Demelza, Hospice Care for Children - SE London

On this page

• 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 2 quality statements in the safe key question and found areas of good practice. The scores for these areas have been combined with scores based on the rating from the last inspection, which was good. The assessment of these areas showed good practice since the last inspection, and our rating for safe remains good. Staff were trained to identify abuse and take appropriate action when children were at risk of harm. There were sufficient staff to care for the children. The recruitment process was thorough and ensured individuals were qualified to give care. Medicines were administered safely to children and young people as prescribed. The hospice was clean and hygienic. Staff demonstrated awareness of infection prevention, control measures, and developments in paediatric palliative care.

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 did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

Children were protected from foreseeable risks because they were assessed and planned for. Staff assessed risks that children were subject to because of their health conditions and implemented plans to manage them. Children's and young people's bedrooms and family suites were clean and tidy. All rooms had ensuite bathrooms to enable privacy and dignity. All areas of the service were visibly clean and free from clutter. Staff arranged equipment, furniture and other items safely. Hoists between bedrooms and bathrooms were available so staff could assist children and young people to move safely. We viewed the family accommodation suite, which was well furnished and looked comfortable with ensuite facilities. The service provided linked rooms connected to the main bedroom for siblings or extended family members. The hospice provided families with food and laundry services during their stay.

Staff told us they ensured continuity of care, including when people moved between services. Staff admitted patients for life-limiting conditions, often for respite care or end-of-life. Senior staff informed us they provided services for young people up to 25 years to ensure a seamless transition into adult services. Staff knew how to make a safeguarding referral and who to inform if they had concerns. They had access to a safeguarding lead. Staff knew where to find details for the local safeguarding authority and the steps to take if they had any concerns.

On this inspection we did not look at feedback from partners.

There were safe systems for record-keeping, infection prevention and control (IPC), assessing patient risks, safeguarding and incident management. Medicine management was generally safe. However, we saw expired adrenaline medication (31/12/23) in the resuscitation grab bag. It was regularly checked and documented. Staff explained that they struggled to obtain a replacement. The Pharmacist completed an adrenaline risk assessment and graded the risk as green. The assessment stated – 'while it is expected that there would be little loss of potency, there is a significantly higher risk having no adrenaline on site'. Therefore, they decided to hold expired adrenaline. The Pharmacist said staff took care to establish current allergies, and exposure to allergens in the hospice was reduced, which produced a low rate of anaphylaxis in patients. Additionally, all children are only admitted if they have their full medication requirement with them, this includes any medication required for known allergies. The service conducted audits to monitor compliance with safety metrics, including drug charts and IPC audits. Audit results were mostly in line with the provider's standard with an action plan to improve areas of lower compliance. Staff carried out daily checks of specialist equipment. The equipment reviewed during our inspection was up to date for testing. The service had clear pathways for children and young people up to 18 years old with life-limiting or life-threatening conditions. The service also supported young people between 18 and 25 via an outreach transition service. The staff planned discharges in conjunction with multidisciplinary teams and patients and families. There were robust systems for securely sharing information with patients GP's.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

Families we spoke with were positive about the knowledge and competence of staff. Staff and specialists had drawn up children's care records, including symptom management plans, and they would provide ongoing support during end-of-life care. Staff supported children's nutritional needs. Staff recorded children's nutritional and fluid intake. Care plans included guidance and advice from speech and language therapists (SALTs) for children who received oral food and drink.

There were sufficient staff to support shifts, sometimes by using bank staff. Staffing was based on patient numbers and acuity. Managers identified nurse staffing as a risk on the risk register with mitigations in place. Staff confirmed they had completed mandatory training appropriate to support them in their role. Staff had also completed sector-specific training relevant to their role (e.g., use of syringe drivers and advance care planning). Staff confirmed they worked together effectively to provide safe care and meet people's needs. Staff reported good communication between the GP and hospice staff. The GP was available for urgent support as well as routine appointments. The GP surgery provided Monday to Friday cover. A pharmacist provided pharmacy cover across three sites. The service had access to a multidisciplinary team, including SLT and physiotherapy. Teams included a family liaison team, community at-home team, fundraising team, and family support office.

The provider checked staff suitability for work by requesting references and reviewing potential staff qualifications. They also arranged a check of Disclosure and Barring Service (DBS) records, which included verifying whether the person had a criminal record. New staff had to complete a probationary period and competency training. The provider managed staffing levels according to patient acuity and staff competencies/skill mix. The service monitored mandatory training completion rates. Training completion rates met the providers' benchmarking standards. Staff at all levels had completed appropriate safeguarding training for their role. Staff knew how to identify children and young people at risk of or suffering significant harm and worked with other agencies to protect them. Over 95% of all staff had received an appraisal within 13 months before our assessment. A staff wellbeing survey conducted annually ensured the trustees and managers addressed any areas that needed improvement.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.