Children's Home run by Barnardo’s in Oxfordshire

SC013143 Unique reference number 18 June 2009 Inspection date Merryl Wahogo Inspector Key Type of Inspection

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9 February 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 8 Inspection Report: SC013143

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Brief description of the service

This is the only full-time care provision for disabled children in the county, and has spaces for five children. There are currently three young people in the home full-time and three young people using it on a short-break basis. It is located not far from the centre of town and has its own car park and garden area. All accommodation for children is on the ground floor, as are the staff offices.

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Summary

This was a key unannounced inspection. All key standards under the National Minimum Standards were inspected. There are outstanding features to this home, notably in relation to staff keeping the young people healthy and helping them to enjoy and make the most of their lives. The recent introduction of short break visits, however, has caused serious problems for the young people on full time placement. The overall quality rating is inadequate. This is an overview of what the inspector found during the inspection.

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Improvements since the last inspection

The statement of purpose has been updated to reflect the new short break placements. An impact assessment of these placements is also being carried out, but has not yet been completed. Nevertheless, it is now clear that the impact on at least two out of the three young people permanently placed in the home is of concern. Furthermore, whilst the understanding was that the short break placements were with a view to developing into full-time placements, this has not proved to be the case. Therefore the action in the last report under Regulation 11 is repeated in this report.

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Helping children to be healthy

The provision is outstanding. Parents are delighted with the range and quality of the food offered. One commented 'Our son has definitely benefited from a wider range of menu than he would accept at home and has improved [their] ability to use utensils and cope with a café style setting for eating meals'. The menu is culturally varied, as well as always having at least one vegetarian and one fish meal during the week. Young people benefit from plentiful salads, offered alongside most meals, which they clearly enjoy. The cook ensures that young people receive meals that are appropriate to their allergies, preferences and dietary requirements. Staff also ensure that young people receive specialised equipment, when specified in care plans, and appropriate support at meal times.

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Helping children to be healthy

The kitchen area is clean and the cook stores all foods safely and hygienically. She also ensures continuous monitoring of fridge, freezer and hot food temperatures.

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Helping children to be healthy

Staff are meticulous about the administration of medicines. Mistakes are avoided by a double checking system whereby staff write on a whiteboard in the corridor when medication has been given. The medication room is orderly and all medicines are secure. One social worker said 'Any concerns about health or general medication are referred back to myself and parents'. Staff 4 of 8 Inspection Report: SC013143 communicate well with paediatricians and GPs and ensure all medication systems are up to date. They support young people to attend relevant appointments and record these thoroughly.

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Protecting children from harm or neglect and helping them stay safe

The provision is inadequate. Staff never discuss private or confidential information inappropriately. In this and other ways they respect young people's privacy. One parent said 'Privacy is of paramount importance and it's always met. Staff members are very professional and duties are managed and maintained to a very high standard'.

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Protecting children from harm or neglect and helping them stay safe

There have been no formal complaints since the last inspection. Nevertheless, staff express great concern about the impact of the new short-break visits on the welfare of those young people for whom this is their home. One full time resident's behaviour has regressed. Another has clearly expressed their opposition to these visits and staff have not recorded this behaviour as a complaint although other actions have been taken. For example the manager has requested an impact assessment.

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Protecting children from harm or neglect and helping them stay safe

One resident is self harming, apparently in response to short-break visits. Safeguarding is, nevertheless, high on the agenda for all staff and one social worker said 'I am always informed promptly of any incidents that are significant'. There is a thorough policy on touch, to which staff adhere well. This ensures that young people get the physical contact they need in a safe manner.

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Protecting children from harm or neglect and helping them stay safe

In the context of the challenges presented by the varied and complex nature of the young people's impairments, staff manage young people's behaviour well. Staff rarely use any kind of restraint, as they are good at anticipating and preventing problems. For example, staff encourage activities in separate areas, if they expect young people to clash in the same communal space. Staff use time out from an area, usually in the young person's bedroom, to help them calm down following an incident. There are no formal sanctions because of the young people's level of understanding, but they are encouraged to apologise if they hurt somebody.

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Protecting children from harm or neglect and helping them stay safe

Staff do extremely well at keeping young people safe from hazards. One parent said 'Staff have visited us at home to coordinate a risk assessment and ensure they have a good understanding of our son's behaviour'. Another comments, 'Decisions in communication between us and [the home] personnel are very impressive'. Risk assessments are kept up to date and new ones created where necessary. Most safety checks are conducted according to specifications, but means of escape testing is only conducted fortnightly, instead of weekly. This poses a small risk in relation to safe evacuation of the building.

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Protecting children from harm or neglect and helping them stay safe

Recruitment practices are thorough and secure and a couple of staff are relatively new.

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Helping children achieve well and enjoy what they do

The provision is outstanding. Staff know the young people very well and take initiatives in supporting them. For example one member of staff bought a face mask and poster of one young man's hero. This young person was absolutely delighted with the mask in particular. Staff also coordinate well with external specialists such as occupational therapists and speech and language therapists. 5 of 8 Inspection Report: SC013143 Staff are in constant communication with schools via home-school books. One social worker said '[The home is] excellent at liaising with the child's school and at ensuring consistency across school and care setting'. They also make every effort to provide continuity in terms of communication with the young person.

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Helping children achieve well and enjoy what they do

Staff are concerned that a number of factors, beyond their control, are limiting the range of external activities available to the young people. Nevertheless, there is a good range of activities available within the building and in the gardens. This all demonstrates their commitment to providing the best possible range of experiences to the young people despite the complexities involved in doing so.

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Helping children make a positive contribution

The provision is satisfactory. Staff assess young people's needs in conjunction with social workers and other professionals. One social worker said 'Key workers and management keep in close communication with myself and other professionals (particularly school staff)'. Care plans are detailed and a social worker says 'Very careful and very comprehensive care plan compiled with parent prior to the child being introduced. These are then revised'.

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Helping children make a positive contribution

Staff are good at supporting the young people who live there permanently to maintain contact with their families wherever possible. One parent said 'Good formal and informal communication has been achieved'. Staff record any contact with parents.

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Helping children make a positive contribution

Staff plan new admissions thoroughly. One social worker says 'Introduction for new children planned with great care and attention to detail'. Nevertheless, concerns raised about the short-break placements have resulted in one senior member of staff conducting an impact assessment. This is not yet available and this report requests it urgently. Furthermore, this report recommends that the local authority conducts welfare reviews for all the young people for who are full time in this home.

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Helping children make a positive contribution

Staff are good at using whatever means of communication possible to consult young people about their choices. For example, they were seen to ask young people which flavour drink they want and also where one young person wanted to sit for dinner.

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Achieving economic wellbeing

The provision is good. Wherever possible, staff support young people to develop independence skills. For example, one young person now prepares their own breakfast.

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Achieving economic wellbeing

Staff are doing everything in their power to support one young person's transition to adult services. They have contributed whatever they can to the transition plan and keep closely in touch with the parents and social worker. However, the latter has not yet identified a definite placement.

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Achieving economic wellbeing

Staff have cleared the walls in the dining room in preparation for redecoration, with plans for the repainting of other areas to follow. Nevertheless, the home remains comfortable and well furnished. Staff ensure that all the bedrooms are highly personalised and appropriately furnished for the particular young people using them. 6 of 8 Inspection Report: SC013143

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Organisation

The organisation is inadequate. The manager and her staff group are unanimous in their assessment of the short breaks impacting badly on those young people in permanent placements. The continued short break placements pose a risk of further damage to the development of the young people in permanent placements.

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Organisation

Yet it is equally true that staff and the parents of the young people on short break visits believe they have benefited enormously. One social worker said 'It has not been easy to introduce three new children into a situation where most of the young people live at [the home] full time. Understandably staff had reservations about this but I have been impressed by the support and high standards of care they have offered to both [groups of] children'.

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Organisation

Supervision is regular and thorough and another member of staff has now been trained in supervision skills since his promotion to a senior position. Management have ensured good levels of staffing, appropriate to the young people's needs, as well as minimal reliance on agency staff. This is a well qualified staff group and the few staff who have not gained an NVQ3 are either completing it or about to start.

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Organisation

The manager continues to try to establish a system whereby all staff can receive training, other than the mandatory courses. She ensures thorough induction and support processes for new staff.

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Organisation

Internal monitoring is good, but not always evidenced by signatures. Nevertheless, the manager demonstrates thorough knowledge of all the issues for the young people. External monitoring visits are now regular and the visitors are mostly sending these promptly, with only a small hitch due to sickness absence recently.

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Organisation

The promotion of equality and diversity is good. It is high on the agenda for staff, who demonstrate respect for each other's backgrounds as well for the young people. Menus and personalised bedrooms reflect some diversity, but more importantly staff demonstrate great flexibility in working with the diverse communication needs of the young people.

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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

10 July 2009 ensure that a written record is made of any complaint, the action taken in response, and the outcome of the investigation. Regulation 24 (5) 24 July 2009 ensure that the home promotes and makes proper provision for the young people accommodated there. Regulation 11 (1a) 7 of 8 Inspection Report: SC013143 17 July 2009 ensure that the impact assessment is completed. Regulation 11 (1a) 24 July 2009 keep under review and, where appropriate, revise the statement of purpose. Regulation 5 (a)

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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 management monitor all medication administration records. (NMS 13) • ensure that means of escape testing is conducted weekly. (NMS 26) • ensure that all behaviour plan routines are dated. (NMS 2) • ask the placing authority to undertake welfare reviews of the young people in full time placement. (NMS 3) 8 of 8 Inspection Report: SC013143

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