Archived: Noah's Ark Children's Hospice

Noah’s Ark Children’s Hospice is a charity that offers support to children and young people who have a life-limiting or life threatening illness. They operate in the five North London boroughs of Barnet, Camden, Enfield, Haringey and Islington, and also in Hertsmere, a borough council in Hertfordshire.

Noah’s Ark provides care for the children and young people affected by illness. This support is community based and is provided by a range of staff including family link workers, social workers, music drama and movement therapist, play workers and home support volunteers, through support groups such as sibling groups and parent groups. There are also over 70 care volunteers who support children in their own homes or through group activities. Overall 450 volunteers support Noah's Ark providing support for administration, retail and fundraising.

Noah’s Ark also offers specialist carers who are able to provide direct care to children and young people. They also employ paediatric nurses who support and train the specialist carers. This is the part of the service which is regulated by the Care Quality Commission (CQC). At the time of the inspection they were providing specialist care to approximately 80 children and young people, whilst supporting an additional 150 children and young people with services not regulated by CQC, and a further 180 bereaved families.

Currently the service is community based. However, there are well progressed plans to continue raising funds and start building a hospice which will house the community teams and a small residential unit to provide end of life care for children and young people who might require this service.

Anyone in the community is able to refer themselves or any child or young person under the age of 19 to the service. Noah’s Ark can provide tailored care which includes medical, emotional and practical care. They provide an out of hours on-call service to families and their staff so they can be accessed in an emergency.

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

Parents were positive about the support they received from Noah’s Ark, this was in terms of the direct support for their children and for the support provided to the entire family which alleviated pressure on them.

Staff were trained to provide end of life care to children and young people in line with their wishes and those of the family. The service was able to offer bereavement support to parents after the death of a child.

The provider completed a range of checks prior to recruitment of volunteers, staff and trustees to make sure they were suitable to work with children and young people. There were policies and procedures in place to make sure children and young people were kept safe. The service had a designated lead for safeguarding children at risk. Staff we spoke with knew what action they needed to take to ensure children and young people were protected from harm.

Staff received an induction programme and subsequently, dependent upon their role, extensive training. They were also encouraged to source training they felt they required and to remain registered with their professional body. Staff told us they received support from their peers and managers through a variety of informal and formal mechanisms.

The needs of children and young people were constantly reviewed and care provided on that basis. Health needs were reviewed by the provider including making sure children received medicines in emergencies.

Parents told us the service was caring. They valued having the continuity and consistency of the same member of staff visiting them and knowing they could access advice if there was an emergency.

Staff were able to tell us how they ensured children and young people were provided with dignified care. They were also able to tell us about maintaining confidentiality and the circumstances of when information had to be shared for the well-being of the children and young people they were working with.

Care was personalised and reflected each child’s and young person’s diverse and changing needs. Plans for care showed how children and young people were engaged in a range of activities at home and in the community, and ways their independence could be promoted.

Staff received training and were aware of the issues relating to the Mental Capacity Act 2005. There were mechanisms in place to ensure care was provided with the consent and agreement of either the parents and/or the young people themselves.

Senior managers within the organisation had an open and inclusive approach. They welcomed challenges from their staff team and trustees. Parents were asked for their feedback about the service and they told us they felt able to raise issues or concerns. There was a rolling programme of audits to monitor the quality of the service. Any incidents and accidents were reviewed to consider any learning or changes that needed to take place to improve the service.

Family carers told us that managers and staff at the service listened to them and worked well with them. We found that the provider worked in co-operation with others including family carers and healthcare professionals. This helped to ensure that children's health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services.

People praised the capability of care workers and the management team. Comments included, 'they're very well trained' and 'they're brilliant with children.' We found that children were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

We also established that the provider had an effective system to regularly assess and monitor the quality of services received, and to identify, assess and manage risks to the health, safety and welfare of people using the service and others.

At this inspection, we found that matters had been addressed. We checked a number of records in the office, and found that they were accurate and fit for purpose. Documents about children such as care plans were securely kept and could be located promptly when needed. The manager had recently undertaken an audit of care records. Recommendations had been made to ensure further improvements on the standards of record keeping. This meant that children were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

Everybody told us that people at the agency treated them with respect, and listened to and acted on their views and preferences. 'It was a very comprehensive needs-assessment process,' said one parent of their initial contact with the agency. Most people felt that staff were suitably skilled and experienced. Parents felt safe using the agency's staff in their own homes. 'I trust them,' said one parent. Everybody felt they could approach the agency if they had a question or concern about the service.

Our checks of care, user-involvement, safeguarding, staff recruitment and complaints systems found the service to be compliant in these areas. However, we found that appropriate records in relation to children, staff members, and the management of the regulated activities, were not always maintained at the agency's office. This may put children at risk of unsafe or inappropriate care.