Children's Home run by Keys Nhcc Ltd in Shropshire

SC020607 Unique reference number 20 October 2009 Inspection date Trevor Hall Inspector Random 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: 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 while continuing to be relatively near to the parent home 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 interim inspection; the home's last full key inspection was undertaken on 27 May 2009, when no actions and six recommendations were raised. The home was judged at that point to be satisfactory. The previous recommendations required improvements to be made in respect of: medication administration and recording; the recording of complaints; the physical condition of the home; the furnishings and fittings; and the state of maintenance both of the house and grounds.

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Summary

This inspection has found that there have been significant improvements in the way the home deals with and records young people's complaints and that all of the issues previously raised in respect of maintenance and provision of adequate facilities have been appropriately addressed. The maintenance arrangements for the home have changed and these new arrangements appear to offer a more appropriate response, particularly to health and safety issues. Young people living within this home receive good support to remain healthy, they live in a home that is generally well maintained and is safe. The home environment and its associated assessments of risks have improved, as has general maintenance of the home, particularly the upkeep of the garden and the grounds. There remains a need for the improvement in medication administration and recording, recommended at the last inspection, to be sustained. The overall quality rating is satisfactory.

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Summary

This is an overview of what the inspector found during the inspection.

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Improvements since the last inspection

The recording and administration of young people's complaints has improved since the last inspection. All complaints received are dealt with promptly and young people are given clear resolutions which they are invited to acknowledge; their refusal is also recorded. 4 of 9 Inspection Report: SC020607 Since the home's last inspection the parent company has changed its maintenance arrangements. These new arrangements ensure that the home has a quick response to maintenance issues, particularly those which have implications for either health or safety. The house continues to bare the brunt of the current residents' destructive and self-harming behaviour, which significantly detracts from the appearance of the home. However, the living environment has been appropriately audited and it is clear that young people's safety is now a priority. All young people have an appropriate bed in their room and have adequate and safe lighting. The grounds

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Improvements since the last inspection

and gardens are now well maintained and no longer present a potential risk to the home's residents.

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Helping children to be healthy

The provision is satisfactory. 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 an up to date detailed health care plan. 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 home's last inspection made a recommendation to ensure that all prescribed medication is appropriately administered to young people and that any refusal to take it is properly recorded. It is clear from the home's records that following 5 of 9 Inspection Report: SC020607 this recommendation, the administration and recording of medication improved; however, failings in the administration and recording of prescribed medication were again prevalent on this inspection and as such the recommendation has been repeated.

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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. The maintenance arrangements for the home have improved considerably since the last inspection and no longer compromise the staff's attempts to provide a safe living environment for the current residents. All of the young people living in the home display acute self-harming behaviour and are very destructive towards the fabric of the home; as such, what should be a homely environment continues to appear spartan and careworn. Young people's rights to privacy continue to be appropriately promoted; however, this is tempered by the need to provide appropriate supervision and support for 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 are 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 all such complaints have been appropriately investigated, recorded and resolutions shared with the young people, who are afforded the opportunity to sign the record; refusal to sign is also recorded. 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.

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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 go missing without authority. 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. 6 of 9 Inspection Report: SC020607 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

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Protecting children from harm or neglect and helping them stay safe

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 going missing 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 national minimum standards 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 people's 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 this home have received additional training in dealing with self-harming behaviours. The 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. Since the last inspection, a comprehensive audit of the premises and environment has taken place specifically targeting the risks these present to the current young people, in an attempt to minimise these risks and

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Protecting children from harm or neglect and helping them stay safe

to make, as far as possible, the physical environment of the home supportive to the young people's needs.

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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 and 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. 7 of 9 Inspection Report: SC020607

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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 an adequately furnished detached property with good domestic style facilities. Due to the destructive and self harming behaviours of the current young people residing in the home, many fixtures, fittings and furnishings are damaged or show obvious signs of having been repaired. Whilst it is clear that every effort is made to ensure that the house is kept safe, the obvious evidence of this damage does detract from the homely appearance of the house. Every young person now has an adequate and appropriate bed in their room and has adequate safe lighting as required by the national minimum standards. 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 remains, however, frequent due to the behaviours displayed by the current residents.

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Achieving economic wellbeing

On inspection, the general decoration and maintenance of the home's interior appeared adequate, but would be enhanced by the replacement of damaged furnishings and some general re-decoration. The exterior of the home has improved considerably, with the garden and grounds returning to the well maintained tidy appearance witnessed on previous inspection. The potential hazard presented by an overgrown garden, with its potential to hide dangerous objects has now been reduced and staff are once more able to regularly 'sweep' the garden looking for such items, prior to young people having access to the grounds.

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Achieving economic wellbeing

Staffing levels have been significantly increased to help monitor the young people's volatile behaviours; unfortunately this has created parking problems that had not been anticipated in the home's original registration. The home has taken appropriate steps to convert an area of the side garden (an area previously overgrown and not used by the young people) into more off road parking for staff, which will more than compensate for the additional staff vehicles.

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Organisation

The organisation is not judged. 8 of 9 Inspection Report: SC020607

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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. (NMS 13.2) 9 of 9 Inspection Report: SC020607

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