Children's Home run by Institute of Integrated Systemic Therapy in Norfolk

SC065792 Unique reference number 8 December 2009 Inspection date Dorrit Andrews Inspector Key Type of 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: SC065792

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Brief description of the service

This children's home is operated and owned by a registered charity and provides medium to long-term therapeutic placements for psychologically traumatised young people. It can accommodate up to four young people, of either gender, aged between 11 and 16 years.

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Brief description of the service

The home is a six bedroom, two storey property with surrounding gardens. It is situated on the outskirts of a small village but within easy reach of local amenities in local market towns and a nearby city.

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Summary

This was an unannounced full inspection and all key standards were inspected. Four young people currently live at the home, three of whom contributed to the inspection.

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Summary

All of the outcome areas were inspected. Being healthy, staying safe, enjoying and achieving, positive contribution and organisation have been judged as good. Economic wellbeing has been judged as satisfactory.

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Summary

Young people receive a good level of care and individualised support. The health needs of young people are responded to well and access to health care professionals is arranged as necessary.

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Summary

Education is valued and staff are committed to supporting young people in their learning and development. Young people report that they are able to talk to staff, they are regularly consulted about day to day matters in the home and that staff listen to them.

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Summary

Staff receive appropriate induction training and have access to additional training opportunities and consultants to support them in their work. Management systems are in place in relation to staffing and the monitoring of the home.

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Summary

Records and documentation are generally well maintained overall. However, a small number of entries to restraint and non-prescribed medication records do not provide full details as required.

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Summary

The recommendation raised at the last inspection has been addressed. 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

At the last inspection the provider was asked to ensure that the pages of the sanctions' record book are numbered. This matter has been attended to.

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Helping children to be healthy

The provision is good. Young people receive a balanced diet and are able to help with preparing meals and occasionally shop for food. Records of menus are maintained and compiled in consultation with young people. Meal times are social occasions and young people are encouraged to serve themselves 4 of 9 Inspection Report: SC065792 and develop their social skills. Young people report that they are able to make drinks, have access to fresh fruit and always have a choice of food.

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Helping children to be healthy

The health care of young people is promoted and they receive health care and guidance as necessary. Health plans are compiled and good records are kept showing that dentist, doctor and optician appointments are made as required. Where young people are anxious and refuse treatment, staff continue in their efforts to arrange appointments and to allay any fears young people may have. Young people report that they feel able to discuss health matters with staff and that staff respond positively. Such matters include diet, personal hygiene and keeping safe.

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Helping children to be healthy

Regular exercise and the pursuit of individual interests and activities is encouraged to promote young people's physical fitness and to enhance their emotional well-being. Examples of activities currently chosen and engaged in by young people include football in the community, Girl Guides, swimming and badminton.

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Helping children to be healthy

Written guidance is in place for staff regarding medication and health matters. These are discussed during induction training and regularly discussed during team meetings. Medication is securely stored and systems are in place for the monitoring and auditing of records. Staff receive first aid training and written permission is sought from those with parental responsibility regarding the administering of first aid and non-prescribed medication. Records are kept of accidents, treatment and medication. Records are maintained to a good standard overall. However, a small number of recorded entries for non-prescribed medication do not record the dose administered. This has the potential to impact on the health care of young people.

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Protecting children from harm or neglect and helping them stay safe

The provision is good. Young people's privacy is respected as far as possible whilst having regard to their safety. For example, staff are expected to knock on doors but will enter in an emergency if a young person is judged to be at risk. Staff handle confidential information appropriately and are sensitive to gender issues when dealing with young people of the opposite sex. Written guidance is in place for staff regarding privacy, confidentiality and safe care practices.

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Protecting children from harm or neglect and helping them stay safe

Young people are aware of who they can turn to when they have a problem or a complaint and are provided with details of the home's complaint procedure and that of their placing authority. Details of help line telephone numbers are also made available. Good records are made of complaints and young people report that they are taken seriously and are listened to. No complaints have been received by Ofsted in relation to the home.

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Protecting children from harm or neglect and helping them stay safe

Policies and procedures are in place to promote and safeguard the welfare of young people. Staff receive child protection training as part of their programme of induction and are familiar with safeguarding procedures within the home. Refresher training for designated staff has been applied for and good links are maintained with the local authority, social workers and young people's schools. Keeping safe issues are discussed with young people and they report they feel safe at the home.

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Protecting children from harm or neglect and helping them stay safe

Young people do not identify bullying as a problem at the home and there is clear understanding of what to do if someone is making them unhappy. Staff work hard to promote tolerance and respect for one another and are vigilant in their supervision of young people and any group 5 of 9 Inspection Report: SC065792 activities. Individual behaviour plans identify potential conflicts and these are linked to handling strategies and discussed during one to one sessions with young people. There are regular community meetings where there are open discussions regarding the impact of behaviours on others.

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Protecting children from harm or neglect and helping them stay safe

Guidelines are in place for staff regarding the action to take if a young person goes missing. There have been two recorded incidents since the last inspection. Records are made of the circumstances of incidents and appropriate parties are informed.

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Protecting children from harm or neglect and helping them stay safe

The management of behaviour is based on establishing positive relationships with young people, communicating clear expectations and developing strategies of support. Staff receive regular behaviour management training including de-escalation techniques and the use of physical intervention. Behaviour and risk management plans are included in each young person's placement plan and may include specific guidance for staff in relation to the use of restraint.

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Protecting children from harm or neglect and helping them stay safe

There have been a number of incidents of physical intervention since the last inspection to protect young people and others from harm or to prevent serious damage to property. Records are maintained of incidents and young people's comments are sought and recorded following the use of physical intervention. However, a small number of records sampled do not contain a full description of events. This has the potential to impact on the welfare of young people. Appropriate records are kept of sanctions. Young people consider the use of sanctions to be generally fair and report that they are implemented in response to 'serious stuff' and include being grounded, missing out on a trip or helping to put something right.

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Protecting children from harm or neglect and helping them stay safe

Risk assessments are carried out in relation to the premises, grounds and activities and a system of review is in place. Records show that regular safety and servicing checks are carried out to fire, electrical and gas installations. Fire safety training is provided to staff, a fire risk assessment is in place and staff and young people are familiar with fire evacuation procedures. These measures contribute to the safety of young people and staff.

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Protecting children from harm or neglect and helping them stay safe

Robust procedures are in place for the recruitment and checking of staff. Records of visitors are maintained and proof of identification is requested where appropriate. These practices reduce potential risks to the welfare of young people living at the home.

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Helping children achieve well and enjoy what they do

The provision is good. Young people receive a good level of individualised support in line with their needs and wishes. A team of clinical consultants support the work of the home and meet regularly with staff to discuss individual placement plans and offer clinical supervision. Staff encourage and support young people to be involved in discussions about their daily lives and planning for their future. A link worker system is operated and young people identify strongly with this. However, young people can and do approach any member of staff with worries and concerns.

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Helping children achieve well and enjoy what they do

Young people report that staff support them in their individual activities outside of the home, are 'very good at listening' and enable them to contribute to meetings when they find this difficult. Community meetings and link worker sessions are used to address any issues within the group and to promote the involvement of all young people in the daily life of the home. 6 of 9 Inspection Report: SC065792 Education is valued and staff are committed to supporting young people in their learning and development. For example, staff take and collect children from school, maintain regular contact with schools and attend school events. All young people are in receipt of education and either attend mainstream school or have a personalised education programme. The transition from junior to senior school has been difficult for some young people and staff work hard to provide practical support to enable young people to maintain school friendships during weekends and

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Helping children make a positive contribution

The provision is good. Admissions to the home are planned and tailored to individual circumstances wherever possible. Professionals involved with young people are invited to discuss placement requests with the staff at the home in addition to providing a range of written information including a detailed social history. Where appropriate, parents are invited to visit. Staff meet young people before they are introduced to the home and, wherever possible, introductory visits take place to help prepare the individual and the existing group of residents. Young people can bring personal possessions with them and they are encouraged to personalise their room. Memorable events and achievements of a young person's stay at the home are recorded and young people are supported to move on in a planned way wherever possible.

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Helping children make a positive contribution

Placement plans detail how young people's needs are to be met on a day to day to basis. Sampled plans are clear and comprehensive, regularly reviewed and updated. Staff encourage young people to participate in placement meetings and reviews. Where this proves difficult, link workers will advocate on the young person's behalf. Young people are supported with their individual contact arrangements and these are appropriately recorded. Any restrictions on contact for the protection of a young person are made clear.

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Helping children make a positive contribution

Regular meetings provide opportunities for young people to contribute ideas and suggestions in relation to the day to day running of the home. The meetings are also used to consult with young people and to seek their views on matters including activities, menus, social events and décor. Recent changes have been made to the use of one of the communal areas as a result of listening to young people. Parents and other significant people are also consulted and their opinions sought regarding key decisions affecting young people's lives.

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Achieving economic wellbeing

The provision is satisfactory. The daily life of the home provides some opportunities for young people to develop skills with the support of staff. For example, helping with cooking, general tidying of bedrooms and shopping for clothes. Tasks within the home are shared between male and female members of staff and emphasis continues to be placed on the nurturing role of male and female staff; this promotes positive role modelling.

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Achieving economic wellbeing

The interior of the home provides domestic-style accommodation that is clean and maintained to a satisfactory standard. Each young person has their own bedroom which they are encouraged to personalise with accessories, posters and personal effects. Communal areas offer opportunities for a choice of play and recreational activities. There are sufficient bath, toilet and shower facilities for young people which are separate to those of staff. 7 of 9 Inspection Report: SC065792 The exterior of the property is showing signs of wear and tear. Some windows have been replaced and further work is planned after the winter. The extensive rear garden and play areas are well maintained and provide young people with opportunities for organised and 'free' play.

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Organisation

The organisation is good. The home's Statement of Purpose is readily available and was updated in April 2009. Further updates are scheduled to reflect recent staff changes. Separate documentation is provided for young people.

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Organisation

A programme of induction is provided to new staff to familiarise them with the daily working of the home. They are subsequently guided and supported in their work by a system of regular meetings, individual supervision and external consultants. These support systems are greatly valued by staff in relation to their link worker roles and in terms of their own personal development. Staff also have access to continuing and post qualifying training in therapeutic childcare through the organisations' university linked worked-based training programme. Personal development plans are maintained and a record of staff training is kept. Comprehensive policies and procedures are also in place, are regularly reviewed and made available to all staff.

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Organisation

Staff report that their work had been particularly demanding during recent weeks and some staff had undertaken extra duties to maintain adequate levels of support and supervision during this challenging time. Effective action has been taken by the management team by providing additional support and stability at the home. A manager is now permanently based in the home with designated responsibility for day to day management rather than sharing their time between two homes as was previous practice. Staff report that the action taken is having a positive impact on the home and that adequate staffing levels continue to be maintained. Young people are made aware of who is on duty and which staff will be sleeping at the home overnight. Cover arrangements are in place when staff or management are absent or on holiday and back up support is reported to be available through the home's on call system.

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Organisation

Good systems are in place to monitor the care of young people and the performance of the home. Copies of Regulation 33 visit reports and Schedule 6 monitoring reports are held on file and made available for inspection. The manager's monthly monitoring reports are also used for ongoing evaluation purposes and to focus discussions with staff and young people where appropriate.

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Organisation

The provision of equality and diversity is good. Staff acknowledge the individuality of young people in their care and are committed to meeting individual needs. Tolerance and respect for one another is promoted together with the involvement of all young people in the life of the home. The pursuit of individual interests outside the home is encouraged and young people are supported to negotiate their place in the wider community.

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Organisation

Young people's needs, development and progress are recorded. Each young person has a case file which is securely stored. Files sampled were well ordered and maintained. 8 of 9 Inspection Report: SC065792

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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 February 2010 maintain a full record of measures of control used, as set out in Regulation 17

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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 the dosage of medication is recorded in all cases (NMS 13.2). 9 of 9 Inspection Report: SC065792

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