Little Havens Children's Hospice

Updated 22 February 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection to the service took place on 23 and 30 November 2016 and was announced. The provider was given five days’ notice.

The inspection team consisted of one inspector. Additionally, the inspector was accompanied by a member of the Care Quality Commissions medicines team and a specialist advisor. The specialist advisor was a paediatric palliative care liaison nurse qualified and experienced in working within a hospice and in the field of palliative and end of life care. Palliative care is a multidisciplinary approach to specialised care for people with serious illnesses.

Before our inspection we reviewed the Provider’s Information Report (PIR). This is information we asked the provider to send us to evidence how they were meeting our regulatory requirements. We reviewed the information we held about the service including safeguarding alerts and other notifications. This refers specifically to incidents, events and changes the provider and registered manager are required to notify us about by law.

We used a number of different methods to help us understand the experiences of people who used the service. We observed the care and support provided for six children on 23 and 30 November 2016. We spoke with one parent and one young person who used the service at the time of the inspection visit to the service. We also contacted and spoke with an additional five parents on 4 January 2017. We spoke with seven nurses [including the ward and deputy ward sister], three healthcare assistants, the siblings lead support worker, one complimentary therapist, the head chef and three volunteers. Additionally we spoke with the registered provider, the registered manager, Director of Care and Executive Nurse, Director of Facilities and the Senior Administrator for Learning and Development. We also spoke with two trustees for Little Havens Children’s Hospice.

We reviewed the care plans and records of three children to see how their support was planned and delivered and four children’s medication records. We also reviewed a range of documents which related to the management and governance of the service. This included quality assurance audits, minutes of meetings for different teams and departments, staff personnel files and staff training and development records.

Updated 22 February 2017

The inspection to the hospice took place on 23 and 30 October 2016 and was announced. On 4 January 2017 we contacted relatives of children and young people who used the service.

Little Havens Children’s Hospice is registered to provide respite and end of life care for up to eight children or young people, aged between 0 and 19 years of age who have a life limiting or life threatening illness and who live in Essex and the surrounding London Boroughs. Support is also provided for families of the children and young people who use the service. Family accommodation is provided on the first floor and includes bedrooms and an open plan communal lounge, dining area and adjoining kitchen.

There was a registered manager in post. However, at the time of the inspection the registered manager was not at work and as a result of this, an interim manager from within the organisation was managing the service on a day-to-day basis. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Parents told us the service was a safe place for their child or young person to access. Parents told us they had no concerns about their child’s or young person’s safety and were confident that the arrangements in place would keep their child safe. Staff were able to demonstrate a good understanding and knowledge of a child’s or young person’s specific support needs, so as to ensure their and others’ safety. Staff understood the risks and signs of potential abuse and the relevant safeguarding processes to follow.

Parents told us there were always sufficient staff available to meet their child’s or young person’s needs. Suitable arrangements were in place to ensure that the numbers and skills of the staff team were effective in meeting the needs and complex needs of children and young people using the service. Appropriate arrangements were in place to recruit staff and volunteers safely so as to ensure they were suitable to work with and support children in their care.

Medicines were safely stored, recorded and administered in line with current guidance to ensure children and young people received their prescribed medicines. This meant that they received their prescribed medicines as they should and in a safe way.

Children and young people benefitted from a staff team that were well trained to meet the complex and specialised needs of children and young people using the service. We saw from their interactions, facial expressions and mannerisms that children and young people were contented, comfortable and relaxed in staffs company. Staff were seen to be warm and caring towards the children and young people they supported and were treated with compassion. Parents confirmed that they, their child or young person was also treated with respect and had their privacy and dignity upheld at all times.

The dining experience for people was positive. Mealtimes were family orientated with children, young people, their families and staff eating together. Children’s and young people’s dietary needs were recorded and where complex nutritional needs were being managed, staff networked with community based services and professionals.

Young people were involved in decisions about their care and treatment. Staff had a good understanding and awareness of the importance of gaining consent when providing care and treatment and working within the principles of the Mental Capacity Act 2005 (MCA). This meant that the rights of young people were promoted and protected where they were unable to make their own decisions.

Care plans accurately reflected the child’s or young person’s care and support needs and they received appropriate support to have their social care needs met. Parents told us that their child’s healthcare needs were well managed. Suitable arrangements were in place to ensure children and young people experienced a comfortable and pain free death. Where appropriate advanced care planning had been considered and discussed and this included the child’s, young person’s and parents’ wishes and choices. Families received appropriate bereavement support.

There was an effective system in place to regularly assess and monitor the quality of the service provided. The provider was able to demonstrate how they measured and analysed the care provided to children and young people, and how this ensured that the service was operating safely and was continually improving to meet their needs. Feedback about the hospice, the services and facilities it provided were actively encouraged and sought. Parents were aware of how to raise any concerns if needed to. Many positive compliments had been made about the service.