Naomi House Children's Hospice

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

The service routinely monitored people’s care and treatment to continuously improve. We found outcomes to be positive and consistent and they met both clinical expectations and the expections of people themselves.

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 Assessing needs during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

The hospice employed a Head of Governance and a Governance Lead Nurse. The hospice participated in both local and national audits. The service kept a local audit plan which were completed and discussed at governance meetings. We reviewed the clinical audit schedule for October 2023, and this showed the types of audits they carried out in and the frequency of these. Some of the audits which the hospice took part in included safeguarding audit, record keeping, controlled drugs and admissions. The service used information from the audits to improve care and treatment. For example, the scores for the hand hygiene audit for the month of September and the discharge audits for the month of April, August and September was lower than the benchmark of 90%. As a result of this, the hospice had commenced an action plan which included on going monitoring of both areas by the clinical team leaders and reminder to care team to ensure discharges were recorded accurately in the notes. Further feedback was achieved through the feedback mechanism ‘I Want Great Care’ which supported families and service users to give anonymous feedback on the services they had received. These responses were reviewed with any actions at the monthly Clinical Committee Meeting. The hospice also participated in a National Business Development Group at both CEO and Director level. This group of Children’s Hospices met quarterly to share ideas, benchmark, and provide peer support. In addition, the Head of Governance participated in a regional hospice governance group who met regularly for peer review, support and shared learning. The service monitored the results and completion of audits and their associated action plans through quality meetings and agreed additional re-audits. The hospice was involved in a number of research projects with universities and National Institute for health and care research to improve outcomes for children and young people.

We reviewed service user surveys post inspection and found all of them to be positive. The hospice sought feedback and suggestions on how the hospice could improve their services. For example, we reviewed the comments from families on the ‘Naomi House on holiday’ survey and staff included a question about what further information the hospice could add to the welcome brochure to improve this. Staff told us that a young person staying at Jacksplace asked if he could help them and they were able to let him complete the hand washing audit.

Staff monitored the effectiveness of care and treatment. They used the findings to make improvements and achieved good outcomes for children and young people. Leaders told us the service monitored people’s care and treatments and their outcomes as part of the initial assessment with the children, young person, and their family. Initial visits to the children and the young person and the family took place jointly with the nursing and family support team to ascertain holistic needs. Staff worked collaboratively with other professionals to ensure that the holistic and clinical needs of the child or young person and their family were met. Staff told us the hospice had just commenced a holistic needs information form to enhance this further. Additionally, the service also sought feedback after every visit via the electronic care platform to monitor and improve outcomes. The hospice carried out reviews to seek improvements. For example, when it was identified that not all staff members had completed their clinical competency, the hospice invested in their clinical education team which allowed all care team members to be appropriately trained to care for all children and young people. As a result, this improved the flexibility of the e bookings process for families. Staff took part in audits and leaders used information from the audits to improve care and treatment. Leaders took responsibility for actions which arose through the action plan, and we saw evidence of this.

Where appropriate children and young people arrived with a pre-existing Advanced Care Plan (ACP). This document detailed wishes and decisions for future medical care, particularly when a person could not communicate due to ill health or deterioration. The ACP contained a distribution list which ensured smooth communication between services like community nursing teams and schools. It provided everyone involved with a clear picture of a child or young person’s needs and wishes, in case of a life-threatening situation. Importantly, all these decisions were made prior to admission to Naomi House and Jacksplace, as the service offered respite, symptom management or end-of-life care, and not primary treatment. The Mental Capacity Act 2005 (MCA) provides a legal framework for making decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take decisions, any made on their behalf must be in their best interests and as least restrictive as possible. Staff had received MCA and the DoLS training and were aware of the implications of this in their practice for some of the young people they supported and their rights to make their decisions were respected.

Consent was sought at the time of referral for all children and young people. This was verbal initially and was always followed up with a written consent. Staff told us that since children attended the hospice for symptom management, respite, and end of life care, decisions around treatment plans would have been made prior to the attendance and these were recorded in the person’s Advanced Care Plan, ACP. The ACP had a distribution list of services involved in a person's care to allow access to important information. For example, district nurses, GP surgeries and other professionals involved in the care. This allowed for clear communication of a person's needs and wants and their wishes during life. This also included consent and any potential treatment plans. When assessing children or young people with complex behaviours, staff assessed information on referrals received. If a risk was identified or the staff felt unsure if this risk could be managed or not, the hospice staff met the child prior to arrival and conducted their own assessment. This would be carried out by the hospice’s practice educator.