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Inspection Summary


Overall summary & rating

Good

Updated 1 April 2020

Shooting Star House is operated by Shooting Star Children’s Hospice. The hospice runs a number of services including eight inpatient beds and a hospice at home service seven days a week, and a specialist palliative community nursing team that conducts assessments and provides children, young people and their families with care, support and advice in their own homes.

The hospice provides care and treatment for children and young person with a life-limiting condition who are aged from pre-birth to 21 years.

We inspected this service using our comprehensive inspection methodology. We carried out the unannounced part of the inspection from 2 to 3 December 2019.

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.

Services we rate

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

  • Staff kept children, young people and their families safe from harm and abuse. Risks were assessed, monitored and managed appropriately.

  • Staff followed best practice in relation to infection prevention and control.

  • Care and treatment records were accurate, stored securely and provided comprehensive details of care and treatment.

  • Staff recognised incidents and knew how to report them. Managers investigated incidents and made improvements to the service.

  • Staff had the appropriate skills, training, knowledge and experience to deliver effective care and treatment.

  • Staff delivered care and treatment in line with evidence-based practice.

  • Staff involved children, young people, their families and carers in decisions about their care and treatment.

  • Staff cared for children, young people and their families with compassion, treating them with dignity and respect. Staff truly respected and valued children and your people as individuals and empowered them as partners in their care, practically and emotionally, by offering an exceptional service.

  • The service was proactive in meeting the needs of children and young people from the whole community. The services provided reflected the needs of the population served and ensured flexibility, choice and continuity of care.

  • The service was proactive at engaging with groups that were hard to reach to ensure equitable access to its services.

  • There were clear processes for staff to manage complaints and concerns.

  • There was an open and transparent culture, with engaged and experienced leadership.

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

  • The storage of equipment did not always keep people safe. We found that equipment was stored in toilets and other areas of the service which were not in line with good practice.

  • Not all outcome measures collected by the service were reported on during governance meetings meaning that outcome measures did not always shape and improve services.

    Nigel Acheson

    Deputy Chief Inspector of Hospitals (London)

Inspection areas

Safe

Good

Updated 1 April 2020

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

  • The service provided mandatory training in key skills and made sure everyone completed it. Mandatory training was comprehensive and more than 98% of all staff groups completed it.

  • The service controlled risk infection well. Staff kept themselves, equipment and premises clean. We saw staff observing ‘bare below the elbow’ guidance and using protective equipment appropriately. There was access to alcohol hand gel for staff and visitors at the entrance to the hospice.

  • Staff completed and updated risk assessments for each child and young person on admission to the hospice. They kept clear records and asked for support when necessary.

  • Staff followed best practice when prescribing, administering and recording medicines. Children and young person’s received the right medicines at the right dose at the right time.

  • Staff kept detailed records of children and young people’s care and treatment. Records were clear, up to date and easily available and accessible to staff providing care. Care plans were person centred and recorded children and young people’s needs, preferences and choices.

  • Staff knew how to protect children and young persons from abuse and worked well with other services to do so. They knew how to escalate any concerns to senior staff in line with the organisation’s safeguarding policy.

  • The service had suitable premises and equipment and looked after them well. The registered manager had good oversight of all contracts relating to equipment checks and servicing and made sure these were done on time.

  • The service had enough nursing, care and medical staff with the right qualifications, skills, training and experience to keep people safe. Daily reviews meant that staffing could be increased or decreased according to the needs of children and young persons.

  • The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. When things went wrong, staff apologised and gave children, young people and their families honest information and feedback.

  • Staff collected safety information and shared it with teams. Managers used this to improve the service.

However,

  • The storage of equipment did not always keep people safe. We found that equipment was stored in toilets and other areas of the service which were not in line with good practice.

Effective

Good

Updated 1 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 evidence of its effectiveness. Managers checked to make sure staff followed guidance.

  • Staff assessed and monitored children and young people regularly to see if they were in pain. They supported those unable to communicate using suitable assessment tools and gave additional pain relief to manage pain.

  • Managers monitored the effectiveness of care and treatment and used the findings to improve them. They compared and benchmarked their results with those of other services to learn from them.

  • 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 monitor the effectiveness of the service.

  • Staff of different speciality worked together as a team to benefit children, young people and their families. Nurses and other healthcare professionals supported each other to provide good care.

  • Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. They knew how to support children and young people experiencing mental ill health and those who lacked the capacity to make decisions about their care.

Caring

Good

Updated 1 April 2020

Our rating of caring went down. We rated it as Good because:

  • Staff cared for children and young people with compassion. Feedback from children, young people and their families confirmed that staff treated them well and with kindness. Children, young people, their families and carers told us that staff went over and above what they expected.

  • Staff provided emotional support to children and young people to minimise their distress. The service looked after staff and supported their wellbeing.

  • Volunteers and all staff groups contributed to help those in need of support. Children, young people and their relatives told us they could ask any questions and were supported when upset.

  • Feedback, thank you cards and regular questionnaires confirmed that children and young people and those close to them valued the services and the emotional support offered by the hospice.

  • Staff involved children and young people and those close to them in decisions about their care and treatment. It was clear from the care records reviewed, that care and treatment was provided collaboratively.

Responsive

Good

Updated 1 April 2020

Our rating of responsive went down. We rated it as Good because:

  • The service planned and provided services in a way that met the needs of local people. Services were focussed on the needs of those using them. There were strong links with local organisations. Children, young people and their families were routinely signposted to additional support.

  • The service took account of children and young peoples’ individual needs. Care plans were tailored to capture people’s choices and preferences. These were comprehensive, and person centred. A voluntary chaplaincy service provided spiritual and emotional support for children, young people and their families and a quiet room with multi-faith equipment was provided.

  • Children, young people and their families could access the service when they needed it. 95% of new referrals were seen in the community within 24 hours, and the inpatient unit admitted and discharged children and young people seven days a week.

  • Children and young people individual needs and preferences were central to the delivery of tailored services. The service was flexible and provided informed choice and ensured continuity of care.

  • The service had identified where people’s needs and choices were not being met and used this information to inform how services were improved and developed.

  • There were clear processes for staff to manage complaints and concerns and staff at all levels in the organisation were engaged with improving services as the result of complaints.

Well-led

Good

Updated 1 April 2020

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

  • Managers at all levels in the service had the right skills and abilities to run a service providing high-quality sustainable care.

  • The service had a vision for what it wanted to achieve and workable plans to turn it into action, which it developed with staff, children, young people, their families and local community groups.

  • Managers across the service promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.

  • The service systematically improved service quality and safeguarded high standards of care by creating an environment for excellent clinical care to flourish.

  • The service had good systems to identify risks, plan to eliminate or reduce them, and cope with both the expected and unexpected.

  • The service engaged well with children, young people, their families, staff, the public and local organisations to plan and manage appropriate services and collaborated with partner organisations effectively.

  • The service was committed to improving services by learning from when things went well or wrong, promoting training, research and innovation.

Checks on specific services

Hospice services for children

Good

Updated 1 April 2020

We rated this service as good overall because:

  • The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment. Staff had access to a robust training and competency programme to ensure they had the skills required to provide good quality care.

  • The service provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance.

  • Staff of different kinds worked together as a team to benefit children, young people and their families. Doctors, nurses and other healthcare professionals supported each other to provide good care.

  • The service planned and provided services in a way that met the needs of local people. The services provided reflected the needs of the population served and they ensured flexibility, choice and continuity of care. The facilities and premises were appropriate for the services that were delivered.

  • There was compassionate, inclusive and effective leadership at all levels. There was a strategy, and supporting plans, aligned with the wider health economy that were stretching, challenging and innovative, while remaining achievable. There was a demonstrated commitment to system-wide collaboration and leadership.

  • Staff felt positive and proud to work in the organisation. The culture centred on the needs and experience of people who used services. Staff told us that they felt pride in the organisation and the work the carried out to ensure children, young people and their families received good quality care.

  • There was an extensive team of volunteers who helped support the service. There was a volunteer strategy, a volunteer induction and training programme. Volunteers were valued members of the service who were provided with support and who felt part of the hospice team.