Children's Home run by Doncaster Children‟s Services Trust Limited in Doncaster

SC032167 Unique reference number 10 June 2009 Inspection date Nicola McEvinney Inspector Key Type of Inspection

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8 December 2008 Date of last inspection .

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This document may be reproduced in whole or in part for non-commercial educational purposes, provided that the information quoted is reproduced without adaptation and the source and date of publication are stated.

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You can obtain copies of The Children Act 2004, Every Child Matters and The National Minimum Standards for Children's Services from: The Stationery Office (TSO) PO Box 29, St Cripins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop

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About this inspection

The purpose of this inspection is to assure children and young people, parents, the public, local authorities and government of the quality and standard of the service provided. The inspection was carried out under the Care Standards Act 2000. This report details the main strengths and any areas for improvement identified during the inspection. The judgements included in the report are made in relation to the outcome for children set out in the Children Act 2004 and relevant National Minimum Standards for the establishment.

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The inspection judgements and what they mean

this aspect of the provision is of exceptionally high quality Outstanding: this aspect of the provision is strong Good: this aspect of the provision is sound Satisfactory: this aspect of the provision is not good enough Inadequate: 3 of 9 Inspection Report: SC032167

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Brief description of the service

This home provides up to 10 long-term and respite placements for children and young people who have physical and or learning disabilities aged from six to 17 years of age. There are currently three young people living at the home permanently and about 20 young people who receive a respite service. The accommodation consists of 10 single bedrooms and communal areas for eating, studying and relaxing. The home is in a residential area, approximately five miles from the town centre, and is close to public transport and schools. There are waking night staff on duty. The home owns their own mini-bus and there are beds and cots suitable for the children and young people who use this service. Hoists are fitted in bathrooms.

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Summary

The purpose of this unannounced key inspection was to check that the key national minimum standards and the requirements and recommendations made at the last inspection have been met.

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Summary

There are some good aspects to this home. There is a well established experienced staff team who are committed to the care of the children and young people who attend the home. Individual care plans reflect the needs of the children and young people and guidance is in place to advise how these needs are to be met, this ensures a consistent approach to their care.

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Summary

The placement of permanent young people over the age of 18 poses a number of problems for the home. There are difficulties in matching sessions and meeting the diverse needs of all the children and young people, particularly when very young children attend the home. Adult services have not been proactive in identifying appropriate move on placements for these individuals and it has been left to the home to move this on. It is not in the best interests of the young people to remain living at this home, particularly when some individuals will not co-operate in efforts to promote their independence.

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Summary

There are no new requirements made at this inspection, although there is one outstanding from the last inspection relating to having permanent young people living at the home. A number of recommendations are made relating to polices and procedures. A recommendation from the previous inspection has not been met, this relates to having young adults living in the home when this is not in their best interests as they are not developing independence skills. The overall quality rating is good. This is an overview of what the inspector found during the inspection.

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Improvements since the last inspection

The home has addressed most of the requirements and recommendations made at the last inspection. There are robust recruitment systems in place to ensure that only suitable people are employed and these systems are monitored by the Registered Manager. There are adequate numbers of staff employed to ensure that the children and young people are cared for appropriately. There are plans to split the home to provide two homes on this site and carpets are to be replaced during this process.

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Improvements since the last inspection

Shifts are organised to ensure that staff involved in meal preparation are not involved in delivering personal care. A number of staff have received refresher restraint training and this 4 of 9 Inspection Report: SC032167 training is planned for the remaining staff. The local authority have agreed to amend the age range from birth to seventeen years to six to seventeen years.

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Helping children to be healthy

The provision is good. Young people are provided with healthy and nutritious meals. Children and young people's likes and dislikes are taken into consideration when menu planning. Care plans for meal times are in place advising staff how the individual takes their meals, for example, what cutlery and drinking vessels they use, whether food is cut up and what assistance is required. This ensures that there is a consistent approach to children and young people's mealtimes. For those young people who have a weight problem staff are proactive in ensuring that they have a healthy balanced diet that will help them to lose weight.

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Helping children to be healthy

As the majority of children and young people attend the home for respite care, parents oversee the health needs of their child. However, information is available on the nature of the disability and the specific health needs for each child and young person. For those young people who live at the home a Health Needs Assessment has been undertaken and health needs are clearly identified. A number of young people have seizures and care plans for the management of these seizures are in place for each child, but, these are not individualised and do not advise staff on how an individual may present pre and post seizure.

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Helping children to be healthy

Medication records are in good order, the local pharmacist undertakes a three-monthly audit of the medication records and stock and is available to offer advice to the staff team. Medication policies are in place, including one for the administration of medication whilst out on trips. The consent to the administration of emergency first aid and non-prescribed medication has been obtained from the person with parental responsibility. Staff are trained in the administration of Buccal Midazolam and gastric feeding, this training is undertaken for each child or young person to ensure staff know how this is to be performed in each case.

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Protecting children from harm or neglect and helping them stay safe

The provision is good. The home has an intimate care policy and staff are very aware of ensuring young people's dignity is respected. Staff endeavour to ensure that same sex carers deliver personal care and only designated staff undertake these duties. Care plans address young people's sexuality and encourage them to keep their bodies private.

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Protecting children from harm or neglect and helping them stay safe

For those young people who have communication skills they are encouraged to access children's rights to advocate on their behalf and the home works well with this organisation. Complaints are addressed appropriately. The home also received a number of compliments from families who have been very happy with the service provided.

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Protecting children from harm or neglect and helping them stay safe

Staff are aware of safeguarding issues and all staff have attended basic safeguarding training and a number of the team have attended a more in-depth course which has been well received. Staff encourage the children and young people to be aware of stranger danger and sex education is part of the school curriculum.

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Protecting children from harm or neglect and helping them stay safe

The home has an anti-bullying policy but none of the children and young people present this behaviour. None of the children and young people have the capacity to abscond. However, 5 of 9 Inspection Report: SC032167 there is not a policy in place to advise staff what action they should take in the event of a child or young person getting lost whilst out of the home.

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Protecting children from harm or neglect and helping them stay safe

The majority of young people do not present with challenging behaviours but where this is the case a care plan is developed to manage this behaviour to ensure that staff have a consistent approach. There are very few sanctions recorded and it is commendable that one sanction was for an individual who was behaving aggressively to staff and this did not result in a restraint. Staff work well with these young people to avoid conflict situations. One restraint has been recorded in the restraint book which was a safe hold to guide a young person away from a situation. Some staff have attended refresher restraint training and this is planned for the remainder of the team.

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Protecting children from harm or neglect and helping them stay safe

All staff have received fire training. Fire records are in good order with drills held regularly including during the night shift to ensure that all staff know what action to take in the event of a fire. There are good individual risk assessments in place identifying and minimising the risk. A number of other generic risk assessments are in place for activities but a number of these have not been reviewed.

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Protecting children from harm or neglect and helping them stay safe

Recruitment files were seen at the head office, these are in good order. There are robust systems in place to ensure only suitable people are employed in the home.

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Helping children achieve well and enjoy what they do

The provision is good. The home accesses a number of services to help meet the needs of the children and young people, for example, speech therapists, dieticians and manual handling co-ordinators. The young adults mental health service (YAMHS) will support the older young people, these sessions are kept confidential. The children and adolescent mental health service (CAMHS) is available to the staff team to advise on managing some behaviours.

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Helping children achieve well and enjoy what they do

Young people's files contain clear guidance to staff on some individual's vision, with strategies in place to promote the best set of circumstances that allows optimum sight. Children and young people's files also contain details of the individuals means of communication. Some young people have an independent visitor who will take them out.

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Helping children achieve well and enjoy what they do

For the children and young people who are living at the home and attend the home regularly Personal Education Plans are in place as appropriate. For those children and young people who receive respite, parents over see their child's education. There are good links with school with staff attending Special Education Need reviews and open evenings.

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Helping children achieve well and enjoy what they do

Staff rotas are planned to ensure that there is sufficient staff on duty to enable the children and young people to go out. The home has a minibus and they go, for example, to the sea side, ice-skating and bowling. During the summer there are play schemes which some individuals attend. Some young people go to the MENCAP youth club and attend disability sports activities. The home celebrates young people's birthdays and occasionally these are at local venues.

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Helping children make a positive contribution

The provision is good. 6 of 9 Inspection Report: SC032167 Care plans are in place clearly identifying the needs of the child or young person and setting out how these needs are to be met. The care plans address the daily routine of the individual showing how they present and how they get up in the morning, their personal care routine, meal times and how they go to bed. This ensures that there is a consistent approach to their care. Key workers also produce a three monthly progress report on each child and young person, recording their progress and development as well as updating the care plans.

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Helping children make a positive contribution

Child care reviews are held as appropriate. The local authority are in the process of reorganising how they conduct these reviews to enable young people and their families to have a more participatory roll in this process.

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Helping children make a positive contribution

The home continue to provide a service for young adults 18 years and over. The home has moved one of these individuals to an appropriate placement and have identified placements for the remaining individuals. The home works with families where appropriate to ensure that the move-on placement is able to meet the needs of the individual. Staff visit with family and the young person to offer support and consistency. For those young people who are reluctant to move staff are encouraging them to visit the home for a weekend to assess whether the home can meet their needs. The home endeavours to match young people when they attend the home to ensure that young people with similar needs attend together. However, this is somewhat compromised by having permanent young people living at the home.

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Helping children make a positive contribution

Children and young people are not offered a service at the home until an assessment has been undertaken to ensure that the home is able to meet their needs.

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Helping children make a positive contribution

Residents meetings are held regularly and the minutes of these meetings are posted on the notice board to ensure families know what has been discussed. Staff are patient and understanding with the children and young people to ensure that their wishes and feelings are heard.

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Achieving economic wellbeing

The provision is good. Pathway plans are in place for those young people who are moving on to adult provision. The local authority have been not been proactive in identify appropriate placements for these older individuals. However, the Registered Manager has liaised with family members and in most cases young people are moving to appropriate placements. Staff encourage young people to develop their self help skills.

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Achieving economic wellbeing

The home is well maintained and furnished to provide a homely environment for the young people. Bedrooms are personalised and appropriate beds are available following an assessment undertaken by the occupational therapist. Some bedrooms have hoists to facilitate moving and handing. Staff have created a pleasant lounge area in one end of the home to enable the permanent residents to have their own space if they choose. There is an extensive outside area for the children and young people to play or enjoy the fresh air.

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Organisation

The organisation is good. 7 of 9 Inspection Report: SC032167 There is a comprehensive Statement of Purpose describing the services offered, although there is not a clear staffing policy. The children's guide is child friendly and appropriate for the children and young people who attend the service.

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Organisation

The promotion of equality and diversity is good.

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Organisation

There are clear arrangements for the staff to deputise in the absence of the Registered Manager. All staff have either attained National Vocation Qualification at level 3 or are registered on this course.

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Organisation

There are sufficient staff employed in the home and there is a good deployment of staff to ensure that the children and young people are supervised and cared for. An individual is responsible for producing the staff rotas and when activities are planned appropriate staffing levels are in place.

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Organisation

The home has had a number of young people who have now reached adulthood which has created a number of difficulties in the home. Adult placements have been identified for these individuals and the home is working hard to ensure the transition is in the young peoples best interests. The Registered Manager is clear that the service will be a respite service in the future and will be resistant to any pressure to have permanent children and young people placed. The home will not be offering a service for babies and the conditions of registration has changed to six to 17 years of age.

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Organisation

The Registered Manager produces a monthly report on the home and undertakes a Schedule 6 monitoring exercise to ensure the home is functioning properly. The homes records are monitored by the line manager of the home.

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Organisation

Children and young people's files contain all the relevant information and are easy to follow.

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Statutory requirements

This section sets out the actions, which must be taken so that the registered person meets the Care Standards Act 2000, The Childrens Homes Regulations 2001 and the National Minimum Standards. The Registered Provider must comply with the given timescales.

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Due date Action Standard

1 September 2009 ensure that the home is conducted in such a way as to promote and make proper provision for the welfare of the children placed (Regulation 11(1)(a)).

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Recommendations

To improve the quality and standards of care further the registered person should take account of the following recommendation(s): • develop epilepsy protocols to advise staff how a child or young person may present pre and post seizure (NMS 12.2) • produce a policy and guidance to ensure staff know what action to take when a child or young person gets lost whilst away from the home. (NMS 19.1) 8 of 9 Inspection Report: SC032167 • review the risk assessments (NMS 26.3) • ensure the home's purpose serves the needs of the young people it accommodates and provides an environment that is supportive to each young person's development (NMS 23.1) • ensure the Statement of Purpose contains a staffing policy (NMS 30.2). 9 of 9 Inspection Report: SC032167

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