Children's Home run by West Sussex County Council in West Sussex

SC067753 Unique reference number 30 June 2010 Inspection date Kevin Whatley Inspector Key Type of Inspection

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11 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 10 Inspection Report: SC067753

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Brief description of the service

The setting is predominantly a respite service for children and young people with both physical and learning disabilities, although longer term placements are catered for. The home is registered for a maximum of 16 young people aged from approximately 7 years upwards.

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Brief description of the service

The home is a purpose-built building which offers the young people a wide variety of facilities. The spacious accommodation includes single bedrooms, communal lounges with dining space, soft play areas and a well-equipped sensory room. There are several large bathrooms which provide enough space and the facilities for those requiring personal care or who are physically disabled. Ceiling tracking for hoisting is available in part of the building, ensuring those who are less mobile are included and involved in activities. The home is close to the local town and countryside which can offer the children and young people a wide range of activities based in the community. A the time of the inspection some 30 plus children and young people were accessing the service, predominantly for respite care.

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Summary

This key inspection was unannounced and took place on a weekday. Young people continue to receive good meal provision which meets their personal choices and special dietary needs. Individualised health care planning ensures young people have their physical and medical needs met; minor shortfalls were found in medication recording procedures. Young people are protected from the risks of harm with staff receiving appropriate training in safeguarding matters. Health and safety issues are addressed well. The individual needs of young people continue to be met in an excellent fashion. Young people have their needs assessed at the point of admission and at regular intervals thereafter. Improvements have been made to the manner in which the views of young people are obtained. Young people benefit from living in a well maintained and comfortable home. The setting continues to be managed well, however monitoring processes

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Summary

could be improved further along with the regularity of formal staff supervision. The numbers of full time staff are down. However, staff continue to provide a committed and thoughtful level of support, guidance and care. The overall quality rating is good. This is an overview of what the inspector found during the inspection.

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Improvements since the last inspection

Three recommendations were made at the last inspection. The first recommendation was to ensure medicines brought into the setting were written into stock records and accurately recorded when given. In general a very robust medication process is in place. However, a minor error was found whereby a discrepancy was identified between the recording of homely remedies and the amount actually held.

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Improvements since the last inspection

The second recommendation concerned the need to introduce a more evidential format for gaining the views of young people. Young people are now formally consulted with staff utilising pictures and photos to communicate more easily. Such meetings have notes taken with any requests being considered fully. 4 of 10 Inspection Report: SC067753 The final recommendation required the service to keep up-to-date records of formal supervision and ensure staff sign when they have received it. The record of supervision confirmed most staff receive regular supervision and sign to acknowledge this has taken place. However a number of staff had not received supervision at the required levels.

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Helping children to be healthy

The provision is good. Young people benefit from good meal provision. The likes and dislikes of each young person are clearly known at the point of accessing the service and planned for. Young people are encouraged to eat healthily with fresh fruit being readily available. Menu's provide a varied diet with young people with special dietary needs having these catered for. Mealtimes are seen as an important part of the day with young people being encouraged to eat with their peers and staff within the dinning rooms.

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Helping children to be healthy

The health care needs of young people are met well. The physical, medical and emotional care needs of each young person are suitably assessed and incorporated into health care plans. Each plan clearly describes the health care needs of young people and how these will be met. There is a focus on young people's learning disabilities and how they communicate their needs and wishes. Full medical histories are recorded including immunisation histories and previous and current illnesses. A number of young people have complex medical needs with staff receiving specific training to ensure they can meet individual concerns such as epilepsy and peg feeding. Young people who have mobility problems have occupational therapist assessments completed which determine how staff will provide assistance and care. Consents for emergency medical treatments and first aid are in place.

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Helping children to be healthy

Sound medication policies and procedures are in place, although these are not always followed. Young people have their medicines stored safely within a dedicated medicines room. Medication storage and administration audits are completed by an external pharmacist with practice deemed to be safe and suitable. In general medication stock controls were found to be robust and accurate, although one recording of a homely medicine was found to be different from the amount actually held in stock. One error had previously been identified by the setting itself with an investigation undertaken including consultation with the relevant parents. This appears to have been a comprehensive response, however records of the outcome of this incident were not clear.

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Protecting children from harm or neglect and helping them stay safe

The provision is good. Young people have their privacy respected with staff knocking on their rooms before entering. All confidential information regarding young people is stored appropriately. Young people who require assistance with personal care have this provided in a sensitive and caring manner.

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Protecting children from harm or neglect and helping them stay safe

The setting has a well defined complaints procedure which young people and parents are made aware of when they access the service. Information as to how to make a complaint is displayed around the home, as are the contact details for advocacy services such as the NSPCC and Childline. Complaints are addressed in a swift manner, however the outcomes of actions taken are not always recorded. No complaints have been received by Ofsted since the last inspection. 5 of 10 Inspection Report: SC067753 As far as possible young people are protected from the risk of harm, neglect or abuse. Good policies and procedures address all key areas of child protection. Staff receive regular child safeguarding training and attend refresher courses as part of the rolling training programme. Staff display a keen understanding of child protection matters.

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Protecting children from harm or neglect and helping them stay safe

The challenging or risky behaviours of all young people are well known and planned for. Comprehensive risk assessments are completed which focus on key concerns including possible violence, self harmful behaviours and poor road safety awareness. Individual behaviour management plans provide a clear guide for staff to follow. All staff are suitably trained in the use of physical intervention with any incidents being thoroughly reviewed and considered. The use of physical intervention is kept as low as possible.

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Protecting children from harm or neglect and helping them stay safe

A number of young people can display particularly difficult behaviours which given their particular needs may be difficult to diffuse through verbal de-escalation techniques. When this occurs, designated staff meet with other care professionals as a 'team around the child' group to identify the most appropriate ways of managing such behaviours and incidents. On occasion extreme behaviours are contained through the specific use of doors as an emergency measure to prevent the risk of significant injury or harm. While this is not the most appropriate manner to manage challenging behaviours it is acknowledged that such an approach has led to a direct reduction in violent and self-harmful behaviours for those young people. Records of such incidents are very clear with staff keeping constant observation with the use of any restriction being short. These practices are closely monitored by the management team and service manager

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Protecting children from harm or neglect and helping them stay safe

for the organisation. It is testament to the whole staff team that these young people have made steady progress within the home and the wider community.

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Protecting children from harm or neglect and helping them stay safe

The levels of staff supervision significantly reduce the risk of bullying behaviours taking place unchallenged. Similarly incidents where young people leave the setting without permission have not occurred for a considerable period of time. Risk assessments are in place for both situations. The use of sanctions is kept to an absolute minimum and is in keeping with the comprehension difficulties many young people have.

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Protecting children from harm or neglect and helping them stay safe

The health and safety of all those who live and work at the home is generally addressed appropriately. The routine checking, testing and servicing of fire fighting and electrical equipment takes place at regular intervals. Fire evacuation drills are carried out.

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Protecting children from harm or neglect and helping them stay safe

The recruitment of staff is completed in a thorough and safe manner. No members of staff work with young people until required checks have been completed. However several staff files did not contain picture identification.

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Helping children achieve well and enjoy what they do

The provision is outstanding. Young people have their individual needs met in an excellent fashion. Specific programmes are in place to meet the physical, social, behavioural and emotional care needs of each young person. Care plans confirm the way in staff should provide care, support and guidance and include individualised behaviour plans. The manner in which young people communicate their needs is paramount with staff understanding the often subtle forms of communication extremely well. 6 of 10 Inspection Report: SC067753 Key-working processes ensure young people have named staff who will focus predominantly on their placement. This enhances liaison with parents, schools and care professionals outside of the setting. Staff display a clear and detailed understanding of the needs of each young person in their care thus enabling them to support their individual needs. Regular whole staff team meetings focus on the individual needs of young people with all aspects of care provision

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Helping children achieve well and enjoy what they do

being reviewed. The ethos of the home remains centred on meeting the individual needs of young people.

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Helping children achieve well and enjoy what they do

A positive and inclusive approach ensures young people are encouraged and supported to engage in their education. All young people have clear educational plans in place which detail the type of programme they should be receiving. A majority of liaison with schools and colleges is facilitated by the parents of young people accessing respite care. The setting is mindful to contribute to educational planning with close links made with schools and colleges ensuring good communication between all parties. When necessary key staff attend school reviews, notably for those young people living at the setting full time. It is clear the efforts and commitment from staff to support young people in their learning is impacting positively in both the level of attendance to education and the progress being made.

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Helping children achieve well and enjoy what they do

The daily routines of the setting include encouraging young people to participate in regular activities. The setting is well equipped with sensory rooms and soft play areas, while a trampoline, climbing frames, bicycles and tough play items can be found outside in the garden. Wherever possible young people are enabled to engage in their chosen activity or interest including horse riding. Trips outside of the setting take place to local parks or leisure centres with a culture of supporting young people to be a part of the local community.

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Helping children make a positive contribution

The provision is good. Young people have their individual needs fully assessed prior to their arrival. Young people are only admitted to the home once it has been confirmed that their needs can be met. All information is considered with parents playing a key role in placement planning alongside any looked after child assessments. The manner in which young people communicate their needs is a guiding factor in the development of all care plans. Each care plan outlines the aims of the placement and how each young person will have their physical, medical and social care needs met. The home has a written admission procedure that supports each young person to settle in. All prospective residents are encouraged to visit the home prior to admission.

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Helping children make a positive contribution

Care plans are regularly reviewed and audited and detailed monthly reports record each young person's progress. Reviews are held and attended by social workers, family members and the home's staff. The outcomes or recommendations arising out of reviews are incorporated in the care planning process. Young people are encouraged to attend their reviews. Key workers have undertaken commendable work in encouraging young people to attend statutory reviews. This includes taking along pieces of work for the young person to show and assisting young people to display progress they are making such as using communication boards.

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Helping children make a positive contribution

Contact arrangements with families and friends are clearly recorded in the young people's care plans. Any restrictions on contact are known. A majority of young people do not have restrictions on contact as they access respite care. Young people living at the home long term, maintain regular contact with parents both in the setting and in their own homes. 7 of 10 Inspection Report: SC067753 Young people are assisted to express their opinions and wishes. Since the last inspection the setting has introduced a more defined and formal process for gaining the views and wishes of young people. Most young people have complex communication needs which necessitate a thoughtful approach. A process has been developed which allows young people to communicate their thoughts and ideas in relation to the general day-to-day routines of the home. By using pictures and symbols young people are able to respond to questions with written notes being

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Helping children make a positive contribution

taken and action plans put in place as a result. These include changes to activity planning and trips outside of the setting. Once young people have become more used to this formal consultation programme it is planned to address how young people perceive the standard of care they receive. The atmosphere in the home was found to be open and relaxed with young people clearly feeling comfortable in the company of staff.

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Achieving economic wellbeing

The provision is good. Wherever possible young people are encouraged to engage in individualised life skills programmes. This offers them opportunities to gain valuable practical skills and learning. This includes addressing matters such as preparing and cooking meals and safety issues when out and about in the community.

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Achieving economic wellbeing

When young people come toward the end of their placements after accessing services at the home for a number of years they are given obvious support and guidance through the period of leaving. Such transitions obviously create uncertainty and anxieties for those concerned. Staff are proactive and positive in the manner in which young people are engaged, supported and prepared. This includes close liaison with parents and social workers ensuring that the best outcomes for young people are always sought.

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Achieving economic wellbeing

The setting provides young people with a good standard of accommodation with all areas being suitably decorated and furnished. Young people are encouraged to personalise their own rooms. Communal areas are set up to offer facilities for both long term and respite care. Young people have been involved in creating posters and collages in the hallways which depict activities and events they have been involved in. Sufficient numbers of bathrooms and toilets are available. All communal areas have been arranged with young people in mind with lounges being well equipped with entertainment items. A few separate areas have been developed which allows young people to relax or gain individual space should they wish. The garden offers outdoor equipment such as a trampoline, climbing frames and toys. The setting was found to be in a good condition throughout with all parts of the home seen to be very clean and hygienic. Since

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Achieving economic wellbeing

the last inspection a dedicated person has been employed to address the maintenance needs of the site. This is clearly having a beneficial effect on keeping the environment in good order.

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Organisation

The organisation is good. Sufficient information is provided regarding the setting and the services it offers. Separate guides are made available for parents and young people including pictorial formats. All guides clarify key aspects of the service including rules, routines and the setting's complaints procedure.

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Organisation

The promotion of equality and diversity is good. In particular young people have their individual needs met taking into account their ability to comprehend and communicate. Staff clearly understand the issues young people have and respond to them accordingly. A good staff gender 8 of 10 Inspection Report: SC067753 balance ensures young people are looked after by both male and female carers. Wherever possible, the home involves parents and carers in care programmes and encourage a 'working together' ethos where appropriate. Young people are not held back by their learning disability. The positive and purposeful environment enables young people to engage fully in their education, chosen interests and to be a part of their local community.

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Organisation

Adequate numbers of staff are available both day and night to meet the assessed needs of young people living at the home. When required additional staff are put in place. The setting currently has a number of vacancies. An active recruitment programme is in place although some staff have recently left leaving some shortage in a few of the teams. To combat this, the setting has been using agency staffing, whenever possible the same temporary staff are deployed to ensure consistency. As a result staffing at certain times of the week comprise of more temporary staff than those employed directly by the organisation.

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Organisation

Staff are knowledgeable and committed, displaying considerable insight into the needs of each young person in their care. Most staff receive regular formal supervision while on going informal supervision is evident on a daily basis. However a number of staff have not received formal supervision at the required level. The organisation offer good training and continuing development opportunities, while the staffing structure is defined with everyone knowing their roles and responsibilities. Regular staff meetings occur with staff being encouraged to highlight examples of good practice and how this may be disseminated across the whole service. Interactions between staff and young people was found to be caring, relaxed and open.

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Organisation

The Registered Manager is an extremely experienced practitioner, holding a wealth of knowledge in the best practice of caring for young people in residential settings. The home is run well with the senior management team continuing to consider the needs of young people first.

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Organisation

Monitoring procedures are in place with the Registered Manager and their deputies undertaking reviews and assesses the standards of care on a regular basis. As mentioned previously in this report a number of recording issues have been found which had not been identified through monitoring. Monthly Regulation 33 inspections are completed with the subsequent reports providing a concise yet detailed overview of how the home is operating against the national minimum standards.

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Organisation

Records required to be kept clearly evidence the progress and development of each young person with a majority of documents being completed compressively and accurately.

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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

19 August 2010 ensure that all staff files contain proof of identity including a recent photograph (Regulation 26, Schedule 2) 9 of 10 Inspection Report: SC067753 19 August 2010 ensure that staff receive formal supervision as required in accordance with Regulation 27. (Regulation 27 (4) ( a))

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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 the administration of medicines is accurate and where errors occur they are recorded with details of any subsequent investigation and the actions taken (NMS 13.10) • ensure all complaints are recorded in full including details of actions taken and the complaint outcome (NMS 16.3) • ensure the numbers of agency staff working at any one time do not exceed 50% of the total numbers of staff on duty. (NMS 30.3) 10 of 10 Inspection Report: SC067753

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