Charlton Farm

Updated 15 March 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 checked 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 10 and 11 January 2017 and was announced. We gave the provider 48 working hours’ notice of the inspection. We also needed to be sure senior managers and staff would be available to speak with us on the day. The inspection team consisted of a lead inspector, a specialist advisor who was a paediatric nurse with specialist experience and knowledge of palliative care and a CQC pharmacist. We also used an additional inspector and expert by experience (this is someone who has used or has experience of this kind of service) to complete telephone calls to parents of children who receive a service from Charlton Farm.

Prior to the inspection we reviewed the information we held about the service, including the statutory notifications we had received. Statutory notifications are what the provider has to send to the CQC about significant events that occur at the service. We also reviewed the information included in the provider information return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We looked at the Annual Quality Accounts which services’ commissioned by the NHS are required to complete which gives information about the quality of the service.

On the day of the inspection there was only a child and parent using the service. This was because the provider was in the process of a planned closure (except for emergencies) for a week to enable staff training and maintenance of the building. We were able to talk with the parent during the inspection.

Additionally, we spoke with 11 members of staff this included carers, registered nurses, registered manager and people within the human resources department. We looked at care records for six children and young people, medicines records for four children and staff recruitment and training records for seven people, including volunteers.

Following the inspection, we had telephone contact with 20 parents of children who receive a service from Charlton Farm. We also had contact from three healthcare professionals who come into contact with the service; this was a district nurse, children’s palliative care nurse and a hospital paediatrician.

Updated 15 March 2017

This inspection took place on 10 and 11 January 2017 and was announced. The service was last inspected in November 2013 and at that time was meeting all the regulations we looked at.

Charlton Farm offers a service to children and young people who have a life limiting condition and their families. They are able to offer short break ‘respite’ care and emergency care for up to eight children or young people at any one time in their accommodation facilities. Children can be referred by a family member or a health and social care professional at any time from initial diagnosis to a point when end of life care is required. Charlton Farm generally provides a service to the entire family who are accommodated at the time of the short break. This allows the young person to be cared for by staff so if required the family are able to enjoy time away from their caring responsibilities.

At the time of our inspection, Charlton Farm were offering a service to approximately 200 children and young people and their families, the majority of whom received up to 14 days of care annually. Parents were able to negotiate with Charlton Farm as to when shorts breaks could be provided. This was managed by Charlton Farm, to ensure fairness so that families received an equitable allocation of popular periods such as weekends and school holidays.

In addition to the short breaks, Charlton Farm offers a range of other services. This includes a dedicated sibling’s team. The team was established in response to the recognition of the impact of having a sibling with a life limiting condition. Activities are arranged for siblings during the families’ stay at Charlton Farm which enables them to have some fun. They are also encouraged to express their views and feelings of having a sibling that is unwell and the impact this has on them.

Charlton Farm also offers end of life care. Families can stay in the accommodation provided so they can be near their child. They are arrangements in place to provide bereavement support to families when the needs are identified. The hospice also offers ‘remembering weekends’, which are open to all bereaved families and allows people to support each other and remember their child.

There are approximately 70 active volunteers who augment the work of the paid hospice staff. In addition, there are 28 shops in the community which are involved in fundraising for the three children’s hospices run by Children’s Hospices South West.

The service had a registered manager in post. 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.

People told us staff at Charlton Farm were kind and compassionate. They felt staff had a shared vision of providing care that was of the highest quality. The provider supported staff to achieve this through an extensive training programme and support from colleagues and line managers.

Children and young people had their health needs met either by medical staff employed by Charlton Farm or by accessing community health and social care professionals. The provider ensured children received their medicines as prescribed and good nutrition.

Parents felt their children were safe at Charlton Farm. There were a number of pre-employment checks to ensure that as far as possible only suitable staff and volunteers were recruited. Staff we spoke with knew how to keep children and young people safe, and what to do if they had any concerns. Staffing levels were sufficient to meet the needs of children and young people staying at the hospice.

Care that was offered to children and young people was personalised and reflected their needs. The needs of children and young people were reviewed prior to every short break visit and during their stay. In this way the provider could assure themselves care was in line with current needs and wishes. Staff were knowledgeable about the children they cared for. They were able to maintain the privacy and dignity of the children and young people whilst providing care and to ensure they met their diverse needs.

Staff were knowledgeable about the individual communication needs of the children and young people. Where possible, they delivered care in line with the child’s wishes. Where this was not possible, staff sought consent from parents or used other measures to ensure the child’s rights were protected and any decisions made were in their best interests.

The provider worked sensitively with children, young people and their families to help ensure the care and wishes of a child could be realised during their life, when they became unwell and after their death. There was bereavement support that was offered to families after the death of their child.

Charlton Farm provided a suitable environment for children and young people. It was clean and hygienic. There were a range of activities available within the hospice or that could be accessed in the community. The provider had responded to the differing needs of teenagers and young people and had tailored the service they offered in response.

There was a clear management structure within the organisation. Senior managers monitored accidents, incidents or near misses in order to prevent re-occurrences. Learning from any of the providers’ three hospices was shared to promote the quality of the service offered. The provider actively sought the views of children, young people and their parents. In this way, they were continually monitoring the quality of the service and trying to improve the outcomes for children and young people.