Children's Home run by Children and Family Services Limited in Luton

SC028599 Unique reference number 18 May 2010 Inspection date Joanne Vyas Inspector Key Type of Inspection

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11 February 2010 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: SC028599

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Brief description of the service

This is a privately-owned children’s home which provides residential care for up to four young people with learning difficulties who may also have a physical disability. The home is an extended detached domestic dwelling in a residential area of a large town. Children have individual bedrooms of which some have en-suite facilities. Required adaptations and equipment are provided. There is a garden to the rear of the home.

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Brief description of the service

Four young people are currently accommodated in the home of which all four participated in the inspection.

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Summary

The home does not comply with all the required procedures and provision of documentation required by the national minimum standards (NMS) and the children's homes regulations. Nevertheless, young people appear happy and well cared for. They also appear to appreciate the family atmosphere provided. They benefit from positive relationships with staff and with one another. However, despite some improvements, the home has not yet fully addressed all the issues raised by the previous Ofsted inspection and further substantial weaknesses have been observed. Staff do not comprehensively identify risks to the health and safety of the young people or ensure the home is free from hazards. Young people are not fully safeguarded and the home is not conducted in a way that fully respects the privacy and dignity of young people. Staffing levels do not enable staff to ensure young people's individual needs are fully

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Summary

addressed. Records are not accurate or up to date. There is currently no Registered Manager in post and monitoring systems need to be improved. The Statement of Purpose does not fully comply with the regulation and the children's guide does not fully comply with the national minimum standards. Medication administration systems are unsafe. Meals are unhealthy and social inclusion at mealtimes is not supported. Care plans and health care plans are not comprehensive. There is little evidence that young people are consulted about the day-to-day running of the home. Staff training needs to be improved further and gas installations have not been serviced annually. The overall quality rating is inadequate. This is an overview of what the inspector found during the inspection.

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Improvements since the last inspection

The responsible individual has made some progress towards meeting the actions and recommendations made at the last inspection. Fire precautions are now robust. The home's safeguarding policy and procedures have been agreed by the Local Safeguarding Children Board. Staff have comprehensive guidance provided within their staff handbooks. However, unexplained bruises found on the young people are still not consistently reported by staff to the local authority. Complaints and sanctions are properly recorded. Staff have made a start on risk assessment but risks are still not identified and as far as possible eliminated. The responsible individual has made some progress with regards to monitoring the matters set out in Schedule 6 but this is not in the form of a report or evidenced by the signing of records on a monthly basis. All young people have a good transition plan in place. Staff training records

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Improvements since the last inspection

are detailed and organised. 4 of 10 Inspection Report: SC028599

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Helping children to be healthy

The provision is satisfactory. Staff know what the young people like and do not like to eat. Young people are encouraged to shop for and prepare meals. Staff prepare healthy menus but add large amounts of high calorie supplements such as mayonnaise to meals for young people, including those who have weight management issues. Social inclusion is not fully recognised or appreciated by staff. For example, young people do not always sit around the table for a meal. The number of staff on duty makes it difficult for staff to ensure that mealtimes are well-managed, orderly, social occasions as they are carrying out other tasks such as dispensing and administering medication during mealtimes.

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Helping children to be healthy

Staff provide good health care for young people living at this home. They are proactive and responsive to the emotional and health care needs of the young people. All young people are registered with doctors, dentists and opticians. However, the health plans for young people are not comprehensive or up to date. For example, information that is specifically for staff to take with them if a young person is admitted to hospital is old and not updated. Therefore the hospital could be acting on out-of-date information which could lead to delays in the treatment provided for a young person.

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Helping children to be healthy

Staff follow some good practices for the safe handling of medication. The home only use prescribed medication. Staff receive training in the safe handling of medication. Two staff always prepare and administer medication. Medication is accurately recorded, received and disposed of appropriately. However, the medication cupboard and fridge are not fully secured. The key for the cupboard is accessible to anyone who enters the office and the medication fridge does not have a lock on it at all. This was addressed immediately and the key was put in a secure key cabinet. Staff dispense and administer medication away from where it is stored which means there is a potential for a problem to occur whilst transporting the medication to where it is dispensed. Medication is dispensed in the evening in the kitchen at the same time as tea is given to young people. This means that both the staff on duty are juggling their

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Helping children to be healthy

attention between dispensing and administering medication and providing care for the young people. This chaotic approach could potentially lead to a serious error and therefore harm to a young person. Staff also pour out syrup-type medication into a small beaker so that it can be drawn up into a syringe. The remainder is tipped back into the bottle which is poor practice as the medication poured back into the bottle could be contaminated. All accidents are recorded and first aid is given as appropriate. All staff are trained in first aid and renew their training regularly.

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Protecting children from harm or neglect and helping them stay safe

The provision is inadequate. The safety and rights of both staff and young people are not fully protected. Staff do not fully implement the home's safeguarding procedures. They continue to consistently not report unexplained bruising of young people to the local authority and when it is reported, the outcome of the report is not recorded. Staff receive training on safeguarding young people as part of their induction and then at regular intervals. Staff have a good knowledge of the bullying policy and ensure bullying or incidents where a young person is making another young person unhappy, are dealt with quickly and effectively. There are no incidents of young people going missing from the home. Concerns raised by parents or young people appropriately and swiftly resolved. 5 of 10 Inspection Report: SC028599 The privacy of young people is not fully respected by staff. Staff give some intimate care such

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Protecting children from harm or neglect and helping them stay safe

as medication through a gastrostomy tube, in communal areas. However, the living arrangements provide space where young people can relax and easily find privacy away from others if they wish. Staff keep bathroom and bedroom doors shut when young people are receiving personal care. All records are kept confidentially. Young people's issues are not discussed openly.

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Protecting children from harm or neglect and helping them stay safe

Staff view young people positively and young people are relaxed around staff. Staff are given training in managing challenging behaviour and break-away techniques. They do not use physical intervention. Sanctions are applied rarely but are fair and appropriate. Staff effectively manage challenging behaviour in a calm and professional manner.

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Protecting children from harm or neglect and helping them stay safe

Young people are protected by appropriate vetting procedures for staff and the monitoring of visitors. Safety checks are completed and staff only commence employment when they have a satisfactory Criminal Records Bureau disclosure and two satisfactory references. All visitors sign in and out of the building and must show identification.

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Protecting children from harm or neglect and helping them stay safe

The home does not have comprehensive risk assessments for all aspects of safety of the premises, grounds, young people’s behaviour and activities. These would include the risk of the potential impact of having young adults living with young people under the age of 18 years. Current practice does not comply with some risk assessments such as the number of staff required for hoisting. Staff said that only one person is now required to hoist but the risk assessment still states that two staff are required. This is confusing and could lead to an accident occurring depending on which procedure is correct. Some risk assessments, in their current form, are unacceptable such as allowing young people to be transported in a car without an escort. The risk assessment does not ensure the safety of either the young people or the driver. Some risk assessments are generic when they should be individual such as the risk assessment for choking.

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Protecting children from harm or neglect and helping them stay safe

Therefore, staff follow the risk assessment by ensuring all young people have their food cut up and so on. The fire risk assessment is, however, comprehensive. All staff are given fire safety training and fire drills are carried out regularly. Fire safety equipment is checked as appropriate and a detailed record kept. The gas installations are not serviced annually and therefore could put young people at risk. Risk assessments are not followed for the storage of hazardous chemicals as dishwasher tablets were found in an unsecured cupboard under the sink. The garden furniture is old and unsafe. Young people are not protected by the home's health and safety procedures.

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Helping children achieve well and enjoy what they do

The provision is satisfactory. Staff are positive in their approach to education and its value for young people. Young people have personal education plans which are reviewed regularly. Staff attend parent's evenings and annual reviews. They communicate effectively with schools. A photographic record of achievement is produced for each young person as evidence of their achievements.

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Helping children achieve well and enjoy what they do

Individual support is not fully detailed in each young person's care plan. Observations and discussions with staff demonstrate that staff struggle to meet each young person's individual needs due to the poor staffing levels. Young people are encouraged to value their own culture and religion by a diverse staff team. The practical individual support is not fully reflected in the planning documentation that is in place. However, staff know the young people well and are very knowledgeable of their individual needs and the implications this has for their care. 6 of 10 Inspection Report: SC028599

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Helping children make a positive contribution

The provision is satisfactory. The Statement of Purpose sets out the home’s admission policy. Young people are supported during the admission process and when leaving the home. Staff carefully consider group dynamics when admitting a new young person.

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Helping children make a positive contribution

Staff have a good knowledge of the young people's individual needs. However, care plans do not provide a comprehensive guide to how a young person should be cared for on a day-to-day basis. This means that new staff won't know what a young person's individual needs are and how to care for them. Parents and social workers are consulted about the care plans through the review process. A record is made throughout the day for each young person documenting their mood, activities, behaviour and other relevant information. However, observations of practice showed that these records do not accurately reflect the activities of the young people. This could be important information especially when monitoring mood and behaviour in relation to epilepsy.

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Helping children make a positive contribution

Staff encourage and support young people in maintaining contact with parents and everyone else who is significant to them. Staff facilitate contact with parents, providing transport where necessary.

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Helping children make a positive contribution

Young people are given opportunities to make choices. However, there is very little evidence to support whether young people are consulted. Young people do not have house meetings or individual recorded time with their key worker. Staff use some signs with young people but these are rarely used or are incorrect when used. However, young people are relaxed in the company of staff and are quick to approach them with any issues they may have. A young person said they like living at this home and particularly likes growing tomatoes.

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Achieving economic wellbeing

The provision is satisfactory. Staff encourage young people to carry out a variety of tasks independently or with support. These include personal hygiene, cooking, shopping and gardening. Each young person's placement plan clearly identifies independence work young people are encouraged to carry out. Each young person also has a comprehensive transition plan in place. Staff provide a consistent and committed approach to enabling young people's successful transition into adulthood.

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Achieving economic wellbeing

Young people live in a homely environment with good quality furnishings. There is a large amount of communal space. The young people have good facilities. Their bedrooms are highly personalised to ensure they meet their individual needs and communal areas are personalised with photographs of young people and their work that has been completed. The home is clean and tidy. However, staff do not report maintenance issues quickly which allows the problems to get worse or become unsafe. Once the issues are reported they are acted on very quickly.

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Organisation

The organisation is inadequate. There is an up-to-date Statement of Purpose, however, it does not fully reflect the practice and functions of the home. The children's guide is in an accessible format and informs the 7 of 10 Inspection Report: SC028599 young person about the activities of the home, routines and so on. However, it does not inform young people how they can secure access to an independent advocate or about how to make a complaint.

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Organisation

Staff training is mostly supported by the organisation. An annual programme covers mandatory training which all staff are expected to undertake. However staff training does not address training on how to fit splints correctly or undertake risk assessments.

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Organisation

Staffing levels do not adequately enable staff to fully meet the needs of young people as discussed throughout this report. A record of staff shifts is maintained on the home's rota and this shows there is a balance of gender and cultural backgrounds of staff wherever this is possible.

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Organisation

The promotion of equality and diversity is satisfactory. Staff struggle to provide an individual service to young people as staffing levels do not allow for this. However, staff know the young people well, interact with them positively and offer individual support whenever they are able.

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Organisation

The post of Registered Manager is currently vacant and the responsible individual has taken on this role. This post is due to be advertised in the near future and then an application for Registered Manager will need to be forwarded to Ofsted. It is clear that the responsible individual has put some monitoring systems in place. However, this is not evidenced by regular signing of records or a report. A monthly health and safety monitoring report is completed but is inaccurate as it states aspects of the home are safe which the inspection has found not to be, such as the garden furniture and a bathroom floor. It is, however, recognised that an independent person visits the home on a monthly basis and reports on the conduct of the home.

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Organisation

Young people's records are not kept in good order and do not reflect the information necessary for staff to care and support them throughout the placement. Some information for young people is old and has not been updated or inaccurate.

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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

30 June 2010 ensure that unnecessary risks to the health or safety of children are identified and so far as possible are eliminated (Regulation 23 b) 30 May 2010 prepare and implement a written policy which is intended to safeguard children accommodated in the home from abuse or neglect. In particular this relates to the need to clarify for staff what action must be taken when a child is found to have either an explained or unexplained mark or bruise on their body (Regulation 16.1) 8 of 10 Inspection Report: SC028599 30 June 2010 establish and maintain a system for monitoring the matters set out in Schedule 6 at appropriate intervals and improving the quality of care provided in the home (Regulation 34.1) 30 May 2010 ensure the home is conducted in a manner which respects the privacy and dignity of children accommodated there (Regulation 11) 30 May 2010 ensure all parts of the home to which children have access are

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Due date Action Standard

so far as reasonably practicable free from hazards to their safety. This specifically refers to hazardous chemicals stored in an unsecured cupboard and garden furniture which is unsafe (Regulation 23) 30 June 2010 ensure the Statement of Purpose fully refers to the matters listed in Schedule 1 of the Children's Homes Regulations (Regulation 4) 30 May 2010 employ sufficient staff for the running of the home taking into account the needs and behaviour of the children and young people (Regulation 25) 31 July 2010 appoint an individual to manage the children's home and submit an application to Ofsted for their registration (Regulation 7) 30 May 2010 maintain in respect of each child who is accommodated in a children's home a record in permanent form which is kept up to date and is signed and dated by the author of each written entry. (Regulation 28)

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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 children are not routinely excluded from communal meals (NMS 10.6) • ensure children are provided with suitably prepared food having regard to their needs and wishes. This specifically refers to providing large amounts of high calorie supplements to meals for children with weight management issues (NMS 10.1) • ensure that meals are set up to be well-managed, orderly, social occasions (NMS 10.2) • ensure each child's health plan covers all the elements specified in standard 12.2 (NMS 12.2) • ensure all medication is kept securely (NMS 13.10) • ensure there is a policy with written guidance, implemented in practice, for storing, disposing and administering medicines to children (NMS 13.10) • ensure gas installations are inspected at least annually (NMS 26.4) • ensure the placement plan for each child sets out clearly the assessed needs of the child,

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Recommendations

the objectives of the placement and how these are to be met on a day to day basis by staff 9 of 10 Inspection Report: SC028599 and the registered person. The plan must include all elements described in standard 2.1 (NMS 2.1) • ensure children's opinions, and those of their families or others significant to the child, are sought over key decisions which are likely to affect their daily life and their future. Ensure there are systems in place for doing this, such as key worker sessions and children's meetings and ensuring that the systems in place reflect the children's differing communication needs (NMS 8.1) • ensure the interior and exterior of the home are maintained in a good state of structural and decorative repair (NMS 24.3) • ensure the children's guide contains information on how a child can secure access to an independent advocate and about how to make a complaint (NMS 1.3) • ensure staff have access to training which specifically address the issues detailed in Appendix

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Recommendations

2 of the Children's Homes Regulations. This specifically refers to the need for staff to either update or complete training in the correct application of splints and undertaking risk assessment (NMS 31.5) 10 of 10 Inspection Report: SC028599

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