Little Harbour

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

This means we looked for evidence that the service involved people and treated them with compassion, kindness, dignity and respect.

At our last assessment we rated this key question good. At this assessment the rating has changed to outstanding. This meant people were truly respected and valued as individuals; and empowered as partners in their care in an exceptional service.

This service scored 100 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We scored the service as 4. The evidence showed an exceptional standard. The service was exceptional at treating people with kindness, empathy and compassion and in how they respected people’s privacy and dignity. Staff always treated colleagues from other organisations with kindness and respect.

Staff attitudes and behaviours when interacting with patients were discreet, respectful and responsive, providing patients with help, emotional support and advice at the time they needed it. The care team greeted patients by name and were kind and caring when interacting with children. Patients and their families felt staff treated them with kindness and compassion. A family member told us their child loved the “unlimited cuddles”. In the most recent family feedback survey, all 30 respondents answered “yes” or a variation of this to the question, “Do you feel staff treat you ,your child and your family with respect and courtesy?”

One family member said their favourite thing about the service was “the level of care given to the children and parents from all staff be it carers, nursing staff, physiotherapist, music therapist, kitchen staff during a stay.”

Staff supported patients and their families to understand and manage their care, treatment or condition. Another family member told us, “Our child can have a fabulous time and we can relax knowing he is well cared for and happy. He loves music with the music therapist and we love the food and no washing up!”

Support for families was continuous; there was access to advice 24 hours a day by phone and families had a dedicated contact team. Bereaved families received continuous support based on their level of need.

Staff felt they could raise concerns about disrespectful, discriminatory or abusive behaviour or attitudes towards patients without fear of the consequences.

We scored the service as 4. The evidence showed an exceptional standard. The service treated people as individuals and was exceptional in how they made sure people’s care, support and treatment met people’s needs and preferences. The service took account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

People’s individual needs and preferences were understood and these were reflected in their care, treatment and support. All children admitted had their likes, dislikes, preferences and communication needs recorded which was either directly reported by them or their families on their behalf. On each admission or attendance, any changes in circumstances were discussed and recorded on their care plans.

Staff actively asked children what they wanted to gain from their stay and what was important to them. Care and activities were planned around these wishes as much as possible. On admission children were asked about ‘things I’d like to do this visit’ and examples included the jacuzzi, making a card for a family member and stories. One child who was visiting the hospice for end of life care wanted to see a unicorn, staff brought in a horse with a coloured mane and added a horn.

Laundry facilities were available so families could do their own washing and ironing if this was their preference. Families also had access to a small kitchenette where they could make tea, coffee and toast.

A family member told us that the service had delivered food to them on Christmas day after they had been in hospital and discharged on Christmas eve.

Patients and their families had a choice of food to meet the dietary requirements of religious and ethnic groups and to account for allergies and intolerances. Following feedback that menus could be more individually tailored, catering staff involved families in menu planning to understand preferences and basing the menus around which families were booked to stay that week.

Cultural and religious needs were recognised and valued, this included visiting a local mosque.

We scored the service as 4. The evidence showed an exceptional standard. The service was exceptional at promoting people’s independence, so people knew their rights and had choice and control over their own care, treatment and wellbeing.

People were supported to have choice and control over their own care and to make decisions about their care, treatment and wellbeing. The service was led by the wishes of the patient and their family. People told us they felt involved in the care of the child and staff asked for their input.

People were supported to maintain relationships and networks that were important to them. People had access to their friends and family whilst using the service. The service was focussed on providing holistic care to both the child and their family. Care for the family was an integral part of the care the hospice staff provided. Families had private spaces to be with their child in the last days of life and had access to outdoor spaces. Families had the option to stay next door to their child or upstairs.

One young person using the service wanted to stay at home as long as possible. The staff worked collaboratively to keep the patient at home and they only came into the hospice for end of life care.

People had access to activities in the local community to promote and support their independence, health and wellbeing. The service provided a range of activities for the children and young people, as well as any siblings and their families at the service as well as trips organised away from the service. They offered passes to local gardens, tourist sites, adventure centres and discounts to spas. One child had a wish to go to the zoo and a staff member liaised with the local zoo to organise a private experience.

There was a dedicated sibling team that provided a safe space for siblings to take part in activities and discussion with other children. We saw how staff rearranged shifts so that parents could enjoy a special valentines meal provided by the catering staff whilst their child and their siblings were cared for.

The service was respectful of different cultures and customs.

We scored the service as 4. The evidence showed an exceptional standard. The service was exceptional in how they listened to and understood people’s needs, views and wishes. Staff responded to people’s needs in the moment and acted to minimise any discomfort, concern or distress.

Staff were alert to people’s needs and took time to observe, communicate and engage people in discussions about their immediate needs. Staff completed comprehensive records about the children and young people which enabled them to recognise situations where they needed to act to prevent any discomfort, concern or distress. A family member said their favourite thing about the service was “feeling 100% free and able to switch off (as parents), watching our disabled child feel safe, calm and confident and watching our other children thrive, feel loved and listened to and feel safe to be themselves.”

Another family member said “My daughter’s methods of communication are quite limited so she therefore communicates with noises, facial expressions and body language. Now most of the staff know her I feel that they all read her pretty well when it comes to if she's happy or sad, likes or dislikes something."

The service listened to and anticipated peoples needs, for example catering staff kept menus simple on busy change over days and had back up meals like pizzas in the freezer in case people did not like what was on the menu.

The service listened to feedback from families and used ‘you said, we did’ to communicate actions. Family feedback had raised concerns about music therapy session being in the same room as the memory tree. Following this the service made plans for a dedicated music room.

We scored the service as 4. The evidence showed an exceptional standard. The service always cared about and promoted the wellbeing of their staff and was exceptional at supporting and enabling staff to always deliver person-centred care.

Staff felt respected, supported and valued. Staff felt positive and proud about working for the provider and their team. One staff member told us they had “never had a job that’s so supportive”. Staff appraisals included conversations about career development and how it could be supported. In the most recent staff survey, 100% of staff said they agreed or strongly agreed when asked if they were proud to work for the service and if they felt like they were making a difference. In the same survey 97% of staff said they agreed or strongly agreed when asked if they would recommend the service as an employer.

Staff were supported to stay healthy and any risks to staff health was discussed confidentially, and actions were taken to reduce recurrence where possible. Staff told us there were regular opportunities to discuss wellbeing, including at team meetings, ‘stop and chat’ meetings, hot huddle and debrief meetings after deaths. Staff told us they were offered individual support following the death of a patient and received ongoing support as needed. The service had a psychologist who offered well being support to staff as well as families.

Staff felt listened to when they raised concerns and were involved in projects to make improvements. For example, one staff member was looking into a project to improve the referrals rate for neonatal care.