Children's Home run by Praxis Care in Leicestershire

SC032069 Unique reference number 24 June 2009 Inspection date Warren Clarke 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: SC032069

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Brief description of the service

This is an independently operated children's home providing respite care, at any one time, for up to four children or young people with learning disabilities/physical disabilities, aged between six and 19 years. Four children were resident at the time of the inspection and one was visiting as a precursor for being resident at a later date. They all participated in the inspection.

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Brief description of the service

The home is a domestic type bungalow and is set back from a main road into the district centre, where there are shops and other amenities. All facilities are on the ground floor and consist of four separate single bedrooms, a large dining room and lounge area and a separate kitchen. The suitably enclosed outdoor area is equipped with appropriately adapted play equipment and an additional sensory garden. The house is decorated and furnished to a high standard and children's bedrooms are personalised in readiness for their stay.

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Summary

This is a full unannounced inspection that assessed the home performance against all the relevant National Minimum Standards (NMS) in the outcome areas: Being Healthy, Staying Safe, Enjoying and Achieving, Positive Contribution, Economic Well-being and Organisation. The home continues to provide the children and young people a high standard of care and maintains its overall good quality rating. There are, however, some deficits such as fire alarms tests not being consistently carried out at the required frequency. 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

At the last inspection five recommendations were made, all in the Staying Safe outcome area. Where it was required that full evidence is retained at the home to demonstrate thorough vetting of staff's suitability, this has been partly achieved pending only the introduction of photo identification to satisfy the specific requirement for evidence of proof of identity. Arrangements have been made, and evidence provided of this, for staff to complete and update training in approved methods of physical intervention in response to the specific recommendation in this regard.

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Improvements since the last inspection

Recommendations for the children's guide to reflect Ofsted details as the current regulator and for complaints to be recorded as specified in the NMS, have been addressed. The complaints record has been structured to provide all the relevant information and the children's guide is currently in the process of a more comprehensive review and updating. The recommendation in relation to the frequency of fire drills has been addressed in part. The manager is consulting with the fire service to establish the necessity of conducting a fire drill at night balanced against the distress this is likely to cause the children.

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Helping children to be healthy

The provision is good. The importance of food as a contribution to the maintenance of the children's and young people's good health and the opportunity that communal dining presents for social interaction, are recognised and are well-established in the home's catering arrangements. In keeping with 4 of 10 Inspection Report: SC032069 the homely approach adopted in the care of the children and young people, staff take turns to prepare meals. The kitchen is properly equipped, domestic in scale and appearance and located such that the children are able to observe food preparation. On occasions some participate in cooking both as an activity and as a means of acquiring useful practical skills. Importantly, the catering arrangements ensure that the children and young people are provided regular meals of sufficient quantity and take full account of special dietary needs and preferences. Menus are, however, set out in brief: for example, 'lasagne and veg'. This does

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Helping children to be healthy

not provide the detail necessary to assess whether the variety and nutritional contents of meals are maintained at a consistently high level.

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Helping children to be healthy

Healthcare planning, management and resources are efficiently employed ensuring that the children and young people are given care of a very high standard to met their complex health needs. Staff approach care on an individual and holistic basis in which each child's or young person's healthcare is informed by a discrete, comprehensive health plan. The healthcare plans demonstrate that staff work effectively with parents and health professionals and maintain continuity of the children's and young people's usual health care regime whilst enabling them to benefit from the social and personal development opportunities the home provides. For example, the home is equipped with all the aids necessary and staff have the training to respond appropriately to the children's mobility and communication difficulties. Where a child's condition is likely to cause pain and he or she is not able to make his or her needs immediately known,

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Helping children to be healthy

a system is in place to assess and manage pain in these circumstances. All the necessary arrangements are in place to ensure the children have access to medical treatment when resident at the home and to respond to emergency situations such as epileptic episodes.

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Helping children to be healthy

Staff place great emphasis on efficiency and safety and this is particularly reflected in arrangements for administering first aid and medication. Those in charge of the home demonstrate that there is official authorisation for staff to act to ensure a child or young person receives medical or dental treatment where necessary. All staff have completed first aid training and such other training and competence assessment as is necessary to equip them to provide safe healthcare. Policies, procedures and practices that underpin this care are shown to reduce medication errors and that the children's medicines are received, stored and given in accordance with current quality standards.

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Protecting children from harm or neglect and helping them stay safe

The provision is good. Staff's care practices and resources provided give proper recognition to the children's and young people's high level of dependency and the need, in these circumstances, to preserve their privacy and dignity particularly in relation to intimate aspects of their care. Each child or young person is allocated an exclusive bedroom when resident and these rooms are equipped so that any personal care assistance needed, such as with dressing, is conducted in private. Bathrooms and toilets are similarly equipped to promote the children's and young people's privacy and as much independence as possible. Staff are bound by a code of conduct which includes maintaining the confidentiality of personal information and in this regard, they act professionally. All records and other documentation with such information are securely stored.

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Protecting children from harm or neglect and helping them stay safe

In the event of any dissatisfaction about the quality of service, the children and young people and others, such as parents, have access to the home's clear complaints procedure. The procedure meets all the requirements in relation to receiving, considering and reporting the outcome of 5 of 10 Inspection Report: SC032069 complaints to complainants. Helpfully, the complaints procedure is well promoted to all those with an interest in the home and its contents are made accessible to the children and young people by being present in formats relevant to their age and understanding. There are no recent complaints, but examples from the past demonstrate that they are taken seriously, thoroughly and fairly considered. However, information promoting the complaints procedure does not, as required, reflect Ofsted as the regulator. It is necessary for potential complainants to be given accurate information in this regard in case they prefer to direct their complaints to the regulator.

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Protecting children from harm or neglect and helping them stay safe

A coherent range of effective measures to protect children and young people from abuse, is well-established in the care regime. Staff are provided comprehensive information on the nature of abuse and a clear procedure for the event of any allegation or suspicion of it. This is combined with safeguarding children training and safe caring practices, such as staff not isolating themselves with a child, to prevent abuse. Some parents who responded on behalf of their children about the effectiveness of the home's measures to keep them safe, expressed satisfaction with this aspect of their care. There are no current concerns about the children and young people who are completely at ease with staff and comfortable in the home's environment.

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Protecting children from harm or neglect and helping them stay safe

Countering bullying features among the strategy that staff employ successfully, to keep the children and young people safe. Prior to their admission to the home the children and young people are assessed, taking account of their vulnerability to bullying and whether their behaviour is likely to adversely impact on others. Staff use this information well to protect where necessary and manage behaviour to reduce scope for bullying. Bullying is not presented as a problem in the home and sufficient supervision ensures that it could not happen without staff awareness. Relationships are good and staff attribute the absence of bullying to malicious intent not being a feature of the children's behaviour.

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Protecting children from harm or neglect and helping them stay safe

Staff work effectively within the home's behaviour management policy, the focus of which is to promote the children's and young people's good conduct and helpfully modify any specific behavioural difficulties they present. The policy also lays down strict safeguarding criteria to which any disciplinary measures must conform, recognising that the children's and young people's disabilities may be a factor in any unacceptable behaviour. Accordingly each child or young person has an agreed behaviour management plan taking these factors into account and setting precise strategies within with staff must operate. This is particularly successful as relationships between staff and children are good and the need for any significant disciplinary measures are rare.

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Protecting children from harm or neglect and helping them stay safe

In successfully protecting the children from harm, the registered person ensures that there are wide-ranging and robust health and safety measures in place. These include risk assessment of all areas of the premises, activities involved in the care of the children and young people and in relation to fire safety. Staff work within a range of health and safety guidelines and procedures for which they are provided initial and refresher training in areas such as fire safety, lifting and handling and food hygiene. This aspect of the children's and young people's care is rigorously monitored by the registered person and independent health and safety specialists. These measures are complemented by the very good security arrangements to protect the children from intruders. One weakness, however, is occasional lapses in conducting and recording fire alarm tests at the required frequency. These are required to be carried out weekly, but

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Protecting children from harm or neglect and helping them stay safe

were not done in the three weeks preceding the inspection. It is imperative that these test are 6 of 10 Inspection Report: SC032069 conducted to provide certainty that the alarm system is maintained in good enough working order to detect and warn of any outbreak of fire.

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Protecting children from harm or neglect and helping them stay safe

The home provides children and young people protection from adults who may be unsuitable to look after them by its thorough approach to staff selection and other measures. All potential staff are vetted by means of references and criminal records check, and are not permitted to commence employment until the registered person is satisfied with the outcome of those checks. Similarly, visitors' access to the home is controlled and they are kept under supervision whilst on the premises. Combined, all these arrangements are successful in keeping the children and young people safe from abuse and harm.

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Helping children achieve well and enjoy what they do

The provision is outstanding. The home sets out to contribute to enhancing the children's and young people's all round development and succeeds in so doing. It provides all the facilities necessary, such as aids and equipment, to ensure there is seamless continuity in meeting each child's or young people's needs arising principally from their disability and health care requirements. Set against the baseline of basic care, the home's stimulating group living environment provides a wide range of opportunities for social learning. Communal dining and group games foster inclusion and living away from the families albeit for short episodes introduces elements of independence.

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Helping children achieve well and enjoy what they do

Staff take particular care to understand each child's circumstances and plan care and personal support to meet their individual needs. This is reflected in staff's effective working partnership with the children's parents over matters such as health care, religion, culture and mode of communication for those who are not able to communicate verbally. Above all, the children and young people exhibit a contented demeanour and respond to staff warmly. They are introduced to a wide range of leisure activities, some challenging, such as horse riding and canoeing, and are generally supported to live full lives, taking controlled risks that befit their age and development. In essence, the home contributes excellently to the children's and young people's wellbeing ensuring that they are not avoidably constrained by their disabilities.

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Helping children achieve well and enjoy what they do

The working partnership of the home, schools and parents epitomises effective 'joined-up' thinking in support of the children's and young people's education. Staff liaise efficiently with teachers and parents ensuring that basic routines are maintained so that children and young people get to school on time with the right equipment. Transport arrangements operate smoothly and where homework is set this gets done. In addition, staff read to the children and through play, games and generally providing a stimulating experience, encourage learning and fun.

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Helping children make a positive contribution

The provision is outstanding. Children and young people receive the care and support they need to facilitate their proper development and to enhance their quality of life and promote their well-being. This is made possible by the home's comprehensive and thorough assessment and care management system, which effectively establishes each child's or young person's overall needs and constructs a clear plan of actions to meet them. For instance, the needs of those with physical disabilities are appropriately accommodated. Staff are trained so that they are suitably equipped both to respond to the children's and young people's complex health needs and at the same time to promote their personal development. 7 of 10 Inspection Report: SC032069 An established system of ongoing observation and assessment of the children and young people enables staff to care for them so that continuity of prescribed regimens in relation to their

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Helping children make a positive contribution

health, education and leisure pursuits is maintained. Information from this process is used effectively to monitor and assess each child's or young person's progress, highlight any concerns such as in regard to their health and to cause care inputs to be readjusted where anticipated progress is not being made. This is all governed by the formal processes of monitoring and review for looked after children and those who are the subjects of statements of special educational needs.

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Helping children make a positive contribution

Although the periods when the children and young people are accommodated in the home are short, no more than a week at a time, the home makes proper arrangements for them to maintain contact with their parents. This may be by visit by parents or by telephone facilitated by staff. Whilst there are no barriers to the children and young people having contact with their friends while resident at the home, such contact is rare because the home is some distance away from most of their local communities.

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Helping children make a positive contribution

Particular care is taken with the introduction of children and young people to the home. In all instances their respite care arrangements are established on a planned basis allowing sufficient time for introductions so that there is familiarisation with the people and the environment. Similar care is taken when a child's or young person's respite care is to cease. The thoughtful leaving process takes full account of the child's individual needs and recognises the home, in most instances, has played a significant part in their lives and that they have established firm bonds during this time.

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Helping children make a positive contribution

Staff hold firm to the principle that because the children and young people have communication difficulties, it is imperative that every effort is made to enable them to make their wishes and feelings known and that these are taken into account in the running of the home. For example, meetings are convened, some facilitated by a visiting children's rights officer, as a means of consulting the young people and keeping them informed of developments. Importantly, staff demonstrate that young people are actually listened to citing changes such as creation of a sensory room as an example of their influence.

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Achieving economic wellbeing

The provision is good. The home's care practices ensure that the children's and young people's respite care contributes to their proper development including nurturing them towards greater independence in relation to their needs and level of functioning. In essence, staff act as good parents teaching and reinforcing basic skills such as dressing, toileting and generally and incrementally enabling the children and young people to try to do more for themselves in activities of daily living. Established and effective working partnerships that staff foster with placing authorities, schools and adult services are successful in sensitively helping the young people to make the transition between childhood and adulthood. This takes full account of their special needs and the particular ongoing support that most will continue to need.

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Achieving economic wellbeing

Provision of a well-equipped, safe and homely environment for the children to live in during periods of respite care contributes substantially to their quality of life and wellbeing. All areas of the home, including gardens, are appropriately adapted and equipped to meet the children's and young people's needs and facilitate the high standard of care dictated by the home's statement of purpose and other promotional information. The building is maintained in sound 8 of 10 Inspection Report: SC032069 condition and all its features combined provide the children and young people a very good material standard of living.

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Organisation

The organisation is good. The very good standard of care that the children and young people are provided, is underpinned by the home's clear operational rationale as set out in its Statement of Purpose (SOP). This document complies with the relevant regulation in that it sets out clearly the principles and methods and the facilities and services that govern the running of the home and the care of the children and young people. Essentially, the SOP is current and it accurately reflects how the home is being run. It has been summarised and presented in guides for children, young people and their parents. These guides provide helpful information about the care a child or young person is likely to experience and what is expected of them and their parents. The children's guide is currently under review because staff believe they can improve on making it more relevant to the children's level of understanding.

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Organisation

Currently, an acting unregistered manager provides the leadership of the home under acceptable professional supervision arrangements made by the registered person. The management is competent in that it provides staff in sufficient numbers commensurate with the number of children and their needs. Staff are also efficiently deployed so that on each shift a named member of staff coordinates the care of each child to minimise the number of those involved in carrying out the child's intimate care. Additionally, management arrangements ensure that staff are allocated sufficient time to complete necessary administrative duties associated with the care of the children and young people. This includes, acceptable deputising arrangements for the absence of the manager, formal handover at the end of shifts to achieve continuity and staff meetings to discuss the children's progress.

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Organisation

Staff are provided with appropriate training to equip them to care for the children and young people safely and competently. This is supplemented by regular one to one supervision and annual appraisal which are intended to ensure that they maintain the level of skill and performance necessary to meet the children's needs. Although staff are provided ongoing in-service training only one third hold the specified qualifications for the post. This does not currently have any adverse impact on the quality of the children's and young people's care, but is not a position that can be sustained, if the home is to meet the challenge of the home's own ambitions for development and the changing needs and expectations of the children, parents and placing authorities.

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Organisation

Established systems operated successfully demonstrate that the manager and the registered person monitor the care of the children and the running of the home on a regular and rigorous basis. The outcome of recent monitoring highlights no worrying patterns in the way the children and young people are looked after nor any major issues concerning the running of the home. Where monitoring activity identifies areas where improvements are needed these are addressed in timely fashion. The home's system of strategic planning enables it to respond to market challenges and maintain the high standard of care it provides. This is reflected in its current annual development plan, which sets objectives for continuing improvements in areas such as staff training, honing of care practices namely more objective recording of care inputs and their impact and wider choice of leisure activities to reflect the children's and young people's age

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Organisation

and changing needs. 9 of 10 Inspection Report: SC032069 The home has good administrative systems including amassing necessary information in order to provide precise care inputs for each child or young person and for monitoring and reviewing their progress. All such information is efficiently organised into individual files which are structured to enable easy access to particular information.

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Organisation

The promotion of equality and diversity is good. Specialising in the respite care of children and young people with severe learning difficulties, the home makes its service available to all whose needs it is able to meet. This includes children of either sex and of any nationality, religion, culture and racial background. This is in principle demonstrated in its policies and, in practice, in its diverse staff team, service users and in how children and young people are looked after to reflect their particular characteristics. Children, young people and parents comment positively about this, the quality of care and the impact the service has on their lives.

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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 the record of menus, as served, is set out in sufficient detail to demonstrate provision of a consistently suitable and varied diet (NMS 10.4) • ensure the complaints procedure and its promotional information reflect Ofsted as the current regulator and provide the necessary details to enable potential complainants to contact it (NMS16.5) • ensure that the fire alarm system is tested at the frequency required by the local Fire Authority (NMS 26.8) • ensure that a minimum of 80 per cent of the care staff team members hold the NVQ level 3 in Caring for Children and Young People or its equivalent (NMS 29.5). 10 of 10 Inspection Report: SC032069

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