Children's Home run by Anna House Limited in Havering

SC058603 Unique reference number 20 February 2010 Inspection date Joanna Heller 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: SC058603

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Brief description of the service

This home is a respite care unit for five children and young people with physical and learning disabilities. The building is a detached, adapted house situated in a residential area. The home has five single bedrooms. Communal facilities include a lounge, kitchen and conservatory all of which are well decorated and maintained. The rear garden is secure and in regular use. The home is close to the local shops and is supported by good local transport links. The service provides support to a small group of families at this point in time and places are purchased via the child's local authority.

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Brief description of the service

Young people and children have packages of care varying from every weekend to occasional overnight stays.

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Summary

This was an unannounced inspection carried out as part of the annual inspection program. All key standards were assessed.

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Summary

The home provides highly individualised child-focused care. Young people say they look forward to coming to stay as staff are lovely people and they make the time spent at the home fun.

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Summary

Areas of shortfall are around staff management, induction and training, arrangement of accommodation, medication and record keeping. 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

At the last visit the home was asked to ensure that locks on bedroom doors are safe, to improve record keeping, evidence a risk assessment for staff working alone and ensure suitable staff sleeping-in accommodation. The home has replaced bedroom door locks, developed the statutory records requested and carried out an assessment of risk for lone working. Staff sleep in accommodation remains an issue.

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Helping children to be healthy

The provision is satisfactory. Staff ensure young people benefit from a variety of nutritious home cooked foods which reflect their choices and cultural heritage. Staff use their knowledge of young people's likes and dislikes and pictorial communication systems to help young people with limited communication to choose meals. Young people say they enjoy the food and get involved in cooking sometimes. Detailed guidelines are in place to direct staff on how to support the young people at meal times and include any dietary needs and allergies.

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Helping children to be healthy

As a respite service the responsibility for long term healthcare remains with the parents. Staff, however, are guided by parents and ensure that all young people have access to appropriate health services such as doctors, dentists and opticians as appropriate. Where appointments with specialist health services are required staff support young people to attend these. A health plan is in place as part of the care plan. Staff have received training in first aid, medication and 4 of 9 Inspection Report: SC058603 food hygiene. Young people with epilepsy regularly use the service, however, no training in relation to epilepsy has taken place.

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Helping children to be healthy

The home has safe systems in place for the storage and administration of prescribed medication. Staff are trained in managing medication. Clear records are held of medication coming into and leaving the home. Clear records are maintained of medication given. A pharmacist visits regularly to review the systems in place. Homely remedies are approved by the GP; however, accurate information is not always carried across on to the detailed homely medication sheet. No such medication has been given; however, this places the young people at risk of being given a medication which has the potential to cause them harm.

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Protecting children from harm or neglect and helping them stay safe

The provision is satisfactory. Young people are safeguarded from unsuitable people gaining employment in the home through robust vetting practices. No staff are employed at the home until checks are completed on their identity, and employment and criminal history. Written references are provided on headed paper and are followed up with a telephone call to ensure their validity.

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Protecting children from harm or neglect and helping them stay safe

A pictorial complaints procedure is displayed to make the complaints process as accessible to young people as possible. However, due to the care characteristics of young people, complaints would in the majority of cases arise from family members or carers. Young people who are able to verbalise say that they would tell the manager if they were unhappy and that it would then be sorted out. They, however, were adamant that they were very happy coming to stay at the home. The home is able to demonstrate that complaints from families are effectively responded to, investigated and managed. Confidentiality is managed appropriately. Files are stored securely and the principles of confidentiality discussed in staff meetings. Staff ensure that when giving personal care privacy is maintained.

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Protecting children from harm or neglect and helping them stay safe

The building is well maintained and systems are in place to ensure its ongoing safety such as annual checks on the gas supply. Fire precautionary arrangements in the home ensure young people and staff are safeguarded from fire in line with current good practice. The home's fire risk assessment, however, states that each young person will have an individual assessment of risk in relation to fire. The assessments shown do not detail the specific issues for evacuation of individual young people should a fire occur. Locks are placed on the external doors of the home to prevent young people going out of the building unsupervised as all are considered very vulnerable.

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Protecting children from harm or neglect and helping them stay safe

During the induction process staff are guided by the manager in basic child protection awareness and the policies and procedures in the home. Not all staff have had further training, however, the manager has identified these staff to attend training in May. Some young people over the age of eighteen are accommodated in the home, but the manager and staff have not undertaken training in safeguarding vulnerable adults. A whistle blowing policy is in place to highlight the process for reporting concerns to outside agencies where appropriate. The policy, however, does not reflect the current management arrangements in the home.

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Protecting children from harm or neglect and helping them stay safe

Bullying is not an issue of concern in the home and young people say they feel safe and well cared for. Behaviour management in the home is very much tailored to the individual. Young people have limited insight into their behaviour and its impact on others. Each young person has a communication passport linked to the behaviour management plan. Behaviour is therefore 5 of 9 Inspection Report: SC058603 viewed very much as a means of communication and staff use techniques such as distraction and praising good behaviour. The specific approaches which have been found to be useful for each young person are highly detailed, including referring to specific television programmes and instructions which help distract. Sanctions are not applied due to the nature of the care characteristics of the young people. Staff are trained in breakaway techniques and managing challenging behaviour. Staff on occasion do have to restrain some young people when they

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Protecting children from harm or neglect and helping them stay safe

place themselves or others at risk. Records of restraint applied are not on all occasions recorded as such, and are not sufficiently detailed as to describe how the restraint was carried out nor how long it took.

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Helping children achieve well and enjoy what they do

The provision is outstanding. Staff deliver highly individualised care in accordance with each of the young people's widely varying needs. Each young person has a highly detailed plan of care which includes all key areas of need and a communication passport. Specific care routines are detailed such as, how a young person likes their hair brushed whilst watching television. Varying methods are used in the home to help staff and young people communicate effectively, for example, pictorial communication systems, symbols and photographs. Key policies such as complaints and fire are displayed in a pictorial format. Young people are helped to understand which people work in the home through staff photos displayed on the wall. The home provides a service to a small group of young people and as such staff get to know young people and their families and carers well.

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Helping children achieve well and enjoy what they do

Young people enjoy active and varied lives whilst staying at the home. Staff spend time doing things with young people such as art and craft which are displayed around the home. Young people say they love coming to stay and that they have lots of fun. Photographs are also displayed around the home of young people enjoying activities such as playing in the garden, going on drives, having a barbeque and going bowling. Over the Christmas period young people enjoyed trips to a Christmas fair and the pantomime. Care records detail particular activities that young people enjoy. A wheelchair accessible bus is provided so that staff can provide good access to the community. Good relationships are developed in the locality and the home often receives donations from local well-wishers.

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Helping children achieve well and enjoy what they do

Education remains the primary responsibility of parents, however, staff maintain good communication with school, family and the service through communication books and regular telephone calls. Where young people have a shared care arrangement between the home and residential school, staff have copies of school reports and attend key meetings. Staff are proactive in providing young people with informal educational opportunities throughout their stay.

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Helping children make a positive contribution

The provision is outstanding. Before agreeing to provide care, the manager ensures that they are clear that the home will be able to effectively meet the young people's needs. No placements to the home have been unplanned. A copy of the central core assessment of need is obtained which is supplemented with the home's assessment process. Young people are encouraged to visit the home and have trial overnight stays. Some young people have a weekly tea time visit to get settled into the 6 of 9 Inspection Report: SC058603 home before staying overnight. The process is very much led by what is in the young people's best interest.

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Helping children make a positive contribution

From the assessment of need staff develop a highly individualised care plan. The care plan is kept under review through placing authority reviewing processes and monthly reviews and reports complied by the home. Copies of these reports are provided to families and placing authorities as appropriate.

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Helping children make a positive contribution

Staff enable young people to make choices about their lives to the best of their ability. Communication plans emphasise the importance of offering choice and recognise young people's means of communication. Young people were observed to be offered choices about activities and appeared to really enjoy the company of both staff and the manager. Young people say that they have a wide variety of opportunities to make decisions and staff always ask them about things.

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Helping children make a positive contribution

Contact from families and friends is actively encouraged. Young people are able to make and receive telephone calls and family members are made welcome. Young people who require supervised contact are taken to an appropriate venue. Introductory visits to prospective foster families are arranged.

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Achieving economic wellbeing

The provision is satisfactory. Young people benefit from a well maintained and welcoming building. Young people are provided with accommodation, furniture and equipment which meets their needs. Young people who are non-ambulant are provided with ground floor bedrooms and an adapted shower room. Bedrooms are single occupancy and young people are able to personalise their rooms with pictures and photos. Where possible young people are provided with the same room each time they stay. Doors are lockable to maintain privacy, but these locks can be overridden to ensure safety. Communal areas are bright with photographs of the young people and their artwork adorning the walls. The lounge and conservatory provide sufficient space for five young people and staff. The garden is enjoyed during the summer months with activities such as Easter egg hunts, barbeques, playing on the trampoline and in the paddling pool.

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Achieving economic wellbeing

A porta-cabin style structure has been erected in the garden to provide additional administrative work space for staff. This is linked to the house through an intercom system. Plans to use this area as a sleep in accommodation have been put on hold as it has yet to be shown that such arrangements are suitable. The previously used staff sleep-in room has been re-designated by the manager as usable for young people. Staff on sleep-in duties are therefore sleeping in whichever rooms are not occupied by young people, this arrangement is not suitable. The change of usage from a room for staff office/ sleep in accommodation to residential accommodation for young people has not been approved by Ofsted.

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Achieving economic wellbeing

No young people have a pathway plan in place as they are likely to require high levels of support throughout their lives. Staff, however, work with placing authorities on transition plans. Staff support young people on all levels to develop their independence in areas, such as communication and self care skills.

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Organisation

The organisation is satisfactory. 7 of 9 Inspection Report: SC058603 The provision of equality and diversity within the home is good. Staff are employed from a variety of backgrounds and are able to provide positive role models of either sex. Young people benefit from highly individualised child-focused care.

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Organisation

The Statement of Purpose is a useful guide but fails to reflect the complexities of the services provided, such as, the provision of shared care types of service. The home is registered to provide care for a maximum of five young people. However, records in the home indicate that the service may have, on three occasions, provided care to six young people.

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Organisation

The children's guide is a summary of the Statement of Purpose and includes key information as to the services provided. However, the document is not written in manner that is easily accessible to young people.

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Organisation

Staffing levels at the home are high and meet the needs of the young people. Many young people require one to one staff support and this is provided. Staffing levels reduce at 8pm when key periods of activity have finished. One waking night staff is provided with another staff sleeping in. This is increased to two waking night staff according to the needs of the young people.

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Organisation

Staff enjoy working at the home and feel well supported through good care guidance and regular staff meetings. Staff now work well together as a team to secure good outcomes for children. However, the staff management and disciplinary processes have not always been effectively enforced and the manager has shown a lack of awareness of employment law, for example, referring to verbal warnings as having been given, but which, could not be evidenced. A comprehensive induction programme is in place, however, this has not been completed for all staff. Staff have benefited from a variety of training relevant to the roles they perform. However, not all staff have undertaken core training in areas such as child protection, adult protection, fire precautions, health and safety and epilepsy. Neither are 80% of staff trained to National Vocational Qualification (NVQ)level 3 in caring for children and young people. Staff

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Organisation

have been promoted to senior positions without completing their induction or core training.

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Organisation

Systems are in place to review the quality of care within the home and feedback from young people and their families is very positive. However, areas of management require improvement.

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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

24 May 2010 accommodate no more young people than specified in the home’s Statement of Purpose (regulation 4(6)) 24 May 2010 ensure key policies and documentation reflect current practices and management arrangements; in particular, the Statement of Purpose and whistle blowing policy (regulation 4) 8 of 9 Inspection Report: SC058603 26 April 2010 ensure any restraint applied is appropriately recorded, and that such recordings are sufficiently detailed as to note the details of the restraint applied, who applied the restraint and how long the restraint was applied for (Regulation 17(4) 26 April 2010 ensure staff who are required to perform sleep in duties as part of their role, are provided with suitable accommodation designated purely for the purpose (regulation 31 (10)) 31 May 2010 ensure all staff and management have training in safeguarding vulnerable adults and children, fire precautions, Health and

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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 correct information is in place, as to which homely remedies staff are permitted to administer to young people ( NMS 13.10) • ensure individual fire risk assessments are in place for each young person, in line with the home’s overall fire risk assessment (NMS 26) • ensure 80% of staff complete NVQ level 3 in caring for children and young people (NMS 29) • ensure the children’s guide is provided in a format appropriate to the understanding and communication needs of young people (regulation 4) • ensure access to appropriate human resources advice and/or the manager to undertake training in employment law awareness (NMS 34.6) • ensure all staff complete a comprehensive induction process (NMS 31) 9 of 9 Inspection Report: SC058603

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