Children's Home run by Keys Nhcc Ltd in Shropshire

SC020607 Unique reference number 27 May 2009 Inspection date Trevor Hall Inspector Key Type of Inspection

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16 December 2008 Date of last inspection .

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This document may be reproduced in whole or in part for non-commercial educational purposes, provided that the information quoted is reproduced without adaptation and the source and date of publication are stated.

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You can obtain copies of The Children Act 2004, Every Child Matters and The National Minimum Standards for Children's Services from: The Stationery Office (TSO) PO Box 29, St Cripins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop

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About this inspection

The purpose of this inspection is to assure children and young people, parents, the public, local authorities and government of the quality and standard of the service provided. The inspection was carried out under the Care Standards Act 2000. This report details the main strengths and any areas for improvement identified during the inspection. The judgements included in the report are made in relation to the outcome for children set out in the Children Act 2004 and relevant National Minimum Standards for the establishment.

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The inspection judgements and what they mean

this aspect of the provision is of exceptionally high quality Outstanding: this aspect of the provision is strong Good: this aspect of the provision is sound Satisfactory: this aspect of the provision is not good enough Inadequate: 3 of 12 Inspection Report: SC020607

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Brief description of the service

This is a children’s home providing care and accommodation for three young persons. The home is owned by a private child care provider.

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Brief description of the service

The home is located in a small village, in a semi rural location. Accommodation is provided in a domestic scale well-appointed detached family house allowing the young people individual bedrooms and ample communal space.

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Brief description of the service

The home's close proximity to a small market town, facilitates access to local recreational and social activities.

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Brief description of the service

A satellite unit to this home provides care and accommodation for one young person. This home is a family house located in the nearby market town. This home is located to take advantage of all the town's local facilities whilst continuing to be relatively near to the parent from where it draws its staffing and support. Both homes have separate routines.

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Brief description of the service

Three young people currently live at the main house and one young person was living at the satellite home at the time of this inspection.

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Summary

The inspection was an unannounced full inspection, the home's last full inspection was undertaken on 21 July 2008, when no actions and 5 recommendations were raised. The home was judged at that point to be good. This inspection was followed up by a random inspection conducted on 16 December 2008, which confirmed the judgement as good and made two additional recommendations. This inspection looked at all key standards and several non-key standards. This inspection raised no new actions but made six new recommendations. Young people living within this home receive good support to remain healthy. Young people live in a home, where their safety is generally well maintained, however, some improvement in the recording of complaints is required. The home environment and its associated assessments of risks needs to improve as does the general maintenance of the home, particularly the upkeep of the garden and the grounds. This home encourages young people to take an active part in

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Summary

the way it runs and encourages them to make the most of their potential and to make a positive contribution to the life of the home. This home is well managed because young people benefit from living in an environment that is centred on meeting their individual needs. Young people living here receive good individual support and their education and health is encouraged and appropriately supported and promoted. 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

At the home's last inspection two recommendations were made, one in respect of providing each young person with adequate lighting in their bedroom the other was in respect of ensuring that at least 80% of the staff group had acquired their level 3 National Vocational Qualification (NVQ) in Caring for Children and Young People. Unfortunately although the home has made adequate provision for appropriate safe lighting in the bedroom previously identified as inadequate, another bedroom no longer meets this requirement, as such the recommendation 4 of 12 Inspection Report: SC020607 has been repeated. The current level of NVQ attainment within the staff group is currently difficult to assess, as additional staff are currently being deployed to the home, due to heightened levels of assessed risk. These extra deployments, some of which, out of necessity, have been agency staff, have therefore changed the bases of the calculation required to assess

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Helping children to be healthy

The provision is good. Young people's health and wellbeing is generally well promoted by the staff within the home. The service provider has developed clear guidance regarding promoting and safeguarding young people's health; these are known and are generally followed by staff working in the home.

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Helping children to be healthy

Young people receive a varied diet, which takes into consideration their individual preferences. Staff provide healthy, nutritious meals that meet young people's daily dietary needs, fruit is always available and they are, within reason, able to make themselves hot drinks and snacks between meals. Young people are encouraged to be involved in planning, shopping for and preparing meals. Staff receive appropriate training to enable them to assist young people with these tasks. The home promotes mealtimes as a social and inclusive occasion with staff and young people participating in the routine together.

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Helping children to be healthy

Staff provide young people with positive health messages and work with local health agencies to encourage young people to lead healthy lifestyles.

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Helping children to be healthy

Young people's health needs are identified and recorded by staff to ensure that their needs are met. Young people are registered with local primary health care professionals at the time of admission and are encouraged by staff to seek regular health checks. Staff record and monitor young people's health appointments, accidents and illnesses and where appropriate take action, to ensure that their health needs are met. Young people are referred to other specialist agencies where this is required and staff provide young people with information, during key worker sessions, about healthy lifestyles.

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Helping children to be healthy

The files for the young people contain signed medical consent forms, a record of all medication prescribed and non-prescribed medication and whether it has been taken. Each young person has a detailed health care plan, however, these are not always dated. Due to the specific health issues created by the home's current residents all displaying significant and regular incidents of self-harming behaviour, it is important that the home maintains up-to-date health care plans on each young person and that these plans include reference to the home's environmental risk assessments.

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Helping children to be healthy

The home has procedures in place to ensure that medicines are appropriately handled and stored to safeguard young people’s welfare. In addition the home has policies that address all aspects of medication including the use of homely remedies. Staff receive training in the administration of medication and first aid. This ensures that young people's health needs are appropriately addressed and promoted. The administration and recording of prescribed medication, however, does not always follow these procedures, medication records show that young people are not always given their medication at the times or with the frequencies indicated on the medication, courses of medication are not always completed and no record is kept of young people refusing their medication or refusing to complete courses of medication. 5 of 12 Inspection Report: SC020607

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Protecting children from harm or neglect and helping them stay safe

The provision is satisfactory. Within this home, young people are generally kept safe by the vigilance of well-trained staff who are supported in their work by clear policies and procedures, however, maintenance issues combined with the specialist nature of the needs of the current residents often compromises these arrangements. Young people's rights to privacy are promoted, however, this is tempered by the need to provide appropriate supervision and support, given the unsafe and self-harming behaviour that is prevalent with these young people.

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Protecting children from harm or neglect and helping them stay safe

The home ensures that all confidential records are kept securely and that there are appropriate arrangements in place for young people to receive and make telephone calls in private. Where restrictions or specific contact arrangements are in place these circumstances are discussed in review meetings and recorded in young people's files.

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Protecting children from harm or neglect and helping them stay safe

Young people understand how to make a complaint if they have any concerns about their care. Details about the home's complaints process is outlined in the Children’s Guide and staff provide information and additional support if young people require this. The home's records confirm that young people have been able to access the complaints process and that generally this has resulted in an appropriate investigation of the complaints, however, the time taken to respond to complaints has on occasion been excessive and no explanation for delays are recorded. Not all responses to young peoples complaint's have been dated, as such, it is not always possible to gauge the time it has taken for the home to properly respond to these concerns. The Registered Manager of the home monitors the complaints record to ensure young people's rights are upheld, and that the process is effective.

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Protecting children from harm or neglect and helping them stay safe

Young people's wellbeing is safeguarded because the home has clear child protection policies and procedures. All staff receive training in child protection and demonstrate a sound knowledge of policies and procedures and the action they would take if they became aware of any child protection issue. They are aware of their responsibilities to report any child protection concerns and the home enables staff to access a copy of the Local Safeguarding Children Board procedures. Records show that appropriate action has been taken when child protection issues have been raised within the home.

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Protecting children from harm or neglect and helping them stay safe

The home has an anti-bullying policy which makes it very clear that bullying will not be tolerated and encourages young people to raise any concerns they have about bullying.

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Protecting children from harm or neglect and helping them stay safe

The young people living in this home are aware of the reason they are being looked after and how staff will promote their safety and protection within the home and in public places. Staff are fully aware of the types of behaviour which children may display and accordingly develop risk assessments that minimise the potential for children to subject themselves or others to harm. Staff know how to respond to challenging behaviours and in circumstances where children may abscond. Children are encouraged to reflect on the consequences of their behaviour after such incidents to learn how to help themselves to be safe and behave responsibly.

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Protecting children from harm or neglect and helping them stay safe

Young people are clearly informed of the home's expectations of them and any action that will be taken if behaviour is unacceptable. This promotes young people's welfare as they are encouraged to behave appropriately and they receive consistent messages from staff as to how 6 of 12 Inspection Report: SC020607 to behave. The emphasis of the home is to promote consistent, improving behaviour that can be praised and rewarded.

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Protecting children from harm or neglect and helping them stay safe

There is a written policy and staff guidance on the actions that should be taken if a young person is absent from the home without consent. The procedures and guidance follow a regional joint protocol, which has been developed to ensure young people's safety is promoted. The protocol also ensures that reporting processes are followed according to individual risks and circumstances. Staff work with young people to minimise and prevent instances of absconding from the home, so that young people are kept safe.

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Protecting children from harm or neglect and helping them stay safe

The recording of physical interventions and sanctions used within the home is good and meets all of the NMS requirements for these records and young people are routinely invited to make comment if either of these interventions are applied.

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Protecting children from harm or neglect and helping them stay safe

All of the home's current residents, including the young person living off the main site at the home's satellite unit, display severe self harming behaviours, which has resulted in numerous and frequent trips to the hospital accident and emergency departments of local hospitals. The home has good environmental risk assessments in place, which make appropriate reference to the young peoples specific problems and the home's existing environment.

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Protecting children from harm or neglect and helping them stay safe

Staff working within the home have received additional training in dealing with such behaviours. Maintenance issues within the home, however, have on occasion added to, rather than helped to mitigate against, the known problems of the young people. This home has, almost by default, become a specialist home dealing exclusively with vulnerable young people who regularly behave in ways that put themselves at risk of harm. Every day objects expected to be in the home, to promote the good care and life experience of the young people, including furnishings and fittings are frequently misused by the young people to cause significant harm to themselves. The home has put into place appropriate individual supports to the young people, either through their own therapeutic provision or through accessing local psychological or mental health provisions, however, a comprehensive audit of the premises and environment, specifically

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Protecting children from harm or neglect and helping them stay safe

targeting the risks these present to the current young people has not yet been undertaken.

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Protecting children from harm or neglect and helping them stay safe

Positive steps are taken to keep young people, staff and visitors safe from fire and other hazards in the home. For example, records indicate that risk assessments are completed in relation to fire and potential environmental hazards. Frequent checks are undertaken on fire equipment, emergency lighting and fire drills are regularly completed. The Registered Manager ensures that utilities, domestic equipment and vehicles are checked to ensure they are safe to use. Young people live in a home which provides physical safety and security.

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Protecting children from harm or neglect and helping them stay safe

Staff personnel files were not accessed at this inspection due to them being held at a central location at the organisation's head office. The Registered Manager confirmed that no new member of staff started work in the home until all the necessary vetting checks had been completed. All visitors to the home are required to provide proof of identity and sign a visitors book to support the protection of young people.

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Helping children achieve well and enjoy what they do

The provision is good. Young people are receiving a very good range of individual support and guidance that is consistent with their identified needs. Staff have a positive attitude towards education and 7 of 12 Inspection Report: SC020607 take a keen and active interest in young people's development and learning. Young people are living in a home where they are consistently encouraged to enjoy and achieve.

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Helping children achieve well and enjoy what they do

Staff have access to a comprehensive range of information that identifies specific needs and support for each young person. A key worker system is in operation where a member of staff takes some responsibility for the delivery and monitoring of a young person’s care and support. Records also take account of potential needs in relation to a young person's diversity such as identity, race, culture and religion. Although some individual support is delivered through key worker arrangements, this process is not promoted to the exclusion of other staff offering support. It is clear that staff in the home work as a team and young people are able to approach all staff for help and support.

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Helping children achieve well and enjoy what they do

The home has made appropriate links with local psychological services and mental health teams to ensure that each young person receives the support and services they need. Young people, where appropriate can also access the home's own therapist.

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Helping children achieve well and enjoy what they do

Staff actively promote the social inclusion of young people in the home's daily routines and events. Young people are supported to access and attend various community based activities and venues according to their own choices and preferences. Staff are keenly supporting young people to develop their own interests and hobbies because significant attention is being paid to this area of personal development and growth. Young people are supported to access specialist external services to ensure all their identified needs are being met. The Registered Manager reviews and updates assessments so staff are informed about what they can do to reduce potential risks to young people.

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Helping children achieve well and enjoy what they do

Young people's care and support is also clearly focused on their overall plan of care, matching the placing authorities aims and objectives in relation to future plans and placements. The Registered Manager and staff have a strong focus on organising themselves around young people and their needs which supports improving outcomes for each individual.

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Helping children achieve well and enjoy what they do

Young people's education is promoted through the home's education policy, it clearly sets out the roles and responsibilities of residential staff in relation to school attendance and learning. Records demonstrate that staff are working in partnership with teachers to support an education timetable that includes academic and vocational activities.

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Helping children make a positive contribution

The provision is good. Young people are fully supported to make a positive contribution to their placement and future plans whilst living at this home. Staff demonstrate that they value the views and opinions of young people. They are involved in all aspects of their care and are given every opportunity to contribute to their own care planning and arrangements. Staff actively and formally seek the views of young people at an individual and group level and respond in a way that values their opinions. For example, young people are regularly involved in placement plan meetings with staff to discuss their needs and this information is clearly reflected in the home's records. Seeking young people's opinions and helping them make decisions about matters that affect them is fully integrated into the care practices of the home.

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Helping children make a positive contribution

Close attention is paid to ensuring that the home's records fully represent young people's current needs. Young people are involved in their care planning and have regular opportunities 8 of 12 Inspection Report: SC020607 to discuss their needs with staff. Staff are successful at engaging with young people and are focused on achieving the stated aims and objectives of individual plans.

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Helping children make a positive contribution

Each young person living within the home has a Placement Plan that identifies the purpose of the placement and how the placing authority's care plan for the young person will be progressed. Up-to-date Looked after Children's (LAC) documentation was completed on each young person which referred directly to the current care arrangements. Young people's records demonstrate that staff are flexible and innovative in their approaches to managing young people's behaviours and in trying to promoting positive outcomes. Case files confirm that the young people's progress is reviewed within the statutory time periods. Staff attend regular in-house meetings to record and update each young person's general progress during the interim period. Monthly reports are completed by key workers and the home prepares chronological reports to keep placing authorities informed. Placement plans include summarised health and education plan

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Helping children make a positive contribution

Young people are able to maintain valued relationships with family and friends because staff support and help facilitate contact and visits. Young people's contact arrangements are consistent with their agreed plans and confirmed that staff support them to stay in touch with significant people in a way that is agreed and they choose.

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Helping children make a positive contribution

Young people are given good support when they arrive and leave the home and these routines are based around individual needs and circumstances. Staff understand that moving home can be very difficult for some young people and this awareness is used to provide support and reassurance in these circumstances. Young people are encouraged to bring their own possessions into the home so they can personalise their own bedrooms.

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Helping children make a positive contribution

Staff use a range of ways to consult with young people in the home. Young people have the opportunity to express their views and opinions in young people's meetings as well as through individual sessions with their key worker. Young people regularly meet with the Registered Manager as part of the consultation processes to ensure the head of the home is directly informed about their views and opinions. Staff are good at consulting with young people about the routines and daily living arrangements of the home. Young people state that staff are good at listening and taking on board their feedback. Staff are active in ensuring that young people are aware that they can speak to independent agencies and professionals outside of the home.

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Achieving economic wellbeing

The provision is satisfactory. Young people receive adequate allowances to cover personal requisites and clothing and are well informed about their entitlements because the home has good arrangements and systems in place to manage allowances, personal needs and pocket money.

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Achieving economic wellbeing

Young people living at this home are appropriately supported to prepare for leaving the home whether this is to return home, to alternative carers or to move into independent living. Where and when appropriate young people are provided with properly constituted Pathway plans, agreed by the placing authorities which give focus to preparing young people to appropriately leave the home.

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Achieving economic wellbeing

Young people live in a well-furnished detached property with good domestic style facilities. Some furnishing issues have arisen, particularly in respect of providing, 'safe' beds and 'adequate 9 of 12 Inspection Report: SC020607 and safe lighting' in all of the young peoples bedrooms. It is unacceptable for young people to be without an appropriate bed for three months it is equally unacceptable for young people to be deprived of adequate lighting. These issues are particularly unacceptable as the young people's behaviour, that have created these issues were known prior to their admission and in respect of adequate lighting had been raised on a previous inspection. The home is located in a semi-rural area on the edge of a small village. This provides young people with an appropriate degree of security as well as good access to local amenities.

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Achieving economic wellbeing

Overall, this care setting is homely and comfortable and is decorated and furnished to a good standard. Damage in the home is, however, frequent as the home now accommodates four vulnerable young people (three on the main site and one in it's satellite unit), who display high levels of destructive and self-harming behaviour. The current corporate maintenance policy, whilst sufficient and adequate to deal with the day-to-day issues of most children's home's, currently lacks an acknowledgement of the need to prioritise remedial work within this home. Whilst damaged furnishings and fittings are always made safe by staff as soon as it is realised that damage has occurred, the eventual substantive repair or replacement of these items is often unreasonably delayed by the current maintenance request system which requires permissions to be sought prior to the most menial repair being conducted.

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Achieving economic wellbeing

The company responsible for running this home provides general maintenance support through a contract with an outside company. All maintenance for the home including grounds maintenance, decoration and emergency repairs are done through this external company.

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Achieving economic wellbeing

On inspection, whilst the general decoration and maintenance of the home's interior appeared generally adequate, the garden and grounds, however, were poorly maintained, with all lawn/grass areas overgrown to a height of over one foot.

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Achieving economic wellbeing

The overgrown and poorly maintained grounds are not only unsightly, but potentially create a situation, particularly in this home with its current residents, where harmful items, such as broken glass, discarded nails and screws can be either hidden by the young people, or accidentally missed by staff, who regularly 'sweep' the garden looking for such items. The ability for the current maintenance arrangements to act quickly and decisively to the level and frequency of minor, but potentially harmful, damage in this home is currently questionable.

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Achieving economic wellbeing

There appears to be a need for an acknowledgement that this home has by default become a specialist home for young people displaying extreme self-harming behaviours. Whilst this has been acknowledged by the provision of both additional training for staff and in the increase in the numbers of staff deployed into the home to improve the supervision of the young people, it still remains to be effectively acknowledged in the home's environmental assessments.

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Organisation

The organisation is good. This home is an effectively managed home which contributes to the positive impact on the care and support young people receive. Overall, young people are being looked after by an experienced, qualified and enthusiastic group of staff that work positively with them to ensure that their needs are met. The registered manager provides clear and effective leadership to the staff team regarding the aims and objectives of the service; because of this, the home continues to maintain a consistent staff team that supports good continuity of care. The home’s Statement of Purpose includes all information, as required by Schedule 1 of the Children’s Homes 10 of 12 Inspection Report: SC020607 Regulations. The young person's guide is presented in a child-friendly way and gives a good summary of what young people can expect from the home.

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Organisation

There is good leadership and management support because the registered manager is qualified, skilled and experienced and provides strong and effective leadership to the staff team and young people. The registered manager is actively involved in the day to day operation of the home and has clear expectations that the staff team will achieve the best possible outcomes for all young people in their care. Young people are receiving good support because most of the staff team are qualified and suitably experienced. The majority of staff are qualified to National Vocational Qualification Level 3 in Caring for Children and Young People.

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Organisation

Good emphasis is given to staff training and development which is focused on areas relating to young people's needs. Young people are provided with appropriate levels of supervision and support because staff manage their time effectively and are deployed in a way that meets their needs. The staff rotas are flexible to meet the changing needs and circumstances of young people. There are clear and accountable systems in place for staff to deputise in the absence of the manager. Good management systems are in place to share information between different shift teams. Young people are being nurtured and comprehensively supported because their needs are being met and risks are managed in a preventative way.

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Organisation

The home's registered manager maintains all of the records required by both regulation and the NMS, including a register of admissions and discharges from the home. Good systems are in place to monitor the service and daily lives of young people currently living in the home.

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Organisation

The promotion of equality and diversity is good. All of the home's recording systems take account of potential needs in relation to a young person's diversity such as identity, race, culture and religion. The home provides an environment where the value of equality and diversity is understood, promoted and celebrated.

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Organisation

The local authority has established a pattern of management monitoring and reporting procedures, which is effectively implemented by the home's registered manager. The local authority conducts monthly review meetings to look at welfare issues within their homes. Findings are reported back to the local authority. Records seen demonstrate that the content of these reports reflect an accurate picture of life for young people resident here. These reports are available to staff.

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Organisation

Young people’s care files are very well organised to include all of the information detailed in Schedule 3 of the Children's Homes Regulations 2001. Confidential or third party information is kept in a separate section of the care file to enable the home to respond, in a timely manner, to any request made by a young person to read their care file.

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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 all prescribed medication is appropriately administered to young people and that any refusal to take is properly recorded. • ensure that responses to complaints are dated, so as to enable responses times to be gauged. • ensure that each child has a suitable bed (NMS 24.5) • ensure that each child has a single bedroom..... with lighting sufficient to read by (NMS 24.5) • ensure that there is a satisfactory maintenance and repair programme for the building, furniture and equipment and any damage is repaired promptly. (NMS 24.3) • ensure that gardens are well maintained and safe (NMS 24.3) 12 of 12 Inspection Report: SC020607

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