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Haven House Children's Hospice Good

Inspection Summary


Overall summary & rating

Good

Updated 28 April 2020

Haven House Children's Hospice provides overnight respite care for up to six children and young people aged from birth to 18 years who may have complex needs associated with life-limiting or life-threatening conditions. They also provide some day care. Haven House will accept initial referrals from anyone in the community who knows a child with a life limiting condition or life-threatening conditions. Additionally, they provide community and day therapeutic and nursing services in the home or at the hospice. 

Haven House offers a multi-professional approach to the health, social care and education of children who attend the service. At the time of our inspection, there were currently 387 children including siblings open to the services and they and their families accessing their provision in a variety of ways. Parents were able to negotiate with Haven House about the most suitable and convenient time for their child to receive support. This could be provided as half days, overnights and in some situations blocks of time to allow parents time to have a holiday or visit family abroad.

In addition to the respite care offered to children at Haven House, there was support for parents and siblings. This support ranged from a specialist toy loan library, complimentary therapies for adults including Reflexology and Rejuvanessence (head and facial massage designed to help relaxation), a bereavement team and an expert parent programme designed to give training and confidence to parents caring for their children. The family flat provided adjacent accommodation for parents and siblings to stay so they could be near their child or young person. The flat incorporated the Butterfly Suite as a specially adapted cold room to provide end of life and post death care. 

The 'Hospice at Home' service was registered with Care Quality Commission (CQC) with the aim of providing families with choices when their child was nearing the end of their life and they wish them to die with them at home. Additionally, Haven House had nurses with neonatal experience to support babies with complex needs associated with their conditions. The hospice had a registered manager in post. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are 'registered persons'. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. The charity had seven retail shops.

We inspected this service using our comprehensive inspection methodology and the inspection was announced. The inspection was 10 and 11 March 2020.

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.

Our rating of this hospice stayed the same. We rated it as Good overall.

  • The service had enough staff to care for children and young people and keep them safe. Staff had training in key skills, understood how to protect children and young people from abuse, and managed safety well.
  • The service controlled infection risk well. Staff assessed risks to children and young people, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
  • Staff provided good care and treatment, gave children and young people enough to eat and drink, and used special feeding and hydration techniques when necessary. Staff assessed and monitored children and young people to see if they were in pain and gave them pain relief when they needed it.
  • Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of children and young people, advised them and their families on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. The service could deliver palliative, respite and end of life services seven days a week.
  • Staff treated children and young people with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to children and young people, families and carers.
  • The service planned care to meet the needs of local people, took account of children and young people’s individual needs, and made it easy for people to give feedback. People could generally access the service when they needed it.
  • Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of children and young people receiving care. Managers and staff were clear about their roles and accountabilities. They had the right skills and abilities to run a service providing high quality sustainable care.
  • The service engaged well with children, young people and the community to plan and manage services and all staff were committed to improving services continually. They strived for excellence through consultation, research and reflective practice.

However, we also found the following issues that the service provider needs to improve:

  • During our review of patient records, we found the use of two electronic systems and paper records during the transition lacked a cohesive approach. Senior leads acknowledged it had taken longer than expected to transfer records but told us that this was because they were were creating updated care plans.

Following this inspection, we told the provider that it should make other improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Nigel Acheson

Deputy Chief Inspector of Hospitals 

Inspection areas

Safe

Good

Updated 28 April 2020

Our rating of safe stayed the same. We rated it as

Good

because:

  • The service provided mandatory training in key skills to all staff and made sure everyone completed it.
  • The hospice had clearly defined and embedded systems and processes to keep people safe from abuse and staff demonstrated understanding of safeguarding processes and awareness on how to escalate and report safeguarding concerns.
  • 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.
  • Staff completed and updated risk assessments for each patient and removed or minimised risks. Staff identified and quickly acted upon patients at risk of deterioration.
  • The hospice ensured they 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.
  • Staff kept detailed records of patients’ care and treatment. Records were clear, legible, stored securely and easily available to all staff providing care.
  • The service used systems and processes to safely prescribe, administer, record and store medicines.
  • The service managed patient safety incidents well. Staff recognised and reported incidents and near misses. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.

However, we also found the following issues that the service

provider needs to improve:

  • During our review of patient records, we found the use of two electronic systems and paper records during the transition lacked a cohesive approach. Senior leads acknowledged it had taken longer than expected to transfer records but told us that this was because they were creating updated care plans.

Effective

Good

Updated 28 April 2020

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

  • The service provided care and treatment based on national guidance and evidenced-based practice. Managers checked to make sure staff followed guidance. Staff protected the rights of patient’s subject to the Mental Health Act 1983.
  • 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.
  • All those responsible for delivering care worked together as a team to benefit patients. They supported each other to provide good care and communicated effectively with other agencies.
  • Key services were available seven days per week to support timely patient care.
  • Staff gave patients practical support and advice to lead healthier lives.
  • Staff supported children and young people 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.

Caring

Good

Updated 28 April 2020

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

  • Staff treated children, young people and their families with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.
  • Staff provided emotional support to children, young people, families and carers to minimise their distress. They understood children and young people’s personal, cultural and religious needs.
  • Staff and management were fully committed to the visible person-centered approach. They all used creative ways to make sure that children and young people had accessible, tailored and inclusive methods of communication.
  • Staff supported and involved children, young people and their families to understand their condition and make decisions about their care and treatment.
  • Staff were able to provide examples of where they had ensured patient’s needs were met in the last days and hours of their lives.

Responsive

Good

Updated 28 April 2020

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

  • The service planned and provided care in a way that met the needs of local people and the communities served. It also worked with others in the wider system and local organisations to plan care.
  • The service was inclusive and took account of children, young people and their families’ individual needs and preferences. Staff made reasonable adjustments to help children, young people and their families access services. They coordinated care with other services and providers.
  • People could access the service when they needed it and received the right care promptly.
  • The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff. The service included children, young people and their families in the investigation of their complaint.

Well-led

Good

Updated 28 April 2020

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

Good

because:

  • Leaders were committed and passionate about patient care and provided a high-quality sustainable service. They had the skills and abilities to run the service and clearly understood and managed the priorities and issues the service faced. Leaders were visible and approachable for patients and staff. They supported staff to develop their skills and take on more senior roles.
  • The service had a child-centred vision and had developed a clear strategy with all relevant stakeholders. The vision and strategy were focused on sustainability of services and aligned to local plans within the wider health economy.
  • Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service had an open culture where patients, their families and staff could raise concerns without fear.
  • Leaders operated effective governance processes, throughout the service and with partner organisations. 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.
  • 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. Data or notifications were consistently submitted to external organisations as required.
  • Leaders and staff actively and openly engaged with patients, staff, equality groups, the public and a wide range of local organisations to plan and manage services. The views of patients and stakeholders were considered before changes were made and they collaborated with partner organisations to help improve services for patients.
  • The service was focussed on service improvement and sharing best practice externally. All staff were committed to continually learning and improving services.
  • The service worked in partnership with other organisations to make sure that they were following current practice and providing a high- quality sustainable service.
Checks on specific services

Hospice services for children

Good

Updated 28 April 2020

We rated this service as good overall because we rated safe, effective, caring, responsive and well led as good.