The inspection to the hospice took place on 23 and 30 October 2016 and was announced. On 4 January 2017 we contacted relatives of children and young people who used the service.

Little Havens Children’s Hospice is registered to provide respite and end of life care for up to eight children or young people, aged between 0 and 19 years of age who have a life limiting or life threatening illness and who live in Essex and the surrounding London Boroughs. Support is also provided for families of the children and young people who use the service. Family accommodation is provided on the first floor and includes bedrooms and an open plan communal lounge, dining area and adjoining kitchen.

There was a registered manager in post. However, at the time of the inspection the registered manager was not at work and as a result of this, an interim manager from within the organisation was managing the service on a day-to-day basis. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Parents told us the service was a safe place for their child or young person to access. Parents told us they had no concerns about their child’s or young person’s safety and were confident that the arrangements in place would keep their child safe. Staff were able to demonstrate a good understanding and knowledge of a child’s or young person’s specific support needs, so as to ensure their and others’ safety. Staff understood the risks and signs of potential abuse and the relevant safeguarding processes to follow.

Parents told us there were always sufficient staff available to meet their child’s or young person’s needs. Suitable arrangements were in place to ensure that the numbers and skills of the staff team were effective in meeting the needs and complex needs of children and young people using the service. Appropriate arrangements were in place to recruit staff and volunteers safely so as to ensure they were suitable to work with and support children in their care.

Medicines were safely stored, recorded and administered in line with current guidance to ensure children and young people received their prescribed medicines. This meant that they received their prescribed medicines as they should and in a safe way.

Children and young people benefitted from a staff team that were well trained to meet the complex and specialised needs of children and young people using the service. We saw from their interactions, facial expressions and mannerisms that children and young people were contented, comfortable and relaxed in staffs company. Staff were seen to be warm and caring towards the children and young people they supported and were treated with compassion. Parents confirmed that they, their child or young person was also treated with respect and had their privacy and dignity upheld at all times.

The dining experience for people was positive. Mealtimes were family orientated with children, young people, their families and staff eating together. Children’s and young people’s dietary needs were recorded and where complex nutritional needs were being managed, staff networked with community based services and professionals.

Young people were involved in decisions about their care and treatment. Staff had a good understanding and awareness of the importance of gaining consent when providing care and treatment and working within the principles of the Mental Capacity Act 2005 (MCA). This meant that the rights of young people were promoted and protected where they were unable to make their own decisions.

Care plans accurately reflected the child’s or young person’s care and support needs and they received appropriate support to have their social care needs met. Parents told us that

During our visit we found that three children were using the respite service provided. We used a number of different methods to help us understand the experiences of children using the service, because the children using the service had complex needs which meant they were not always able to tell us their experiences. We spoke to the relatives of two children, who told us that the care was good and that staff were caring, understood their child’s needs and gave appropriate support. We spoke with seven staff members including managers. We reviewed three care planning files and other records available.

We found that the provider had ensured that children using the service were safe from the risks of inadequate nutrition and dehydration. There were effective systems in place for working with other professionals and providers involved in the child’s care and the management of medicines.

We found there were systems to ensure records were appropriately kept for children receiving care and for the staff employed.

The care seen at Little Havens Children’s Hospice was personalised and focussed on individual needs of children, siblings and families. Both staff and people who use the service could show how risks were assessed and care and treatment was planned and delivered to support children during their stay. Speaking with a relative and five staff, we could see that where children did not have the capacity to consent, the provider acted in accordance with legal requirements.

We saw that children were protected from the risk of infection because appropriate guidance had been followed. Whilst the contracted hospice staff files were satisfactory, the on call general practitioners (GP) records require improvement as they were incomplete. There was an effective complaints system available and we could see that comments and complaints people made were responded to appropriately.

We were unable to speak with children who use the services and their relatives at the time of our inspection. However, we reviewed feedback obtained by the provider and this showed that people felt that the hospice was very supportive and caring and provided care in a dignified way. Positive comments were seen about all the services offered from inpatient care, the respite service and from those who had used the hospice's services for the first time.