Children's Home run by Kent County Council in Kent

SC037282 Unique reference number 20 August 2009 Inspection date Liz Daniels Inspector Key Type of Inspection

p.1

18 February 2009 Date of last inspection .

p.1

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.

p.2

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

p.2

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.

p.3

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: SC037282

p.3

Brief description of the service

Fairlawn is owned by Kent County Council and provides respite care for children and young people aged between five and 18 years, who have learning difficulties, physical disabilities and other associated complex needs. Over 100 children and young people stay at the unit on an occasional or regular basis; access to the service is through referral and is funded by the local authority. The number of staff or young people in the unit is based on a dependency assessment of care needs and a maximum of seven young people can be accommodated at any one time. A team of nurses funded by the Primary Care Trust and care staff funded by the local authority care for the young people. Staff are supported with specific training to meet the young people's needs.

p.4

Brief description of the service

The unit provides a range of facilities including office space, a kitchen, communal areas, bedrooms, bathrooms, a sensory room and soft play areas. A separate facility upstairs can also provide the opportunity for the young people to develop some independence and learn life skills. Outside there is a sensory garden and a large grassed area where there are swings, a play house and an adventure area on a safe surface. Off road parking is available in front of the complex and the unit has its own adapted transport, enabling the young people to access activities and education in the local community.

p.4

Brief description of the service

Copies of the statement of purpose are available from the unit for parents and social workers. A young people's guide is given to new young people entering the service that details the unit, the staff and the daily routine.

p.4

Summary

This unannounced inspection was the first visit to the unit for the year April 2009 to March 2010. All of the standards considered by Ofsted to be key standards were inspected, although the recruitment of new staff could not be fully inspected. The visit provided the opportunity to meet with the registered manager, one of the nurses and several of the care staff. All the young people staying overnight were also there for part of the inspection and were able to demonstrate that they were enjoying their time at the unit.

p.4

Summary

This setting provides a welcoming, pleasant and comfortable place for the young people to stay when receiving respite care. A motivated and experienced staff team put in excellent measures whereby meeting the young people's individual needs is an integral part of how the unit runs. They see their role as enabling each of the young people to 'have a voice' whereby their views are included in decisions made about them, as well as ensuring they are kept safe, are healthy and are happy whilst away from home. The overall quality rating is good. This is an overview of what the inspector found during the inspection.

p.4

Improvements since the last inspection

There were two actions issued at the last inspection, both of which have been addressed. As a result, there is greater clarity as to when individual young people should be given medications which are prescribed 'as required' and complaints are now included in the monitoring to fulfil Regulation 33. 4 of 9 Inspection Report: SC037282 Similarly, two recommendations were made at the last inspection; one has been undertaken but the other could not be fully inspected as there has not been recruitment of new staff since the last inspection. The recommendation has therefore been re-issued, for consideration at the setting's next inspection. However, the names of all witnesses are now recorded in the physical intervention log.

p.4

Helping children to be healthy

The provision is good. The meals for the young people are prepared in a well-designed, spacious kitchen. A varied, nutritious menu is planned and meals are happy sociable occasions when the staff and young people eat together. When required, the young people have specific foods which meet their individual dietary needs and the staff demonstrate understanding when assisting the young people with eating. All the staff are trained in food hygiene.

p.5

Helping children to be healthy

Many of the young people have complex health needs which the staff explore; each has a health plan and this with their care plan details the care required to meet their health needs. Illnesses, accidents or injuries are well recorded and excellent liaison between the staff and health professionals enables continuity of care for the young people. The staff regard health promotion as an integral part of each young person's care and the overhead hoist system ensures all young people can use the bath and wash facilities as well as be involved in activities arranged at the unit.

p.5

Helping children to be healthy

Medications are safely stored in a locked cupboard and good processes are in place for their safe administration. Any medications the staff administer are well recorded on each young person's Medication Administration Record (MAR chart); balances of these medications are monitored and recorded enabling a clear audit trail in the event of any discrepancies. Limited non-prescription medications are held as stock. Most of the staff are trained in the administration of first aid and well-stocked first aid boxes are in the unit and company vehicle. Shifts are adjusted to ensure a staff member trained in first aid is always on duty.

p.5

Protecting children from harm or neglect and helping them stay safe

The provision is good. The staff recognise that the young people must have privacy and ensure information about them is handled confidentially. Comprehensive policies underpin good practice when the young people's possessions are searched or personal care is carried out. A payphone is available for the young people to make private calls to their families and wherever possible a mixed staff group is on duty, enabling sensitivity to gender issues.

p.5

Protecting children from harm or neglect and helping them stay safe

The staff recognise that each young person has the right to complain and that their concerns must be taken seriously. They are alert to signs that a young person may be concerned, distressed or unhappy and use a variety of communication systems to allow them to express their anxiety. The unit's procedure outlines that informal concerns are managed by the unit's manager and more serious complaints are formally investigated through the local authority complaints process. Feedback from parents confirms that they believe concerns are acted upon and appropriately investigated. Good records are maintained.

p.5

Protecting children from harm or neglect and helping them stay safe

The staff recognise and know how to respond to safeguarding concerns, whereby the welfare of the young people is promoted. The unit's policies and procedures are well established and 5 of 9 Inspection Report: SC037282 comprehensive, requiring that all staff have an enhanced Criminal Records Bureau (CRB) disclosure before employment and all the staff are trained in child protection. In addition, the local safeguarding procedures are readily available in the unit for the staff to reference.

p.5

Protecting children from harm or neglect and helping them stay safe

The staff are very alert as to what constitutes bullying and effective strategies ensure the incidence is minimal. Careful planning of the groups to be accommodated includes consideration for which young people are likely to bully as well as those who are vulnerable; in addition, the staffing ratios provide good supervision for the young people. Whilst they stay at the unit, the spacious environment enables the young people to be together or to be in separate smaller groups as appropriate. Discussion about any incidence ensures trends are identified and effective preventative measures are introduced.

p.6

Protecting children from harm or neglect and helping them stay safe

Clear strategies ensure those young people at risk of unauthorised absence are identified and that the staff are responsive; one recent incident was immediately and appropriately managed with all the necessary people involved and informed. Any incidence is well investigated and preventative measures are explored. If required the young people can then meet with their social worker when they return, to discuss their reasons for absence.

p.6

Protecting children from harm or neglect and helping them stay safe

Good measures are in place to manage the young people's behaviour, resulting in appropriate sanctions being given and the use of physical intervention only in situations where a young person or others are at risk of harm. Overall, good records are maintained, although the specific detail of the consequence of behaviour including its duration, is not always recorded in the sanctions log. In general, particular behaviours are incorporated in the young people's care plan although their 'positive handling plan' is not always completed.

p.6

Protecting children from harm or neglect and helping them stay safe

Robust measures are in place to maintain the safety and security of the young people. Appropriate risk assessments are undertaken for the premises and for activities, equipment is appropriately checked and the necessary contracts are in place. In addition, positive steps are taken to protect against the risk of fire and other hazards; twice yearly fire awareness training ensures that all personnel are appropriately trained and weekly daytime fire drills with creative 'mock scenarios' twice yearly enables all the staff to familiarise themselves with how to respond across the 24 hour period.

p.6

Protecting children from harm or neglect and helping them stay safe

Visitors and contractors are well vetted and agency staff checks are undertaken prior to their working at the unit. In addition, the manager is fully aware of the measures that must be in place for the safe recruitment of staff. However, as no new staff have been recruited since the last inspection, the written evidence to support the recruitment process could not be viewed at this inspection.

p.6

Helping children achieve well and enjoy what they do

The provision is good. The staff provide a high level of personal support for the young people. Although the setting does not use a key worker system each young person has at least one member of staff allocated to look after them for each shift; individual time with them provides opportunities for the young people to share any personal concerns they may have. Individual and group activities counter the risk of a young person becoming isolated but professional services are accessed when needed. In addition, the monthly visits from the person undertaking the visits to fulfil Regulation 33 enable the young people to raise any queries with an independent person. 6 of 9 Inspection Report: SC037282 Discussions with family members and observation of the young people confirm that they respond well to the care that they are given.

p.6

Helping children achieve well and enjoy what they do

Education is promoted as valuable and the staff support the young people in their learning. They enable their attendance at school as well as provide appropriate learning toys and resources. The staff communicate with the schools as required and good liaison at the 'Looked After Child' reviews enables the staff to be aware of the young people's Personal Education Plan (PEP).

p.7

Helping children achieve well and enjoy what they do

The staff organise activities and leisure interests that are suitable for the young people and stimulate their interests; very good facilities and an abundance of pastimes and games are evident around the unit. Festivals and celebration days are remembered and all the activities take account of the particular needs, capabilities and supervision each young person requires. An overhead hoist system ensures that no young people are excluded from areas of the unit or specific activities; equally the staff recognise that the young people may wish to be alone and have some 'free time'. The staff believe they gain the views of the young people through recognising that the way they behave and whether they are relaxed indicates their likes and dislikes about the service.

p.7

Helping children make a positive contribution

The provision is outstanding. The young people's needs are assessed through the 'looked after child' framework which underpins the development of comprehensive care plans, risk assessments and health plans. Each young person's care plan is reviewed with family members at each admission and updated if required; similarly they are updated following the 'looked after child' reviews or discussions with the young person's social worker. Comprehensive daily logs are also maintained and reports sent regularly to the young people's social worker.

p.7

Helping children make a positive contribution

Reviews of care are held within the 'looked after child' framework. The unit provides a pre-review report and key staff from the unit, health professionals, education staff and family members are involved, whereby the young people's progress, likes and dislikes are contributed; some of the young people attend for all or part of their reviews, where practical. All the required paperwork is held in the young person's file.

p.7

Helping children make a positive contribution

Most of the young people live with their families and attend the unit for respite, whereby contact visits are not usually arranged during their stay. However, for those young people who stay at the unit for longer periods, contact arrangements are agreed and supported, enabling the young people to maintain valued relationships. In such instances, the progress of each contact is recorded.

p.7

Helping children make a positive contribution

Admissions to the unit are very well planned and structured, in consultation with health professionals and appropriate staff. Similarly, the staff spend time with the young people explaining and preparing them for their move to adult services; a pilot project starting in September will include teaching life skills to some of the older young people and is a positive development in continuing to ensure that they have a smooth transition.

p.7

Helping children make a positive contribution

The staff recognise the different ways in which the young people express their views and ensure those views are promoted when key decisions are being made about their lives. The staff also consider it very important to explore the views of parents and professionals involved with the 7 of 9 Inspection Report: SC037282 service; questionnaires, telephone discussions, informal discussions, communication books and the young people's reviews are some of the forums used to gain their opinions.

p.7

Achieving economic wellbeing

The provision is outstanding. The staff support the young people as they prepare for their move to adult services. They guide them as they move through their adolescence and provide them with age appropriate advice and support with their physical development and wellbeing. Although learning life skills may not be appropriate or possible for many of the young people accommodated the staff work with their family and social worker to support their transition into adult services. For those who are able, a flatlet within the unit provides space where the staff can work with the young people and help them learn some meal preparation and cooking.

p.8

Achieving economic wellbeing

This respite unit is purpose built and offers considerable space and facilities. Its entrance is accessible for young people who are less mobile and it is set within its own grounds which provide space for relaxing and recreation. A sensory garden and excellent activity equipment that includes slides, climbing apparatus, a large lawned area and a new safe surface, make it suitable for young people with varying needs and disabilities. Ample communal space within the unit provides space for the young people to play together, relax or have some quiet time alone. Spacious wash facilities and the overhead hoist system enable all the young people to share all the facilities and take part in all the activities.

p.8

Achieving economic wellbeing

The general décor, furniture and furnishings of the unit make it welcoming, pleasant and comfortable with excellent facilities for the young people. Repairs are undertaken promptly and the property is maintained in a good state of structural and decorative repair.

p.8

Organisation

The organisation is good. The unit's statement of purpose is current and reflects how the setting operates, how the young people will be cared for and what services they can expect. It is well circulated to parents each year and to all new staff. The young people's guide in picture and word format is also comprehensive, although written, anticipating that parents or staff will go through it with the young person.

p.8

Organisation

A knowledgeable, experienced and well qualified manager leads the staff team, supported by shift leaders who deputise for her in her absence. The staff team is a mix of trained nurses and care staff, 80% of whom are trained in the National Vocational Qualification (NVQ) for the care of children and young people at Level 3 or above, or are undertaking the course.

p.8

Organisation

Sufficient staff are rostered to care for the young people and meet the unit's statement of purpose. Some young people who have complex health needs are only accommodated when there is a nurse on duty for each shift; recently some shifts have not had nurse cover, whereby a few respite dates have been changed. However, this appears to be a short term arrangement whilst additional staff are recruited to join the nursing team. The numbers of care staff rostered to be on duty are dependent on the dependency rating for the young people being accommodated; any shortfalls are covered by the permanent staff undertaking extra duties or by the use of regular agency staff. There are good training opportunities for the staff and they 8 of 9 Inspection Report: SC037282 feel well supported although there has been some slippage in the formal supervision sessions that had previously been timetabled.

p.8

Organisation

Quality assurance and reflection on practice is fundamental to how the service runs. Robust internal monitoring is undertaken to monitor the care of the young people as well as the unit's performance against its statement of purpose. Appropriate records are reviewed and the frequency of events and any trends are identified; they are then reviewed with the staff whereby their significance is recognised and appropriate action taken. Monthly monitoring visits are also undertaken by a senior member of staff in the local authority and recommendations made are acted upon.

p.9

Organisation

The promotion of equality and diversity is good; all the young people accommodated have disabilities but all are treated equally. The staff see them all as individuals and are proactive in ensuring their diverse needs are met. The ethos of the unit is to recognise and support the different views, needs, cultures, language and faiths of any young person accommodated there. A mixed staff team ensures that the individual personal, social, health and emotional needs of each young person are explored and care given to meet them.

p.9

Organisation

All the young people have comprehensive individual files that are a permanent secure record of their history and progress. They are stored appropriately but can be shared with the young people with staff support, if requested.

p.9

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.

p.9

Due date Action Standard

30 October 2009 ensure all staff receive appropriate training, supervision and appraisal (Regulation 27).

p.9

Recommendations

To improve the quality and standards of care further the registered person should take account of the following recommendation(s): • ensure staff are appropriately trained in the use of first aid (NMS 13) • ensure the records of sanctions include the specific details of the sanction given (NMS 22) • ensure all records that detail the individual care needs of the young people are completed and updated, to support the young people (NMS 22, NMS 2) • ensure the records of staff recruitment demonstrate that all recruitment checks are obtained prior to the start of employment (NMS 27) (Previous recommendation - re issued as unable to fully inspect at this inspection). 9 of 9 Inspection Report: SC037282

p.9