The Banyan Tree

SC396186 Unique reference number 23 July 2009 Inspection date Rosemary Dancer 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 9 Inspection Report: SC396186

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Brief description of the service

The home provides long-term care and support for up to four young people, between the ages of 10 and 17, with emotional and behavioural difficulties. The home is a large three storey house with five single bedrooms (one of which is for staff). It has a lounge, dining room, games room, kitchen, utility, separate toilet and bathroom. The utility room also houses a further toilet and shower. At the bottom of the private garden is an administration block. The home is close to shops, a park and public transport. It is within easy reach of the town centre.

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Summary

This was a full unannounced inspection all relevant key standards were inspected. This has been judged as a satisfactory service but it has many good and some outstanding features. Overall young people's health needs are addressed to a high standard. The provision of support for their emotional health and well-being is especially strong. However, some shortfalls were identified in the recording of the administration of medication and the dispensing of medication when a young person is spending time out of the home. These issues mean that practice in relation to the handling of medication is not safe overall.

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Summary

Overall there is a strong commitment to safeguarding young people. Young people's right to privacy is taken seriously and there are effective systems in place for young people to make a complaint. There is a zero tolerance approach taken to bullying and the safeguarding practice is robust. Young people who are missing are protected through sound policies, procedures and practice and there are very good working relationships with the local police missing persons unit. The approach taken to the management of behaviour in the home is strong and achieves very good outcomes.

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Summary

The staff recruitment practice and the security arrangements are robust and ensure that only suitable people are granted access to the young people. While the majority of heath and safety matters are addressed effectively there is a poor practice in the home of leaving fire doors propped open for long periods of time. In addition to this not all of the fire doors have a flush fitting. These issues potentially place young people and others at serious risk should a fire break out.

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Summary

Support for young people in respect to enjoying and achieving is outstanding. Excellent support is given to each young person and attention is given to promoting to the full educational support. An impressive array of activities is provided to young people and these are seen as valuable means of helping young people to grow and develop. Comprehensive plans are made to support young people's development during their time in the home and these are subject to ongoing review and update. The relationships that exist between staff and young people are impressive and clearly have impacted on the positive outcomes achieved to date.

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Summary

The accommodation provided to young people is of a very good standard. The managers and staff are committed to caring for young people and helping them to reach their full potential. Staff are well supported by the managers and there are good training opportunities in place. There systems for monitoring in place but these did not pick up the shortfalls identified in this report. Issues of equality and diversity are addressed throughout the policy and procedure documents and reflected in practice. 4 of 9 Inspection Report: SC396186 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

There was one recommendation made following the last inspection. The manager was asked to ensure a clear record of the nature of restrain was made; this is now being done.

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Helping children to be healthy

The provision is satisfactory. Overall young people's health needs are met to a high standard and there is some outstanding practice in this outcome area. However, there are some shortfalls which could impact adversely on young people's health and well-being.

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Helping children to be healthy

Young people are fully involved in the menu planning and are provided with a nutritious and healthy diet. Good attention is paid to ensuring young people have a good knowledge about what constitutes a healthy diet. They are encouraged to take exercise and in general keep themselves fit and well. Young people can, if they wish, shop for food and prepare meals.

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Helping children to be healthy

Food handling and hygiene training has been provided to staff and this supports staff in ensuring the hygienic preparation of food. However, there were containers of food such as sauces and jams, which had not been labelled with the date of opening. This could mean that foodstuff beyond its best could be eaten by the young people.

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Helping children to be healthy

Young people say their health needs are catered for well. They confirm that they are supported to attend routine and specialist health appointments and that staff work with them in developing their understanding about dangers to their health such as through smoking and drug use.

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Helping children to be healthy

All young people are registered with a GP and with other health professionals such as dentists. Staff play an active role in promoting the health of the young people living in the home. Detailed health plans are in place and these support staff and young people in ensuring that health needs are identified, recorded and addressed. Regular review of health matters take place. Staff are especially in tune with the emotional needs of the young people. They have received training in transactional analysis which is an integrative approach to the theory of psychology and psychotherapy. Staff are supported in using this theory by a consultant psychologist who meets with them on a monthly basis. This provides a consistent approach in supporting young people with their emotional needs and well-being.

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Helping children to be healthy

Medication is stored securely and a stock control system is operated. There are systems in place in respect to the recording of administration of medication but on occasion records are made that medication has been administered when it has not. Also there are regular occasions when medication is removed from the container labelled by the pharmacist, is then re-packaged to be sent out of the home with a young person, for example during a home visit. This means that some of the processes for medication administration are unsafe and fail to fully protect young people.

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Protecting children from harm or neglect and helping them stay safe

The provision is satisfactory. 5 of 9 Inspection Report: SC396186 The privacy of young people is promoted by staff to a good standard. For example all staff sign a confidentiality agreement and abide by it ensuring that information is kept securely and only shared on a need-to-know basis. Staff provide young people with a range of arenas to raise complaints when they are unhappy about something. There are weekly get together meetings during which young people can raise any issues and there is a complaints book which young people can use to write a complaint. The manager views this book and addresses any issues arising. There are also key work sessions during which issues can be discussed and on an informal basis young people can approach any member of staff to talk about anything worrying them. Young people say they are confident about making complaints and one young person said, '“you get listened too, things get sorted out.'

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Protecting children from harm or neglect and helping them stay safe

The arrangements for safeguarding young people are robust. Staff are trained in safeguarding children and young people and know how to respond when an allegation is made. Staff work with young people to help them to develop self-protection strategies. There is a zero tolerance approach taken to bullying and staff show a high awareness of what constitutes bullying and how to counteract it. In the event of a young person being missing from the home staff work hard to return them home. There are very good links with the local police missing persons unit. One young person commented, “ they (the staff) listen to you and try and work with you to get you back home”.

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Protecting children from harm or neglect and helping them stay safe

The approach to behaviour management is one of the many strengths of this home. There are clear assessments and behaviour management plans in place in respect to each young person. This ensures that an individualised approach is taken to managing less favourable behaviours. Staff are very good at recognising and responding in a positive way to acceptable behaviours and a reward system is in place. When a young person displays unacceptable behaviour there are clear consequences. Young people confirmed that they are aware of these and feel that they are fair. One young person described the sanctions applied as, 'not too over the top.' There is a system in place for recoding incidents, physical interventions and sanctions given. The recording is not made as detailed in the standards.

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Protecting children from harm or neglect and helping them stay safe

Another strength of this home is the good relationships staff and young people have been able to develop. There is a high level of mutual respect and an appropriate level of affection shown. Staff provide good role models to young people and generally any differences are sorted out by discussion and debate.

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Protecting children from harm or neglect and helping them stay safe

Attention is given in many areas to ensuring the safety and well-being of young people, staff and visitors to the home. For example routine checks are carried out in respect to installations such as the electrical systems, regular fire alarm tests are carried out as are fire drills. A range of risk assessments are in place and actions are taken to minimise the risks identified. There are two areas which potentially place people at risk of harm. Firstly, the shortfall in labelling jars of foodstuffs with the date of opening, therefore making it difficult to know when food should be deemed unsuitable to eat. Secondly, the practice of wedging fire doors open and some ill-fitting fire doors place people in the home at risk from harm by fire.

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Helping children achieve well and enjoy what they do

The provision is outstanding. Young people are very well supported by the committed management and staff team. Individual support is given via formal means such as keywork sessions and on a less formal basis through the managers and staff making themselves available to talk to young people at anytime. Staff 6 of 9 Inspection Report: SC396186 support young people in developing relationships with the other young people living in the home but also try and help young people to develop as individuals and make and maintain appropriate friendships outside the home. Where young people show a prejudice towards another person or group of people staff work with young people in helping them to develop more positive attitudes about others differences.

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Helping children achieve well and enjoy what they do

Educational needs are very well-catered for with some very positive outcomes having been achieved. For example, where there have been attendance issues in the past young people have supported in improving their attendance record with some reaching 100 percent. There is an education plan in place for each young person and for school leavers there is lots of encouragement and support provided in accessing further educational opportunities such as college courses. There are high expectations of the young people in terms of achievements and a high level of support in place to support the best outcomes possible.

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Helping children achieve well and enjoy what they do

Activities along with education are seen as important in helping young people to grow and develop in preparation for adulthood. Time and money is invested in helping young people to take part in a range of activities that interest them. For example, each young person has a lap-top computer and there are arranged trips out to theme parks and to bowling and ice skating. Young people are encouraged to broaden their horizons through travel in this country and aboard such as planning and arranging a camping trip in this country and attending a four week summer camp in America.

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Helping children make a positive contribution

The provision is outstanding. Young people are provided with an excellent standard of care. There is a robust approach taken to developing and reviewing written care plans and these inform all work carried out with the young people. The managers and staff spend time in getting know each young person and their wishes and needs well and this means that all work carried out is aimed at achieving the best outcomes possible. Young people confirmed that they are involved in the development of their plans. A daily log is maintained and this information feeds into the weekly and monthly reports which in turn feed into the reports for the young persons statutory review. Young people are supported in making their views known and in taking part in the review process. One young person said that he was happy with how he was consulted about his plan, through the keywork system and was confident that his wishes and feelings are taken into account.

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Helping children make a positive contribution

Support for establishing and maintaining contact with parents and other significant people is of a very good quality. Staff have a heightened awareness about the emotional impact contact arrangements can have on young people. All such arrangements are monitored closely and where issues arise staff deal with these in an appropriate way.

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Helping children make a positive contribution

There are clear arrangements in place in respect of young people moving into the home. Information about the young person and their needs will have been considered and where it is felt that the placement could be a possibility a placement meeting is held. From this meeting there are meetings and visits to the home by the young person and these include some overnight stays before the moving in date. The arrangements mean that young people can move into the home in a planned and sensitive manner.

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Helping children make a positive contribution

The managers and staff take a pro-active approach in making sure that young people are consulted about issues effecting them. There are a range of arenas that young people can use 7 of 9 Inspection Report: SC396186 to share their opinions such as the young peoples meetings facilitated on a weekly basis. Issues arising during this meeting are fed into the staff team meeting for discussion and then the following week at the next young peoples meetings feedback is given. Young people spoke about the keywork system in place and how this is a good arena for them to debate and discuss issues. The relationships which have developed between staff and young people are excellent and young people feel able to approach any member of staff with any issues they ay have.

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Achieving economic wellbeing

The provision is outstanding. The premises provide very good accommodation for the young people to live in. The interior and exterior décor is of a high standard and young people are provided with pleasant relaxing surroundings. All usual equipment is provided and there is a large games room available in which young people can take part in a range of activities. For example there is there a pool table, a range of books, DVDs and art and craft materials. Young people are supported to personalised their bedrooms to that they have a relaxing and private place they can use when they want some time alone.

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Achieving economic wellbeing

There are no young people with formal pathway plans in place but staff in the home work at all times towards helping the development of independent living skills. For example, young people are encouraged to use public transport, be involved in shopping for food and cooking, cleaning their bedrooms and one young person is planning a camping trip. There are a range of financial allowances available to young people and they are supported by staff in developing budgeting skills. Staff ensure that young people develop an understanding about issues around equality and diversity, both relating to them and to others. This will be key in them being able to function effectively in a multi-cultural society.

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Organisation

The organisation is satisfactory. There is clear information which explains the aims and objectives of the home. For adults this is in the form of a statement of purpose and this document underpins the work carried by the home. For children and young people there is a welcome guide which tells them what services they can expect. The promotion of equality and diversity is good. Both the statement of purpose and the guide for young people clearly set out a strong commitment to the promotion of equality and diversity and this is evidenced in all areas of practice.

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Organisation

The managers and staff are appropriately qualified, experienced and skilled in meeting the needs of young people living in the home. They show a very strong commitment to supporting the young people to reach their full potential. Staffing levels are set to ensure that the needs of young people living in the home at any one time can be met. There are clear arrangements in place in respect to deputising for the manager and in the event of staff shortages continuity of staffing is achieved in the main through using overtime. Staff are supported through formal systems such as planned and structured supervision and less formal systems such as peer support. The training opportunities available to staff are good and support staff to provide a good quality of care. Placing social workers are very satisfied with the care provided, one described staff as child focused and good communicators. It was also said that the home ' has

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Organisation

high standards of service and achieves good outcomes for children.' 8 of 9 Inspection Report: SC396186 The care of young people is monitored by the manager and a representative of the registered individual carries out visits to the home under regulation 33. The frequency of the regulation 33 visits have not always been as required and neither of these systems identified the safety issues relating to the medication and fire doors, both of which could have implications for the safety and well-being of young people.

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Organisation

There are case records made and maintained for each young person. The information contained within the files support staff in caring effectively for the young people and provide valuable information for the young person about his/her time in the home.

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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

14 August 2009 make suitable arrangements for the recording, handling, safekeeping, safe administration and disposal of any medicines received into the home. In particular to ensure that prescribed medication is not recorded as having been adminsitered in advance and in ensuring it is retained in the original container received from the pharmacist (Regulation 21.1) 14 August 2009 ensure there are adequate arrangements for containing fires. This in particular relates to making sure that fire doors are not wedged open and ensuring that each door provides effective means of containing a fire (regualtion 32 (c)) 14 August 2009 maintain a system for monitoring the matters set out in schedule 6 with particular reference to the use and maintainence of the fire doors (regulation 34).

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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): • maintain separate dedicated bound and numbered books to record required details of the use of physical intervention and separately any sanctions imposed (NMS 22.9 and 22.10) • ensure that positive steps are taken to keep children, staff and visitors safe from hazards. This is with particular reference to making sure that as containers of foodstuffs are opened the date of opening is recorded (NMS 26.1) • ensure that visits made out under regulation 33 are carried out at least once a month and include an assessment of the physical condition of the building. This is with particular reference to the condition and use of fire doors (NMS 32.1). 9 of 9 Inspection Report: SC396186

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