Little Bridge House

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• 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 ‘learning culture’, ‘safe systems, pathways and transitions’, ‘safeguarding’, ‘safe environments’ and ‘safe and effective staffing’ quality statements for the safe key question. We rated safe as good. The service worked with people and partners to maintain safe care for people using the service. Staff felt safe to raise any concerns and learnt from incidents and safeguarding concerns. The premises were safe and supported the delivery of care for children. Children had access to a range of equipment and facilities to support their care.

This service scored 78 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We spoke with family members who were confident about raising concerns. We saw evidence that family members were involved in investigations if they wanted to be and that an explanation of the event was provided.

Staff were confident about raising concerns and supported to learn when things went wrong. Incidents were reviewed by managers and were discussed at a weekly meeting. The incidents from the providers other locations were also discussed at this meeting and learning shared across all locations.

Staff had effective systems to raise concerns both formally and informally.

Relatives said they appreciated the care provided by the team at the hospice. They said it was safe and enabled them to enjoy respite from their caring commitments. The service provided transition weekends for young people over the age of 14, which included having a doctor talk about medical consultations as an adult and explained patient’s rights. The feedback received by the provider for this weekend was positive.

Staff ensured patient care plans were completed with the relevant information. We were told that patients and family members accessing the hospice were contacted by the service in advance of their stay. On admission, a care plan was completed for the young person in conjunction with the child and family members which was individualised to their needs. Each child and young person had a ‘key contact’ who co-ordinated their care and got to know them well.

The hospice worked with the local trust, community nursing and general practitioners (“GP’s) to ensure continuity of care was provided for children and young people including when people moved between different services.

Referrals were discussed at a weekly meeting which consisted of doctors, senior nurses, family support and senior management. There were clear processes and systems to help with deciding eligibility of each patient to access the service. The service had clear processes with policies and procedures that supported safe care when patients were transitioned between different services.

Family members said that they felt safe whilst staying at the hospice. Children we spoke with said they felt safe and comfortable with staff members.

Staff knew how to report any safeguarding issues and felt supported to raise concerns with the management team. Staff had received the safeguarding training required for their role. Clinical staff were trained to Level 3 for Safeguarding children and all other staff were trained to Level 2. We saw evidence that the service responded to concerns quickly and worked alongside patients and family members.

The service had 2 appointed leads for safeguarding. Staff understood when and how to raise a safeguarding concern and we saw evidence that safeguarding concerns were shared with other agencies when appropriate.

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 saw patients and siblings enjoying using the excellent play facilities at the hospice. Children had access to messy play, soft play and different sensory activities. Parents told us there was always plenty for their child to do and that activities were tailored to each individual child. We asked a patient what they thought about staying at the hospice and they replied ‘I absolutely love it’. Parents commented that they felt relaxed and calm and that the service offered was ‘a lifesaver’. Patient and family feedback collected by the provider indicated that the premises, including the children and family spaces provided an outstanding environment. One family member commented that it was like staying at a hotel.

Staff had access to all the equipment they needed to support safe care. The service ensured the same equipment was used across the group of hospices to enable cross-working and shared training. The service had a maintenance team who regularly assessed environmental risks.

The premises were safe, clean and provided a welcoming and inviting environment. We checked equipment and portable appliances and found that these were in date and maintained regularly. The hospice was well equipped with specialist equipment and fully accessible bath and shower rooms. There was a post bereavement suite where families could stay with their child following their death. All of the facilities were child and young person friendly and there was a large sensory garden, games room, jacuzzi/spa, messy play, soft play and sensory rooms. Each child had a room plan so their bedroom could be set up with the décor, equipment and bedding of their choice. The families over night rooms offered privacy and comfort and a place for parents to relax.

Waste was safely managed and there were procedures for ensuring all equipment was regularly checked. The garden and the grounds were safe and tidy and there were processes for ensuring activity areas were suitably clean and organised.

Children and young people and their families including siblings said the staff were great and there was always someone to provide the support which the children and their families required once they were at the hospice. One parent commented on the service “This is the only place where I can totally relax and get a good night’s sleep, because I totally trust the staff to look after my child….it clearly doesn’t happen at home or even when we’re away on holiday with our family, only here can I do that…”. Another parent commented they felt “100% safe with staff and their skills”. We observed staff playing with patients and their siblings. We saw how the children were relaxed with the different members of staff and that staff knew each child’s individual and complex needs and supported them to play and take part in activities. Staff were allocated a child and family and reviewed all essential information prior to their visit to ensure that their needs and preferences were met.

Leaders kept staffing numbers at a safe level. The service mainly accepted planned Hospice stays. End of life care was considered on a case by case basis with staffing levels considered prior to accepting patients. When patients were admitted to the location, there was enough qualified, skilled and experience people to provide safe care that met patients individual needs. The service was not at establishment for carers, nursing staff and team leaders and this was mitigated by not providing a 7 day a week service in order to keep staffing at a safe level. The service was actively recruiting to increase staffing numbers. The service ensured there was a minimum of 2 qualified nurses for each shift. This included 1 nurse who was a registered sick children’s nurse. The service also used bank staff to support shift cover. Staff were up to date with mandatory training and any role specific training or education. However, not all staff had completed an annual appraisal. At the time of the assessment , 66% of the care team had received an appraisal within the previous year. We were told by the service that those staff with outstanding appraisals had been booked in for completion over the following weeks. We received confirmation from the service that as at September 2024, 94% of the care team had completed their annual appraisal. Staff said they received supervision. However, there was insufficient supervision oversight from service leaders as records were held by the individual. The provider told us that this process was going to be moved centrally so that they could be assured staff were receiving regular supervisions in the future.

The service had processes to ensure staff had an induction and were compliant with mandatory training. The service had process to ensure the safe recruitment of staff.

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.