Children's Home run by Choices 4 Children Limited in Lancashire

SC400880 Unique reference number 24 November 2009 Inspection date Fiona Parker Inspector Key Type of Inspection

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25 September 2009 Date of last inspection .

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

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

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About this inspection

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

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The inspection judgements and what they mean

this aspect of the provision is of exceptionally high quality Outstanding: this aspect of the provision is strong Good: this aspect of the provision is sound Satisfactory: this aspect of the provision is not good enough Inadequate: 3 of 10 Inspection Report: SC400880

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Brief description of the service

This home is registered to provide care and accommodation for up to four young people of either gender, who are aged from four to 17 years. The home provides care for children with learning disabilities.

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Brief description of the service

This home has recently re-registered due to the company changing its name. The responsible individual and registered manager remain the same and the only change as a result of this registration is the inclusion of one place for a child with emotional and behavioural difficulties.

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Brief description of the service

The property is a converted farmhouse, set in 13 acres of grounds. It is located in a semi-rural area, but is within easy reach of shops, schools, public transport and various leisure and community facilities. Transport is available for young people to enjoy opportunities.

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Brief description of the service

There are four bedrooms on the first floor for young people in addition to their own bathroom. There are separate facilities and sleeping arrangements for staff members. On the ground floor there is an open plan lounge and dining room, a kitchen and a staff office. An enclosed garden with play equipment is situated to the rear of the home.

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Brief description of the service

Two young people currently live in the home and both were present at times during this two day visit. One young person spoke with the inspector and both young people were observed in their home.

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Summary

The overall judgement is inadequate due to shortfalls in the outcome areas of staying safe and organisation. Although these concerns relate mainly, but not wholly to three occasions this year the combination of shortfalls in behaviour management are found in key policies, risk assessments, practice, records and management overview systems. There is also a policy in place allowing young people to be cared for in staff member's homes away from their registered home for short periods. This does not ensure young people's safety and results in an overall judgement of inadequate.

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Summary

Where issues of poor practice and recording have occurred these have not been sufficiently addressed in management systems and appropriate action taken to ensure young people's welfare is promoted at all times. The home has achieved some good outcomes in other areas particularly in being healthy. Young people presented as happy and comfortable with all staff members during this two day visit.

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Summary

The register manager and responsible individual openly discussed all issues and made some immediate changes and plan further timely improvements.

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Summary

As the actions and recommendations from the previous inspection have been mostly addressed the capacity to make improvements following this inspection is credible. The overall quality rating is inadequate. This is an overview of what the inspector found during the inspection. 4 of 10 Inspection Report: SC400880

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Improvements since the last inspection

The last inspection took place under the previous registration on 5 May 2009, three actions and two recommendations were made and the overall judgement was satisfactory. Good progress has been made on most, the outcomes of statutory reviews are now recorded on files and the staff team has received training in respect of autism. The two most recently employed staff members are due to complete national vocational qualification level 3 in December 2009. This will meet the standard of 80% when this is achieved. The home has explored advocacy support and to-date one young person has received an independent visit.

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Improvements since the last inspection

Actions in respect of behaviour management are not met and further actions have been made under this regulation.

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Helping children to be healthy

The provision is good. Young people enjoy a range of food choices and benefit from structured family mealtimes where they can share their news about the day. Young people can help with tasks such as preparing food or washing pots and clearly enjoy sharing their pride with such achievements to those around them. Children's safety in the kitchen is fully considered and tasks are appropriate for their age and understanding. Staff are aware of the importance of promoting healthy eating and balancing this with likes and dislikes. Discussion with young people show they are aware of different foods including cultural foods. Menus show a variety of food is offered which is mainly healthy however there are some weeks where not so healthy foods such as chips feature frequently therefore not always fully promoting a healthy varied diet.

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Helping children to be healthy

Young people's holistic health and medical needs are fully promoted in the home. Records support a range of appointments and contact with health professionals to ensure young people remain healthy and well. Specialist health instructions are clear on files and staff can demonstrate the care they provide. The manager is proactive in requesting appointments should needs change and closely liaises with parents where this is appropriate. All staff are trained in first aid so are able to respond to young people's daily immediate health care needs.

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Helping children to be healthy

Young people's medication needs are safely administered and plans are clear on the times and dosage for each young person. Records for disposal do not always evidence the amount of medication or reason for returns to the pharmacist. Minor discrepancies in records have not been identified during management review. In addition the arrangements for the storage and recording of controlled drugs requires review to ensure this meets current medical advice. These shortfalls have not directly impacted upon young people's health care.

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Protecting children from harm or neglect and helping them stay safe

The provision is inadequate. Safeguarding procedures in the home are not sufficiently robust to ensure safe arrangements and guidance for staff is in place. The home's policy does not detail the actions staff should take in response to concerns should this involve a manager. The new arrangements for Local Safeguarding Children's Boards including the role of a local authority designated officer are not fully understood and the home has not forwarded a safeguarding policy for agreement. Young people's welfare could be compromised as a result of these shortfalls. 5 of 10 Inspection Report: SC400880 The home's physical intervention policy is in need of immediate review and refers to the previous method in which the qualifications of staff ceased in 2007. Risk assessments also have not been reviewed in light of the new method employed in the home. Records show incidences where behaviour has not been appropriately managed or responded to. The account of incidences is

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Protecting children from harm or neglect and helping them stay safe

not always recorded appropriately therefore this does not conclude whether young people's behaviour was appropriately responded to and their welfare safeguarded.

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Protecting children from harm or neglect and helping them stay safe

A record of a restraint undertaken during the responsible individual and registered manager's leave period does not conclude the restraint was undertaken due to a risk of harm to self, others or serious damage to property as required by regulation. Therefore although restraints are infrequent in the home it is not possible to conclude the appropriate application of restraints is fully understood by all the staff team. Risk assessments do not provide sufficient detail on likely behaviours or outline the strategies to guide staff on the agreed actions they should take in response to challenging behaviour and appropriate sanctions. Records do not detail behaviour young people may display due to their learning difficulties. These shortfalls do not always offer children appropriate protection and the support with behaviours associated with their needs.

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Protecting children from harm or neglect and helping them stay safe

Management overview of incidences does not appropriately identify the areas of concern therefore young people have not been appropriately safeguarding through management processes on these occasions. Of further concern is a policy detailing arrangements to care for young people briefly in the staff or manager's home. This had occurred on one known occasion with a young person no longer resident. This policy has been immediately removed.

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Protecting children from harm or neglect and helping them stay safe

General risk assessments for the environment and activities are satisfactory. Good systems are in place to ensure a physically safe environment, however the unlit steps outside are a potential hazard during darkness. Fire drills and checks meet the standards with the exception of an absence of a night time fire drill.

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Protecting children from harm or neglect and helping them stay safe

Basic policies are in place to support privacy and dignity in line with the care needs of young people. Staff describe knocking on bedroom doors, giving young people their own space where possible and teaching them to respect their own privacy.

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Protecting children from harm or neglect and helping them stay safe

Recruitment processes are in place and meet the standards in most aspects. However there are shortfalls in relation to fully checking and recording any gaps in one employment history and photographic identification missing. Risks assessments are not completed in relation to information obtained during recruitment checks to evidence decisions leading to employment. Although the staff team is now complete the manager and responsible individual report some recruitment difficulties this year and there have been occasions where new staff employed have been found to be unsuitable during the probationary period. This can potentially disrupt young people's routines and attachments.

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Helping children achieve well and enjoy what they do

The provision is good. Young people receive individual support on a daily basis and benefit from good supervision levels to ensure their specific needs are met. The ethos is for all staff in the small team to provide support and discuss feelings and views as young people raise them through the day. This is in line with what suits young people rather than a formal pre arranged key work system. Some young people benefit from independent visits arranged by their local authority. 6 of 10 Inspection Report: SC400880 All young people living in the home enjoy full time education in provision appropriate for their needs. Attendance at school is excellent and supported by regular transport arrangements, any absences are authorised due to illness. There is good liaison between colleges and the home to support young people receiving consistency between the two environments. Education plans detail the support young people can expect and the home ensures they attend parent evenings

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Helping children achieve well and enjoy what they do

and meetings to promote young people's full opportunities. Records show frequent contact with schools and records of progress such as school reports. Young people also enjoy activities such as after school clubs.

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Helping children make a positive contribution

The provision is satisfactory. Young people's individual needs are outlined in placement plans supported by additional information on files. There are shortfalls in the detail of young people's needs particularly in respect of behaviour management. Detailed reports are provided by the home to contribute a current assessment of young people's needs and progress in formal statutory reviews. Contact arrangements are promoted and young people clearly benefit from maintaining significant relationships and the positive experiences this brings. Young people are able to express their views in a variety of ways including monthly children's meetings. These are mainly positive meetings with young people expressing views and staff taking appropriate action when required. However on at least 3 occasions minutes reflect meetings used to talk about behaviour serving an adult agenda which can deny young people's formal opportunity to express themselves.

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Helping children make a positive contribution

Suitable admissions and leaving policies are in place and young people are supported to move positively to long-term arrangements where this is an agreed plan. Where children have needed to move in emergency situations meetings have been held and plans agreed.

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Achieving economic wellbeing

The provision is good. Young people are supported to achieve independence in line with their capabilities and future plans. Staff support and encourage young people to achieve daily tasks such as caring for themselves and helping in the house. Appropriate links are in place with transitional teams and the home contributes to overall assessments for young people's future plans. Transitional meetings and assessments are in place where appropriate. Staff follow information in the daily logs to work with young people on independence tasks and can clearly discuss achievements. However there is an absence of clarity on the targets, achievements and review of these in a structured plan.

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Achieving economic wellbeing

Young people benefit from a homely, comfortable and peaceful environment with suitable and spacious facilities. Individual bedrooms and separate bathroom and toilet facilities are available. Young people's safety could be compromised despite supervision levels, due to the absence of bathroom locks which can be opened from the outside by staff should an emergency require this.

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Achieving economic wellbeing

Young people can choose the decor in their own bedrooms and clearly football teams and cartoon characters are popular choices. A computer, games consoles, books and activities are readily available and young people enjoy the use of these daily. 7 of 10 Inspection Report: SC400880

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Organisation

The organisation is inadequate. The promotion of equality and diversity is satisfactory. The staff team have received equality and diversity training and are committed to meeting the individual needs of young people and developing their experiences. Equality and diversity policies are in place and records show some examples of considering equality and diversity experiences and needs in plans.

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Organisation

A statement of purpose outlines the aims and objectives of the service and contains most of the information required with the exception of the responsible individual's experience, qualifications and current staffing arrangements. A children's guide is available in picture format including photographs to inform young people what they can expect.

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Organisation

The staffing policy is currently out of date and does not reflect the current staffing arrangements, for example this refers to the role of senior workers when there are no senior posts. The expected shift patterns are not clear in the policy. One staff member is currently working three consecutive 24 hour shifts. Although this is through choice there are potential longer term implications which may impact upon the quality of care young people receive. This has not been considered in this arrangement.

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Organisation

A full programme of staff training is in place and the company is committed to fully training the staff team. Two recently appointed staff members are due to complete national vocational qualification level 3 in December, this will result in full compliance with this standard.

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Organisation

Management systems are in place to review the records and practice in the home, however there are three occasions where issues have not been sufficiently assessed and incidences which require further clarification not fully explored. There are a number of key policies in need of review therefore staff are not sufficiently guided to care for young people, particularly in managing behaviour and understanding needs arising from learning disabilities.

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Organisation

In addition the regulation 33 visits are not complying with regulations and identifying shortfalls or improvements to promote the quality of care for young people. There are also shortfalls in monitoring visits in respect of consulting young people, staff and any others.

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Organisation

The shortfalls result in potentially unsafe or unsatisfactory care practice and on occasions compromising the care young people receive. Although the examples of these are relatively few in the overall care young people receive the shortfalls have occurred at practice and management level. The register manager and responsible individual openly discussed all issues and made some immediate changes and plan further improvements.

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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

8 of 10 Inspection Report: SC400880 31 December 2009 ensure there are suitable arrangements for the recording, handling, safekeeping, safe administration and disposal of any medicines received into the children's home in particular in relation to controlled drugs (regulation 21 (1) ) 31 December 2009 prepare and implement a written policy which is intended to safeguard the children accommodated in the home from abuse or neglect with particular reference to including allegations against the registered manager (regulation 16 (1) ) 31 January 2010 ensure the procedure under paragraph (1)(b) shall in particular provide for liaison and co-operation with any local authority which is, or may be, making child protection enquiries in relation to children accommodated in the home (regulation 16 (2) (a) 31 December 2009 review and where appropriate revise the behaviour management policy (regulation 17 (3) (a) 26 November 2009 ensure no measure of control, restraint or discipline which is

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Due date Action Standard

excessive, unreasonable or contrary to paragraph (5) shall be used at any time on children accommodated in a children's home (regulation 17 (1)) 31 December 2009 ensure any offer of employment to a person is subject to paragraph (3) (d) being complied with in relation to matters specified in schedule 2 (regulation 26 (5) (a) ) 31 December 2009 ensure the statement of purpose consists of the matters listed in schedule 1 in particular the experience and qualifications of the responsible individual (regulation 4 (1)) 31 December 2009 keep under review the statement of purpose and where appropriate revise the statement of purpose, in particular changes to policies and procedures (regulation 5 (a)) 31 December 2009 ensure a person is fit to work in the children's home and has the qualifications, skills and experience necessary (regulation (3) (b) 31 December 2009 establish and maintain a system for monitoring the matters set

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Due date Action Standard

out in Schedule 6, improving the quality of care provided in the children's home and provide consultation with children accommodated in the home, their parents and placing authorities. (regulation 34 (1) (a) (b) (3)

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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 the record of menus demonstrates provision of a suitable and varied diet and does not show frequent availability of foods such as chips (National Minimum Standards 10.4) 9 of 10 Inspection Report: SC400880 • ensure that staff (not children) are able to open the doors to bathrooms, showers and toilets from the outside in case of an emergency (National Minimum Standards 25.6) • ensure that at least four fire drills, including evacuation of staff and children from the building and fire drills held at night, take place in a 12 month period (National Minimum Standards 26.8) • ensure that there is an effective system to decide on appointment in light of any concerns about suitability that are declared or discovered through the recruitment process ( National Minimum Standards 27.2)

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Recommendations

• ensure that unnecessary risks to the health and safety of children accommodated in the home are identified and so far as possible eliminated, in particular individual risk assessments are clear on strategies for managing young people's behaviour • ensure that there is adequate lighting outside the home to ensure children and staff can enter and leave the home safely (National Minimum Standards 26.1) • ensure that children's opinions are sought over key decisions and children's meetings that take place are not used for staff to discuss behaviour (National Minimum Standards 8.1) • ensure that there is comprehensive plan for young people preparing to leave the home which contributes to transition plans for children with disabilities and special education needs • ensure that there are clear arrangements for staff to deputise in the registered person's absence (National Minimum Standards 29.2) • ensure that staff working extensive shift patterns are competent and able to meet the needs

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Recommendations

of the children. (National Minimum Standards 21.1) 10 of 10 Inspection Report: SC400880

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