Children's Home run by Derby City Council in Derby

SC036019 Unique reference number 15 June 2010 Inspection date Chris Fuller Inspector Key Type of Inspection

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27 January 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 12 Inspection Report: SC036019

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Brief description of the service

The children’s centre was opened in 1976. Set in its own grounds, it is one of a number of children's residential facilities. The building complex houses three separate units each with five placements. The service currently provides 15 placements for young people aged between 10 to under 18 years of age in medium to long-term placements. Each unit may also take emergency admissions. There are 12 young people currently accommodated; several of the young people were seen during the inspection. There is a lounge, multi-purpose room, dining area and utility room on each unit. All bedrooms are single. The home is within easy reach of facilities and amenities which may be accessed by public transport.

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Summary

This unannounced full inspection monitors the key national minimum standards in respect of the outcome areas of being healthy, staying safe, enjoying and achieving, positive contribution, economic well being and organisation. In addition the five actions and four recommendations made at the previous inspection in January 2010 were also monitored. At that time the centre was assessed as inadequate.

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Summary

During the past year there has been a period of considerable change and upheaval in the children's centre, with a significant number of different young people resident in the units, changes in staffing arrangements and refurbishment of the premises. Throughout this period management and staff have worked extremely hard to maintain the health, safety and welfare of the young people. At the same time there has been a concerted effort to develop the facilities and services for young people while promoting their individual placement plans.

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Summary

Following this inspection, the overall judgement is satisfactory. There are two actions and five recommendations made on this occasion. These arise in the being healthy, staying safe and positive contribution outcomes. 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 inspection there were five actions and four recommendations made. The service has taken satisfactory action to address all of these issues. Young people accommodated in the home were not provided at all reasonable times with access to a telephone on which to make and receive telephone calls in private. A room has been made available on each unit where young people can make and receive telephone calls in privacy. There were not suitable facilities within the children’s home for young people to meet privately at any reasonable time with visitors, parents, relatives and friends. A room has been provided on each unit to enable young people to receive visitors in privacy. The premises are unsuitable for the purpose of achieving the aims and objectives set out in the home’s Statement of Purpose. The responsible individual has produced a two year plan for the relocation of the service. The children’s centre was not

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Improvements since the last inspection

maintained in good structural repair with suitable facilities and decoration. Each unit has been refurbished with significant improvements to facilities, equipment and decoration to improve the environment that young people live in. Young people's names and personal information were being recorded in communal records such as staff meeting minutes without due 4 of 12 Inspection Report: SC036019 consideration of confidentially. Staff meeting minutes are now compiled in a manner which respects young people’s privacy and ensures confidentiality. Staff and management were unclear of the issues relating to data protection. Deputy managers have received training and guidance has been issued to all staff relating to recording. There is minimal recording of private information and where this does occur auditing of the records identifies this and rectification takes place. There were instances where it was unclear that concerns raised by young people

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Improvements since the last inspection

regarding a restraint had not been referred to the safeguarding board or investigated in any way or a response made to the young person. The expected procedure to be followed regarding the referral of child protection allegations or for requests for advice has being clarified with the local safeguarding board and local authority designated officer. The management and staff were using unacceptable measures of behaviour management such as removal of footwear and locking of doors to prevent young people from leaving the building in order to keep them safe. The manager of the centre has made changes to the use of both removal of shoes and the locked door policy to reflect the homes behaviour management policies and procedures. The children’s centre did not have adequate guidance available to staff for physical intervention and restraint of young people. The management have reviewed the behaviour management

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Improvements since the last inspection

policies, procedures and training with a view to revising behaviour management techniques and strategies and improving practice in managing challenging behaviour. However, there are some issues relating to practise in respect of behaviour management, use of the rooms in the administration area, sanctions and the incentive programme that have new actions or recommendations made on this occasion.

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Helping children to be healthy

The provision is satisfactory. The young people‘s health and dietary needs are clearly identified and met. Young people are provided with a range of healthy nutritious meals through well balanced menus. These are discussed at residents meetings and wall mounted in dining rooms. Young people’s choices are taken into consideration and they can request alternatives. Young people are supported to develop independence skills and do their own shopping, cooking and cleaning. They have access to the unit kitchen to prepare snacks and drinks.

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Helping children to be healthy

Health care plans for young people are detailed and based on a clear assessment of their health care needs. Staff promote healthy lifestyle choices in daily routines, personal care, exercise and activities. There are facilities on site for young people to engage in a range of exercise and activities. Young people are supported to establish routines for regular health care checks at local health services. Specific and specialist medical issues are followed up by the children in care nurse and key workers, for example, substance misuse, sexual health and mental health. Staff support attendance at medical appointments and monitor ill health or injuries.

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Helping children to be healthy

The service has extended its resources through appointment of a primary mental health worker dedicated to children in care. Young people and staff benefit from direct one to one work training and consultation on a range of mental health issues. There is an effective working relationship between the primary mental health worker and enhanced care project staff to provide a useful consultation service for the three unit staff teams. This is of particular value where external resources are limited or young people are reluctant to access them.

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Helping children to be healthy

Staff are trained in the safe handling and administration of medication and first aid and understand the correct procedures to follow. Policies and procedures are in place and there is 5 of 12 Inspection Report: SC036019 a designated lead for medication on each unit. There are suitable arrangements for the storage of all medication including homely remedies and controlled drugs. Staff generally keep clear records of the administration of medication and these are regularly monitored by management. However, there was no individual medication risk assessment completed for a young person that was self-administering medication. This means potential hazards may not have been identified and addressed. Staff receive training in first aid and demonstrate a clear understanding when attending to accidents or injuries. There are a suitable number of first aid boxes available on the units and in vehicles.

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Protecting children from harm or neglect and helping them stay safe

The provision is satisfactory. Arrangements for the recording of confidential information has improved. Some staff members have undertaken data control training, and all have being made aware that any personal and confidential recordings should not be made in communal records. Managers at the home audit the records and where any information is discovered which may be of a confidential nature, corrective action occurs. Young people’s individual files are held securely in a locked cabinet within a locked office.

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Protecting children from harm or neglect and helping them stay safe

The privacy and dignity of young people is respected by staff. Young people are able, following a risk assessment to have their own key for their bedroom. Each room is also equipped with a lockable storage container. Staff members announce their arrival at a young person’s room and will knock on doors prior to entering. Should a room need to be searched, a policy is available for staff guidance and records are held of all such events. Young people are given information regarding the searching of rooms. The privacy and dignity of young people is respected by staff. A telephone point and handset has been incorporated into each of the multi-purpose rooms on each unit so that young people are able to hold telephone conversations in private.

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Protecting children from harm or neglect and helping them stay safe

There is a complaints system in operation which young people know how to access. Concerns can be raised internally to a member of staff or additionally young people have the opportunity to make a complaint directly to the local authority by use of a pre addressed complaint card. There is some confusion amongst staff as to the actual format which should be used to make an external complaint. Evidence of satisfaction or otherwise with the outcome of a complaint is recorded. Young people are also able to raise any concerns with the visiting independent advocates. The system in place ensures young people's concerns are listened to.

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Protecting children from harm or neglect and helping them stay safe

A child protection policy and procedure is available in the home. Any allegations made are directed to a senior manager who undertakes responsibility for referring to the appropriate workers. A record is held of all referrals made to child protection officers. There have been four referrals made since the last inspection, one of these continues to be progressed. All have being investigated by external child protection workers in conjunction with local children's services. Outcomes of the investigations are held in the record. A meeting has being held with the local authority designated officer to ensure that practices in the home are consistent with local procedures. Staff are trained in safeguarding matters and the welfare of young people is protected with an appropriate response being made to any allegation or suspicion of abuse.

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Protecting children from harm or neglect and helping them stay safe

An effective system is in place to address any bullying issues and staff make it known that there is a zero tolerance approach to any instance. The subject is discussed at every young peoples meeting enabling any concerns to be raised. Each young person is assessed as to the likelihood of them becoming involved in a bullying situation and details are entered on their 6 of 12 Inspection Report: SC036019 placement plan. There are open discussions held and any identified issues are dealt with by individual work undertaken during key work sessions. Young people are protected from bullying by the system in operation.

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Protecting children from harm or neglect and helping them stay safe

Managers and staff are acutely aware of the risks which may face some young people should they go missing from the home. Young people are given information about risks both formally during one to one sessions and informally on the residential units. Risks which are individual to young people are recorded in their placement plan and strategies to deal with these are included. There is a written locked door policy in operation which is only implemented when it is identified that a young person would place themselves in imminent danger should they leave the home. Whilst doors which link the three units by the main corridor are kept locked to prevent disruption on a unit by young people from an adjacent one, an exterior door allowing access outside remains open on each unit. Additional doors are locked to prevent access by unknown persons. The external door would only be locked as per the policy if by leaving a

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Protecting children from harm or neglect and helping them stay safe

young person would be placing themselves in danger. However this would not prevent other young people from leaving the home should they wish to do so, the door being opened for them upon request.

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Protecting children from harm or neglect and helping them stay safe

The manager of the centre stated that the removal of footwear from young people identified to be vulnerable was no longer used as a method of ensuring young people did not leave the home. Young people confirmed that this did not happen and there are no records relating to its use since the last inspection.

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Protecting children from harm or neglect and helping them stay safe

An identified room is available within the administration block of the centre which may be used for individual work with young people when they are upset and creating a disturbance to other young people. This room is some distance from the residential units along a corridor. Whilst use of this room for consultations with young people is practical when they attend willingly, it is not suitable or safe, given the distance from the living units for use with young people who are subject to physical restraint and require to be moved to this area. The considerable distance from the units and layout of corridors mean that it may place young people at risk if physical restraint is undertaken in these areas.

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Protecting children from harm or neglect and helping them stay safe

The behaviour management policy does not sufficiently detail the individual practice undertaken in the centre nor does it offer clear relevant guidance on behaviour management to staff.

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Protecting children from harm or neglect and helping them stay safe

Behaviour management recording, restraints and sanctions are all recorded appropriately, audited and able to be commented on by young people. Staff are trained in physical restraint techniques, but, there is insufficient guidance available in relation to the types of holds used, meaning it is difficult to completely and accurately record holds used during a restraint occurrence. The numbers of restraints which occur vary between individual units and are often linked to the level of disruptive behaviours displayed by individual young people. Individual restraint plans are in place for young people who may suffer from asthma and similar conditions. This ensures that appropriate physical management techniques can be used when the need arises.

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Protecting children from harm or neglect and helping them stay safe

Sanctions are implemented when young people display unacceptable behaviour. Often their use is unimaginative and there is a reliance on one type of sanction, the withholding for a short period of pocket monies. There are some examples of good use of diffusion techniques which negate negative behaviour and avoid sanctions. 7 of 12 Inspection Report: SC036019 Some good professional relationships exist between young people and staff. Some staff are not sufficiently skilled in engaging with young people to divert them from disruptive behaviour and to recognise the build up to these situations. An incentive scheme is in place which aims to encourage and reward socially acceptable behaviour. However, the scheme remains inconsistent in its application between residential units and does not always adapt to individual needs. This has been recognised by senior management who have begun to develop a new scheme to be implemented across the centre. The lack of an effective reward structure does

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Protecting children from harm or neglect and helping them stay safe

not assist young people to understand the boundaries of acceptable conduct.

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Protecting children from harm or neglect and helping them stay safe

There are good health and safety procedures available, regular testing of equipment and security and safety checks ensure that young people and staff at the centre are kept safe.

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Protecting children from harm or neglect and helping them stay safe

The home has an established and effective system for the vetting and supervision of visitors. The management have established a thorough and comprehensive system for the recruitment of suitable staff to work with young people.

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Helping children achieve well and enjoy what they do

The provision is satisfactory. The young people are given individual support in all aspects of their identified needs and wishes. Placement plans address individual needs ranging from health care, education, mental emotional health, religious or cultural and leisure interests. Generally, staff are pro-active in identifying resources and support for young people. Staff receive training in some therapeutic theories and the use of strategies such as coping diary worksheets and behaviour modification programmes. Staff work with the staff from the enhanced care project and the mental health practitioner to develop their skills and understanding. This also aids consistency of care which can be variable throughout the units. Key workers and care staff support individual placement plans through escorting, attending meetings and transporting young people to appointments when appropriate. Young people benefit from the reduction of the number of placements

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Helping children achieve well and enjoy what they do

available on each unit which provides an increase in facilities and staff availability. The religious, cultural, ethnicity, disability, linguistic and sexuality care needs of young people are assessed and addressed in detailed individual placement plans.

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Helping children achieve well and enjoy what they do

The home supports and enables young people to access educational opportunities and resources. Young people’s personal education plans are held on their files and staff encourage young people to attend reviews and participate in their action plans. Staff aim to establish educational routines on the units for those young people not in mainstream or full-time education. Staff support completion of homework through direct communication with schools to monitor attendance punctuality and any issues. Young people are provided with computers/laptops for school work and education programmes to support learning. Following refurbishment improved facilities are available on each unit and a dedicated computer room for the centre. There is a good range of resources and facilities for education and leisure functions with a craft room, computer room, games hall and individual multi-purpose rooms on the units. Action is taken

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Helping children achieve well and enjoy what they do

to address high levels of school non-attendance, suspension, or exclusion. Young people have a wide range of educational abilities and attainment. There is an increased input from the enhanced care project which promotes learning and development in a therapeutic environment. This is particularly supportive to young people who find it difficult to engage in educational routines. Some young people have completed exams and look forward to end of year proms while others are looking forward to further education and or seeking job opportunities. 8 of 12 Inspection Report: SC036019 Young people are given support and encouragement to participate in leisure activities and personal hobbies or interests. Staff encourage young people to socialise constructively with their peers through playing games such as rounders, football and basketball. Staff develop individual programmes, to promote learning, confidence and self esteem of young people,

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Helping children achieve well and enjoy what they do

through education projects and activities.

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Helping children make a positive contribution

The provision is satisfactory. The centre has had a considerable number of placements over the past twelve months with refurbishment of the premises having a significant impact on the admissions and discharges. Management have generally managed the changes in young people and staffing of units extremely well. This has been especially important due to the number of emergency placements made and the relocation of another children’s home within the centre for a period of time.

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Helping children make a positive contribution

Staff clearly outline the individual needs and wishes of the young people in comprehensive placement plans. Young people understand the reason for their placement and the objectives included in their placement plans. These are regularly reviewed and updated. Young people are encouraged to contribute to the review process and take part in decision making about plans for their future. However, there was an emergency admission where there was very little information available about the young person and their needs and there were no arrangements in place for the 72 hours review.

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Helping children make a positive contribution

Staff support positive relationships with relatives, friends and placing authority staff. Contact agreements and records hold clear information about contact for young people as part of the placement plan. There are also specific arrangements for supervised or unsupervised phone calls to relatives. Staff network closely with the police where there is unauthorised contact to protect vulnerable young people. Staff monitor all forms of contact such as use of mobile phones and computer technology to ensure contact arrangements are safe and a positive experience for young people.

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Helping children make a positive contribution

The staff maintain relevant information relating to the admission and discharge of young people. Group risk assessments are completed and held on file for some young people with a clear record of action to be taken where there are shortfalls so that the specific needs of young people are addressed. Where it is possible there are introductory visits to the home and young people receive welcome guides and boxes suitable to their age group and gender. This means young people are better prepared for moving in to the centre. The staff liaise with social work staff and other services to prepare young people for moving on to new placements or into the community. Young people are encouraged to be fully involved with these arrangements so that they develop self-confidence and self esteem.

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Helping children make a positive contribution

Young people are regularly consulted, formally and informally about their needs and wishes through many different systems and processes. There are regular meetings which include staff from independent advocacy agencies providing young people the opportunity to speak to an objective independent person. Most young people will engage at some level with staff in one to one sessions which are generally very well recorded with a clear focus on specific issues relating to the individual young person. Peer group meetings are held where young people express views and wishes about the daily life on the units. Young people have been consulted about some aspects of the refurbishment and given the opportunity to influence some of the daily decisions made about the home. 9 of 12 Inspection Report: SC036019 The majority of staff develop positive relationships with young people based on mutual respect and understanding. Staff are generally able to set clear expectations and boundaries with young

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Helping children make a positive contribution

people. Some young people stated they had very good support and get on well with most staff while there are occasions with some staff where this is not the case. Deployment of staff facilitates continuity of care where possible to standardise practice within each unit.

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Achieving economic wellbeing

The provision is satisfactory. The ethos of the children’s services encourages and enables young people to remain in care until they are 18 years of age and sometimes longer if this meets their needs. Staff support and encourage young people to develop independent living skills. Young people take part in the daily household tasks, such as, shopping, preparation of meals, laundry and tidying their own rooms. Staff enable the young people to access local services such as leisure facilities, job centres, housing associations and banks. The staff work well in partnership with other agencies to achieve positive outcomes for young people.

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Achieving economic wellbeing

The children’s centre is a detached property in grounds with car park space provided. The home is located in a residential area with access to a range of community facilities and resources for health, education, recreation and leisure. Following recent refurbishment of the centre the space, facilities and grounds have improved tremendously and provide a safe secure environment for young people. A room on each of the three residential units has been converted into a meeting/information technology room for young peoples use. This enables young people to meet with families or professional visitors in a private environment. Staff and young people are working together to decorate individual bedrooms and choose suitable domestic style fabrics and furnishings for communal areas to improve the atmosphere on the units. The bathrooms and toilet areas are light fresh with washable sealed flooring. The management and staff have

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Achieving economic wellbeing

reviewed use of different rooms in the administration area and are furnishing them to maximise their use in a suitable manner to provide additional facilities for young people. Staff and young people feel the changes have made a significant improvement to facilities, atmosphere and quality of daily life and on the units.

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Achieving economic wellbeing

The refurbishment provided some structural improvements to room sizes, bathing and private meeting facilities and basic maintenance of the premises for young people being looked after. The management have reduced the number of placements from 17 to 15 with five bedrooms on each unit. This means there is additional individual space in some bedrooms and communal space generally for young people. There is a programme for maintenance, decoration and repair which ensures all health and safety issues are addressed and made safe. The senior management are aware of the long term unsuitability of the premises and have produced a two year plan for the replacement project for the facilities provided at Moorfield children centre with a completion date of July 2012.

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Organisation

The organisation is satisfactory. The promotion of equality and diversity is satisfactory. The individual needs of young people are addressed well, regarding personal, social and cultural issues. This is demonstrated, for example, specialist health care support, safeguarding projects, education provision and assistance to care leavers. Staff engage young people in discussion, challenge prejudice and raise awareness of diversity issues. 10 of 12 Inspection Report: SC036019 The Statement of Purpose accurately reflects the service provided and is reviewed annually and updated. Young people receive a welcome pack/box which is gender and age specific when they first arrive on the unit. This means they have some personal requisites and items which belong to them. They also receive a copy of the new revised general children’s residential service welcome guide. This is produced in colour printed in different languages and formats so that

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Organisation

young people have all the relevant information about the service they need including useful contact numbers.

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Organisation

Staff are supported through individual supervision and regular staff meetings. The management team are generally available and approachable. Clear communication systems and sharing of information are very important for staff and management due to the number of personnel and management structure.

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Organisation

Staff are encouraged and supported to attain qualifications. The majority of staff have completed national vocational qualifications. There are established programmes for staff to complete the children's workforce development council induction training and assessment during the probation period. Similarly there are extensive wide ranging training opportunities available for all staff. This is complemented by a newly introduced system for managing individual performance which identifies areas of achievement and development. Staff attend training to achieve and maintain competency in their care practice.

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Organisation

The young people benefit from the individual care provided by an experienced and relatively stable staff group. There is an adequate number of staff on each shift to provide care for young people. Staffing levels are risk assessed and increased to meet the needs of young people. The staff are extremely caring and committed to providing consistent, stable care in a safe, secure environment for young people.

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Organisation

The home is monitored in all aspects of service delivery and appropriate action is taken to maintain quality of care within the home. Regular monthly visits and reports are completed by the senior management team providing useful constructive feedback to management and staff at the centre. The management team in the centre complete their own monitoring of systems and services to ensure the quality of the care practice is maintained. There is evidence of feedback to staff and action taken on any errors or issues that arise.

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Organisation

Young people’s records are held securely and confidentially and cover all matters required in the regulations. Management and staff work hard to keep young people safe and enable them to achieve positive outcomes.

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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 July 2010 ensure that the behaviour management policy in use at the home reflects the practice undertaken (Regulation 17) 11 of 12 Inspection Report: SC036019 30 June 2010 ensure that during any physical restraint, young people are not removed to an area or room which does not form part of the residential living environment. Areas of the administration block must only be used for individual sessions with young people with their consent. (Regulation 17)

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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 young people keeping and administering their own medication are assessed by staff as sufficiently responsible to do so (NMS13.9) • ensure that information and stationary given to young people to be used in the event they wish to make a complaint is consistent throughout the units (NMS 16.2) • revise the use of sanctions to ensure they are imaginative and relevant to the misdemeanour (NMS 22.4) • revise the incentive scheme to ensure that it is effective in encouraging young people to display socially acceptable behaviour (NMS 22.3) • ensure that a review is initiated as soon as possible and never more than 72 hours later, after any emergency admission. (NMS 5.6) 12 of 12 Inspection Report: SC036019

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