Children's Home run by Keys Care Limited in Norfolk

SC370949 Unique reference number 12 October 2009 Inspection date Sharon Treadwell 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 10 Inspection Report: SC370949

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Brief description of the service

The home is a large detached house, with four bedrooms, located on the outskirts of a rural village. The home is able to accommodate three male or female young people ranging in age from 10 to 16 years. Although rurally situated, the home is close to a large town and is located only 30 miles from a major city centre.

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Brief description of the service

All young people have single bedrooms, there is separate sleeping accommodation for staff on duty at night and there are adequate bathroom and toilet facilities. Communal facilities include a kitchen/dining room, lounge and utility room on the ground floor and 'the den' on the first floor, which is used for craft work, homework and for young people needing individual time. The den is sometimes used for education if young people are out of school and for any therapeutic work undertaken with young people by the provider organisation's therapy team.

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Summary

This unannounced key inspection of the home reviewed the home's capacity to meet all key national minimum standards. Three young people are currently accommodated and all participated in this inspection to some degree.

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Summary

Young people are provided with very individualised care by an enthusiastic and committed staff team. There is an open and welcoming atmosphere at the home and relationships between staff and young people appear sound. Placement planning is robust and written plans cover all aspects of young people's health, education and welfare needs. The manager of the home exercises good leadership and this is valued by the staff. The staff team have time for young people, promote improvements in their behaviours and attitudes and value their achievements.

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Summary

Currently, admissions to the home do not always appear to be being made in accordance with the Statement of Purpose. There have been a number of emergency, short term placements during the last eight months and insufficient attention is being given to the potential impact of such placements on other young people who are in long term placements at the home. Such placements have the potential to seriously disrupt the behaviour of young people in long term placements and destabilise them. 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

During the previous key inspection the manager's limited involvement in the recruitment process, combined with lack of access to recruitment documents, made it impossible for the home to demonstrate safe recruitment. No new staff were recruited between the key and interim inspections making it impossible to assess whether this shortfall had been appropriately addressed. The manager confirms that she is now fully involved in recruitment of staff for this home and sound records are now in place to demonstrate that this process is safe and appropriate.

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Improvements since the last inspection

One recommendation was made during the previous inspection and this related to the home's Statement of Purpose not incorporating all the required information. The document has been fully reviewed and updated and is now clearer and more accessible. However, there is still 4 of 10 Inspection Report: SC370949 insufficient clarity about the policy and procedure with regard to emergency admissions to the home. Staff try hard to create a homely domestic environment but young people's often disruptive and unpredictable, and sometimes aggressive, behaviours result in regular instances of structural damage at the home, which make this very difficult.

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Helping children to be healthy

The provision is good. Very robust health care plans are in place for all young people accommodated at the home and these are regularly reviewed and updated. Young people are strongly encouraged to have their annual looked after children medical and staff ensure that appointments are made for these to take place. Staff are diligent in ensuring that young people are appropriately registered with local doctors and actively encourage them to visit the dentist and optician regularly. The home's Statement of Purpose details that it provides 'therapeutic residential care' and this is supported by ready access to the provider organisation's team of specialists, who are able to undertake individual assessments if placing authorities commission them. Some young people are reluctant to engage in direct work with therapists and, in these cases, necessary work may be undertaken by staff guided by the qualified therapist. The therapist visits the home once a month in a

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Helping children to be healthy

consultancy role and meets with individual key workers to discuss specific work as well as with the staff team to talk about group dynamics. Staff value this input in promoting the therapeutic element of care.

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Helping children to be healthy

Signed consent to medical treatment is in place for all young people to ensure that staff are able to source essential medical care in a timely way. No young people are currently taking regular prescription medication but, where a course of medication has been prescribed, such as antibiotics, appropriate records have been retained of receipt, administration and disposal. The home has lockable storage for medicines and staff undertake regular audits of stock held. Where young people are judged responsible enough to administer their own medicines, such as skin creams and inhalers, appropriate written risk assessments have been completed to support these judgements.

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Helping children to be healthy

Young people are involved in compiling the menu each week and are encouraged to become involved in the weekly shop and in preparing meals. The menu reflects a well balanced, healthy diet with good variety, such as pasta and fajitas, and plenty of fruit and vegetables. The range of activities available to young people promotes an active lifestyle.

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Protecting children from harm or neglect and helping them stay safe

The provision is good. There is careful selection and vetting of staff working with the children in the home and there is monitoring of visitors to prevent children being exposed to potential abusers. Young people's placement plans are organised under the Every Child Matters headings. The staying safe section records that the staff have talked through the complaints process, spoken with them about how bullying will be challenged and about what will happen if they go missing from the home and have talked about things like appropriate dress code within the home. Young people say that they feel safe and well cared for. Young people's privacy is respected by staff and room searches are only undertaken when the safety of staff or young people is thought to be at risk, such as concern for fire setting. Appropriate records are retained of any room searches made. Bullying is not considered to be an issue within the home currently but it is a regular item on

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Protecting children from harm or neglect and helping them stay safe

5 of 10 Inspection Report: SC370949 the agenda for the young people's meeting because it is an issue of concern within young people's schools.

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Protecting children from harm or neglect and helping them stay safe

The home has robust safeguarding procedures and all staff undertake appropriate training. Designated safeguarding officers, within the provider organisation, are detailed in information on the wall in the staff office for ease of reference. All staff display sound awareness of their notification responsibilities should a child protection concern arise. Two recent incidents, which could potentially have constituted child protection concerns, were quickly referred by the staff for full investigation and were appropriately notified to Ofsted.

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Protecting children from harm or neglect and helping them stay safe

Appropriate systems are in place to report and record unauthorised absences and these are extremely infrequent. Most of the young people accommodated at this home have complex and unstable care histories and the potential to display some extremely challenging and disruptive behaviours. All young people have a behaviour management plan detailing the potential triggers for adverse behaviour and highlighting some of the strategies likely to diffuse behaviours when they arise. For example, tactical ignoring or use of humour in order to avoid the need for physical restraint. It is a demonstration of the effectiveness of these strategies that there has been only one physical intervention recorded since the previous inspection. All staff have received appropriate restraint training and the deputy is a qualified trainer in positive handling techniques. Each young person's positive handling plan details the preferred holds,

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Protecting children from harm or neglect and helping them stay safe

should restraint be required. The home completes a bullet point summary to clarify young people's daily routines and presenting behaviours, which is useful to inform relief or agency staff completing occasional shifts.

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Protecting children from harm or neglect and helping them stay safe

Individual risk assessments are robust and detail how the risks posed, by young people's presenting behaviours, are safely managed. These risk assessments are regularly reviewed and updated to reflect any improvement or deterioration in behaviour. All relevant insurances and health and safety checks are in place and staff are diligent in completing weekly checks on fire safety equipment, regular checks on water temperatures and in ensuring that young people are fully aware of the fire evacuation procedure. A drill is undertaken whenever a new young person is admitted to the home and evacuations routinely involve night time drills. The home has actively involved the local fire service in working specifically with young people who are admitted with a fire raising history. This work is crucial in raising such young people's fire safety awareness and in promoting the safety of all those living at the home.

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Protecting children from harm or neglect and helping them stay safe

Young people say that they fully understand how to complain if they are unhappy. Although no complaints have been made at the home the staff have supported some young people to raise complaints in school and records have been retained, in the complaints folder, of the responses received. The home additionally retains a compliments folder and some very positive comments have been made by the placing social workers of young people: 'I feel yourself and the staff are very professional in every way' and 'you have done your best with X, working with him to put in boundaries and consequences and acting in his best interests.' Young people too, have made some very positive comments about their placements: 'this placement is the only one I have actually adored; I actually bonded with you lot.'

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Helping children achieve well and enjoy what they do

The provision is good. All young people receive dedicated individual support from their key worker sessions. These sessions are held regularly, are well recorded and demonstrate that young people are actively 6 of 10 Inspection Report: SC370949 engaging with staff at the home. Relationships between staff and young people are observed to be mutually respectful and staff demonstrate a sound knowledge of young people's very individual care needs. Staff are observed to be enthusiastic in engaging with young people and to have time available to involve them in conversation and activities.

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Helping children achieve well and enjoy what they do

Young people are strongly supported and encouraged to engage with education. Many of the young people, referred for placement at this home, have exceptionally disrupted education histories and are provided with high levels of individual support to promote their educational achievement. Most young people at the home are enrolled in a local special school, owned by the provider organisation, and their sometimes violent and aggressive behaviours can prove challenging to manage. Staff have established sound working relationships with education staff to promote young people's continuing attendance when behavioural issues have caused extreme concern. Young people's records contain copies of individual education plans and statements of special educational needs, where appropriate, and staff monitor the completion of personal education plans and endeavour to ensure that the home receives a copy. Some young people

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Helping children achieve well and enjoy what they do

are making good progress and have been supported to obtain places on college courses and on work experience. There is very good staff recognition of young people's preferred leisure interests and young people are being supported to access the local go-karting track regularly, at the moment, since this is the favoured pastime. Staff also encourage young people to try new activities and support young people to join local groups, such as the sea cadets, if they are interested.

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Helping children make a positive contribution

The provision is satisfactory. The Statement of Purpose describes this as a 'medium to long term residential home' and details that 'most placements will be planned'. Since the interim inspection in March 2009 there have been three young people admitted to the home as emergency admissions and the longest of these placements was seven weeks. Two young people, accommodated at the home, are in long term, stable placements and these emergency, short term placements, generally of young people in crisis, are extremely destabilising for them. Young people in long term placements have displayed resentment and antagonism towards the others and records demonstrate that there have been behavioural consequences for all young people. Written records, in the home, note some admissions as 'directed referrals' from the provider organisation, indicating that there is insufficient opportunity for the manager and staff to consider the potential negative impacts

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Helping children make a positive contribution

on existing residents and to adequately prepare those existing residents for a new admission. Staff say that each new admission prompts a 'revision of the pecking order' for the young people. The manager always completes a written impact risk assessment in relation to new admissions but, when a young person is admitted as a 'directed referral', in an emergency, consideration of potential impact is often irrelevant. The manager, and many of staff at the home, have considerable residential experience and are competent to manage a range of challenging behaviours but wide scale emergency placements, of short duration, do not fit with the home's stated aims and objectives.

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Helping children make a positive contribution

Placement planning, for all young people who become accommodated at this home, is timely and robust. All aspects of young people's care needs are addressed well. Some young people have had comprehensive psychological assessments completed, since admission. All young people have sound individual placement plans, which reflect the stated aims of their placing authority care plan and are supported by daily living plans. These plans identify clear routines 7 of 10 Inspection Report: SC370949 in respect of waking, bedtime, meal times, education and the meeting of religious and cultural needs. Young people's care is also well informed by written health care plans, positive handling plans and contact plans, which clarify the frequency of family contact and how it will be facilitated. Some young people are placed a long way from their families, for personal safety reasons, and staff ensure that regular contact arrangements are well facilitated. Young people

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Helping children make a positive contribution

are also well supported, by the staff, to retain contact with their home area. Placement plans are compiled under the five Every Child Matters outcome headings and there is good, clear reference to how positive outcomes are being promoted in each area. Plans reflect achievable goals for young people and realistic target dates are set for their achievement.

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Helping children make a positive contribution

The home works co-operatively with placing social workers and staff strongly encourage and support young people to make written submissions to their looked after children reviews as well as attending to make a personal contribution. Young people confirm that they have sound relationships with staff at the home and staff reflect a genuine concern for the young people's safety and welfare and positive pride in their achievements. Young people have ample opportunities to voice their opinions through regular, recorded individual sessions and through weekly scheduled young people's meetings. Young people's meetings always have a clearly stated agenda reflective of issues raised by young people and those staff wish to raise with young people.

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Achieving economic wellbeing

The provision is satisfactory. Young people receive weekly pocket money and clothing money and all are supported and encouraged to open a bank account. The young people are involved in household tasks such as shopping, cooking and keeping their rooms tidy. Only one young person showed the inspector his bedroom but other young people said they had been able to decorate their bedroom in colours of their choice and were happy with them. The home is clean and tidy and staff demonstrably work hard to create a homely and welcoming environment for the young people and for visitors. Young people's often disruptive and unpredictable and sometimes aggressive behaviours result in regular instances of structural damage at the home. Young people have a tendency to take their frustrations out on fixtures and fittings. Recently flooding, resulting from damaged radiators affected the young people's bathroom and the hall. Both rooms are

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Achieving economic wellbeing

without floor covering and some areas need repainting. Some external doors are poorly fitting and doorbells at the home are not functioning. The manager details that many minor repairs are now undertaken immediately by staff, such as replacing door handles. A maintenance request has been lodged for replacement flooring and this is likely to be fitted next week. The lounge is attractively decorated and furnished and very homely. The den is well decorated and a new computer is ready to be installed once staff feel more confident that it will be treated respectfully.

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Achieving economic wellbeing

The home utilises the provider organisation's independence training folder, which requires young people to demonstrate the progressive acquisition of necessary independence skills, verified by their key worker. Although none of the young people currently accommodated is old enough to have a pathway plan, some have already begun to complete the independence programme. Demonstration of the specified skills leads to the award of bronze, silver, gold and platinum certificates. Those young people working through the folder are achieving well. The staff are pro-active in raising the profile of pathway plans and have already raised, at a looked 8 of 10 Inspection Report: SC370949 after children's review, the requirement for planning to begin for a young person who is only 15.

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Organisation

The organisation is good. The Statement of Purpose details that young people will only be admitted in an emergency 'when the placement is clearly identified as likely to be medium to long term'. As detailed within this report, this is clearly not happening currently. The home's policy and procedure, in respect of emergency admissions, is not clearly stated enough in the statement or is not being fully clarified with placing authorities. The statement does provide some good information about the services provided to young people and the aims and objectives of the home. the young people's guide provides good information about what they can expect from the home.

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Organisation

The promotion of equality and diversity is good. Young people are highly valued, by the staff, as individuals and their particular needs are clearly identified and demonstrably being met. Staff recruitment, since the previous inspection, has brought better a better gender balance within the staff team and young people are now benefiting from regular access to positive male role models. The home has obtained a copy of an equality and diversity handbook and DVD, used by the provider organisation's schools, and intends to use this material to promote positive discussions in young people's meetings. Where young people require specific skin and hair products, these have been appropriately sourced by the staff. Staff say that they try to always adopt a non-judgemental approach with the young people they care for.

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Organisation

The Registered Manager of the home is fully qualified and has a range of relevant experience in working with challenging young people. There is a stable staff team, sufficient in number to meet young people's care needs, and they promote a positive and welcoming atmosphere in the home.

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Organisation

Young people's supervision requirements are clearly identified at the start of their placements and, for example, if young people's care plans identify a one-to one staffing requirement appropriate staffing levels are put in place. A deputy manager and two senior staff provide cover in the manager's absence. The provider organisation has a demonstrated commitment to enrol staff for national vocational qualification training as soon as they have completed their induction. All staff are currently receiving regular formal supervision at the required frequency. The manager says she receives good support and supervision from her operational manager. The home is well staffed at present and is not utilising agency workers at all, which promotes consistency for young people. Staff are receiving appropriate training opportunities covering areas such as safeguarding, equality and diversity and restraint and the manager has recently

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Organisation

requested training for staff about the gang culture. The home has been particularly successful in engaging young people with such backgrounds.

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Organisation

The manager and staff have worked well to establish some very sound working relationships with associated professionals such as youth offending workers, the police and the fire service and these relationships are utilised to promote improvements in young people's behaviours and attitudes.

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Organisation

Records reflect good monitoring systems. The manager completes a comprehensive monthly report of her monitoring of care practice issues and a representative of the provider organisation 9 of 10 Inspection Report: SC370949 visits each month and submits a very detailed report of the visit to the manager of the home and to Ofsted.

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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): • ensure that the procedures for emergency admissions to the home are clearly stated and that full account is taken of the potential effect of emergency admissions on stable long term existing placements (NMS 5.4; 5.7) • ensure that the interior and exterior of the home is maintained in a good state of structural and decorative repair and that any damage is repaired promptly (NMS 24.3) • review the Statement of Purpose to properly reflect, to placing social workers, staff and parents, what young people's needs can be met by the home and specifically the criteria and policy in relation to emergency admissions (NMS 1.2). 10 of 10 Inspection Report: SC370949

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