Coniston House

SC379123 Unique reference number 16 July 2009 Inspection date Julian Parker Inspector Key Type of Inspection

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20 January 2009 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: SC379123

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Brief description of the service

The home offers placements for up to five young people who may have a combination of mental health, psychological, emotional or complex care needs that present challenging behaviour. The service is designed to offer medium to long-term care placements. The home's programme of care incorporates a structured balance of education, recreation and therapeutic interventions tailored to meet individual needs.

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Brief description of the service

Care is provided in large detached, family-style house in an urban location. It has the benefit of easy access to the comprehensive range of recreational and leisure amenities in the local expanding new town. The house has been modernised and refurbished to offer a very good quality, spacious living environment with individual rooms for young people.

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Summary

This was a full unannounced inspection that concentrated on the 25 key National Minimum Standards. Three young people are living in the home, were present during the inspection and participated in some of the process. The inspection focussed on areas relating to health needs, keeping young people safe, education and how individual support is provided. The inspection looked at how young people are consulted, how care is planned and how staffing and management arrangements support the operation of the home.

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Summary

The home is judged as satisfactory. Young people receive an individualised care package that is sufficiently flexible to adapt to their changing needs and keep them safe. Access to education is promoted using an independent agency. The registered person provides direction and leadership to the relatively small staff team. Staff are clear about their roles and consistent in carrying out their responsibilities to address the needs of young people in their care.

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Summary

This inspection identifies the need for improvement in some of the home's health related, recruitment and organisational records to fully confirm compliance with the National Minimum Standards. 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

The last inspection raised three actions and one recommendation. Measures have been taken to address most of them.

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Improvements since the last inspection

The registered person has ensured that Health Plans have been compiled indicating how the medical and health needs of young people are being addressed and recorded. Confirming the safety of young people using the homes behaviour management systems has also been improved by the more systematic recording of measures physical restraint and sanctions being introduced.

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Improvements since the last inspection

Some improvement has been made to the detail recorded in the homes Statement of Purpose regarding staff numbers, however, this inspection requires further detail of staff experience to be included. 4 of 9 Inspection Report: SC379123 The regularity and recording of young people's meetings, including in-house community meetings has been formalised confirming that young people can talk about the care they receive.

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Helping children to be healthy

The provision is satisfactory. Young people are provided with choice and encouraged to contribute to menu planning and preparation at the home. Staff support young people with information that helps their understanding of what constitutes healthy eating and a balanced diet. The home has a cook and staff receive training in basic food hygiene.

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Helping children to be healthy

The health and psychological needs of young people are identified and recorded through the use of formal health plans. Staff at the home ensure that the health, psychological and medical needs of young people are practically addressed in an age-appropriate and focussed manner. Young people are registered with local health professionals and attend health appointments with staff support. The home provides the young people with good, informed advice, guidance and support with healthy living, medical, emotional and sexual health matters consistent with their assessed needs and level of understanding. This is achieved by broad consultation including individual young people, their parents, a wide range of health professionals and placing authority social workers.

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Helping children to be healthy

Staff are trained in first aid and the administration of medication, however, in house policies for the timely disposal of unused medication has not always been followed in practice.

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Protecting children from harm or neglect and helping them stay safe

The provision is satisfactory. The welfare and physical safety of young people living at the home is promoted by staff following the company's policies and procedures. These have been developed to comply with regulatory requirements and good practice in areas of child protection that include countering bullying, effective behaviour management, dealing with missing persons and safeguarding children. Procedures conform with the requirements of the Local Safeguarding Children Board. The company provide statutory training that informs and equips staff to care for young people safely. In this way young people are protected by staff who understand their safeguarding responsibilities.

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Protecting children from harm or neglect and helping them stay safe

Young people's privacy is respected. Personal information about them is confidentially and securely stored and staff are sensitive with how they communicate about young people with other professionals. Young people have access to a telephone that they can use in private. They are provided with their own lockable bedrooms and made aware of the particular circumstances in which these may need to be searched.

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Protecting children from harm or neglect and helping them stay safe

Young people know how to raise any concerns or complaints. Although the home has formal policies and procedures, concerns are usually effectively addressed long before they become a complaint. No formal complaints have been made since the home started operating. Young people have access to independent representatives such as their social workers or advocates from the children's advocacy organisation Voice. The home's complaints policy is summarised in the young person's guide. 5 of 9 Inspection Report: SC379123 Young people are encouraged to develop socially acceptable behaviour and respond positively to the boundaries set by normal living. Staff are trained in behaviour management and physical intervention. Young people are aware of the expectations being made from them prior to moving to the home. The staff team understand the range of challenging behaviours individual young people may present and how these may be effectively addressed. Direct and positive

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Protecting children from harm or neglect and helping them stay safe

interpersonal relationships between staff and young people allow relatively low staffing levels to operate the home safely and promote a relaxed homely environment. All behavioural incidents are evaluated by the home's Manager. The views and opinions of young people are always taken into account in relation to any sanction to improve the transparency and effectiveness of staff practice.

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Protecting children from harm or neglect and helping them stay safe

Staff confirm their awareness of potential dangers to young people through risk assessing all aspects of safety in the living environment, for example, the risk from fire and hazards that include risk from individuals behaviour and activities. This helps to ensure that young people are kept safe.

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Protecting children from harm or neglect and helping them stay safe

There are effective procedures in place for the monitoring of visitors to the home. The company's recruitment and selection process indicates that while the policy for appointing new staff is thorough and include the need for a Criminal Records Bureau (CRB) check, the additional checks have not in all cases been robustly applied leaving potential shortfalls in the process that confirms staff working with children are fully competent and fully vetted.

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Helping children achieve well and enjoy what they do

The provision is good. Young people are cared for by a staff team who demonstrate a good understanding and awareness of child development and how to help young people understand and moderate some of their challenging behaviour. The home looks after young people who have the need for a safe, facilitating, community-based environment that provides consistency of support, positive adult nurturing, explicit behavioural boundaries and in some cases access to mental health resources.

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Helping children achieve well and enjoy what they do

The home aims to enhance young people's self-confidence and practical abilities in accordance with their care and placement plan. Young people are assisted to access both in-house and community based activities that help develop particular interests and skills, promote self-esteem and are age-appropriate. The staff team try to stimulate young people's positive awareness of gender issues, diversity, inclusion and tolerance both within the home and the wider community.

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Helping children achieve well and enjoy what they do

Young people are assisted by care staff to comply with any imposed statutory orders and improve their own potential by accessing external services appropriate to their specific care needs. The home facilitates young peoples access to a company-based therapy team that can address psychological or mild mental health related issues.

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Helping children achieve well and enjoy what they do

To assist young people to achieve educationally upon placement at the home young people are assessed by NT&AS (National Teaching and Advisory Service) as a time limited, interim measure while an appropriate full-time local educational placement is commissioned. Education is provided by one-to-one tuition and guided study within a wider bespoke curriculum. Placing authority Personal Education Plans support this form of intervention confirming that the education of school age young people is receiving appropriate levels of attention. 6 of 9 Inspection Report: SC379123

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Helping children make a positive contribution

The provision is good. Admissions to the home are comprehensively assessed and well planned between placing authorities and the provider. Young people are invited at an early stage to contribute their views about moving into the home. Care planning is effective because young people are provided with an in-house Placement Plan, that identifies the purpose of the placement and how the placing authority's formal care plan can be achieved. Young people are encouraged to contribute to the contents and aims of their plan. The progress of placement plans is kept under review, formally by statutory Looking After Children (LAC) reviews and informally every fortnight by the home's own reviewing procedures. Proactive planning and consultation with individual young people helps in the achievement of the placement aims.

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Helping children make a positive contribution

Placement plans are discussed by the staff team regularly to ensure that they can accurately reflect the care being provided and record those changes considered necessary to improve how care is delivered. Recording follows the Every Child Matters outcomes format.

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Helping children make a positive contribution

Young people are practically supported to maintain contact with their families where this is permitted by the arrangements detailed within their care plans. These plans make explicit the authorised arrangements for contact between young people, their family, friends and professional workers such as social workers. In keeping with the young people's plans the owning of a mobile phone and unsupervised visits can be goals confirming trust and self-responsibility.

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Helping children make a positive contribution

Young people are supported and encouraged to express their views and opinions about their life in the home. The young persons guide provides information about the advocacy services available to them if they need to speak to someone independently. Young people are expected to attend daily community meeting and regular Children's meetings, with their own agenda, to specifically discuss their own issues.

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Achieving economic wellbeing

The provision is satisfactory. The home provides care for young people in a renovated, large detached family house. The home's location is within easy reach of the town centre retail complex and has convenient access to local recreation, leisure and further educational facilities that can assist a young person to integrate into the wider community.

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Achieving economic wellbeing

The large detached property provides ample, homely, and generally well-maintained accommodation for young people. The home includes two reception rooms, a spacious lounge, five young people's bedrooms, a kitchen, utility, dining room, two bathrooms, WCs on both floors, staff office and a staff sleep-in room. There is an extensive conservatory offering year round recreation space. The home is decorated and furnished to a good standard providing young people multiple areas for relaxation, recreation, education and a degree of privacy. The garden provides sufficient outdoor private green space and is separated from safe, off-road parking for vehicles by a fence and locked gate that increases the homes domestic security.

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Achieving economic wellbeing

Where age appropriate, preparation is made for young people to eventually leave care by helping them practise and acquire the skills needed for adulthood as a component part of their everyday home routine. Life skills are learnt through participation with staff involved with the task of running the home, such as shopping, cooking and undertaking some daily household chores 7 of 9 Inspection Report: SC379123 such as tidying personal bedrooms and being supported to attend meetings arranged by the Local Authority Leaving Care Team. Pathway Plans are compiled but have not always been signed to young people to confirm their agreement.

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Organisation

The organisation is satisfactory. The Statement of Purpose for the home includes the majority of the information prescribed by Schedule 1 of the Children's Home Regulations. Further detail relating to staff qualification is required to fully confirm the operational adequacy of the home. There is a Children's Guide that provides a useful source of information for young people placed at the home.

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Organisation

Young people living at the home are supported with every aspect of their daily living by the home's team of competent and trained staff. Staff show commitment to providing safe and consistent care. The experienced and qualified Registered Manager and newly appointed Deputy Manager support staff with day-to-day guidance and access to professional development opportunities. Staff have attended induction and all statutory training to help them provide care specific to young people's particular needs. The home is committed to meeting NVQ requirements with a stable staff team.

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Organisation

The staff rota confirms the complement of staff in the home. The rota effectively covers all shifts and night duty with both waking and sleeping in staff. Shortfalls in the home's rota are currently covered by in-house staff. The arrangements for safe one-to-one work with young people remain subject to constant review but have not been fully addressed by individual risk assessments to ensure both young people or staff safety.

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Organisation

The registered person has a process to monitor the operational efficiency and quality of care being provided by the home. Monthly monitoring through the use of a Regulation 33 visitor have recently been introduced to confirm that the home is operating within the scope of its Statement of Purpose however as the Registered Manager is also the provider operational monitoring is continuous. Young people's feedback to regulation 33 visits add a service user dimension to this process.

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Organisation

The promotion of equality and diversity is good. The young people living at the home receive an individualised service in a home chosen to provide a bespoke package of care fitting to individual age, ability and potential risk. All staff display a good knowledge of the young people they are working with, including their cultural and disability background, which helps ensure that holistic needs are being addressed as far as is possible. The home has developed explicit policies and procedures promoting equality diversity in all aspects of their service for children from differing backgrounds and cultures.

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Organisation

Young people's individual case files are stored and arranged in a manner that is accessible to the staff team whilst retaining confidentiality. Case recordings would be more effective if they were always comprehensively recorded, dated and signed off by managers. Young people are made aware of the contents of their files and know they can request access to them should they need to. 8 of 9 Inspection Report: SC379123

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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

13 August 2009 ensure the registered person's guidance on the disposal of unused medicine is implemented in practice and in a timely manner Regulation 21(1) (NMS 13.10) 13 August 2009 obtain for all staff, before they start work at the home, all the information set out in Regulation 26 including appropriate personal references Regulation 26(6) (NMS 27.1) 13 August 2009 obtain for all staff, before they start work at the home, all the information set out in Regulation 26 and address any concerns within a recorded interview process Regulation 26(6) (NMS 27.2) 13 August 2009 employ sufficient staff for the running of the home taking into account the needs and behaviour of the children and young people. Where one member of staff is on duty at any one time ensure a recorded risk assessment has been carried out, identifying any likely risks to children staff and others Regulation 25(1) (NMS 30.5) 13 August 2009 include in the Statement of Purpose details of the current staff

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Due date Action Standard

group, their roles and qualification. Reg 4(1) Schedule 1 (5) (NMS 1.2).

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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 an Impact Risk Assessment indicating how the home may impact on the referred young person and the young person on the existing residents is recorded (NMS 5.7) • encourage young people to sign file copies of their Pathway Plan (NMS 6.4) • ensure that all required detail under schedule 3 is contained within young peoples case files (NMS 35.2). 9 of 9 Inspection Report: SC379123

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