Archived: Noah's Ark Children's Hospice

Updated 28 January 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 checked 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 took place on 6 and 7 December 2016 and was announced. We gave the provider 48 hours’ notice of the inspection as the service is community based and we needed to be sure staff would be available to speak with us. The inspection team consisted of a lead inspector and a specialist advisor. Our specialist advisor had experience of palliative and paediatric care.

Prior to the inspection we looked at information we held about the service, including the statutory notifications we had received. Statutory notifications are what the provider has to send to the CQC about significant events that occur at the service. We also considered the information included in the provider information return (PIR) which was completed comprehensively. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

During our inspection we spoke with eight members of staff which included nurses, activities co-ordinator, a specialist care worker, a social worker and the registered manager. We accompanied a social worker on one of their visits and were able to directly talk to a parent about their views of the service. We attended a ‘Pathway’ meeting which was a multi-disciplinary meeting to review care plans, reflect on complex cases and deliver group supervision.

We looked at records relating to the running of the service and its governance arrangements. We also looked at computer and paper records relating to six children or young people who used the service. We reviewed staff recruitment and training records for eight members of staff, which included records for volunteers and information held about the trustees.

After the inspection we talked over the telephone with seven parents of children who receive a service from Noah’s Ark.

Updated 28 January 2017

This inspection took place on 6 and 7 December 2016 and was announced. We last inspected this service on 4 December 2013 when it met all the regulations we looked at.

Noah’s Ark Children’s Hospice is a charity that offers support to children and young people who have a life-limiting or life threatening illness. They operate in the five North London boroughs of Barnet, Camden, Enfield, Haringey and Islington, and also in Hertsmere, a borough council in Hertfordshire.

Noah’s Ark provides care for the children and young people affected by illness. This support is community based and is provided by a range of staff including family link workers, social workers, music drama and movement therapist, play workers and home support volunteers, through support groups such as sibling groups and parent groups. There are also over 70 care volunteers who support children in their own homes or through group activities. Overall 450 volunteers support Noah's Ark providing support for administration, retail and fundraising.

Noah’s Ark also offers specialist carers who are able to provide direct care to children and young people. They also employ paediatric nurses who support and train the specialist carers. This is the part of the service which is regulated by the Care Quality Commission (CQC). At the time of the inspection they were providing specialist care to approximately 80 children and young people, whilst supporting an additional 150 children and young people with services not regulated by CQC, and a further 180 bereaved families.

Currently the service is community based. However, there are well progressed plans to continue raising funds and start building a hospice which will house the community teams and a small residential unit to provide end of life care for children and young people who might require this service.

Anyone in the community is able to refer themselves or any child or young person under the age of 19 to the service. Noah’s Ark can provide tailored care which includes medical, emotional and practical care. They provide an out of hours on-call service to families and their staff so they can be accessed in an emergency.

The service had a registered manager in post who was the Director of Care. A registered manager is a person who has registered with the Care Quality Commission (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.

Parents were positive about the support they received from Noah’s Ark, this was in terms of the direct support for their children and for the support provided to the entire family which alleviated pressure on them.

Staff were trained to provide end of life care to children and young people in line with their wishes and those of the family. The service was able to offer bereavement support to parents after the death of a child.

The provider completed a range of checks prior to recruitment of volunteers, staff and trustees to make sure they were suitable to work with children and young people. There were policies and procedures in place to make sure children and young people were kept safe. The service had a designated lead for safeguarding children at risk. Staff we spoke with knew what action they needed to take to ensure children and young people were protected from harm.

Staff received an induction programme and subsequently, dependent upon their role, extensive training. They were also encouraged to source training they felt they required and to remain registered with their professional body. Staff told us they received support from their peers and managers through a variety of informal and formal mechanisms.

The needs of children and young people were constantly reviewed and care provided on that basis. Health needs were reviewed by the provider including making sure children received medicines in emergencies.

Parents told us the service was caring. They valued having the continuity and consistency of the same member of staff visiting them and knowing they could access advice if there was an emergency.

Staff were able to tell us how they ensured children and young people were provided with dignified care. They were also able to tell us about maintaining confidentiality and the circumstances of when information had to be shared for the well-being of the children and young people they were working with.

Care was personalised and reflected each child’s and young person’s diverse and changing needs. Plans for care showed how children and young people were engaged in a range of activities at home and in the community, and ways their independence could be promoted.

Staff received training and were aware of the issues relating to the Mental Capacity Act 2005. There were mechanisms in place to ensure care was provided with the consent and agreement of either the parents and/or the young people themselves.

Senior managers within the organisation had an open and inclusive approach. They welcomed challenges from their staff team and trustees. Parents were asked for their feedback about the service and they told us they felt able to raise issues or concerns. There was a rolling programme of audits to monitor the quality of the service. Any incidents and accidents were reviewed to consider any learning or changes that needed to take place to improve the service.