Children's Home run by Kent County Council in Kent

SC037282 Unique reference number 21 July 2010 Inspection date Liz Daniels Inspector Key Type of 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: SC037282

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Brief description of the service

This unit is owned by the county council and provides respite care for children and young people aged between five and 18 years, who have learning difficulties, physical disabilities and other associated complex needs. Over 100 children and young people stay at the unit on an occasional or regular basis; access to the service is through referral and is funded by the local authority. The number of staff or children and young people in the unit is based on a dependency assessment of care needs and a maximum of seven children and young people can be accommodated at any one time. The children and young people are cared for by a team of nurses funded by the Primary Care Trust and care staff funded by the local authority.

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Brief description of the service

The unit provides a range of facilities including office space, a kitchen, communal areas, bedrooms, bathrooms, a sensory room and soft play areas. There is a recently installed spa bath. Upstairs, a separate flatlet provides the opportunity for the children and young people to develop some independence and learn life skills. Outside there is a sensory garden and a large grassed area where there are swings, a play house and an adventure area on a safe surface. Off-road parking is available in front of the complex and the unit has its own adapted transport, enabling the children and young people to access activities and education in the local community.

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Brief description of the service

Copies of the Statement of Purpose are available from the unit for parents and social workers. A children and young people's guide is given to young people entering the service that details the unit, the staff and the daily routine.

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Summary

This unannounced inspection was the first visit to the unit for the year April 2010 to March 2011. The key standards were inspected and the visit also provided the opportunity to meet with the senior team leader and several members of the care team. The Registered Manager was unavailable on the day of the visit. Some of the young people currently accommodated were at the unit for parts of the inspection and were able to demonstrate that they enjoy being there.

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Summary

This setting provides a comfortable place for the young people to stay and an enthusiastic, motivated staff team provides care to meet their needs. There are excellent arrangements in place to keep the young people healthy, and good measures undertaken to maintain their safety. Meeting the young people's individual needs is seen as an integral part of how the unit runs and the staff are keen to enable the young people to achieve their full potential. 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

One recommendation was made at the last inspection. Whilst there has been progress in ensuring staff have some supervision, regular sessions are not yet established for all staff, as required by regulation. An action has therefore been made.

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Helping children to be healthy

The provision is outstanding. 4 of 10 Inspection Report: SC037282 The young people enjoy varied, healthy meals which are prepared by an enthusiastic cook, with consideration for each young person's likes, dislikes and dietary needs. The food is well presented and meals are well ordered, happy occasions. The staff are sensitive to the needs of each young person; they support those young people who need help with feeding and similarly, are considerate towards those who are unable to eat. Food is appropriately stored and well labelled once opened.

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Helping children to be healthy

Many of the young people have complex health needs and are cared for by a competent team of nurses and carers. Comprehensive health plans detail their health history, health care needs and medication. Illnesses, accidents and injuries are well monitored and recorded; body maps are used appropriately. Although optical and dental appointments are rarely arranged during a young person's stay at the unit the staff ensure they access health professionals when required. The staff regard health promotion as an integral part of each young person's care and encourage outside activities where practicable. The overhead hoist system ensures all young people can use the bath and wash facilities as well as be involved in activities arranged at the unit.

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Helping children to be healthy

Medications and treatment are well administered and the staff are very thorough in their record keeping. Medication administration records are used and any medications administered or omitted are appropriately recorded; weekly monitoring enables the date and time of any discrepancies to be tracked. Those with parental responsibility provide signed consent for the administration of first aid treatment and prescribed medication, prior to each young person's stay at the unit. Similarly, the use of certain household medications is also authorised by them. Well-stocked first aid boxes are in the unit and company vehicles. Good rota planning ensures staff trained in first aid, the management of medications and specific emergency health care are always on duty.

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Protecting children from harm or neglect and helping them stay safe

The provision is good. The staff respect the young people's privacy and are sensitive when sharing information about them. Comprehensive policies underpin practice to ensure the young people are cared for with dignity. Staff training during their induction ensures they recognise the importance of providing the young people with privacy; equally they balance that well with the need to supervise and care for them. A payphone is available for the young people to make private calls to their families and wherever possible a mixed staff group is on duty, enabling sensitivity to gender issues. Good sized bedrooms and bathrooms provide space for personal care.

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Protecting children from harm or neglect and helping them stay safe

The staff believe that all complaints must be taken seriously. They recognise that each young person has the right to complain and that their concerns must be listened to, investigated and acted upon. They are alert to signs that a young person may be concerned, distressed or unhappy and use a variety of communication systems to allow them to express their anxiety. Similarly, records confirm that parents' concerns are addressed and followed up well by senior staff. The unit's complaints procedure is well publicised for those involved with the service; it outlines that informal concerns are managed by the unit's manager and more serious complaints are formally investigated through the local authority complaints process.

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Protecting children from harm or neglect and helping them stay safe

The nurses and care staff are trained in child protection and readily respond to safeguarding concerns to ensure the young people's welfare is given the highest priority. Any concerns are well recorded and body maps used appropriately. However, some of the ancillary staff who have contact with the young people have not had training. The local safeguarding procedures 5 of 10 Inspection Report: SC037282 are readily available in the home for the staff to reference alongside the unit's comprehensive policy. Sound recruitment procedures require that all staff have an enhanced Criminal Records Bureau disclosure before employment.

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Protecting children from harm or neglect and helping them stay safe

The unit's anti-bullying policy and procedure as well as the young people's anti-bullying charter, all endorse that bullying is considered to be unacceptable. The staff are very alert as to what constitutes bullying and intervene promptly. Careful planning of the groups to be accommodated includes consideration for which young people are likely to bully as well as those who are vulnerable; in addition, good staffing levels enable the young people to be well supervised whereby the risk of any intimidation is greatly reduced. Similarly, appropriate staffing ratios and risk assessments result in very few instances of unauthorised absence.

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Protecting children from harm or neglect and helping them stay safe

The staff focus on all that is positive for each young person. Each has a positive handling plan that identifies what they are good at and like doing, as well as any modifications to the environment or routines required to prevent situations arising. The staff guide the young people as to what is socially acceptable behaviour and discourage them when their behaviour is inappropriate. The result is that behaviour is very well managed and there are a low number of incidents. Physical restraint is rarely necessary but appropriate sanctions are used. Good records are maintained which are monitored and each event evaluated as part of the unit's quality assurance. However, the names of the young people who witness incidents are not always recorded. The nurses and care staff are all trained in behaviour management techniques.

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Protecting children from harm or neglect and helping them stay safe

The staff are diligent in making sure that the environment is safe and free from hazards, which helps the young people to feel physically safe when they stay at the unit. Appropriate risk assessments are undertaken and the organisation has the required public liability insurance. Positive steps are taken to protect against the risk of fire and other hazards. Weekly day time fire drills include an evacuation of the building by staff, although an evaluation of how well this is undertaken is not recorded. In addition, creative 'mock scenarios' to explore how challenging young people may be supported in the event of a fire at night are also held. However, these too are not recorded or evaluated as part of the fire records. All the staff are trained in fire awareness.

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Protecting children from harm or neglect and helping them stay safe

The unit's controlled entry system enables visitors to be well vetted before admission. They and any contractors must sign in and are supervised whilst on site. When staff are being recruited the necessary information is received prior to employment. Discussions with staff confirm that the required checks are made and all the information is initially centralised with the local authority before being copied for the setting. However, the information within staff files on site do not all comply with regulation; there is no confirmation that a reference is always received from the person's most recent employer or proof of identity which includes a recent photograph.

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Helping children achieve well and enjoy what they do

The provision is outstanding. The staff provide a high level of personal support for the young people. A member of staff is allocated to look after them for each shift and staffing levels allow for one-to-one care for children who need extra support. Professional services are accessed when needed and individual time with each young person provides the opportunity for them to express their personal concerns with any staff member. Group activities counter the risk of a young person becoming isolated and the monthly visits from the person undertaking Regulation 33 enables them to 6 of 10 Inspection Report: SC037282 raise any queries with an independent person. Observation of the young people confirms that they respond very well to the care that they are given.

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Helping children achieve well and enjoy what they do

The staff promote education as valuable and support the young people in their learning by enabling their attendance at school. Excellent liaison between the staff and schools enables continuity of care as well as the facilitation of practical arrangements such as transport. Learning resources which include books and a computer are available at the unit. Education is seen as a valuable consideration during the young people's reviews and their teachers are invited to contribute, whereby the staff are aware of the young people's personal education plan.

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Helping children achieve well and enjoy what they do

The staff organise many activities and leisure interests for the young people, taking into account their individual needs and capabilities. There is an abundance of games, pastimes and facilities evident around the unit and outside. The overhead hoist throughout the unit enables all the young people to join in with any activity whereby no young person is excluded. Equally the staff recognise the young people's need to relax and enjoy quieter time. Staff use different communication methods to consult with the young people as to what they would prefer to do. They also confirm they gain their views by recognising the way they behave, and whether they are relaxed or not indicates their likes and dislikes about the service. Festivals and celebration days are remembered.

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Helping children make a positive contribution

The provision is outstanding. Individual care plans, risk assessments and health plans are developed for the young people to detail their social care needs and how they will be met. They are well monitored and shared with family members each time the young person stays, and are therefore updated when required. Similarly, they are also updated following reviews of care or discussions with the young person's social worker. Good daily records of events and progress are maintained.

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Helping children make a positive contribution

Reviews of care are generally held annually or as required. Although the young people do not usually attend (which is appropriate for them), the staff and other appropriate personnel are included whereby the young people's progress, likes and dislikes are contributed. A comprehensive pre-review report prepared by the staff details the care required and the progress the young people are making. All the required paperwork is held in the young person's file.

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Helping children make a positive contribution

As most of the young people live with their families and attend the unit for respite, there are few instances when contact visits are arranged during their stay. However, the staff are supportive and encourage contact as required. Each young person's contact arrangements are known and are agreed at their review. The home is welcoming for families when they visit and records of contacts are maintained. Appropriate policies and procedures underpin the practices in place.

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Helping children make a positive contribution

The admission process is very well planned, structured and managed sensitively. When a young person is new to the unit, introductory visits take place to help them feel settled before they try an overnight stay. Information about the unit is available for the young person as well as their parents or carer and they are encouraged to bring small personal possessions with them. Similarly, the transitional work which is now being undertaken is a very positive development to support the young people in their move to adult services. 7 of 10 Inspection Report: SC037282 The staff are alert to the young people's feelings and explore different routes to ensure they are included when key decisions are made about their lives. Equally they consult with family members about the care of the young people and regularly send out questionnaires to gain their views about the operation of the unit.

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Achieving economic wellbeing

The provision is outstanding. The staff are providing some excellent support for those young people who are preparing to move to adult services. Very good arrangements are made to enable them to learn life skills if they are able. Careful planning and reasonable timescales ensure that all the right measures are in place to facilitate a smooth transition to adulthood; the staff confirm that no young person leaves the service without a clear plan as to their future arrangements. Appropriate personnel are involved and records maintained.

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Achieving economic wellbeing

The setting provides comfortable accommodation that is decorated, furnished and very well maintained. The unit is a purpose built facility set within its own grounds and situated near a large town where shops and facilities are easily reachable by car. Set back from the road, there is a car park which provides sufficient space for several cars to park. A large enclosed area to the back of the unit is very well equipped with play equipment, providing safe recreational space for the young people. The exterior of the property is in a good state of structural and decorative repair. Internally some recent refurbishment has enhanced the accommodation. A sensory room provides space for relaxation. Similarly, several play areas and sitting rooms ensure there is space for all those who stay to be together or spend time alone. A recently installed spa bath is also a much enjoyed feature. A good sized dining area provides sufficient space for

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Achieving economic wellbeing

the staff and young people to eat together. Most of the bedrooms are bright and appropriately furnished; however, the two rooms which are easier to clean are now showing general signs of wear and tear.

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Organisation

The organisation is good. The unit's Statement of Purpose fulfils the requirements of regulations as it reflects what the setting sets out to do for the young people, how they will be cared for and what services they can expect. Copies are circulated to all parents annually and to each new staff member. Similarly, a young person's guide in picture, symbol and word format is given to the young people.

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Organisation

A knowledgeable, experienced and qualified Registered Manager continues to lead the staff team; she is supported by an experienced and competent senior team leader who deputises for her in her absence. Staff are supported with specific training to meet the children and young people's needs. The staff team have a range of skills, qualifications and experience; the four nurses support the care team in meeting the young people's health needs and the appointment of two health care support workers is a positive addition to the team. Similarly, the care team ensure each young person is cared for in a holistic way and enabled to enjoy a wide range of activities; more than 80% of them are trained in a National Vocational Qualification for the care of children and young people at level 3.

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Organisation

Appropriate numbers of staff are on a roster to meet the home's Statement of Purpose, and the shifts undertaken allow sufficient time for the completion of records, as well as the handover of information. The staff team aim to cover any shortfalls by working additional shifts whereby 8 of 10 Inspection Report: SC037282 minimal agency staff are used. All new staff undertake a satisfactory induction programme although the content of the teaching is not recorded. Good access to training enables the staff to be updated in key areas; all staff have at least six paid training days per year. Staff are very positive about the timetabled supervision sessions they have and see them as supportive; however, sessions for some staff including those who are new are not as frequent as they should be.

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Organisation

Good quality assurance and reflection on practice is fundamental to how the service runs. Robust monitoring of the care of the young people and the unit's performance against its Statement of Purpose is undertaken; recommendations are made and acted upon. Monthly visits to comply with Regulation 33 are undertaken, documents are sampled, signed and dated and a report produced; this includes recommendations which direct the manager towards areas for improvement.

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Organisation

The promotion of equality and diversity is good. Although all the young people have disabilities the staff see them all as individuals and are proactive in ensuring their diverse needs are met. The ethos of the unit is to recognise and support the different cultures, abilities, communication needs, language and faiths of any young person accommodated. A mixed staff team ensures that the individual personal, social, health and emotional needs of each young person are explored and care given to meet them.

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Organisation

A wealth of information about each young person is held and makes up a record of their history and progress. It is stored securely but the young people can request to see the information and to learn what is in it, with staff support.

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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

20 August 2010 obtain for all staff, before they start work at the home, all the information set out in Regulation 26 27 August 2010 ensure that all staff receive appropriate training, supervision and appraisal. (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 provision of training for all staff, including ancillary staff, in the prevention of abuse, recognition of abuse, dealing with disclosures or suspicions of abuse and the unit's child protection procedures (NMS 17.8) • ensure the records of restraints and sanctions include the name(s) of any other staff, children or other people present (NMS 22.9) 9 of 10 Inspection Report: SC037282 • ensure that any deficiency identified from drills is noted and the action taken to remedy the deficiency (NMS 26.8) • ensure all the bedrooms are decorated to a standard which creates a pleasant domestic environment. (NMS 24.2) 10 of 10 Inspection Report: SC037282

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