The Children's Trust - Tadworth

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• 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

We assessed three quality statements in the safe key question. We found good care planning that ensures holistic care for children. We saw compassionate care delivered to children throughout their day and night with observations completed. Comprehensive risk assessments are in place including clear protocols to support children if their health deteriorates.

We found a competent workforce that are fully supported and trained to look after children safely.

This service is not scored or rated.

Find out what we look at when we assess this area in our information about our new Single assessment framework.

The judgement for Learning culture is based on the latest evidence we assessed for the Safe key question.

Through discussion with staff, reviewing clinical records, care plans, risk assessments, observation and medicine charts we could see the use of clear systems, protocols and pathways that staff used effectively. Children received holistic care through robust care planning which was updated as a child’s needs change and develop.

We found some inconsistent documentation of the National paediatric early warning system (PEWS) and some decision making from PEWS scoring that was not documented in clinical records. Leaders spoke to us about strengthening audit processes and subsequent learning for staff. Leaders also told us of their plan to implement National PEWS to strengthen practice.

The judgement for Safeguarding is based on the latest evidence we assessed for the Safe key question.

The judgement for Involving people to manage risks is based on the latest evidence we assessed for the Safe key question.

The judgement for Safe environments is based on the latest evidence we assessed for the Safe key question.

Staff received a comprehensive induction programme which was tailored to each staff level as well as individual need. There was robust oversight of staff’s competencies with regular line management and support provided to all staff. Staff were able to tell us about the array of informal and formal support and training they received.

The judgement for Infection prevention and control is based on the latest evidence we assessed for the Safe key question.

Individualised care planning was mostly in place and tailored to clinical need. However, in some cases these were unclear and as a result staff did not always follow, for example the documentation of medicine dosing intervals. Medicines Administration Record (MAR) charts did not always contain full dosing instructions, for example in relation to strength or volume for administration. No evidence of impact was seen and prior to inspection leaders had already identified this as an area to strengthen.

Where specialist advice was sought, for instance from the hospice team or tertiary clinicians, the information provided was not always clearly recorded in the persons notes. For instance - ‘dose increased as per regime’, for another person staff told us of additional pain relief doses that had been recommended, however this was not recorded in the notes.

When required medicines (PRN) were not always administered according to the prescribed instructions. In addition, there was not always sufficient information to guide staff in the administration of PRN medicines. For instance, where 2 medicines were prescribed for pain relief, as to which to use first and second line or in which situations.