Naomi House Children's Hospice

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 reviewed the safe systems, pathways and transitions, Safe and effective staffing and medicines optimisation quality statements for the safe key question. We were assured chidren and young people received safe care and treatment.The service had good processes in place and staff had access to policies and procedures that aligned with national guidance. However, staff told us there were times when staffing felt challenged which meant they did not always have enough staff to provide individualised care to service users. We did not see any evidence of impact or incidents relating to children and young people as a result of this and the senior nursing team reviewed staffing and the complexity of children and young people on a daily basis to ensure that safe care was delivered.

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.

The service obtained feedback about people’s experience through the “I Want Great Care” platform. Families received a feedback link after each admission, and the responses were reviewed at monthly oversight meetings. Senior Leaders at Naomi’s House and Jacksplace acted on this to drive improvements for the service. For example, a parent’s feedback highlighted the difficulty of completing detailed care plans on admission. The hospice responded by initiating a project to explore pre-visit calls and gather necessary information beforehand, streamlining the admission process. Additionally, the hospice provided us with impact case studies which described positive experiences of children and young people who had used the service. For example, to help ease the burden on young people with Neuromuscular conditions (which includes Duchenne Muscular Dystrophy (DMD) the service launched a “one-stop clinic” in collaboration with clinicians from University Hospitals Southampton. Medical professionals from across disciplines facilitated the clinic, eliminating the need for patients to make multiple appointments. In addition to supporting the young people this innovation helped to free up hospital time and ensured continuity of safe care, fostering strong partnerships.

Staff followed trust guidelines on how to identify and report incidents. The service used an online incident reporting system and shared a monthly summary of incidents by email alongside highlighting specific learning from incidents on the ‘How We Are Doing Boards’. These were located within each hospice and visible to everyone. Staff told us this information was readily available and clear. Policies and procedures were held on a central drive and staff knew how to access these. Staff demonstrated a comprehensive approach to identifying and supporting children and young people with specific needs including learning disabilities, autism, and mental health conditions. For example, the hospice utilised a dedicated Practice Educator who conducted home visits to assess the support needed by people with potentially challenging behaviour. In addition, staff described positive working relationships with the Paediatric Palliative Care Consultants and told us they were readily available for support and attended at short notice. The hospice usually had a hospice doctor in-house Monday to Friday, and telephone support available 24/7. A Specialist Paediatric Palliative Care Consultant was present 3/4 days a week in addition to an Associate Specialist for Adults providing safe cover. Similarly, leaders described positive relationship with partners which included the Integrated Care Board (ICB), social care, community nursing teams and the local acute trusts. Staff had a good understanding of recognising a deteriorating child or young person, promptly initiating Paediatric Early Warning Score (PEWS) monitoring. During hospital transfers, the hospice routinely ensured essential documents like PEWS charts, seizure plans, food regimes, and Advanced Care Plans (ACP) were readily provided. The hospice kept printed copies of these documents during a child or young person’s stay, which were readily available. All nursing staff undertook the Recognising the Deteriorating Child training.

The hospice used an Eligibility Assessment Tool which determined if the child or young person met the service criteria. There was a fast-track system for urgent and end-of-life referrals. There was an internal process for children to transition from Naomi House to Jacksplace. Naomi House cared for children under 18 years old and Jacksplace cared for young people aged between 18 to 35 years old. However, this transition could happen at 16 years old if the young person wanted this. Our review of 3 records demonstrated excellent teamwork, with referrals made for social concerns, children’s services, and the ICB. Children and young people had an Advanced Care Plan (ACP), which outlined treatment preferences, pain and symptom management, end of life care wishes, religious and spiritual beliefs, and others. We reviewed 3 ACP’s onsite and found them to be clear and thorough. We examined 3 instances of transition between services and found excellent communication with detailed written information. For example, a discharge letter had been sent to a person’s GP surgery, named consultant, Next of Kin, children’s community team, and social worker. This included a completed Recommended Summary for Emergency Care and Treatment (ReSPECT) form with clear direction for all clinical teams. A ReSPECT form outlines a person’s preferences for care should a life-threatening situation arise. On admissions, baseline ‘normal’ observations were discussed and recorded in the relevant care plans. Observations were not routinely carried out unless clinically indicated during assessment or required as part of the goals of the stay. Staff told us they initiated PEWS and continuous monitoring for an unstable child or young person or where there was concern. Minor changes triggered consultations with the hospice doctor while serious changes led to immediate 999 calls. A Nurse always accompanied a child or until the parent could be in attendance or the child or young person handed over to the ward.

The hospice worked with external partners to ensure continuity of care, including when people moved between different services. This included the ICB, social care, community nursing teams and the local acute trusts. The hospice shared their quarterly quality reports with the ICB. We saw evidence of discussions around workforce and incidents which took place via email. Through professional challenge, staff described a collaborative environment where people felt empowered to raise concerns and contribute to providing better care. Additionally, Naomi House and Jacksplace were part of the Hampshire and Isle of Wight Hospice Collaborative Network. This meant the hospice partnered with NHS palliative care teams in hospital and the community, offering specialised services and support. Two Paediatric Palliative Care Consultants and an Associate Specialist for Adults shared their time between the hospice and another trust. Additional joint posts also included a Clinical Nurse Specialist for Adults, Band 6 Physiotherapist rotation post and a pharmacist visit from a local acute trust under a Service Level Agreement. This helped to support evidence-based practice, new innovation and the delivery of holistic care to those using our services.

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.

All new starters in the hospice received a comprehensive induction. We reviewed 5 staff records which we found to be complete and up to date. These included Disclosure and Barring Service (DBS) checks, confirmation of revalidation requirements, satisfactory references, qualifications required for the role, and Nursing and Midwifery Council (NMC) registration where appropriate. All staff including volunteers had a renewed DBS check every 3 years and the hospice kept a spreadsheet to track this. The hospice kept an Application for Enhanced DBS and Barred List Checks document which informed them what level of DBS was required for different staff groups. We were told this was cross-referenced with DBS guidelines. Naomi House and Jacksplace had a UK Visas and Immigration (UKVI) sponsor license which was renewed every 4 years. A UKVI sponsor license allows employers in the UK to sponsor someone from outside the country for work purposes. The hospice kept an International Nurses pre-employment checklist which had been completed and signed off with all relevant certificates to evidence all checks had been carried out. The hospice had a recruitment policy to ensure the management of employees was fair, equitable and transparent and adhered to both internal practices and legislation surrounding fair selection and employment. In order to be able to attract and retain clinical staff the hospice had introduced financial incentives within its recruitment and retention policy. This was monitored to establish effectiveness. Staff had regular 1:1's and received annual reviews and a 6 monthly review. Poor performance was managed with the creation of a performance development plan with the line manager which would involve support from the Practice Educator if required.

A review of the nursing rota from the last 3 months showed there was not always enough staff to provide 1 to 1 care. However, not all children and young people required this level of support during their stay, and staffing numbers were reviewed daily to assess acuity and dependency within the hospices against staffing levels and skill mix ensuring the delivery of safe care at all times. We spoke with some staff who told us there were times when staffing felt challenged. However, leaders told us they had an overview of a child or young person's needs prior to arrival through pre-stay calls and could therefore assess staffing levels and skill mix to support this. For example, a child requiring 2 nurses would prompt them to assign 2 nurses instead of 1. Staff completed mandatory training, and these included mental health awareness training and safeguarding. Staff told us they were up to date with their mandatory training requirements. The hospices provided additional training in emotional intelligence and compassion fatigue and facilitated external study days and conferences for staff. The "Wessex Preceptorship Group" shared study days with hospitals in the region which included Naomi House and Jacksplace. Competency assessments included working with both children and adults as this facilitates flexibility across the workforce. Staff told us they felt supported with completing these competencies and had a wide range of skills.Leaders identified staff recruitment as an area of risk. To address these concerns, the hospice had recently recruited 6 internationally educated nurses who worked closely with the Practice Education Team to ensure they were confident and competent to provide safe and effective care. The hospice relied on a combination of permanent staff and bank staff who were familiar with the service. Any staff member who was unfamiliar with the service, received a full induction and orientation.

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.

The hospice had an overarching medicines management policy and multiple medicines management SOPs including the prescribing and transcribing of medications. The hospice had an Accountable Officer for the safe storage and administration of Controlled Drugs who was an active member of, and reported into the local intelligence network. The hospice adhered to the Wessex Children’s Hospice Trust Standard Operating Procedure, SOP for the management of controlled drugs and records seen supported this. The service completed risk assessments for medications. For example, we reviewed a completed risk assessment for the potential delay in prescribing medications when a doctor or non-prescriber was unavailable. The risk assessment and systems in place were robust. Staff told us that a doctor would normally review the MAR chart within 24 hours, however, this was not always achievable. Therefore, there was a risk that medicines could be transcribed without having been checked by a doctor or a second checker however, all charts were checked and countersigned by the admitting parent. Although this was not best practice, there was no evidence of harm or impact as a result and the hospice was following its own policies and procedure. The hospice used the hospice UK national audit tool and completed audits in medicine chart and controlled drugs. Where noncompliance was identified, the hospice produced action plans for this.

Staff demonstrated consistent adherence to policies and procedures for safe medicines management and no concerns were raised. Medicines were administered orally, intravenously, through special access ports, or through feeding tubes. Nurses told us they received comprehensive training on medicines management through induction, study days, supervised practice shifts, and a formal competency assessment. Clear guidance through a Standard Operating Procedure (SOP) was in place for both self-administering medication and parental-assisted administration. It was clear for self-administration, children needed to show they understood the decision, known as “Gillick competence”. The term Gillick competence refers to whether a child under the age of 16 has the capacity to consent to medical treatment, without the need for parental permission. Staff we spoke with understood Gillick competence and gave examples how they would implement this when caring for children and young people. A designated Practice Educator tracked staff competencies, and Senior leaders told us they proactively checked staffing rotas in advance to ensure nurses with the required expertise were present for such admissions. For example, those requiring medicine administration via a central line. A central line is a long tube inserted into a large vein nearing the heart, which is sometimes used to administer intravenous medication required long-term. Therefore, medicines must be administered aseptically, to assist the prevention of infection, and nursing staff must be competent to do so. This proactive approach aimed to match each child's medication needs with the right skilled nurse, ensuring safe and effective care. Medical staff were involved in the monthly Clinical Committee meetings which included a review of medication incidents and action plans to prevent future errors. We saw evidence of this in meeting minutes. Medication errors were also discussed at the quarterly doctor’s team meetings.

We observed a medicines administration round where medicines had to be given via gastrostomy. A gastrostomy is a type of feeding tube that is surgically placed in the stomach, allowing for direct delivery of food or medication. Medicines were prepared in line with the Medication Administration Record and signed for once given. We observed friendly and professional interactions with staff, families, and service users. Staff explained what they were doing and why and requested parental consent. The medicine storage room was secure. Fridge temperature logs showed consistent checking and control measures. The medicine storage room was spacious, clean, and well-organised with clearly labelled cupboards designated for different areas, further enhanced by labelled pictures and individual boxes for each child or young person’s medicines further enhanced by labels with pictures to identify the bedroom. We identified challenges in tracking the opening date of liquid medications, particularly those brought in by children or young people admitted from home. These medicines would arrive unlabelled and sometimes out of hours without doctor or pharmacy access. However, administering them was often necessary due to critical health needs and potential negative consequences of discontinuation. To address this concern, we discussed with Senior Leaders the potential of including expiry dates based on dispensing, not opening, for improved safety management. Additionally, we observed mitigating actions like doctors verifying and re-labelling medicines on admission with the appropriate dose changes. While this is an ongoing challenge, we saw no evidence of unsafe care or treatment.