Children's Home run by Nottinghamshire County Council in Nottinghamshire

SC036726 Unique reference number 19 January 2010 Inspection date Sharon Treadwell 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: SC036726

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Brief description of the service

This home is operated by the local authority and provides a residential service for eight young people, aged 7 to 18 years, and a short break service for four young people, aged 4 to 18 years. The home additionally has an emergency bed on the short breaks unit. All the young people have severe learning disabilities and challenging behaviours. A large house, set in pleasant and safe grounds, is divided into two designated areas to accommodate the two aspects of service provision. Both areas provide attractive and accessible communal rooms, play areas, bedrooms and bathroom facilities. The home is in a rural area close to a large town. Good local shopping and recreational amenities are close by.

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Summary

This is an unannounced key inspection and all key national minimum standards have been fully inspected.

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Summary

The young people accommodated at this home have recently taken part in a nationwide consultation project being conducted by Ofsted. The project is seeking to improve the capacity for young people with communication difficulties to contribute their views to the inspection process. Five young people returned questionnaires and the views expressed are reflected within this report.

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Summary

A confident, competent, highly motivated and well trained staff team ensures that young people's physical, emotional and social needs are fully met and that positive outcomes are well promoted. Robust placement planning and close working relationships with young people's families, their placing social workers and associated health and education professionals ensures that young people receive consistent care to promote social and life skill development. Young people and their families value the professional and dedicated support they receive from this home.

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Summary

Only one shortfall has been identified in respect of records retained in relation to fire drills conducted at the home. The overall quality rating is outstanding. This is an overview of what the inspector found during the inspection.

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Improvements since the last inspection

The home was judged to be outstanding following the previous inspection and no shortfalls were identified.

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Helping children to be healthy

The provision is outstanding. Young people's health needs are robustly prioritised within the home. Young people's records contain clear and comprehensive health information. Many young people have complex health care needs and high medication requirements. There are sound working relationships with young people's families, with the local pharmacy and with health professionals to ensure that young people's specific medical conditions are closely monitored and that they consistently receive any necessary treatment in a timely way. Appointments are made for young people in 4 of 9 Inspection Report: SC036726 residential care to visit dentists and opticians as needed. Many of the young people have no verbal communication and their individual records clearly detail how they demonstrate that they are in pain or feeling unwell to support staff in recognising that medical attention is needed.

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Helping children to be healthy

All staff complete regular first aid training and medication management training. Staff have a clear understanding of medication protocols and there are robust recording systems for the receipt and administration of both prescription and non-prescription medicines. Managers retain excellent oversight of staff practice in relation to the administration of medication and any inconsistencies or shortfalls are quickly addressed. There are robust emergency protocols in place, for example, where young people are subject to seizures, and dedicated training is provided where this is relevant in relation to specific medicines required to manage these.

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Helping children to be healthy

There is very good promotion of healthy eating. Young people and staff have been involved in growing potatoes and vegetables in the garden. All food is home cooked on the premises and meals incorporate lots of fresh fruit and vegetables. The menu is displayed for young people on colourful picture cards. There is a vegetarian option available every day and special diets, such as gluten free or carbohydrate free, are well catered for. The cook has a list of each young person's likes and dislikes and takes account of these when compiling the menu. The staff ensure that young people receive appropriate support with any dietary issues, such as encouragement to lose weight. Dieticians, or other professionals, are involved wherever necessary.

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Protecting children from harm or neglect and helping them stay safe

The provision is outstanding. Sound staff recruitment practices and robust monitoring of visitors to the home ensure that young people are kept safe. The manager retains appropriate records to confirm that all required checks are undertaken before staff commence employment.

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Protecting children from harm or neglect and helping them stay safe

Staff have a sound awareness of young people's need for privacy. The design of the home provides good opportunities for young people to be engaged in individual activities. Residential action plans give very good attention to how young people's personal care needs are to be met in a sensitive manner. The plans demonstrate that, wherever possible, young people are supported with their personal care by staff of the same gender. Bullying is rare although staff are fully aware of the potential for young people's unpredictable, and sometimes aggressive, behaviours to impact on other young people. High staffing levels and the close supervision young people receive promote the safety of all young people. Security at the home is high, because young people's learning disabilities render them particularly vulnerable, and all external doors are fitted with coded locks. Absences without authority are extremely unlikely, but good

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Protecting children from harm or neglect and helping them stay safe

individual protocols are in place, within young people's residential action plans, to identify how such incidents should be managed.

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Protecting children from harm or neglect and helping them stay safe

Management and staff demonstrate an excellent understanding of the particular vulnerability of the young people they care for. All staff receive regular child protection training, specifically related to working with young people with learning disabilities. Generally the young people accommodated have no verbal communication and staff have received training in a wide range of alternative communication systems such as Makaton, picture systems and British Sign Language. Young people's residential action plans fully clarify their preferred method of communicating. The care taken to ensure that staff are able to communicate confidently with 5 of 9 Inspection Report: SC036726 young people ensures that they are well equipped to pick up on any worries or concerns young people may have whilst at the home.

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Protecting children from harm or neglect and helping them stay safe

Young people, accommodated on both units, display some extremely challenging behaviours. Residential action plans fully detail how young people's individual behaviours present and are best managed. The plans are regularly reviewed and updated and there are good systems for ensuring that any changes to young people's plans are shared with all staff. Each young person has a comprehensive risk management plan, which is structured in such a way as to prioritise both their personal safety and that of other young people and staff. The use of restraint, breakaway techniques and sanctions is very well recorded. Staff receive regular training to ensure that such interventions are used appropriately and safely and there is excellent management oversight of these records.

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Protecting children from harm or neglect and helping them stay safe

There have been two complaints received since the previous inspection. Both complaints were from parents and were managed in a timely and appropriate manner. Records clarify that both complainants were fully satisfied with the home's response. The home has received a large number of compliments, and expressions of appreciation, from young people and their families, such as 'thank you for always being there when we really needed someone'.

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Protecting children from harm or neglect and helping them stay safe

Robust systems are in place to ensure that young people, staff and visitors are kept safe. A range of extremely comprehensive risk assessments are in place to promote this. Wholly appropriate insurance cover is in place and regular health and safety checks are undertaken in relation to the premises generally and electrical and fire safety equipment. One member of the senior staff team has designated oversight of health and safety issues. A comprehensive fire safety risk assessment, completed by the local authority fire safety advisor, is in place but is out of date. The home has, however, completed its own fire safety risk assessment and this is acceptable, though less comprehensive. Fire drills are held at regular intervals but are always held on the same day of the week. This system has the potential to exclude some young people, particularly those accommodated on short breaks, from ever being included in a fire drill. No

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Protecting children from harm or neglect and helping them stay safe

record is currently retained detailing which young people and staff are involved in fire drills. Although all staff receive fire training, and have a good understanding of how they will ensure all young people are safe, the failure to retain a record of those involved in fire drills leaves the home unable to demonstrate that all young people have full awareness of the emergency evacuation procedure.

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Helping children achieve well and enjoy what they do

The provision is outstanding. Staff demonstrate a very good knowledge and understanding of young people individual care and support needs, and a strong commitment to promoting positive outcomes for all the young people in their care. Careful and comprehensive care planning and robust risk assessment ensures that staff are able to support young people to develop their identity and independence through positive social interaction and enjoyable leisure experiences. Young people are seen very much as individuals and receive a high level of individualised support. There is robust management oversight of young people's individual care plans to ensure a consistent focus on achieving identified aims and objectives.

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Helping children achieve well and enjoy what they do

Staff work closely with young people's families and with education and health professionals to promote consistent approaches. Young people attend various special schools and staff are in regular contact with their teachers and always attend educational meetings. Young people 6 of 9 Inspection Report: SC036726 who stay at the home for short breaks have their education organised by their families, who retain primary responsibility, but staff support their educational attendance and achievement well.

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Helping children achieve well and enjoy what they do

Young people are very well supported to access a wide range of activities. Some of these, such as camping, canoeing and horse riding, would be difficult for families to facilitate due to the high supervision requirement necessitated by young people's presenting behaviours. The manager details that care provided in the respite unit is more focused on play and leisure activities to enable young people to gain maximum benefits from their short stays. A wide range of in-house activities is available to all young people, with good access to books, games, art and craft materials, television and educational toys, as well as a snoezelen, equipped with excellent sensory equipment, on each unit. The home has good outside play space with a 'secret garden' providing young people with really good sensory experiences. Staff are commendably innovative in providing young people with a whole range of new opportunities and experiences.

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Helping children achieve well and enjoy what they do

Staff have developed a resource booklet, shared with families, to detail holiday and activity venues, which have taken special account of the needs of young people with learning disabilities.

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Helping children achieve well and enjoy what they do

Young people speak very highly of the activities they are able to be involved in but say 'I can join in if I want but don't have to'. The activities young people highlight as the best are: going to the pub; swimming; being with staff; trips out; cinema visits; DVD; cooking activities; eating the food; walks. Asked what they do not like about the home only one issue was highlighted by a young person who commented that they did not always like the other young people.

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Helping children make a positive contribution

The provision is outstanding. There is very good communication between the staff and young people's families, particularly where young people are accommodated on the short breaks unit. The schedule for short breaks is prepared for the year to allow families to identify any specific requirements and to plan ahead. Good care is taken to ensure that the mix of young people promotes positive experiences and good opportunities for socialisation.

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Helping children make a positive contribution

All placements are made through the local authority inter-agency panel and are preceded by a core assessment of the young person's needs. Residential action plans, developed by the home, contain comprehensive information about young people's very specific learning disabilities and their care needs and identify very clear and achievable placement objectives. Staff have good access to information about all the young people, through the local authority's electronic recording system, and implement sound placement recording systems. Very few of the young people placed are able to communicate their views verbally but they are very positively supported to express their views through their relationships with the staff. The staff very clearly describe themselves as 'advocates for the young people' and as 'responsible for improving outcomes for them', saying 'that's what we are passionate about here'. Young people are well supported

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Helping children make a positive contribution

to understand plans for their care, and how their needs will be met, by good use of pictures, signs and symbols around the home. A monthly newsletter is also circulated to young people's families to keep them updated about developments within the home and provide information about the various activities their children have been involved in.

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Helping children make a positive contribution

Young people say that they feel safe at the home and they feel listened to. Most say that they have a say in how they are cared for. Young people commented: 'it's nice here'; 'I like Minster View'. 7 of 9 Inspection Report: SC036726 The staff have, on occasions, done some excellent outreach work with young people and their families. One case in particular was highlighted during the inspection where it had been inappropriate for the young person to be accommodated at the home because of separation anxieties. The staff team are clearly skilled and keen to extend their capacity to provide such a service but appreciate that this has staffing implications.

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Achieving economic wellbeing

The provision is outstanding. The internal accommodation, provided at the home, defies the external institutional appearance of the building. On each of the units there are several small, cosy rooms, which have a very homely and comfortable feel. The accommodation is maintained and decorated to an exceptionally high standard and furnishings and the standard of cleanliness are first class. The management and staff pride themselves on the fact that 'we never stand still'. There is a clear demonstration that changes are regularly made to meet the specific needs of young people accommodated, for example, a 'teen room' has been developed for older children and is equipped with a dart board, a football table and electronic games console. A room, in the short breaks unit, is currently being converted to provide a play room for younger children to reflect the changing nature of referrals. All young people have single bedrooms and these are well

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Achieving economic wellbeing

personalised. The selection of furniture and fittings reflects sound awareness of young people's profound learning disabilities and a commendable focus on promoting their safety whilst also reflecting a commitment to maintaining a domestic style environment. Each unit has a display board with photographs showing the young people which staff are on duty and there are several photographs of young people, engaged in various activities, around the building. There is a warm, welcoming feel to the home, which is clearly appreciated by young people's families.

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Achieving economic wellbeing

Young people receive appropriate allowances and are encouraged to save towards special trips. Residential action plans demonstrate that the staff actively promote the development of self-help skills and encourage and support all young people to achieve their full potential in all areas. Most of the young people will never have the capacity to be wholly independent and preparation for moving young people on generally involves staff in working with the local authority transitions team to identify appropriate adult services to provide continuing support or care. Whilst management and staff reflect that 'the interface between children's and adult services is not always brilliant', they are able to describe some very positive transitions that have taken place with young people. Many of the families, of young people who have moved on, retain contact with the home and keep staff informed about the young people's progress.

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Achieving economic wellbeing

Some of the young people, currently accommodated, are being helped to learn to shop and cook and staff recognise and celebrate all young people's achievements, however minor.

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Organisation

The organisation is outstanding. The home's Statement of Purpose provides a clear statement of the services provided and robustly identifies the aims, objectives and ethos of the home. There is a strong, knowledgeable and committed management team and a caring and competent staff team who demonstrate a sound understanding of the issues involved in caring for young people with learning disabilities.

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Organisation

The promotion of equality and diversity is outstanding. The staff team represents a good mix in terms of gender, culture and age ensuring that young people have access to wide ranging positive experiences. The staff demonstrate a commendable commitment and dedication to 8 of 9 Inspection Report: SC036726 ensuring that the primary care needs of young people receive a high priority. Co-operative working with families and associated professionals promotes the progressive development of young people's social, emotional and life skills. Socially unacceptable behaviours are robustly challenged. There is a commitment to ensuring that all young people, despite their disability, are given access to the same opportunities as able bodied young people. Some innovative activities are designed to raise young people's awareness of the multi-cultural nature of society. Young people have taken part in role playing how couples get married in various cultures. This

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Organisation

involved young people playing English, African and Indian bride and groom with receptions featuring food from each of these cultures. A wide range of festivals is celebrated in a manner that young people can really enjoy, with Halloween providing the opportunity to sample bug slime punch, witches fingers and marshmallow ghosts. All staff undertake equality and diversity training and the home has developed a good range of multi-cultural resources.

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Organisation

Staffing levels are wholly adequate to ensure that young people's needs can be appropriately met. Regular agency staff are utilised to maintain staffing levels where necessary. The role of domestic staff, in maintaining high standards of care, is well recognised by managers and these staff are highly valued as members of the team. Staff meetings and formal supervision provide forums for staff to raise issues of concern and are used well by managers to promote consistency in the way in which care is provided to young people. Staff feel that their opinions are listened to and valued and say that managers are approachable and have an 'open door policy'. Staff are provided with excellent training opportunities and are able to access courses relevant to the work they do and which promote personal development. There is demonstrated commitment to supporting staff to complete national vocational qualification training and senior staff are

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Organisation

encouraged to undertake management training. This is a well managed home where there are sound systems for monitoring performance and good delegation of responsibility to senior staff. Monitoring visits, on behalf of the local authority, are made at monthly intervals and reports detail that all elements of practice are carefully examined.

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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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Recommendations

To improve the quality and standards of care further the registered person should take account of the following recommendation(s): • retain records to demonstrate that all young people are aware of the emergency evacuation procedures for the home, including those for use at night, in case of fire. (NMS 26.7) 9 of 9 Inspection Report: SC036726

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