Children's Home run by Milestones Care Homes Ltd in Wirral

SC065780 Unique reference number 19 May 2010 Inspection date Nick Veysey Inspector Key Type of Inspection

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4 November 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 12 Inspection Report: SC065780

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Brief description of the service

This children's home cares for up to three children from six years to 17-years-old with emotional and behavioural difficulties. It is a semi-detached house with four bedrooms near the centre of the town. The location of the house enables young people to access a range of community facilities easily. It is close to local shops, public transport and other community facilities.

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Brief description of the service

All three young people living in the home took part in the inspection.

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Summary

At this unannounced full inspection all the key national minimum standards were inspected. The focus of the inspection was to find out how well the home meets the needs of young people living there.

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Summary

This is a good service with outstanding features in relation to individual support for young people, promoting young people’s health, involvement in decisions affecting their lives, young people’s enjoyment of their leisure time and education, including the development of people’s talents, skills and interests.

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Summary

The Registered Manager is currently on an extended leave of absence, and the registered provider has made suitable arrangements for the management of the home while the Registered Manager is away. The home is effectively managed with a clear commitment to excellent child-focused residential care. The acting manager has effectively used the staff’s competence, skills, experience and ideas to develop creative and innovative practice that has resulted in positive outcomes for young people.

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Summary

Young people enjoy an exceptional standard of care and support. They feel safe, listened to, encouraged to learn and develop, and be actively involved in the decisions affecting their lives and the running of the home. Young people feel able to talk to staff about their worries and receive the help they need.

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Summary

Young people are looked after by enthusiastic, imaginative and caring staff that place a strong emphasis on promoting and safeguarding young people’s well-being. Staff clearly enjoy working with young people, treat them with understanding, honesty and respect, and support and encourage young people to achieve.

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Summary

This is a strong service with outstanding practice in every area, however, the home has been judged as good on this occasion because of a number of minor shortfalls in meeting certain regulations and national minimum standards. The home has not let Ofsted know about serious events involving young people; staff have not had recent training in the use of restraint to protect young people; some evidence about staff’s suitability to work with young people is not available for inspection; the home does not have a system for recording when medication leaves the home; young people’s views are not always recorded when a restraint has been used; and the gas installation has not been checked for over a year. It is testament to the acting manager that he had already identified most of the shortfalls and has taken suitable action to address them. This shows that the home has the capacity for further improvement.

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Summary

The overall quality rating is good. 4 of 12 Inspection Report: SC065780 This is an overview of what the inspector found during the inspection.

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Improvements since the last inspection

At the last inspection the manager was asked to ensure that young people’s health records are always up-to-date, young people have access to their personal education plans, and that records show how effective each sanction has been in improving young people’s behaviour. The manager was also asked to ensure that the have a medication system for the management of any controlled drugs kept in the home.

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Improvements since the last inspection

Since the last inspection the home has taken effective action to address all these issues. Young people's records now contain up-to-date information about their health and education needs and the effectiveness of behaviour management plans. This means that staff have a better understanding of how to help meet young people's needs on a daily basis. The home has also introduced a suitable system for managing controlled drugs and staff have had training in handling medication safely.

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Helping children to be healthy

The provision is outstanding. Young people enjoy healthy, varied and interesting meals from different cultures that meet their dietary needs. Staff clearly understand what makes a healthy and balanced diet and encourage young people to develop healthy eating habits. Young people said, ‘staff like us to eat our three main meals a day as well they remind me to eat’ and staff encourage us to not eat a lot of chocolate and to start eating cereal bars, yoghurts, fruit and cheese snacks'.

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Helping children to be healthy

Staff actively involve young people in choosing meals, going shopping for ingredients and cooking. Young people said, ‘We pick healthy food menus with staff. We have culture nights and we eat healthy found from around the world'. Also they said, ‘We have also made a culture folder where we picked meals from different countries what we would like to cook'. The meals include homemade French onion soup, Chinese sweet and sour chicken and healthy burgers from the USA. One young person said, ‘I like making fajitas from Mexico'. Culture nights are very popular and sometimes take place two or three times a week. They are a creative and effective way to encourage young people to learn about food, nutrition, cooking, to try new and different foods and think about healthy diets.

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Helping children to be healthy

Young people's physical health and emotional well-being are actively promoted. Young people have easy access to community health services and are registered with a local doctor, dentist and optician. Information about their health needs and how their general and specific health needs are met are included in individual health plans. The health plans are comprehensive and kept up-to-date to provide a clear picture about how young people's health needs are being met on a daily basis.

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Helping children to be healthy

Staff have an excellent understanding of the full range of young people’s health needs and closely monitor young people to make sure they are healthy. They encourage young people to attend routine health checks, such as going to the dentist and optician. They also ensure young people get suitable medical advice and treatment when young people are feeling unwell or if they are concerned about young people’s health and development. Young people said if you are feeling unwell, ‘you go to the doctors or lie on the sofa with the quilt’ and ‘staff will check up on us to see if we’re ok'. 5 of 12 Inspection Report: SC065780 Staff always encourage young people to take an active interest in looking after their own health and leading healthy lives. The home places a strong emphasis on promoting healthy lifestyles. Young people access information about a wide range of health and social issues, including sexual health, smoking, alcohol, drugs, diet and emotional well-being. Young people get

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Helping children to be healthy

excellent information and advice to help them know about the range of different options they have. This enables them to make informed choices about their health, including if they want staff to accompany them to appointments. Staff also encourage young people to be active and take regular exercise, including mountain biking, keep fit exercises and horse riding. Also, staff and young people are taking part in a local charity walk.

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Helping children to be healthy

The home’s procedures for managing a full range of medication are put into practice to ensure young people’s welfare is promoted and protected. Staff are trained in first aid and handling medication; they have a clear understanding of the home’s procedures and a detailed knowledge of each young person’s medication. Medication is securely stored. Staff make sure that young people only have medication specifically prescribed for them and take it in line with the prescription instructions. The home’s quality assurance systems are effective in monitoring the management of medicines and ensures that the procedures are carried out safely.

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Helping children to be healthy

However, the home does not have a system for when medication temporarily leaves the home to enable young people to take their medicine while they are at other settings, such as parents’ homes and on school trips. Although, medication has left the home only occasionally, staff cannot accurately account for the medication to ensure young people have the medication they need with them.

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Protecting children from harm or neglect and helping them stay safe

The provision is good. Staff respect young people's privacy consistent with good parenting and the need to protect young people. Young people have single bedrooms to promote privacy and dignity. The accommodation provides space where young people can relax easily and spend time to be alone when they wish. Information about young people is managed confidentially and held securely in the office. Young people have the opportunity to use telephones and the internet to keep in contact with their family and friends.

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Protecting children from harm or neglect and helping them stay safe

Young people feel comfortable talking to staff about their worries and know concerns are taken seriously and addressed. Young people generally get on well, and do not experience any bullying. Staff are very vigilant and act decisively to challenge unacceptable behaviour, such as swearing. Staff work effectively with young people to enable them to cooperate well with each other and learn how to share, for example, taking turns to use the computer. In this way staff help young people to develop their clear expectations of how they treat, and should be treated by their friends and families.

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Protecting children from harm or neglect and helping them stay safe

Young people feel safe. Staff give protecting young people from harm a high priority. Staff understand fully their responsibilities to promote and safeguard young people’s welfare. Staff are knowledgeable about the home’s procedures for responding to concerns about young people's safety. They work effectively with safeguarding agencies to protect young people by sharing information and putting safeguarding plans into practice. 6 of 12 Inspection Report: SC065780 On occasions staff have failed to notify Ofsted of serious events involving young people. However, this has not had a negative impact on young people because staff have always taken suitable practical steps to ensure that young people are protected.

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Protecting children from harm or neglect and helping them stay safe

Staff are very aware of young people’s vulnerability and the risks they face in the community. They provide young people with excellent advice about personal safety, in particular when they are out in the community. Young people said staff help them to keep themselves safe because, 'they talk to me about using public transport, staying away from certain people and always take my mobile phone with me’.

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Protecting children from harm or neglect and helping them stay safe

Staff work extremely hard to ensure that risks to young people are effectively managed. The home has detailed individual risk assessments and plans for what staff should do if young people go missing. The plans clearly set out what action is taken to protect young people, including contacting young people by telephone, collecting them when they are found and ensuring they are warmly welcomed home.

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Protecting children from harm or neglect and helping them stay safe

Staff are very good at encouraging young people to develop socially acceptable behaviour and challenge difficult behaviour constructively. Young people know what standards of behaviour are expected and the possible consequences of any poor behaviour. Staff view young people in a positive light and encourage acceptable behaviour by praising and rewarding them, talking to them, trying to understand their behaviour and building positive relationships with them. Staff have a good understanding of the issues that influence young people’s behaviour, such as poor family relationships, trauma, and the impact of separation and loss. These insights enable staff to work well with young people and identify the best ways to help them. For example, staff have helped young people to get up to school on time by asking the young people to say what time they want to be called, avoiding disagreements when staff try to wake

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Protecting children from harm or neglect and helping them stay safe

them. By giving young people a say has enabled them to take responsibility for themselves and be up to leave the house on time.

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Protecting children from harm or neglect and helping them stay safe

Young people feel that staff treat them fairly. Even when young people do not agree with staff, such as about coming in times, staff explain their reasons and will take into account young people’s feelings and negotiate.

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Protecting children from harm or neglect and helping them stay safe

Staff keep accurate records of any sanctions used with young people. This provides useful information for monitoring the effectiveness of individual behaviour management strategies. Staff use restraints very rarely and only when young people or others are at immediate risk of harm. The restraint records, however, do not clearly show young people’s views about what had happened.

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Protecting children from harm or neglect and helping them stay safe

Although staff are trained in managing challenging behaviour, they have not had recent training in the safe use of restraint. The acting manager has already identified this shortfall and arranged training for all the staff in July 2010. When staff have used restraints they have done so appropriately and effectively and no one has sustained any injuries as a result, but it is crucial that they have the opportunity to be competent and confident in the use of restraint to protect fully young people's safety.

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Protecting children from harm or neglect and helping them stay safe

Young people live in a safe environment. They are protected by a comprehensive range of detailed health and safety procedures and risk assessments. Staff carry out regular health and safety checks, including fire drills, to ensure the premises are safe and secure. However, the 7 of 12 Inspection Report: SC065780 gas installation and boiler has not been checked by a qualified engineer to see if they are working properly for over a year.

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Protecting children from harm or neglect and helping them stay safe

The recruitment and selection of people working at the home is thorough to make sure young people are protected. For example, before staring work all staff have appropriate Criminal Records Bureau checks. The home always views the recruitment of the right person for the job as much more important than filling a vacancy. However, two of the staff files did not contain two written references. This is an administrative error; the references have been mislaid and the acting manager has written to the referees for copies of the missing references. The home has suitable systems in place to ensure that visitors to the home are suitably checked and supervised to protect young people.

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Helping children achieve well and enjoy what they do

The provision is outstanding. Young people are very well-supported with their individual needs. They are able to talk to staff about problems and receive exceptional individual support when they need it. Staff are very enthusiastic, spend a lot of time individually with young people and clearly enjoy working with them. Young people's individual needs are clearly identified in their records and put into practice effectively. There are many excellent examples of staff providing advice and support with a wide range of young people's possible needs, including sexual health and relationships, healthy lifestyles, family relationships, emotional well-being, dealing with feelings and problems and life skills.

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Helping children achieve well and enjoy what they do

Education is actively promoted and plays an important part in the lives of young people. Staff see education as important and have created an environment that encourages young people to learn and develop their confidence and skills. Young people’s educational needs are identified and the arrangements for meeting their needs are put into practice effectively. The home’s structured daily routine supports young people’s attendance at school, college and work. Staff praise and celebrate young people’s achievements. Young people’s school and work reports show that they were trying hard and making progress.

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Helping children achieve well and enjoy what they do

Young people are well-supported by staff with school and college work. They have plenty of space for study and have the equipment they need to complete their work, such as a personal computer, books, arts and craft materials.

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Helping children achieve well and enjoy what they do

Staff work innovatively and creatively to help young people develop their skills and knowledge through work projects in the house. For example, young people and staff recently completed a project to decorate the activity room. Young people were given a budget and planned how they wanted the room to be decorated, furnished and equipped. The results are exceptional; the room is now brightly decorated, suitably furnished, and used all the time. The project enabled young people to develop skills in budgeting, design, art, decorating, overcoming problems, working with other people, negotiation and compromise. Based on the success of the project staff plan to set up new projects, such as making a vegetable garden.

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Helping children achieve well and enjoy what they do

Staff are excellent at supporting young people who have left school gain access to suitable training and employment in areas that interest them. Young people said that staff are good at, ‘help with job hunting’ and 'helped me get my Saturday job by helping me give out my CV'. Young people are successful in finding work. 8 of 12 Inspection Report: SC065780 Young people take part in a wide range of activities in the community, including swimming, horse riding, mountain biking, adventure trails, going to the cinema and seeing friends. Staff find out about young people’s interests and work hard to find activities that young people like.

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Helping children achieve well and enjoy what they do

Staff actively encourage and support young people to purse their interests and talents. One young person said, 'Staff encouraged me to enter a poetry competition and I won. I wouldn't have entered if staff hadn't encouraged me'. The young person is very proud of their achievement and this is an excellent example to young people being enabled to develop confidence in their abilities. Also, through activities young people find new things that they enjoy and are very good at, building their self-esteem. For example, one young person was very good at climbing trees along an adventure trail and helped staff who felt nervous of heights.

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Helping children make a positive contribution

The provision is outstanding. The home’s records provide a detailed insight into the individual needs of young people and the plans in place to meet them. This provides very good evidence that young people live in a service that is able to meet their needs and provide the support they require. Staff keep detailed records about young people’s progress and experiences showing clearly how young people’s needs are being met on a daily basis.

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Helping children make a positive contribution

Young people’s placements are reviewed regularly to make sure that they continue to meet their needs. Staff work very closely with young people, their parents, and the other agencies involved in their lives to monitor their progress, take into account any changes in their lives and identify the best way to support young people. Staff help young people understand decisions made about young people’s lives. Young people said, ‘I am not happy with the decision about where I see my family, but staff explained it and I understand the reasons'.

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Helping children make a positive contribution

Young people are encouraged to make decisions about their lives and to influence the way the home is run. Young said that they are able to make their views known ‘all the time’ and have a say in what happens in the home. They are involved in decisions about what food they eat, what they do in their spare time, how the house is decorated and the plans for their future. Staff actively seek young people's views and ensure that they are listened to and their views about their lives taken into account. Young people said, ‘staff are good at listening'.

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Helping children make a positive contribution

The home encourages young people to have regular contact with their families and friends. Staff actively facilitate and support young people seeing their families. Young people have clear arrangements for contact with their families to help them maintain and build positive relationships. Staff ensure young people have suitable regular contact and that the arrangements promote and safeguard young people’s welfare.

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Helping children make a positive contribution

The home has a very friendly atmosphere where everyone usually gets along. Young people enjoy positive relationships with staff based on affection, honesty and respect. Staff view young people positively and value them as individuals. They are helpful and clearly enjoy spending time with young people. They have clear professional and personal boundaries with young people consistent with excellent childcare.

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Achieving economic wellbeing

The provision is outstanding. 9 of 12 Inspection Report: SC065780 Staff actively encourage and support young people to develop the skills they need for adult life suitable to their age and understanding. Young people routinely learn skills through taking part in the running of the home, and carrying out tasks, such as cooking, going to the shops, tidying their bedrooms, bringing their washing down, managing money and decorating the house. This results in them developing a wide range of life skills to support them in the future. In addition, staff encourage them to develop their personal, organisational and social skills, such as personal hygiene, using public transport and getting themselves ready for school.

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Achieving economic wellbeing

Young people live in a very comfortable and homely environment that meets their needs. The house is clean, decorated and furnished to a high standard. Young people like the accommodation and have personalised the home to reflect their interests and individual tastes. Young people play a central role in choosing furniture, colour schemes and how the house is decorated.

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Organisation

The organisation is good. The Registered Manager is currently on a long-term leave of absence from the home. The provider has made suitable arrangements for the management of the home by appointing an acting manager with appropriate skills, knowledge and qualifications to run a children’s home. The acting manager exercises effective leadership to ensure that the home is run in the best interests of young people and staff are suitably guided and supported to promote and safeguard young people’s welfare.

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Organisation

The acting manager has been particularly effective in using the experience, skills and imaginative practice of the staff to develop the quality of care provided. He has encouraged staff to use their initiative in their work with young people, and this has resulted in some creative and innovative practice that is helping young people achieve excellent outcomes. The project to ‘makeover’ the activity room; giving young people more control over when they get up for school; and the encouragement of young people’s talents are excellent examples of this approach that have achieved positive results for young people.

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Organisation

The promotion of equality and diversity is outstanding. Evidence supports a strong commitment to delivering equality and diversity in practice. Staff recognise young people as individuals with different needs, backgrounds, talents, interests and views. They ensure that young people receive an individual service designed to meet their personal needs. For example, the home has recruited staff with a particular set of skills and interests to work with specific young people. Staff have an excellent knowledge of the young people they are working with ensuring their needs are met. The home values the rights of individuals to be different and promotes respect and dignity.

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Organisation

Young people know what support they can expect from the home and how they will be looked after. The children's guide provides important information about the home in a way that is easily understood by young people. In addition, the home has a clear written statement for parents and social workers of how the home operates and plans to meet young people’s needs.

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Organisation

Staff feel very well-supported and have a clear understanding of their roles and responsibilities. They confirm that when they need support and guidance, the acting manager is always available and helpful and they receive one-to-one supervision regularly. In addition, daily handover and monthly team meetings allow the whole staff team to discuss the running of the home and to 10 of 12 Inspection Report: SC065780 look at ways to improve the service they offer. Staff have every opportunity to reflect on young people’s progress, how best to support them and the management of young people as a group.

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Organisation

Young people are looked after by a competent staff team who have a wide range of skills, experience and qualifications including social work, teaching, youth work and nursing. The skills within the team match the needs of young people living in the home well. The numbers of staff on duty meets the needs of young people in the best possible way. This includes the support they need for activities, visits and appointments. Staff have access to suitable training. The training programme comprehensively covers the needs of young people and provides staff with the skills and knowledge to effectively do their jobs.

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Organisation

The home has good systems in place to review the quality of care provided. The provider and acting manager consistently monitor the running of the home every month. They identify areas for improvement and steps are taken to address the issues.

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Organisation

The home’s written records provide a comprehensive picture of individual young people’s needs, development and progress. Young people’s records contain up-to-date information about them, including the relevant documents from placing authorities. The quality of placement and health plans is good, the records contain sufficient information to show how young people should be supported on a daily basis.

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Organisation

Although there is evidence of outstanding management practice, organisation has been judged as good because of the number of minor shortfalls found in relation to helping young people staying safe. The acting manager is actively addressing these shortfalls, but there are failures to fully comply with regulations and national minimum standards. However, the shortfalls do not negatively impact on the welfare of young people living in the home.

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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

31 May 2010 notify Ofsted, without delay, of any serious events listed in Schedule 5 in relation to the children's home (Regulation 30(1) and Schedule 5) 31 July 2010 ensure staff receive appropriate training, in particular in the use of restraint (Regulation 27(4)(a)) 31 May 2010 obtain for all staff, before they start work at the home, all the information set out in Schedule 2, in particular two written references, including one from the person's last employer, where possible. (Regulation 26 and Schedule 2) 11 of 12 Inspection Report: SC065780

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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 when young people's medication is taken from the home for them to use in another setting, such as their parent's home or school trip, a record is kept of the date of transfer, the name and strength of medicine, the quantity and the signature of staff arranging the transfer. A similar record should be kept when young people's medication comes back into the home (NMS 13.2) • ensure that when restraint is used young people are encouraged to write or have their views recorded and sign their names against them in the records kept by the home (NMS 22.14) • ensure that gas installations and boilers are checked at least annually. (NMS 26.4) 12 of 12 Inspection Report: SC065780

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