Children's Home run by Building Bridges Care Homes Ltd in St Helens

SC063284 Unique reference number 13 July 2009 Inspection date Elizabeth Taylor 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: SC063284

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Brief description of the service

The home is a large detached house situated in a residential area close to a town centre. Each young person has their own bedroom. There is a large garden to the rear and parking space to the front of the house.

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Brief description of the service

The home provides care for five young people of mixed gender with emotional and behavioural difficulties, between the ages of 11 to 17 years. The house is close to local shops, transport links and community resources. Three young people contributed to the inspection process.

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Summary

At this unannounced full inspection, all key standards were inspected. This is a satisfactory service overall with some good outcomes for young people.

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Summary

Young people benefit from a good standard of care and positive relationships with the staff team. There is an effective keyworking system whereby staff ensure young people are able to make informed choices and understand the consequences of their actions and decisions. Young people are supported to benefit from further education or training and to participate in leisure activities which increase their self-esteem and are enjoyable. They are provided with a range of facilities and support to improve their independence and prepare them for adulthood. The overall quality rating is satisfactory. This is an overview of what the inspector found during the inspection.

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Improvements since the last inspection

Two actions were raised following the last inspection. Both related to ensuring staff were aware of local procedures for referring concerns about young people's safety to the appropriate agency. Action has been taken to gain a copy of the local safeguarding children board procedures and staff are aware of these and the referral process. Contact details for the board are also readily available to staff. This ensures they can act promptly to keep young people safe. Six recommendations were made to improve practice in the home. All staff have received training in food hygiene. This ensures young people's meals are prepared and cooked safely, to promote their good health. The home was asked to ensure accurate records were maintained in respect of measures of control imposed on young people. Detailed records continue to be maintained but there is some confusion around the recording of restrictive measures which do not involve

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Improvements since the last inspection

holding young people. This recommendation remains valid. Action has been taken to ensure certificates are in place to show electrical and gas appliances are regularly serviced. This shows young people live in accommodation which is maintained in good order and promotes safety for the young people.

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Improvements since the last inspection

The home's recruitment and selection process has been revised to incorporate a robust vetting process. However, there remains a weakness in the vetting process for agency staff. The statement of purpose for the home has been revised. This provides accurate information for parents and other interested persons about how the home operates and the service it provides.

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Helping children to be healthy

The provision is good. 4 of 9 Inspection Report: SC063284 Healthy eating is promoted. Whilst young people are fully involved in planning the weekly menus, they are implemented flexibly. For instance, if young people choose to have a different meal to the one planned for that day, staff are happy to change the dish to their preferred choice or offer an alternative. Young people are advised about healthy eating and have lots of opportunities to be involved in food shopping and cook their own meals. Young people are able to make drinks and snacks, and drinking water and fresh fruit is readily available.

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Helping children to be healthy

Young people's current health care needs and details of their medical histories are outlined in individual health care plans. Records show staff work closely with different health professionals and local services to address young people's varied health needs. For example, the looked after children nurse regularly visits the home to meet the young people and advise them about their health care. Young people are also referred to specialist services, such as substance misuse advisers. This means young people are supported to learn how to keep themselves healthy.

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Helping children to be healthy

All staff are trained in the safe administration of medication. The home provides secure storage for items of medication, both prescribed and homely remedies. Accurate records are maintained in respect of medication brought into the home and disposed of. Individual medication administration records for young people are clearly maintained and show young people receive any necessary treatment. However, the specific time of administration of some medication is not always recorded. This is important to ensure the recommended daily dose is not exceeded.

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Protecting children from harm or neglect and helping them stay safe

The provision is satisfactory. Privacy, dignity and confidentiality are promoted within the home. The number and design of baths, showers and toilets ensure young people's privacy and dignity is upheld at all times. Information about young people is kept securely and staff respect young people's right to confidentiality.

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Protecting children from harm or neglect and helping them stay safe

The home maintains clear records in respect of compliments and complaints received from service users, their families and other stakeholders. Young people know about the formal complaints procedure, but say they prefer to tell staff about any concerns they may have, and that staff act quickly to resolve matters. The home has taken prompt action to address concerns about anti-social behaviour in the locality and the manager is working closely with other professionals to ensure young people living in the home are not unfairly associated with the difficulties.

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Protecting children from harm or neglect and helping them stay safe

Staff are aware of their role and responsibility in keeping young people safe. They have access to clear written child protection procedures and have completed training in safeguarding young people. This training is repeated on an annual basis to ensure staff remain familiar with the local authorities safeguarding procedure and the home's safeguarding policies. Young people feel able to openly discuss their behaviours which place them at risk of harm and care staff know how to act to keep young people safe from abuse.

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Protecting children from harm or neglect and helping them stay safe

Young people say any behaviour perceived as bullying is quickly addressed. Perpetrators are spoken to and control measures are imposed, if necessary, to reduce the likelihood of further incidents. Young people say these are effective in practice in stopping such behaviour.

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Protecting children from harm or neglect and helping them stay safe

The home's policy and procedure regarding young people going missing from care provides clear guidance for staff and is jointly developed with the local police force. Individual risk 5 of 9 Inspection Report: SC063284 assessments reflect young people's differing levels of vulnerability and age. Records show episodes of young people not returning to the home on time or going missing are responded to appropriately. Relevant people are kept well informed and professional meetings are convened to address concerns about persistent absenteeism by some young people.

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Protecting children from harm or neglect and helping them stay safe

Staff and young people share an understanding about what behaviours are acceptable and unacceptable in the home. An incentive scheme is used to encourage young people to behave acceptably. Young people receive appropriate sanctions when their behaviour does not meet the expected standard; they usually involve reparation for damage, or loss of privilege. All staff are trained in the safe management of challenging behaviour and there is a clear policy regarding the use and recording of physical intervention. However, recording in this area is confused. Entries in the restraint log do not involve staff actually holding young people. Rather, they show practical measures, such as, locking the kitchen door for a short period are used to enable an incident to be resolved quickly and safely.

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Protecting children from harm or neglect and helping them stay safe

Good attention is given to ensuring young people live in accommodation which supports their safety and well-being. Good attention is given to fire safety matters and equipment in the home is regularly serviced. Whilst records show regular drills are carried out, records do not show which staff or young people participate in them. However, all the young people confirm they have been instructed what to do in the event of a fire.

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Protecting children from harm or neglect and helping them stay safe

The home maintains suitable records to show staff are appropriately checked and vetted. A small number of agency persons have been deployed to work isolated shifts in recent months. Whilst information has been supplied by the agency as proof of their suitability to work with young people, details for one worker could not be found. This does not fully promote safety for young people and is inconsistent with the home's own procedures which promote a robust vetting process.

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Helping children achieve well and enjoy what they do

The provision is good. Records such as individual placement plans, risk assessments, health records and key working sessions demonstrate the level of individual support provided to each young person. Staff have a detailed knowledge of each young person and plans for their care. A keyworker system is effectively implemented in the home although records show all staff are actively involved in advising and supporting individual young people. Communication with other professionals and interested persons is good and staff ensure that all those relevant to the care of the young people are kept well informed about significant events and changes in young people's needs.

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Helping children achieve well and enjoy what they do

Staff promote the importance of education and help young people to gain and maintain placements. This is achieved through good key working systems and regular contact with schools, colleges and support agencies, such as Connexions. Young people have access to a range of resources to help with their studies, such as books and a computer. At the present time some young people are unsure about what further education or training they wish to pursue. Staff are working with them to ensure they are aware of the various options available to them and are supported to benefit from the opportunities available to them.

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Helping children achieve well and enjoy what they do

Activities are used to promote and develop young people's interests. Staff share their own hobbies and interests and this is successful in helping them to engage positively with some of the young people. Some of the young people have developed local contacts and friendships 6 of 9 Inspection Report: SC063284 though these are not always of a positive nature. Plans for young people to have a holiday during the summer vacation have not yet been finalised but they are fully involved in discussions and decision making.

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Helping children make a positive contribution

The provision is good. Young people have individual placement plans which reflect the level of guidance and support they need to enable them to develop and achieve. Written plans though are not always formulated in a timely manner. For example, plans to show how the home will care for a young person are not developed until some weeks after their admission. However, other records such as risk assessments, behaviour management plans and keyworking sessions show how staff act and care for young people, to promote their safety and well-being.

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Helping children make a positive contribution

Regular reviews of placement plans, both through the key worker summaries and statutory reviews, ensure progress is monitored and staff are aware of their responsibilities. Young people are aware of aspects of their placement plan, but do not routinely sign them or receive a copy.

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Helping children make a positive contribution

Contact with friends and family is promoted and supported. Parents are involved with the care of their children through regular contact from staff and encouragement to visit the home. Young people are encouraged to bring friends home though and reasonable by young people.

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Helping children make a positive contribution

Admissions to the home are generally conducted in a planned manner, which helps to prepare young people for the move. Young people say staff help them to settle by making them feel welcome. They confirm they receive a leaflet when they are admitted which explains how the home is run. Staff also check they understand the leaflet and answer any queries they may have.

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Helping children make a positive contribution

Young people are consulted about both their care and the general running of the home. Whilst young people generally choose not to meet on a regular basis as a group, other records show their views are sought and acted upon. For example, young people engage in regular key worker sessions and are involved in discussions about their behaviour both inside and outside the home and about suggestions for developments in the home such as food choice, activities and holidays. Young people are also involved in their formal review meetings and plans for their care.

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Helping children make a positive contribution

Relationships between staff are positive, structured and child-centred. Staff work well together to ensure they work consistently to support young people, who clearly feel comfortable with staff. For example, one young person said, 'They are good at looking after you and we are good at getting on with each other, and they are good at arranging activities. It is just like a family'.

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Achieving economic wellbeing

The provision is satisfactory. An independence training pack is used to enable staff to assess the young people's progress with life skills and to help develop such skills. This provides young people with a foundation for their adult life and supports their pathway plan. This means that the transitional arrangement is well co-ordinated. Young people have access to facilities in the home to develop practical daily life knowledge and skills. They also learn how to access different types of services which can provide continuing advise and support. Staff help to prepare young people by discussing their options and by ensuring they understand the possible impact of their choice and decisions. 7 of 9 Inspection Report: SC063284 The house is spacious and offers a range of rooms to relax, study and meet with friends and family. Communal rooms are well decorated and furnished and are homely in appearance. Each

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Achieving economic wellbeing

young person has their own bedroom, which includes a wash-hand basin. The rooms are decorated and personalised according to individual tastes. Young people are responsible for keeping their rooms clean and tidy as part of their independence plan. However, staff support them with this and make sure that the rooms are generally maintained in good order. Nevertheless, some remedial work is needed to raise the upstairs accommodation to the same good standard as downstairs. For example, repairs to wardrobes and to wall-plaster in one of the showers.

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Organisation

The organisation is good. The home's statement of purpose accurately reflects the service provided by the home. It provides parents and professionals with a clear description of how the home is managed and operates. Young people have access to a children's guide to the service which includes important information such as complaints, pocket money allowances and other day to day arrangements. Although reference is made to independent agencies and help-lines which advise and support young people, no contact details are provided to assist them in easily accessing such services.

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Organisation

The promotion of equality and diversity is good. Young people benefit from a stable staff team who have built up a good knowledge and understanding of young people's individual needs. Young people's placement plans are personalised to reflect their individual needs and they receive care which respects and promotes their identity and heritage.

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Organisation

Staff are well supported and trained. All staff hold recognised qualifications in caring for children which reflect their role and responsibilities; this exceeds the minimum standard. There are effective communication systems within the home and staff promote and practice an open, friendly and child-centred culture. Staff are generally deployed in numbers sufficient to provide safe and effective care. There is minimal use of agency staff to provide cover at times for annual leave or sickness. Overall, young people benefit from a staff team who communicate well and whose practice is consistent and supportive.

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Organisation

The report format in respect of monitoring the quality of service offered to young people has been revised. The Registered Provider continues to carry out visits to the home on a monthly basis and submits reports in a timely manner. However, they do not show young people are spoken with and not all significant records such as complaints and sanctions are checked on each occasion.

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Organisation

Young people have case records that contain all the information needed by staff to provide safe and effective care. The records are stored securely and young people are able to encouraged to contribute to the contents of the records though most choose not to do so.

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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. 8 of 9 Inspection Report: SC063284

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Due date Action Standard

7 August 2009 obtain for agency staff, before they start work at the home, evidence of their suitability to work with young people (Regulation 26) 14 August 2009 ensure that there is an up to date placement plan for each child or young person accommodated at the home (Regulation 12).

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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 records of medication dispensed to young people include the times of administration (NMS 13) • ensure menus reflect both planned and actual meals provided to young people (NMS 10) • ensure measures of control are recorded in the appropriate log (NMS 22) • ensure fire records show which staff and young people are involved in monthly drills (NMS 26) • ensure placement plans are developed in a timely manner for young people newly admitted to the home (NMS 2) • ensure records show each child's placement plan is regularly reviewed (NMS 3) • ensure minor repairs are effected to bedrooms and shower rooms to maintain a good standard of accommodation overall (NMS 24) • ensure the external monitoring system regularly assesses elements of care such as complaints and measures of control (NMS 32).

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