Little Harbour

Updated 4 April 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 was planned to check 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 12 December 2016 and was unannounced. The inspection team consisted of an inspector, a pharmacy inspector and one specialist advisor. The specialist advisor had experience of children's and young peoples palliative and hospice care.

Before the inspection we reviewed any information we held about the service and notifications we had received. A notification is information about important events which the service is required to send us by law. We received the Provider Information Record (PIR). The PIR is a form that asks the provider to give some key information about the service, what the service does well and the improvements they plan to make.

We met and spoke with five children and with five parents during the inspection. The children we met had complex needs and were not able to tell us their experiences because of their complex ways of communicating or age.

We spoke with the registered manager (head of care) and 12 staff. This included senior team leaders, the practice educator, medical and nursing staff, senior cook, care workers and a volunteer.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of children and young people who could not talk with us. We observed how the staff interacted with the children, and their families. We looked at how children and young people were supported during their stay.

We reviewed a range of care records for six children. We also reviewed records about how the hospice was managed. This included, staffing records, audits, meeting minutes, training records and governance records.

Updated 4 April 2017

Little Harbour is a children’s hospice. The hospice supports babies, children, teenagers and young adults up to the age of 21 with life limiting or life threatening conditions and provides accommodation for respite (short breaks), and end of life care. The service is registered to accommodate up to a maximum of six children and their families. On the day of the inspection two families were staying at the service and one family was visiting the service for the day.

We carried out this unannounced inspection on 12 December 2016. 95 families were actively being supported with 20 bereaved families receiving support from Little Harbour. The hospice can accommodate up to six children or young people and there are additional facilities and suites to enable parents and siblings to stay at the hospice with the child.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The children we met during the inspection had complex needs and were not able to tell us their experiences because of their complex ways of communicating. We observed how the staff interacted with the children and their families.

We identified two areas that needed further development at the service. The registered manager told us following a recent staffing restructure and staff leaving there were a number of posts that were to be recruited to. Some practice specific posts were particularly difficult to recruit to. Due to this it had impacted on the number of families the service could support at any one time. For example on the day of our inspection only two families were able to be supported on a 24 hour basis due to staffing levels. This was to ensure that the staff ratio would meet the child and family’s needs safely. We found that due to the strategies the management team had put in place they were able to provide a safe service to the families they supported, however, they were not able to use their resource to its full potential.

We found that the fridge temperature was not monitored consistently. This could mean that medicines were not stored at their correct temperature and could affect the medicine. We recommend staff should monitor and record the temperature of the medicines refrigerators daily.

Our findings were that children, young people and their families were being cared for by competent and experienced staff. Staff were caring and showed children and their families kindness and compassion. Staff were very motivated and demonstrated a commitment to providing the best quality care to children, young people and their families.

Children received care and support in a personalised way. Children and young people had good links and access to the healthcare support they needed during their stays at the hospice. All parents were happy with the care provided by Little Harbour. Staff knew children well and understood their complex needs.

Parents told us their children were safe in the care of Little Harbour. One parent told us "The staff are fantastic. When I come here I can rest, I know that my son is in safe hands and so I can sit and have a cup of tea and not worry.”

Children were relaxed and comfortable with staff. Staff knew how to recognise any signs of abuse and how they could report any allegations.

Any risks to children and young people's safety and health needs were assessed and managed in order to minimise the risk.

Children and young people and their families including siblings received a responsive service. Their needs were fully assessed, planned for and met. Children, young people and families were involved in developing care plans and keeping these under review.

Children and young people were supported to play, develop and take part in activities and new experiences in the hospice.

Parents gave positive feedback about the qualities, skills and knowledge of the staff. Staff were recruited safely and received an induction, core training and specialist training so they had the skills and knowledge to meet children and young people's needs. The hospice had not yet implemented the Care Certificate but was aiming to do this.

Children and young people were protected from the risks of infection by the systems and equipment in place.

We found the hospice building was well maintained. The hospice was designed and decorated to meet the specialist needs of the children and young people.

There was a children, young people and family focused culture at the service. Children, young people and families were involved and consulted about all aspects of the service. There was a clear management structure and staff, children and young people and their families felt comfortable talking to the managers.

There was a positive culture in the service, the management team provided strong leadership and led by example. All of the staff were highly motivated and keen to ensure the care needs of the families they were supporting were met. Every member of staff we spoke with was very open and proud of the service they provided.

There was a management structure in the service which provided clear lines of responsibility and accountability. There were systems in place to monitor the safety and quality of the service provided. An improvement plan was being developed to drive continuous improvements across the service.