quickly and appropriately, including outside of normal working hours. Families who used the service and staff were actively encouraged and empowered to raise concerns and to challenge risks to people’s safety.

The service had a safeguarding policy and provided training aligned with the Royal College of Nursing Intercollegiate document: Safeguarding Children and Young People: Roles and Competencies for Healthcare Staff (2019).

Staff received appropriate training, specific to their roles on how to recognise abuse in both children and adults in line with national guidance. All staff, including clinical, staff, family support and non-care staff all received appropriate safeguarding children and adults training. In May 2025, the completion rate for nursing and care staff for level 3 safeguarding children training was 95%. Staff in all areas completed safeguarding adults Level 1 training. In May 2025, the compliance for the nursing and care staff was 100%. Non care staff had a compliance of 98% for safeguarding adults training. Volunteers also completed safeguarding training of the appropriate level.

Staff were trained to recognise when people were at risk of abuse or felt unsafe and were proactive when challenging and reporting unsafe practice. The designated safeguarding lead (DSL) for the service had completed level 5 safeguarding training. The DSL demonstrated extensive knowledge, clarity, and operational efficiency in their role. The DSL worked with external partners and attended and contributed to safeguarding assurance committee meetings. This was chaired by a medical Trustee who had significant safeguarding knowledge. Staff and leaders included safeguarding as a standard agenda item at the weekly clinical safety meeting. It was also a standard agenda item in, monthly multi-disciplinary team (MDT) clinical governance meetings, and trustee board meetings. The service participated in quarterly safeguarding audits.

Staff knew how to identify adults and children at risk of, or suffering, significant harm and worked with other agencies to protect them. Staff could give examples of how to protect people from harassment and discrimination, including those with protected characteristics under the Equality Act 2010. Staff showed a good understanding of safeguarding processes and could give examples of when these had been implemented.

Leaders had displayed safeguarding posters throughout the service, featuring pictures and names of the safeguarding leads. They included the external telephone number of the local authorities for children and adults.

The service provided reflective supervision, incident debriefs and monthly safeguarding meetings for staff. Staff had access to both internal and external safeguarding supervision.

Staff followed safe procedures for visiting. The residential building was secure. There was a signing in book and staff accessed the building with secure key cards.

The service had a lone worker policy for those who worked in community. Community staff had phones provided by the service that contained apps that could be used to contribute to their safety.

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 involved patients and families in risk discussions, particularly through transition planning and flexible short breaks. Records showed joint planning for children with complex needs, and risk assessments were updated when needed. Staff accessed risk assessments using a digital patient record system for both inpatients and those being cared for at home. Staff showed us that risks were flagged on the system and easy to locate, for example, safeguarding risks. Staff knew about and dealt with any specific risk issues, for example, any risks relating to seizures, falls and behaviour.

The service supported both short breaks and emergency stays. The pre-assessment team were based on site, but they could also attend the home environment to complete preadmission assessments if this was more suitable. Staff worked with families and patients to carefully plan admissions. The admission paperwork was consistent and well-recorded and discharge plans were discussed in advance.

Staff shared key information to keep people safe when handing over their care to others. They made sure that handovers were robust and included important information this included assessments of their emotional, cultural, and physical needs. Staff ensured these aspects of the assessment process bore equal weight in identifying risks to patient wellbeing. Staff showed empathy and had an enabling attitude that helped children and their families to use imaginative ways to manage risk, while supporting people to stay safe. An example of this allowing family pets into the service following risk assessment.

Care staff had a protected 20 minutes after their initial handover to read over the care plan of the person they were caring for. This gave staff a greater insight into the patients under their care.

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

The service had high standard of security, with thorough identity checks for all visitors and effective safety measures throughout areas chosen for young people. We saw safe and attentive supervision across the entire service, with visible staff and leaders. Access to secure areas was controlled, ensuring safety at all times.

The service had large accessible living areas with ample space for babies, children, and young people to explore. There was a large dining room, a hydro pool, changing facilities, music, sensory, soft play, and cinema room. Upstairs had an arts room that was accessible by lift or by ramp from the balcony area. Walls contained puzzles and mirrors at heights accessible to wheelchair users.

Most of the bedrooms had direct door access to a large green courtyard garden. The service had considered spaces with varying ages in mind. There were age-appropriate toys in different areas, allowing children and young people to enjoy age-appropriate independence safely.

The service offered two dedicated bereavement bedrooms, each with access to a spacious conservatory, bathrooms, kitchen, and dining areas. Leaders and staff thoughtfully designed these spaces to feel homely and calm, giving families a peaceful environment to spend up to 5 days after their loved one’s passing. The rooms were equipped with supportive items like cold blankets and cuddle cots, allowing families to say goodbye in comfort and privacy.

The service had a large outdoor play area, which was wheelchair accessible. This was closed for maintenance when we attended due to a risk assessment that had highlighted that the flooring needed relaying. Leaders planned for this to take 5 weeks in total. There was plenty of green spaces, including other areas for outdoor play in the large courtyard and surrounding garden. This included a canopy covered green space, a memory garden and trail.

The outdoor spaces were full of children’s toys and games, including water play toys. The service had paved the paths to accommodate wheelchairs and help children and young people view the raised flower beds; the plants had been selected to provide as much smell and visual stimulation as possible.

The service had a memory garden with a stream and pond that was dotted with personalised memory stones containing babies, children, and young people’s names. This area had seating and served as peaceful and tranquil area to remember loved ones.

The service maintained enough suitable equipment to safely care for children and young people. Staff received training on its use and reported no concerns about its availability or condition.

There were emergency call bells located in all rooms. Staff told us that team members came quickly when called. Families we spoke with had no concerns with staff response time and drew attention to the one-to-one care their loved ones received.

The service had equipment that was age and size appropriate. We saw manual handling aids, profiling beds, accessible bathing, and hoist-supported soft play areas. The service had a rolling maintenance and replacement programme to ensure equipment was safe to use.

All key systems, including electronic access control, air conditioning, CCTV, electrical installations, and extraction systems, were subject to regular, scheduled servicing and certification. The service had arrangements for medical device servicing and cleaning of equipment. We saw equipment service logs, and equipment was within service date at the time of the assessment.

The estates team remained on site throughout the week and supported staff with equipment needs and hydro pool management. The hydro pool featured a chlorine alarm to alert staff to high chlorine levels. Emergency signage in the pool area clearly outlined safety protocols.

Staff completed health and safety risk assessments with mitigating actions in line with Health and Safety Executive (HSE) guidance. These included fire safety, water safety, security, and other environmental risks.

The service had a newer facility opposite the main building called Hill Farm. This contained large accessible living spaces and had access to a large, fenced garden. It was visibly clean and well maintained, although not used often. Leaders informed us that it was being used for a range of group activities, including transition, post-bereavement support and bereavement groups, alongside events such as Festive Wishes and Family Exploration Days. Leaders told us they planned to use the facility for transitional stays and holidays for families in the near future. They did not provide a timeline on this.

The service had a clear protocol for fire evacuation. Staff participated in regular unannounced fire drills. The service had recently undergone a fire safety assessment. We saw that remedial work was underway to address the concerns. The service had recognised and recorded this risk on their risk register. Staff completed emergency evacuation risk assessments for both inpatients and community patients and documented these in care plans.

Staff disposed of clinical waste safely. We saw waste was segregated appropriately.

The design of the environment followed national guidance. Babies, children, and young people were cared for in individual bedrooms. Two of the bedrooms had en-suite bathrooms. The remaining bedrooms shared bathrooms, with each bathroom serving two bedrooms. The shared bathrooms were accessible from both bedrooms, with two separate doors, one leading from each bedroom. Leaders told us that bathrooms were rarely shared due to how they limited the number of inpatients at any time. Leaders shared that they were actively upgrading the door locks to make it easier to see when a bathroom was in use, enhancing privacy and convenience for everyone. Each door connecting to the adjoining rooms was fitted with a high-mounted external lock, positioned out of reach of young children. This feature enabled more secure control over access from either side, ensuring privacy and safeguarding the occupants of the neighbouring rooms.

Leaders told us there were no incidents or parental concerns regarding the shared bathrooms. There were hoists in bedrooms, bathrooms and throughout the service. allowing freedom of access for children and their families.

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

Leaders regularly reviewed staffing levels and skill mix. There was a comprehensive and in-date safe staffing policy. The service provided a nurse-led environment. Leaders and staff told us that staffing could be flexed to meet the needs of the service. We saw evidence of this in the rotas. The service offered self-rostering for staff which supported flexible working.

The service did not employ a medical lead at the time of assessment. However, leaders were actively recruiting a Paediatric Consultant with a special interest in paediatric palliative care. They told us that care was coordinated by the patient’s lead consultant and local NHS hospital teams. Staff developed care plans for all babies, children and young people who attended the service. This included a ‘top to toe’ assessment document jointly developed with NHS teams. Leaders told us these teams attended the service and reviewed patients as needed. A GP attended daily to review patients. Staff called emergency lines out-of-hours. Leaders emphasised the multidisciplinary (MDT) approach to patient care.

Leaders and staff told us the service had enough staff to run safely. Each shift included at least 2 registered children’s nurses and support staff, with systems to maintain a minimum one-to-one staffing ratio throughout the day. A Band 6 nurse was on call for every shift, alongside another senior nurse. We reviewed 2 months of staffing rotas and found actual staffing matched the planned levels.

The service did not use agency staffing. However, they used a small pool of experienced bank staff, who were fully orientated and trained.

Community and inpatient nurses were trained in both areas and could crossover if needed for cover and flexibility of staffing.

We saw staff sickness rates for the 3 months prior to the assessment. The overall sickness rate for nurses was 5% and 17% for health care assistants and nursing associates.

Leaders told us the service had 1 part-time Band 5 vacancy at the time of the assessment.

Staff received and kept up to date with their mandatory training. The service provided mandatory training that was comprehensive and met the needs of the staff and people using the service. The average compliance for nursing and care staff in the service was 95% across all mandatory training. We were unable to break down the other staff figures to site specific.

Staff completed training in infection prevention control (IPC), Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

The service provided access to external training, including, but not limited to, advanced autism training, mental health first aid, and bereavement training. We did not see the staff compliance for these modules.

Leaders provided staff with regular simulation training. This was to keep staff up to date on emergency situations. Leaders changed the theme weekly to keep the training up to date and extensive. This was well received by the staff we spoke with.

Nursing and care staff completed clinical competencies that included, but were not limited to, tracheostomy and nasopharyngeal care, respiratory care, Invasive long-term ventilation, non-invasive ventilation, and post death care. A tracheostomy (also called a tracheotomy) is a procedure where a hole is made at the front of the neck. A tube is inserted through the opening and into the windpipe to help you breathe. A nasopharyngeal airway (NPA) is a flexible tube inserted through the nose into the nasopharynx to maintain an open airway, especially in patients with compromised breathing.

Physical therapists worked closely with families, communities, and other health professionals to develop and deliver holistic therapy support in different environments to babies,’ children and young people. They were able to support patients in a range of environments throughout the hospice and at home.

Volunteers formed a vital part of the staffing team. The service carried out appropriate recruitment checks for new volunteers. Volunteers completed the same mandatory training and induction as other staff, including face-to-face sessions. They met with leaders every 6 weeks for check-ins and could request additional support if needed.

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

The service was visibly clean and well furnished. All areas we observed were tidy and free from clutter. Staff kept cleaning records up to date, showing areas had been cleaned in line with protocol.

Staff placed cleaning notices on inpatient room doors, showing when each room was cleaned and by whom. Housekeepers spoke proudly about their work and their role in keeping the premises clean.

The service’s living areas had carpet, which housekeeping staff cleaned in line with their Infection Prevention and Control (IPC) policy. A designated machine was used to clean the balls in the soft play area.

Staff wore polo shirts with embroidered names and remained bare below the elbow, in line with uniform policy.

Staff completed mandatory training that included IPC. We observed appropriate hand hygiene during our assessment. The service’s 2024 quality account reported monthly hand hygiene audits had high compliance rates.

The service carried out quarterly IPC audits. We reviewed the March 2025 audit, which showed 100% compliance in equipment decontamination, clinical practice, and respiratory care. The audit covered this service and 2 other services run by Demelza House Children’s Hospice, but we could not break down the rest of the results fully by individual location.

We saw the service completed required actions from audit findings within set deadlines. For example, staff introduced a cleaning schedule for soft toys. The service aimed to improve IPC information for patients and visitors, with actions underway and a July 2025 deadline.

The evidence showed a good standard. The service 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.

Staff stored medicines safely and securely, including Controlled Drugs. Emergency medicines for children were readily accessible. Staff were appropriately trained and had up-to-date competencies.

Nursing staff completed medicines reconciliation when children and young people were admitted to the service. Medicine reconciliation is the process where staff check that patients have the correct medicines when they move between services or are admitted from home.

Nurses transcribed babies’, children and young people’s medicines onto medication charts which was checked by a second nurse. This was then signed by a GP. Transcribing is the act of making an exact copy of the medicine administration instructions. Staff clearly recorded allergies and ensured that medicines brought in by families were safe to use. Nursing staff administered medication to children and young people, and they recorded it on a medication chart checked by a second nurse. They also recorded instructions for enteral feeds. This is also known as tube feeding and is a method of delivering nutrition directly to the gastrointestinal tract when a person cannot eat normally.

Staff regularly checked emergency medicines for treating anaphylaxis (severe allergy) and completed essential safety checks on intravenous medications. They reviewed any dose changes with the palliative care team before implementing them.

Staff used recognised tools, such as the Wong-Baker Faces pain scale, to help children express whether they were in pain.

The service had access to a paediatric pharmacist based in a London children’s hospital, who provided additional medication advice. The pharmacist attended the service 1 day per week to provide clinical pharmacy expertise and oversight'

Staff reported medicine incidents, which managers reviewed regularly. In April 2025, the provider published an annual report across the 3 hospices, highlighting a reduction in transcribing errors in Demelza Children’s Hospice - Kent following improved training and support.

The service established the medicines assurance committee, which has expedited the management of local clinically significant issues.

Staff individually assessed over the counter (OTC) medicines that children, young people, or carers wished to continue, and continued if appropriate. However, there was no opportunity for children to self-administer their own medicines if they wished to do so.

There was no information provided to children, young people, or their carers about the use of unlicensed or off-label medicines (where its use is not covered by the manufacturer). This was not covered in the providers policy which meant people may not have always been informed about their treatment being unlicensed.