Children's Home run by Cheshire West and Chester Council in Cheshire West and Chester

SC034849 Unique reference number 19 August 2009 Inspection date Karen Forster Inspector Key Type of Inspection

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24 November 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: SC034849

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Brief description of the service

This local authority children's home is a purpose built, single-storey building that provides short break care for up to six children with disabilities. It is appropriately adapted to address the needs of children and young people with physical and learning disabilities. Single bedrooms are available for each child. The home is situated on the outskirts of a town development.

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Brief description of the service

There were six young people staying at the home at the time of the visit, who all contributed toward the inspection according to their needs.

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Summary

This visit is an unannounced key inspection including all of the 'Every Child Matters' outcome areas, plus an additional area of organisation. The service is good service which promotes the outcomes of the short stay users well. The home's strengths include the staff's keen insight into the needs of individual young people and positive care practice that addresses both personal care needs and the emotional well-being of children. The areas identified for development include the review programmes related to both the young people's placement plans and the quality of care within the home. 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 three recommendations raised at the last inspection have all been suitably addressed by the service. The individual with parental responsibility has provided signed consent for staff to administer first aid treatment and prescribed medication. The young people's manual handling assessments are available in their records within the home. The photographic and textual content of the home's Statement of Purpose and individual placement plans, have been shared with families for their comment and agreement.

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Helping children to be healthy

The provision is good. The young people enjoy a well balanced and varied menu during their stay in the home. Individual food preferences and any personal allergies are well recorded and closely followed by catering staff. This means that tasty food is suitably prepared and well presented, in line with any special dietary needs of individuals. Clean, well maintained specialist eating aids are provided wherever required. Young people with support needs at meal times receive sensitive and discrete help at very appropriate levels.

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Helping children to be healthy

Young people's current health care needs along with strategies to address the same are outlined in basic health care plans for young people using the service. This means that care staff are aware of presenting needs relating to either clinical, dental or ophthalmic fields. The individual with parental responsibility has provided signed consent for house staff to administer first aid treatment and prescribed medication. Pain relief medication is also prescribed by the young people's General Practitioner, which means all stored medication can be safely administered to young people with no adverse reactions. 4 of 9 Inspection Report: SC034849 Medication storage and administration within the home meets the standards. The service provides a secure cabinet for drugs provided within prescribed containers by the young people's families. Medication administration records are very clearly maintained by two staff at each

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Helping children to be healthy

administration. This means that young people are offered medication in line with their medical prescription and staff on subsequent shifts know when medication has been offered and administered.

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Protecting children from harm or neglect and helping them stay safe

The provision is good. The home's personal care procedures promote the privacy and safety of young people. Staff are careful to respect young people's privacy when supporting individuals to complete continence programmes, which are discreetly completed within the group. Personal data relating to young people is stored securely in line with internal policy and the standards.

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Protecting children from harm or neglect and helping them stay safe

The home maintains a good procedure for the collection of compliments and complaints from service users. There is a pictorial communication tool used within one to one contact between young people and staff from an independent advocacy service, which captures the compliments and concerns regarding the service from individuals. Where complaints are lodged with the service, the recording system indicates that the issue is suitably recorded by staff and followed up by senior staff within the service. This means that complaints from young people and stakeholders are given the appropriate level of attention.

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Protecting children from harm or neglect and helping them stay safe

Children’s safeguarding procedures are good, with young people’s welfare a priority. Staff confirmed that they are aware of their responsibilities within the home’s child protection procedures and some have received refresher safeguarding training. The local authority's safeguarding procedures are available within the home to complement the home's clearly written safeguarding policies.

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Protecting children from harm or neglect and helping them stay safe

There is an anti-bullying policy maintained within the service, where the stated aim is to support the victims of any bullying. Daily records and manager's quality checks within the home indicate that there is no history of bullying for young people within the service.

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Protecting children from harm or neglect and helping them stay safe

The home's protocol regarding young people going missing from care suitably reflects the dependency levels of the service users. The home's policy is clear, meets the standards and senior staff are familiar with the content. This means that any episodes of missing young people would be followed up with suitable responses, reflective of the gravity of the situation.

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Protecting children from harm or neglect and helping them stay safe

Young people using the service are helped to appreciate when they present acceptable behaviour, through the use of meaningful positive rewards. This means that young people receive consequences that they value and which encourage the presentation of acceptable behaviour. The consequences of any unacceptable behaviour are in line with the standards and suitable for the group, for example a brief loss of privilege.

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Protecting children from harm or neglect and helping them stay safe

The home's policy regarding physical intervention meets the standards, however not all staff have received instruction in the safe control of challenging behaviours. The preferred model of physical intervention includes de-escalation and only uses restraint as a last resort, which meets the standards and helps to keep young people safe. The recording of restraints within the home meets the standards. A written account containing all of the elements required by the standards, is completed for episodes of physical intervention within the home. 5 of 9 Inspection Report: SC034849 The home ensures that the environment young people use for their short stays is safe and free of hazards. The home's mechanical hoists and ceiling hoists are regularly serviced, to keep the equipment safe for users and operators. The staff group are suitably trained in moving and handling techniques, which means non mobile young people can transfer between mobility

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Protecting children from harm or neglect and helping them stay safe

aids safely. Copies of manual handling assessments and risk management statements are in place and provide safe moving procedures for relevant individuals. The home's checks on utilities within the home, including oil and electrical supplies and fire systems are in order and meet the standards.

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Protecting children from harm or neglect and helping them stay safe

The home maintains suitable evidence for all of the clearance checks for new staff, as required by schedule two to the regulations. This means that young people are cared for by suitably cleared staff.

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Helping children achieve well and enjoy what they do

The provision is good. Young people receive a personalised care service which is very suitable to their needs and promotes their abilities. Staff work hard to follow the parent-led care information provided during the initial stay. This provides a continuity of care and maintains consistent relationships between the home's carers and the young people's families. This means that all changes in presented needs are consistently passed onto the home's staff from families, to enable a good quality of care to be provided to individuals. The level of both verbal and written communication between staff in the home is sound and means that staff are consistent in their approach toward individual young people. Therefore young people enjoy consistent, safe care programmes that optimise their abilities and help to further develop their social and self-help skills.

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Helping children achieve well and enjoy what they do

Young people, their families and staff within the home work well with professionals from within the respective school networks. This helps individuals to access education and therapy programmes suitable to their needs. This therapy could include speech and language input; physiotherapy or occupational therapy programmes. The home provides good support towards the young people's next day in school. For example, checking all mobility equipment is suitable for use in the school day, which could include wheelchairs and slings. This means that young people are well equipped for their school day after their stay within the service.

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Helping children make a positive contribution

The provision is satisfactory. The strengths and needs of all the young people using the short stay service are well assessed, and copies of the placing social worker's core assessment are in evidence. Most of the home's placement plans reflect the individual's respective assessment, however, isolated documents have minor gaps where full information regarding mobility aids is not included. The placement plans, for example, tend to provide broad plans for individuals with no medium or long term care objectives. This makes it difficult for key staff to plot the progress of individuals, and to recognise the valuable contribution that the residential element makes toward the overall package of care.

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Helping children make a positive contribution

Key staff within the home discuss and review the care provided to young people and the outcomes for individuals. The care of individuals, however, is not consistently independently reviewed, and in some cases statutory review frequencies are not being met. An annual review programme falls below the statutory frequency of six monthly reviews and means that outcomes 6 of 9 Inspection Report: SC034849 for young people are not sufficiently checked out with young people, their families, key carers from the home and social workers.

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Helping children make a positive contribution

Young people spend short periods within the service, maintaining close contact with their families throughout. This is evident by the home's log of telephone contact between key staff with family members and the written accounts of communication between the service and home. This promotes a partnership culture of care provided by families and the service, where young people enjoy a consistent approach by all carers.

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Helping children make a positive contribution

The young people's records include detailed pre-admission information, including core assessments and some files include placement information records. Internal risk management strategies are agreed pre-admission, providing the home's staff with a wealth of relevant information to inform their safe care of individual young people. A positive level of contact between the service and young people and their families is developed prior to the first programmed stay. The home's records indicate that prospective young people visit the home before their first over night stay, which means that they are prepared and informed during the initial admission to the short stay service.

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Helping children make a positive contribution

There are suitable strategies within the home for the involvement of young people in their placement plans and daily choices during their stays. Young people's views on their service are collected through a programme of one-to-one sessions between young people and staff from an independent advocacy service. Individuals are actively encouraged, enabled and supported by all staff within the home, to contribute toward their daily care and to make choices throughout their stay.

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Achieving economic wellbeing

The provision is good. Young people using the service are provided with opportunities to develop self-help skills, which provides individuals with a foundation for their adult life. There is evidence that those young people eligible to use adult services, have commenced their transition toward this goal. Relevant planning data is included within the home's records, which means that young people and key staff are informed of the move and can suitably prepare for the change programme.

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Achieving economic wellbeing

Single bedrooms are provided for young people, which are well decorated and equipped suitably for each stay. Risk assessed and well maintained specialist equipment, such as hoists and bed sides are provided where necessary, according to the needs of the occupant. The bathroom is equipped with very suitable aids and adaptations, including ceiling tracked hoists and a specialist toilet unit. The young people and staff have the use of communal areas that are comfortable, domestic in style and well maintained. Due to the nature of the short stay service the resident group alters daily, along with their needs for recreational space. The communal areas afford a good level of choice of recreational areas, including two lounges, dining room, soft play area, sensory room and a garden area.

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Organisation

The organisation is good. The home provides a clearly written statement of purpose which meets the requirements of schedule one to the regulations. This means that clear and current information relating to the service, is available for stakeholders and interested parties. The circulation of the document to 7 of 9 Inspection Report: SC034849 the families of service users demonstrates the consultative nature of the service, as the registered manager has invited comment on the content of the statement of purpose.

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Organisation

The promotion of equality and diversity is good.

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Organisation

Young people benefit from the staff group's well developed understanding and sensitive approach to their additional needs. Young people are able to use mobility and continence aids discreetly and safely within the service, which helps them to be as independent as possible. The majority of shifts in the home are staffed by female only staff teams, thus reducing the male role model for the young people. The quality and detail of parent led referral forms, enables carers to personalise the living environment for young people. This personalisation ensures that their individual identity and heritage needs are promoted, however the young people's records are unnecessarily colour coded according to the gender of the subject.

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Organisation

The establishment’s staffing levels are suitable for the numbers of young people and their care needs.

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Organisation

The home provides a clear procedural guide for staff, which outlines the authority's policies regarding such issues as safeguarding; personal care, medication and moving and handling. Training largely matches these specialist areas, however there are some gaps in the behaviour management training programme for staff.

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Organisation

A good proportion of the care staff are qualified with a National Vocational Qualification (NVQ) at level three. This means that young people are cared for by competent staff, and the abilities of most of the care staff have been verified by an independent body. The service benefits from the supervision of a well qualified and experienced, part time Registered Manager.

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Organisation

The home's induction programme is mainly policy based and local to the home. Whereas this does prepare staff for shifts within the home, it does not reflect the wider arena of residential childcare and working within the field of disability. There is no evidence of a competence element to the programme, such as the induction standards for care staff provided by the Children's Workforce Development Council.

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Organisation

The quality of care is robustly monitored by the Registered Manager, and the resulting reports include feedback from young people, their families and social workers. This means that internal and external feedback is used well to inform a regular review of care, and information is then utilised to improve practice and enhance outcomes for young people. The comprehensive nature of this quality review programme, means that the shortfalls within the authority's checks on the quality of care in the home have negligible impact on the young people. The quality monitoring programme completed by representatives of the local authority, falls below the requirements of regulation 33. The shortfalls occur both in the frequency of visits and in the provision of completed reports to the home.

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Organisation

The service maintains two well indexed files, that contain most of the young people's personal information as required by schedule three to the Children’s Home’s Regulations 2001. Isolated files do not contain the social worker's placement information record. This means that in some cases the level of written information shared between social worker and the home, has to be supplemented with verbal exchanges to inform the care of the young people. 8 of 9 Inspection Report: SC034849

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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

31 October 2009 ensure that the care of young people is reviewed at statutory frequencies and that records are maintained of the same (Regulation 12) 31 October 2009 ensure that the Responsible Individual's quality monitoring programme is completed and recorded in line with the regulations (Regulation 33) 31 October 2009 ensure that young people's records include all of their personal information, in line with the requirements of schedule three to the regulations. (Regulation 28)

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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): • ensure that all staff are trained in the management of challenging behaviour (NMS 22) • provide placement plans for young people that include measurable care targets and all relevant data regarding mobility aids (NMS 2) • maintain as far as possible a balance of male and female care staff within each shift (NMS 30) • provide a competence based induction programme for new staff, such as the induction units provided by the Children's Workforce Development Council (NMS 31) • review the use of different colour coded files for the records relating to female and male service users. (NMS 35) 9 of 9 Inspection Report: SC034849

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