Julia’s House, a hospice in Devizes, has been rated outstanding overall, following an inspection by the Care Quality Commission (CQC) in October.
The service is run by Julia’s House Limited, a charity which provides respite care to children and young people with life-limiting or life-shortening conditions. The charity runs two hospices, one in Broadstone, Dorset (also rated outstanding overall), and one in Devizes, Wiltshire. The two locations work as one team.
Care is provided free-of-charge, with each family being offered an allocation of care hours for their child, which they can use as they wish. Support for bereaved families is provided for up to five years following the death of a child (most other services offer support for up to three years). At the time of the inspection, the charity was supporting approximately 52 families, including 10 bereaved families. During the COVID-19 pandemic, the service accommodated up to two children at one time within the hospice, and also provided increased support for children in the community.
This was the first inspection of the Devizes hospice since it registered with CQC. Following the inspection, the service was rated outstanding overall and outstanding for being well-led and caring. Safe, effective and responsive were all rated as good.
Cath Campbell, CQC’s head of hospital inspection, said:
“When we inspected Julia’s House in Devizes, it was clear that both leaders and staff were passionate about the care they provide to children and their families, and we found many examples of outstanding practice.
“The service offers day care sessions at the hospice, as well as community-based care in the child’s own home, but the provider had done an audit which identified that many families wished for their child to be cared for at the hospice in their final days. In response to this, they appointed two doctors and created a specialist end of life suite, designed sensitively with children and their families in mind. They also worked with another local hospice so they could access expert guidance from specialist consultants trained to support children facing a terminal illness.
“During the COVID-19 pandemic, when families wanted to shield, nurses visited children and their families from the end of the garden, so they wouldn’t feel alone, brought them shopping and collected medicines for them. They also organised a virtual sibling club, virtual storytelling, online gaming events and play therapy sessions, to give parents a break and allow the children and their siblings to speak to other people outside their family. When one family member had to undergo emergency surgery, staff stepped in at short notice to provide respite, so the child could continue to be cared for at home rather than going into foster care.
“When a child sadly passes away, the charity contributes £1,000 towards the cost of funeral services and creates memory boxes to help families remember their loved one. Each year the service holds a ‘remembering day’ for all bereaved families to remember their loved ones. Staff described their care as a ‘hug around the family’ and families told us of the incredible support they received from the hospice, with the sibling of one child saying ‘they have always been like a family to us, without them I would not of had the most amazing childhood’.
“Leaders at the service encouraged participation in research and innovation throughout the service. There were two parent trustees on the board to ensure accountability and transparency in the service, and there was a very open culture around reporting incidents, with a focus on learning from these, rather than on individual errors.
“Despite the challenges of the COVID-19 pandemic, the team at Julia’s House has worked incredibly hard to adapt rapidly and maintain exceptionally high standards of care for children and their families. Leaders and staff are thoroughly deserving of their outstanding rating, congratulations to all.”
Inspectors found the following during this inspection:
- Leaders had an inspiring shared purpose to deliver outstanding care. The vision and values of the service were central to the whole organisation and visible to staff who understood them and applied them in their work. Leaders created, developed and used reliable information systems to monitor and consistently improve the service and they motivated and supported staff to develop their skills to enhance the care they provided
- Staff felt respected, supported and valued and told inspectors of the supportive and caring nature of staff at all levels of the organisation. Staff were clear about their roles and accountabilities and felt they were encouraged and engaged. The service engaged well with children, their families and the community to plan and manage services. Constructive challenge was consistently sought by leaders and they strived to improve services continually for the benefit of children and their families. All staff were involved and committed to improving services
- The service had enough staff to care for children and young people and keep them safe. Staff had training in key skills, understood how to protect children and young people and adults from abuse, and managed safety well. All children were allocated a named nurse responsible for reviewing risks assessments for the children in their care, which they acted on and kept good care records
- The service-controlled infection risk well. They mostly managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service
- Staff provided good care and treatment, gave children and young people enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of children and young people, supported them and their families to make decisions about their care, and had access to good information
- Staff consistently treated children, young people and their families with compassion and kindness. They always respected their privacy and dignity. Staff recognised and respected the totality of children’s needs and that of the whole family. Staff helped children and their families to understand their conditions and supported them fully to be involved in their care. There was a strong, visible child-centred culture and staff provided emotional support to patients, families and carers in every way they could. Children and their family’s social needs were highly valued by staff and embedded in their care and treatment. Families consistently and overwhelmingly told us they felt truly cared for by the service
- There was a strong focus on the safety and well-being of staff, including emotional support for staff who were caring for children with life-limiting conditions
- People could access the service when they needed it. The service planned care to meet the needs of local people, took account of children’s individual needs, and also those of family, particularly siblings of the child who was unwell. They made it easy for people to give feedback and all concerns or complaints were investigated
- The service was designed to provide a pleasant and stimulating environment for children. There was a sensory room, a music room, a craft cupboard on wheels, and computer equipment for children to use. A well-maintained sensory garden had a large ramped area with cars for children to race in, and an integrated trampoline suitable for use in a wheelchair.
However:
- The medication policy did not contain clear guidelines on the timescales for review of medication administration charts and some children had not been weighed in line with the service’s medication policy.
Full details of the inspection are given in the report published on our website.
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