Children's Home run by Cornwall Council in Cornwall

SC040491 Unique reference number 17 March 2010 Inspection date Michelle Oxley 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: SC040491

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Brief description of the service

The home provides short-term respite care for children and young people with a learning disability or combined learning and physical disability. The home operates for five nights each week spanning Wednesday through to Monday morning. Packages of respite care vary in length and frequency. Most children stay for one night at a time but others stay for weekends. Where possible children stay in the room they are familiar with and with children of similar needs and interests. The building is single storey, providing level access. Enclosed play areas are provided outdoors where children receive support to access a range of play equipment.

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Summary

The purpose of this unannounced inspection is to assess the home's performance in meeting key national minimum standards. The recommendations from the previous inspection are also followed up.

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Summary

Following this inspection, this service has been graded as an outstanding provider of care for young people. The key strengths are around improvements made in the systems to protect and promote welfare, the excellent approach to behaviour management, the sensitive process for introducing young people to the service, the effective management, the ethos of continuous improvement and the stability and commitment of the staff team.

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Summary

Following this inspection there are three good practice recommendations. The overall quality rating is outstanding. This is an overview of what the inspector found during the inspection.

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Improvements since the last inspection

Following the last inspection there were two recommendations made, these have been addressed as follows:

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Improvements since the last inspection

A recommendation was made regarding combing two types of care plan to form one overall care plan. The management team now use one document as an initial assessment tool. This recommendation is met.

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Improvements since the last inspection

A recommendation was made regarding including information in the care plan about how to protect young people who need help with personal care needs. There have been some updates of information relating to this in risk assessments for young people but this has not happened in every case. This recommendation rolls over as it is partially met.

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Helping children to be healthy

The provision is outstanding. Mealtimes are social occasions, staff and young people sit at the dining table together. Staff are provided with guidance about the support young people need with eating. A support plan for each young person who is staying over is posted in the kitchen. This includes a good level of detail such as the type of cup a young person uses, if food should be cut up or any allergies. Young people have access to freshly prepared meals. Fresh fruit and vegetables are delivered 4 of 9 Inspection Report: SC040491 every week. Young people are able to make decisions about the food they eat and help to plan the menu for the following week.

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Helping children to be healthy

The team manage diverse health needs well. The team have established links with medical professionals, families and carers to ensure that consistent care is provided and in order to monitor health needs. The Registered Manager ensures that only young people with health needs that can be well supported by the team are admitted. Written guidance regarding dealing with care, health and personal hygiene needs is set out in writing in order to provide information to the team about how to meet needs. The staff team receive training in specific medical needs from a health care professional. The home has on hand notes for guidance on infectious diseases and the contact details of the health protection agency. Staff are mindful of good health and demonstrate this through care practice. For instance, exercise through walking and games are promoted as is part of a healthy lifestyle.

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Helping children to be healthy

There are stringent systems in place to manage medications. These include systems to manage controlled drugs. Lockable medication cabinets are in place and all medication administered and coming in and out of the home is carefully monitored. First aid boxes are located in accessible places. Staff are trained in first aid and handling medication.

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Protecting children from harm or neglect and helping them stay safe

The provision is outstanding. The team respect young people's privacy and dignity. Young people and staff have devised a set of rules for the home together. These include staff knocking on bedroom doors and young people not going into each others bedrooms. Some young people bring their mobile phones in to the home, some rules around the use of picture phones in particular have been devised but these do not prohibit young people from making calls either using their mobile or the land line.

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Protecting children from harm or neglect and helping them stay safe

There have been no recent complaints at the home. Families and visitors can easily access information about how to complain. Accessible information about how to complain for young people has been devised using signs and symbols. A key worker system is in place which enables young people to express their views to staff.

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Protecting children from harm or neglect and helping them stay safe

The team works positively to protect young people and to promote their welfare. Staff receive training updates in child protection training including specific training in the protection of young people with learning disabilities for some staff. One member of staff has completed a comprehensive course in safeguarding young people at level three. A new safeguarding file has been implemented. This provides staff with clear direction about how to proceed. Since the last inspection there have been improvements in the way that body maps and occurrences, incidents and accidents are recorded. This has led to more effective monitoring by the managers and consequently improved protection for young people.

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Protecting children from harm or neglect and helping them stay safe

The team reinforce respectful relations in order to promote positive relationships and prevent bullying. Careful consideration is given to the group dynamic at the point of admission. High staffing ratios mean that staff can detect any potential situations early and intervene to address these. The team work with young people to develop positive group relations. A counter bullying policy is in place. 5 of 9 Inspection Report: SC040491 There have been no absences without authority from the home. Young people are well supervised which serves to prevent this from occurring. Nevertheless a written procedure is in place for staff to follow should they need to.

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Protecting children from harm or neglect and helping them stay safe

Some proactive work has taken place regarding behaviour management. Physical interventions are rarely used at the home. There is one recorded low level physical intervention since the last inspection. As a result of this, the team have examined the incident in conjunction with the young person’s family. They have looked in detail at factors which may have contributed to the incident occurring with a view to avoiding this in the future. This led to the development of a set of excellent positive handling strategies being developed and agreed with the family. The approach to this incident is outstanding and demonstrates a commitment to positive behaviour management. Staff have received refresher training in physical interventions. There is minimal use of sanctions at the home. Positive modelling, diverting and developing communication help young people to learn socially acceptable behaviour.

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Protecting children from harm or neglect and helping them stay safe

A set of generic risk assessments is in place including risk assessments of the building. This is currently being updated. Equipment such as hoists and lifts are regularly serviced as is fire fighting equipment. A fire safety risk assessment is in place. Some staff have received training in risk assessment.

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Protecting children from harm or neglect and helping them stay safe

The visitors' book records all visitors to the home. A separate arrangement is in place to inspect staff records for this service these were found to be held in line with the requirements of the legislation.

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Helping children achieve well and enjoy what they do

The provision is outstanding. Young people receive individual support in line with their needs. They are well supported through the home's key worker system. Each young person has a key worker and a co-key worker who shadows in order to learn about working with different young people. The home provides care for young people with varying needs. The staff team demonstrate an ability to relate to each young person and adapt their approach accordingly. Young people have helped devised house rules with the team, with the main rule being that staff should always listen to young people.

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Helping children achieve well and enjoy what they do

The team have developed positive links with local schools. For example, staff attend education reviews and vice versa. Staff have linked in with school to observe practice in order to support education and care. The team recognise the value of linking in with school staff in terms of supporting school work and developing consistent approaches to care.

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Helping children achieve well and enjoy what they do

Young people are provided with excellent opportunities for social and leisure development. The team are keen to ensure that young people enjoy their time and the home. Children are rarely left unoccupied. Staff work hard so that children are engaged in activities they enjoy. The team are keen to ensure that young people have the chance to engage in a wide range of leisure activities within and outside of the home. Activities are provided on a group and an individual basis. The manager is mindful of creating a positive group dynamic through the admissions process, so that children have the opportunity to develop as a part of a social group. At home, young people enjoy a huge range of toys and games, arts and crafts, television, a computer and sensory room. Outside there is a well-equipped play area, soft football pitch, wheelchair swing, trampoline, playhouse and more. Young people engage in off site activities

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Helping children achieve well and enjoy what they do

6 of 9 Inspection Report: SC040491 which include local walks, cinema, bowling and day trips. All activities are risk assessed and take place according to the needs of the young person.

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Helping children make a positive contribution

The provision is good. Each young person has a care plan which sets out their needs and directs the team in how to meet these. Care plans contain good, detailed information about how staff are to proceed. There are two care planning documents in place, one is used to gather initial assessment and planning information and the other contains less information but is updated in line with changing needs. This contains the pertinent information that the team may need during their shift. Following the last inspection a recommendation was made regarding combing these documents in to one overall placement plan or care plan as set out in national minimum standards. This has not occurred as a decision was made within the organisation that one copy of the plan would be used as a document for initial assessment the other as the ongoing care plan or placement plan. Both sets of information can be easily accessed by staff. Following the last

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Helping children make a positive contribution

inspection a recommendation was made regarding setting out in writing the arrangements for protecting young people who require personal care in the context of privacy and protection. This has occurred for some young people but not in every case.

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Helping children make a positive contribution

Young people have their needs monitored and reviewed effectively. The Registered Manager and the key worker attend children's reviews. Review notes are held on children's files and where applicable, the Registered Manager ensures that the team meets actions set at reviews.

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Helping children make a positive contribution

The home's admissions procedures are excellent. New introductions to the home are managed carefully and sensitively. All new admissions tend to be planned, emergency admissions are rare. Although the home is able to cater for a wide variety of need the manager is very clear about remit of the service and the type of needs that the team are able to meet. When making decisions about new admissions the manager is mindful of the needs of the group and the pressures placed on staff as well as the group dynamic. Admissions are dealt with flexibly and according to the specific needs of the young person. This dictates the speed at which they are introduced to the home. Young people may make drop-in visits or stay for tea or an overnight visit until they and their families feel comfortable about a longer stay. This approach is exemplary as it means that placement stability is more likely in the long run.

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Helping children make a positive contribution

The team consults young people, families and significant others about key decisions. The staff provide support to families as the team endeavour to understand and work in the context of each families unique set of circumstances. The level of communication between parents and staff is good. Staff value the opinions of parents and work in conjunction with them where possible. Staff place importance on developing communication with young people in order to improve their means of listening and interacting. Signs and symbols are used as communicators in a variety of forms, according to the needs of each individual. Young people are consulted and given choices on an ongoing basis. For example, staff always enable young people to choose what they would like to eat and which activities they would like to be involved in. Each young person has a key worker who they can link with.

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Achieving economic wellbeing

The provision is good. 7 of 9 Inspection Report: SC040491 The building is fit for purpose and provides the space and facilities that young people need. The house has six bedrooms; all have en-suite facilities or are within close proximity to a bathroom. Two bedrooms can accommodate more than one child and two bedrooms have electronic height adjusted sinks plus over-head tracking hoist facilities linked to the adjacent bathroom. These rooms have 'medic' beds to provide graded postural support. The layout of the home is suitable for a mobile hoist and mobility aids. Communal areas comprise of a lounge, dining room, conservatory, playroom and a computer room. The kitchen facilities include a low work surface and a sink for young people using wheelchairs. Since the last inspection the sensory room has been extended and upgraded to provide improved facilities. Other facilities include a front entrance conservatory, an office and a further office room with an en-suite

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Achieving economic wellbeing

shower room used by staff who sleeping in. There is a car park at the front and a large enclosed garden at the rear with a soft play area and lawn. Overall, the building is well maintained but the décor is looking tired and in some places worn.

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Organisation

The organisation is outstanding. The Registered Manager shows effective leadership and is a committed and enthusiastic leader. The approach to management is one of enabling and encouraging the staff team to develop their own skills. This in turn has fostered an ethos of continuous improvement. Staff are keen to take on new roles and responsibilities assisted and supported by the manager.

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Organisation

Staffing levels are usually set at four team members during the day, one waking night and one sleeping night staff, although this is flexible and can be changed in response to particular needs. The staff team is well-established with minimal turnover. The team are responsive and motivated and demonstrate a willingness to find new and creative approaches to care practice. Agency staff are sometimes used, the home uses the same agency workers so that young people have a consistent team.

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Organisation

There is an ongoing programme of training and development opportunities for the team. Staff training includes child protection, physical interventions, epilepsy awareness, moving and handling, first aid and handling medication. Training opportunities are monitored through the supervision process and staff are enabled to attend training outside the main programme should they show an interest. New staff under go an induction process which involves completing a training booklet. They are also mentored by an established member of staff. Although the team say that they feel well supported there has been some slippage in the frequency of formal supervision which has fallen outside the time frame of at least one and a half hours each month as stated in national minimum standard 28.

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Organisation

Children's files contain sufficient information to ensure that the home can provide efficient care and these are held securely in a locked cabinet.

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Organisation

There are diligent systems in place to monitor the home's performance. The manager oversees the relevant log books and effectively manages performance and practice at the home. A system of regulation 33 reports is in place.

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Organisation

The promotion of equality and diversity is outstanding. Staff promote equality of opportunity in terms of access to facilities and service for young people with a range of physical and learning disabilities. The team endeavour to understand the differing needs of the young people they work with by developing an understanding of different disabilities and the barriers facing young 8 of 9 Inspection Report: SC040491 people. The team have developed their ability to communicate with young people in order to listen to their needs and wishes. The manager ensures that the service remains flexible enough to cater for diverse and individual needs ensuring that young people who may require a smaller group situation are not prohibited from using the service. Cultural and religious needs are set out in young people’s placement plans.

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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 care plans or risk assessments include information about how to protect privacy in the context of child protection (NMS 2) • refresh the décor throughout the home (NMS 24) • ensure that all staff receive at least an hour and a half of one to one supervision once each month. (NMS 28) 9 of 9 Inspection Report: SC040491

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