Little Harbour

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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

This means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

This service scored 75 (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 3. The evidence showed a good standard. The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Staff understood what incidents to report and how to report them. They discussed incidents with managers and demonstrated how learning and improvement actions had reduced the risk of recurrence.

The service had identified a theme of medication‑related incidents related to handover and completion of documentation. Following this, the service introduced a medication handover improvement plan. This formalised medicine chart handovers, added signature boxes to all charts and required appropriate oversight and countersignatures. Mid‑shift reviews of medicine charts were implemented and verified through the medication system, and nurses were required to discontinue charts on discharge when medicines were returned to families.

Quarterly data quality audits had identified low compliance in several areas of patient documentation. In response, the service developed a data quality improvement plan focusing on training, monitoring and strengthening documentation standards. Common issues included incomplete progress notes, inconsistent completion of pain and wound charts, missing parental confirmation on sign‑in checklists, incomplete tissue viability assessments, gaps in ventilation and tracheostomy observations, and baseline observations not always completed within 24 hours of admission. The improvement plan aimed to address these repeated issues and promote a more consistent and accurate approach to record‑keeping across the service.

Between February 2025 and February 2026, 87 incidents were reported, most resulting in no harm. There were no severe or moderate harm incidents. Staff described a culture of openness, transparency and learning, and understood their responsibilities under the duty of candour.

We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The service had safe and effective referral and admission processes that ensured essential information about the patient was received to determine if the patient’s needs could safely be met. Staff worked closely with families and other healthcare services to maintain continuity of care during admission and after discharge. A service‑level agreement was in place with the local NHS Trust for a liaison nurse who supported coordination across both organisations. Staff visited patients whilst they were in hospital. Discharge information was routinely shared with families and the child’s GP and any specific individuals the parents nominated.

Weekly children's community nursing meetings ensured relevant information was effectively handed over to community teams, including the community nursing team, the liaison nurse and short break centres. Clinically relevant updates from a child's stay such as medication changes or medical concerns were routinely shared with community teams to support safe and coordinated care.

The service supported children and young people aged 0 to 18 years, and transition planning began around the age of 14 to allow time to assess future needs, prepare for changes and build familiarity with adult services. Transition was approached as a gradual, integrated process rather than a single event. A designated transition lead and champions within each team worked with acute transition leads and partner agencies to ensure needs and risks were managed safely using a multidisciplinary approach. It was difficult for families who had children approaching transition as there were no similar services available for the families and the children in the adult area.

The service also provided respectful post death care that aligned with the wishes of families. This included the use of a separate entrance for funeral directors, which helped minimise distress to other service users.

We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

Staff were trained in safeguarding, understood how to raise concerns and did so when needed. Staff gave examples of how they protected and identified patients at risk of, or suffering, significant harm. This included working in partnership with other agencies.

There was a safeguarding lead for the service who was level 4 trained in safeguarding and the service has access to 3 safeguarding level 5 trained leads. Staff received role‑specific safeguarding training, with level 3 compliance for children at 97%. Trustees also completed safeguarding training relevant to their roles.

Staff were committed to promoting safety, dignity and quality of life. They were confident in recognising early signs of abuse, neglect or discrimination and escalated concerns promptly in line with safeguarding procedures. Evidence of proactive safeguarding practice was demonstrated during weekly caseload reviews and Family Support meetings.

Where applicable, staff understood the Mental Capacity Act. Young people aged 16 and over who were believed to lack capacity received a Mental Capacity Assessment. These assessments were completed with involvement from the young person and their family, in settings that were most appropriate. They were often carried out over multiple visits to account for fluctuating capacity, enabling staff to gain an accurate understanding of the individual’s decision‑making ability. Although most patients were below the age threshold for the legislation.

We scored the service as 3. The evidence showed a good standard. The service worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Staff communicated with patients and their families so that they understood their care and treatment. This included finding effective ways to communicate with patients with communication difficulties. All care staff were trained to capture the voice of the child. This training was delivered during the induction period, with regular refresher sessions for all hospice‑based teams.

On admission, staff completed relevant risk assessments using recognised tools. Parents were actively involved in this process, particularly when there had been changes in the child’s condition since their last stay. These risk assessments included but were not limited to a child’s risk of skin damage, bed risk assessment, nutritional needs and bowel function. Risk assessments were reviewed frequently to support personalised care planning and minimise potential harm.

Staff used a nationally recognised tool to identify deteriorating patients and escalated concerns. A doctor was available on site 7 days a week. Staff continuously monitored safety and emerging risks, working closely with both the patient and their family.

When transferring care, staff shared end‑of‑life plans, including information such as pain management assessments, to ensure continuity and safe handover.

Psychologists were available to offer support to patients and families dealing with bereavement or the emotional impact of life-limiting or terminal conditions. Any child or young person exhibiting concerning mental health symptoms was reviewed with the GP or responsible consultant, and referrals were made when necessary. In urgent situations, staff sought emergency assistance. Children and families requiring additional emotional support were referred to the Family Support Team. Referrals were discussed weekly by a senior nurse, doctor, psychologist and the family support team leader. Actions included one‑to‑one psychology sessions, financial advice, additional care‑team support or sibling support. Staff also worked with external agencies including bereavement charities to ensure a multidisciplinary response. .

Routine overnight observations were carried out hourly, with any planned deviations clearly recorded, whether due to clinical judgement or parental preference. These were tailored to individual needs, and some children received one‑to‑one support in their rooms overnight to maintain safety, such as where there was a high aspiration risk. Patients requiring ventilation were checked each hour as standard. Staff also used audio or visual monitors, with consent, to provide additional oversight and reassurance.

We scored the service as 3. The evidence showed a good standard. The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

There were processes to ensure equipment and the environment were well maintained and safely met the needs of the patients admitted to the area. Staff knew how to report faulty equipment.

The service offered a range of facilities designed to support the needs of children, young people, and their families. These included recreational spaces such as lounges, a games room, soft‑play, a hydrotherapy pool and a sensory room. Bathrooms were equipped with height‑adjustable baths and showers, along with hoists to support safe transfers. Suitable hoisting equipment was also available in every bedroom.

Resuscitation grab bags were available for both paediatric and adult emergencies. Resuscitation bags and emergency equipment were monitored on a daily, weekly or monthly basis, in line with emergency checklists, to ensure they were safe and ready for use in an emergency. All equipment underwent annual servicing.

The service had a hydrotherapy pool for children and young people to use. The pool had a call bell alarm system, a hoist for lifting children in and out and regular chlorine level checks.

We scored the service as 3. The evidence showed a good standard. The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Staffing was provided for patients according to their needs. The service was established for up to 4 children and planned their staffing based on the dependency scores of the children they had admitted or were due to be admitted. The service had their own bank of staff which could enhance staffing if the dependency indicated additional staff were required. There was a doctor available 7 days a week. The service also had access to social work support and a physiotherapist attended weekly as a minimum and provided additional sessions when needed, including chest physiotherapy during symptom‑control stays and hydrotherapy sessions.

In addition to the staffing for the inpatient children and young people, the workforce was further complimented by a psychologist, a team who supported patients’ siblings, music therapists, domestic staff and volunteers. There was an in house education lead that offered support to staff to help them feel confident in their competencies.

New staff completed a 6 week induction and were supported by experienced colleagues. Existing staff were encouraged to develop advanced skills to enhance the quality and safety of care. When a child had an unfamiliar clinical need, staff sought specialist training from external professionals.

Staff were up to date with mandatory training which was comprehensive and met the needs of the patients and staff. Data showed overall compliance was 83%, with further sessions scheduled for March to raise completion rates in areas with lower uptake, such as manual handling.

We scored the service as 3. The evidence showed a good standard. The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Staff protected patients from the risk of infection by maintaining the environment and equipment to ensure they remained visibly clean and tidy. There was daily surface cleaning in all areas and a full deep clean on changeover days. Each room had a record of the cleaning schedule.

The service assessed and managed the risk of infection. Staff requested any details around patients infectious status when transferring into the service and monitored infection risk when children were admitted to enable them to take the appropriate steps if required.

There was a lead for infection prevention and control (IPC) and a working group with representation from each team. The service also had access to an IPC nurse at the local hospital for additional advice.Senior staff liaised with health protection teams whenever concerns or queries arose, and sought advice where infection risks were identified. When any potential infection risk was highlighted, a deep‑cleaning process was implemented across the hospice.

The service completed audits to provide assurance that both children and young people were provided with safe care in line with IPC standards. The most recent environmental audit outcome for 2025–2026 was 97%. Hand hygiene compliance for the same period was also high at 95%. The few areas that did not meet expected standards related to staff wearing nail polish or having nails that were too long. These issues were addressed with the team through meeting discussions and reminders about required infection‑prevention practices.

Staff worked to a lower threshold for reporting sickness, recognising the increased vulnerability of the babies, children and young people in their care.

We scored the service as 3. The evidence showed a good standard. The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happen.

Staff followed safe practice in medicines management, including the use of controlled drugs (CDs). CDs were stored in a locked cupboard in the pharmacy. At the time of our inspection a magnet that was kept in a locked cabinet was being used to open the medicines stock cupboard. However there was a plan to put a more robust lock in place.

Staff maintained records of medicines administered and remaining stock in line with national guidance.

Some staff had additional training and gained qualifications to become non-medical prescribers (NMP) to enhance quality of care and give better access to medicines for children using the hospice.All medication‑trained staff were required to complete an annual medication competency assessment, which included a mathematics test to ensure accuracy in calculating medication doses. New starters were required to complete this competency before undertaking any medicines management tasks.

As children had complex medication prescriptions, staff were encouraged to transcribe or prescribe in pairs and to do so in a private, distraction‑free environment to minimise the risk of errors.

There was a formal agreement with the local trust for pharmacy oversight and medication supply. As part of this arrangement, a paediatric pharmacist attended the service on site for a dedicated half‑day each quarter to provide support and ensure safe medicines management.