Children's Home run by Keys Group Progressive Care & Education Limited in Southampton

SC389180 Unique reference number 28 June 2010 Inspection date David Coulter Inspector Key Type of Inspection

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12 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 9 Inspection Report: SC389180

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Brief description of the service

The home is registered to accommodate up to five young people aged 9 to 17 years with multiple disabilities that can include a learning disability, a physical disability and in some cases a sensory impairment. The home provides long-term placements. While the home consists of an older property, it has been extensively renovated and extended to meet the specialised needs of its residents, including those with mobility difficulties. All the young people are accommodated in single rooms on the ground floor. Other facilities include a specially designed garden/play area at the rear of the property. The home is situated in a residential area of the city and is well served by public transport. It is also accessible to a range of local amenities and services including a number of special schools.

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Summary

During my unannounced key inspection visit to the home I was able to undertake a tour of the premises, check a range of records and documents and meet with the manager and a number of staff. It was also possible to meet and observe five of the six residents on their return from school.

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Summary

Evidence collected during the inspection indicates that staff have clearly identified the physical, social and emotional needs of the young people in their care and have developed effective strategies to ensure they can be effectively met. Young people are encouraged to pursue healthy lifestyles by eating nutritious food and taking regular exercise.

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Summary

A number of the current residents have medical conditions that require regular interventions. Staff have completed specific training to carry out delegated nursing tasks. Staff are quite clear of their roles and responsibilities and regularly seek out the advice and guidance of health professionals to ensure effective working practices. There are robust procedures for both storing and dispensing medication. Staff have established effective monitoring systems to monitor the health and well-being of each young person.

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Summary

The home provides good quality accommodation that has been specifically designed to meet the needs of young people with disabilities. Young people are provided with their own rooms that are decorated and furnished specifically to meet their needs. There is a rolling programme of redecoration and refurbishment.

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Summary

The home is now operating to its full capacity and as a consequence has expanded its staff team. The home is effectively managed and operates with a group of well motivated and experienced staff. It is evident that young people are settled and living full and active lives.

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Summary

Though there are two recommendations arising from this inspection, neither affect the quality of care on offer which is outstanding. The overall quality rating is outstanding. This is an overview of what the inspector found during the inspection. 4 of 9 Inspection Report: SC389180

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Improvements since the last inspection

Each young person now has a dedicated health document that forms part of their placement plan. This document is used to monitor how the complex health needs of each young person are being met and by whom.

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Helping children to be healthy

The provision is outstanding. The home accommodates a group of vulnerable young people with complex needs. The physical, social and emotional needs of each young person are identified on admission. Due to their disabilities many of the young people experience health difficulties that require regular medical interventions. Well developed health plans provide guidance for staff on how the care needs of each individual can be effectively met. The health and well-being of each young person is monitored on an on-going basis and guidance is updated in response to changing circumstances. Staff have undertaken training to enable them to carry out a number of delegated health tasks. Specialised medical support is obtained from a number of health professionals including community nurses, occupational therapists and paediatricians. Consents for all medical interventions have been appropriately obtained from parents. Staff respect young peoples

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Helping children to be healthy

dignity and intimate care needs are highlighted in care plans and carried out sensitively. Specialised training has led to the development of good working practices that ensure that medication is both stored and dispensed appropriately. Information is provided for staff on the nature of each medicine and its possible side effects. All staff undertake first aid training that is regularly updated.

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Helping children to be healthy

Staff promote the concept of healthy living and encourage young people to eat healthily and take regular exercise. The home operates a four week rolling menu that incorporates individual's preferences and special dietary needs. All meals are prepared on the premises using fresh produce. Healthy snacks and drinks are available in-between meals. Young people's questionnaires indicate that the food on offer is good. Meals are social occasions and young people and staff eat together in a dedicated dining room. Young people are provided with at least one opportunity during the week to eat out. While an accurate written record is kept of each young person's food intake, fluid intake records are inconsistent.

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Protecting children from harm or neglect and helping them stay safe

The provision is outstanding. Individuals are accommodated in their own rooms that are furnished and decorated to meet their own specific care needs. Due to the nature of their disabilities most young people require visual checks at regular intervals. Staff try to strike a balance between each individual's right to privacy and an appropriate level of supervision. Night staff often have to check on young people during the night and try and do this with minimum disruption. Young people are treated with dignity and respect when receiving personal care. Confidential information relating to each young person is stored in an appropriately locked facility within the home's office.

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Protecting children from harm or neglect and helping them stay safe

The homes management aim to ensure that it employs high quality staff who are committed to working with a very vulnerable group of young people. All prospective staff have to complete a thorough recruitment process that necessitates applicants to complete a detailed application, submit to a Criminal Record Bureau check and provide two written references. New staff have to demonstrate their commitment by completing a training programme before taking up their 5 of 9 Inspection Report: SC389180 post. The concept of safeguarding and the identification of best practice forms part of their induction training. The home has a safeguarding policy and there are clear guidelines for staff on the reporting of any concerns to the area safeguarding team. Staff spoken with were clearly aware of their personal responsibilities in regard to reporting any worries or concerns. Staff receive regular refresher training on safeguarding issues. New staff have to demonstrate their

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Protecting children from harm or neglect and helping them stay safe

competence before assuming their full responsibilities.

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Protecting children from harm or neglect and helping them stay safe

Staff have developed a range of policies, procedures and working practices to ensure young people and staff are kept safe. Risk assessments are widely used to identify any areas of potential concern. All assessments are subject to regular review. Health and safety procedures are regularly checked as part of the company's quality assurance system. Inspections are also carried out by external agencies such as environmental health and fire safety. The homes fire alarm system is tested regularly and evacuation exercises carried out. Access to the building is limited and all visitors have to report to staff on admission, produce identification and sign in. There is a secure garden area to the rear of the property. The home has a well established policy and procedure for the recording and reporting of incidents.

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Protecting children from harm or neglect and helping them stay safe

Each young person has a behaviour management plan that provides guidance for staff on how to promote positive behaviour and achieve a consistent approach. Staff reinforce positive behaviour and young people are regularly reminded by staff of what is socially acceptable. While staff have undertaken training in the use of physical interventions they are only ever used if it is felt a young person is putting themselves or others at risk. When faced with challenging behaviours staff normally deploy a range of distracting strategies. Sanctions are not widely used and are only applied if it is felt a young person can comprehend the reason and make the connection between their actions and consequences. Sanctions normally consist of a short period of 'time out'. Bullying is not an issue amongst the current residents; however, due to their complex disabilities many of the young people experience involuntary actions that

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Protecting children from harm or neglect and helping them stay safe

could result in them striking out. Staff are clearly aware of this and use risk assessments to identify any potential difficulties. Staff operate on a one-to-one basis with young people and this minimises opportunities for incidents to occur. None of the current residents are capable of leaving the home unaccompanied and are not believed to be of significant risk of being absent without authority.

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Protecting children from harm or neglect and helping them stay safe

Staff deploy a range of techniques, including pictorial cards, to seek out the views of young people on all aspects of their lives within the home. Staff address any worries before they develop into major concerns. Staff provide regular reports for parents and placing authorities on the well-being of each young person. These reports provide specific information on their general health, their eating habits, sleep patterns, personal care, communication and social activities. The home has a written complaints policy and all young people, their parents and placing social workers are made aware of it on admission. No complaints have been made since the last inspection.

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Helping children achieve well and enjoy what they do

The provision is outstanding. Due to the high care needs of the young people being accommodated staffing levels are kept high. Staff normally work on a one-to-one basis with one young person for the duration of their shift. There is an expectation that staff will be conversant with the physical, social and emotional needs of all residents. Young people were observed on their return from school and 6 of 9 Inspection Report: SC389180 all appeared to be at ease in their surroundings and enjoying the attention they were receiving from staff. A daily record is made of how the needs of young people are being met. Communication between staff on different shifts is good and all shifts overlap to ensure important information is passed on. A key and co-worker system ensures that the needs of each individual are carefully monitored. Key and co-workers regularly liaise with teachers, placing social workers and family members.

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Helping children achieve well and enjoy what they do

The home has an education policy that ensures that young people have access to appropriate education. All the current residents have educational statements and have placements in special education schools. Staff regularly liaise with teaching staff to ensure that key information is appropriately shared. Staff attend education reviews and work with teaching staff to help individual young people master specific skills. For example, young people work toward a number of goals each term such as the ability to wash their hands effectively or the ability to feed themselves. Their progress in such areas is monitored both in the home and at school.

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Helping children achieve well and enjoy what they do

Young people are encouraged to live full and active lives and are provided with access to stimulating activities both within the home and local community. Staff support young people in pursuing specific interests and hobbies. One young person is particularly fond of horses and regularly attends a riding class specifically for young people with disabilities. A number of the young people have mobility difficulties and are confined to wheelchairs. The home has its own specially adapted transport that is used to access activities in the local area. Young people meet up socially with other young people at a weekly youth club. Young people have access to a range of recreational activities within the home including DVD players and music centres.

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Helping children make a positive contribution

The provision is outstanding. The home has effective policies and procedures for both admissions and departures. The policy ensures that admissions are planned well in advance. Detailed transition plans are developed to help minimise the stress associated with moving to a new environment. Young people are encouraged to visit the home on a number of occasions prior to admission. The impact on existing residents is always taken into consideration before a new placement is made. As detailed medical information is required before any placement is made, emergency placements are not normally considered. Staff liaise closely with placing authorities in advance of any placements or departures. The home is operating to full capacity and it is anticipated that the current group are likely to remain unchanged for a number of years.

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Helping children make a positive contribution

The home has an effective placement planning system. Placement plans provide staff with a profile on each young person, identify their care needs and provides guidance for staff on how they can be effectively met. A separate document is used to collate information relating to each individual's health. Placement plans make clear contact arrangements with family and friends. Staff involve young people and their parents in the development of their placement plans. Placement plans are monitored monthly and updated in response to changing circumstances. All placements are reviewed in accordance with looked after children guidance. The outcomes and recommendations arising out of reviews are incorporated in the care planning process.

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Achieving economic wellbeing

The provision is outstanding. 7 of 9 Inspection Report: SC389180 Staff support young people in acquiring a range of skills that will help them in later life. Although staff encourage young people to develop new skills they are aware that, due to their disabilities, all have limited capacities. All training is tailored to the needs and capabilities of each individual. Staff are aware of the vulnerabilities of each individual and risk assess all activities. Staff liaise closely with parents and teaching staff in an effort to establish a consistent approach to the way skills are being developed. Staff call upon the expertise of different therapists to help them develop effective training methods. Records demonstrate that young people have made significant progress in developing skills in areas such as communication, personal care and decision making.

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Achieving economic wellbeing

The home is specifically designed to meet the needs of young people with disabilities. It is situated in a good location and is accessible to a range of facilities including shops and a park. There is parking at the front of the building. The home is clean, tidy and bright. It is structurally sound and is subject to regular maintenance. All young people have their own rooms on the ground floor that have been decorated to reflect their own tastes and furnished to meet their specific needs. There are adequate bathrooms and toilets. The home has an effective heating system and air conditioning. Although the home has a range of specialised equipment, staff reported that with six residents all requiring personal care before school an additional hoist would be extremely helpful. While staff utilise space in the home effectively it is apparent storage space is at a premium. The medical requirements of a number of young people now

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Achieving economic wellbeing

necessitate the home storing large quantities of fortified foods as well as bulky continence pads. The manager is clearly aware of the problem and is investigating the possibility of increasing storage capacity by the side of the building.

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Organisation

The organisation is outstanding. The staff have produced a comprehensive Statement of Purpose that clearly reflects the nature of the service on offer. A young person's guide has also been produced in a pictorial format for young people with communications difficulties. Young people are supplied with a guide as part of the admission process.

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Organisation

The home operates with a stable staff team who have the skills, qualifications and experience to meet the needs of the young people presently accommodated. Staff are drawn from a cross-section of the local community. Staffing levels are adjusted in-line with the changing needs of young people. There is a culture of training and professional development within the home and an expectation that each member of staff will increase their knowledge and skills on an on-going basis. The organisation provides access to a wide range of training opportunities. All staff receive monthly supervision and an annual appraisal. The manager closely monitors the training profile of each staff member to ensure that all mandatory training requirements are met. Staff meetings are held monthly and there is an open agenda.

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Organisation

Evidence indicates that the home is operating effectively and the complex care needs of the young people are being appropriately met. The manager has a 'hands on' approach and offers effective leadership by working alongside staff. The home is subject to monthly monitoring visits, undertaken by a manager from within the organisation. The promotion of equality and diversity is outstanding and staff provide opportunities for young people to experience a range of cultural experiences. Young people are introduced to a range of foods from different cultures both in the home and in the local community. Staff are pro-active in advocating on behalf of 8 of 9 Inspection Report: SC389180 the young people in their care to ensure they can access the necessary resources and services to improve their quality of life. Each young person has a dedicated record that contains the information required in Schedule 3. Records examined contain recent and relevant information

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Organisation

and are kept in an appropriately locked facility

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Statutory requirements

This section sets out the actions, which must be taken so that the registered person meets the Care Standards Act 2000, The Childrens Homes Regulations 2001 and the National Minimum Standards. The Registered Provider must comply with the given timescales.

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Recommendations

To improve the quality and standards of care further the registered person should take account of the following recommendation(s): • ensure all health monitoring sheets are completed fully (NMS 12.2) • acquire another assisted hoist to ensure the personal care needs of individuals can be more effectively met at busy times of the day. (NMS 24.9) 9 of 9 Inspection Report: SC389180

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