Children's Home run by Surrey County Council in Surrey

SC370703 Unique reference number 19 August 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: SC370703

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Brief description of the service

The home was registered in May 2008 and is a large detached purpose built service, which offers short breaks to a maximum of 22 children and young people aged between five and 18 years. The service is currently registered for 15 children and young people in three flats.

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Brief description of the service

The service is designed for children and young people with a learning disability and specifically for those on the autistic spectrum, who attend a specialist school located on the same campus. The accommodation at the unit is on two floors, accessible by both stairs and a lift and divided into four separate flats, each offering services to children within a specific age range. Each flat has a living room, kitchen-diner, bathroom and toilet facilities and the required number of individual bedrooms. Communal facilities include a laundry, small garden and transport. The service can access a range of facilities within the local specialist school including; outdoor play areas; a hydrotherapy pool; sensory rooms; soft play areas and an art room. Staff are provided with facilities which include office space, sleeping-in accommodation, separate toilets and a locker room.

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Brief description of the service

During the inspection, each of the three flats currently being used were occupied by at least two young people at any one time. Information about the unit and a copy of the last inspection report can be obtained by contacting the unit's manager.

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Summary

This unannounced inspection was the first visit to the unit for the year April 2010 to March 2011, during which key national minimum standards were inspected.

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Summary

Overall, this setting provides a comfortable place for the young people to stay. An experienced manager leads a knowledgeable, enthusiastic and motivated staff team in providing care to meet the young people's needs. There are good measures in place to keep them healthy and to maintain their safety. The team work closely with parents, the school staff and other professionals; they ensure that they get to know, understand and communicate effectively with each young person whereby their views are listened to. Overall, meeting each young person's needs in order for them to achieve their full potential is fundamental to their plan of care; excellent outcomes are being achieved for them.

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Summary

However, records do not confirm that all staff have participated in fire drills and behaviour management records are not always completed as required by children’s homes regulations. 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 actions were issued at the last inspection two of which have been met. The Registered Manager was asked to ensure that all types of restraint practiced in the home were in keeping with the training the staff receive. As a result, records now include the names of any holds used when a young person is restrained. In addition, the manager was asked to ensure that the testing of portable electrical equipment is carried out annually. Portable appliance testing has been undertaken since the last inspection. There was also a requirement that the manager ensured new staff receive regular formal supervision and that this can be evidenced. Although 4 of 10 Inspection Report: SC370703 good progress is being made and each new staff member has a buddy as well as their supervisor to turn to for support, formal recorded supervision with new staff is not yet being undertaken as frequently as required by regulation.

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Improvements since the last inspection

Similarly, three recommendations were also issued at the last inspection. The manager was asked to ensure staff were familiar with the unit's policy relating to unauthorised absence, to ensure the fire alarms are tested weekly and that 80% of staff have obtained a National Vocational Qualification (NVQ) at Level 3 award. All of these have now been met.

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Helping children to be healthy

The provision is good. The young people enjoy varied, healthy meals which they and the staff prepare together as appropriate. Each young person learns how to prepare meals and snacks through an individualised learning programme which is developed using words, pictures or sign language as needed. The weekly menu is planned with consideration for each young person's likes, dislikes and dietary needs, but each young person can also choose a suitable alternative to the food offered if they prefer. Healthy eating is promoted and well publicised through wall displays and balanced meals pictured in the kitchen areas. The food is well presented and meals are well ordered, happy occasions enjoyed by the staff and young people. Food is appropriately stored and well labelled once opened. Most of the staff are trained in food hygiene.

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Helping children to be healthy

As the young people attend the unit for short breaks, their parents usually arrange access to health professionals as required to promote their good health. Similarly, optical and dental appointments are rarely arranged during their stay. However, during their stay the staff encourage the young people to exercise and to enjoy outside activities; an enclosed garden area and a variety of play equipment enables the staff and young people to spend time together outside. Illnesses, accidents and injuries are well recorded with the appropriate use of body maps. Health education is discussed using pictures and other suitable communication methods; the staff are sensitive when managing issues of personal hygiene, encouraging the young people to be as independent in their care as they can be. Each young person's person centred plan includes the care required to meet any health needs. These are supplemented by the

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Helping children to be healthy

24-hour programmes which guide staff in how to support the young people with their personal care.

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Helping children to be healthy

Overall, medications and treatment are well administered. The staff ensure that a young person's prescription medication comes into the unit with them and goes out with them at the end of their stay, whereby none is held as 'stock'. Medication administration records are maintained and prescription medications are audited daily. However, the instructions for the administration of some medications are not always fully recorded; this makes it unclear as to what dose of medication has been given. The required consents are in place for the administration of homely medications and a small stock is appropriately stored. Controlled drugs (CDs) are well stored, recorded and audited during the young people's stay. However, the CD book continues to show a balance of medication in stock which is wrong; although this appears to be because the medication has not always been signed out of the premises when it has been sent home with

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Helping children to be healthy

a young person. This identifies that the risk of a disparity is not being found promptly. An identified first aider is on duty for each shift and well-stocked first aid boxes are in the unit and company vehicle. 5 of 10 Inspection Report: SC370703

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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. Wherever possible a mixed staff group is on duty, enabling sensitivity to gender issues and 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 recognise the importance of the young people raising their concerns and ensure they are supported to do so. 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. 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. No complaints have been recorded since the last inspection; the staff confirm that although they capture anxieties the young people experience, how these are followed-up are not always recorded.

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Protecting children from harm or neglect and helping them stay safe

All staff have either completed or are booked to undertake basic training in safeguarding, whereby they know how to respond to safeguarding concerns. The local safeguarding procedures are readily available for the staff to reference and these are supplemented by the county council and the unit's own policies. 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

Bullying is considered to be unacceptable; the staff are very alert as to what constitutes bullying and have put strategies in place to ensure its incidence is minimal. Careful planning of the groups accommodated and good staffing levels enables the young people to be well supervised which greatly reduces the risk of any intimidation. Equally, in the event, staff are responsive to prevent a situation escalating.

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Protecting children from harm or neglect and helping them stay safe

Similarly, staff awareness, appropriate staffing ratios and risk assessments have resulted in no unauthorised absence.

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Protecting children from harm or neglect and helping them stay safe

Behaviour is well managed and this has resulted in a low number of incidents. The staff recognise that challenging behaviour is often a result of a young person's anxiety; by alleviating that they then guide them as to what is socially acceptable behaviour, whilst discouraging them when their behaviour is inappropriate. Minimal sanctions are used and physical restraint is rarely necessary. In general, satisfactory records are kept. However, records of physical intervention do not always include the duration of a hold. In addition, the logs are not always signed to confirm they are reviewed each month as part of the regulation 33 visits. Similarly, the manager does not always record the date the logs are monitored to confirm they are reviewed regularly.

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Protecting children from harm or neglect and helping them stay safe

Overall, there are good measures in place to maintain the safety and security of the young people. Appropriate risk assessments are undertaken and the unit has the required public liability insurance. All portable appliance testing, gas safety and electrical installation checks are current. Positive steps are taken to protect against the risk of fire and other hazards; records confirm that the staff and young people involved have been responsive when the fire alarm has been activated as an emergency. However, records are not completed for organised fire 6 of 10 Inspection Report: SC370703 drills; there is therefore little evidence that new staff are involved in a fire drill soon after joining the team, or that all staff have been included in a drill within the last year. This presents the risk that the staff may not all know how to care for the young people in the event of a fire.

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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 sign in and are supervised whilst on site. When staff are 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.

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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. Good staffing levels allow for one-to-one care for those young people who need extra support. Individual time with each young person provides the opportunity for them to express their personal concerns with any staff member. Similarly, group activities counter the risk of a young person becoming isolated. Staff clearly recognise and respect each young person's individual needs and work hard to ensure that their wishes and feelings are considered when their stay is being planned; observation of the young people confirms that they respond very positively to the care that they are given. Professional services are accessed when needed, although as the young people attend the unit for short breaks, this is usually arranged by their parents.

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Helping children achieve well and enjoy what they do

Education and learning is clearly valued by the unit which works closely with the school situated on the same campus. In term time the unit accommodates those young people who have been assessed as likely to benefit from a residential learning programme; each has a set of educational goals that they work towards each time they stay. At weekends and during school holidays the unit provides short breaks for those young people and others. Again, the purpose of the stay is to enable each young person to develop and reach their full potential; thorough planning ensures there are consistent strategies as to how this will be achieved. The young people are given high levels of support which have resulted in some excellent outcomes. Feedback from parents is very impressive regarding the ability of staff to engage with the young people and enable them to learn social and life skills, as well as achieve some independence.

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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 and there are lots of games and equipment for them to enjoy. Staff consult with the young people as to what they would prefer to do; equally the staff recognise the young people's need to relax, enjoy quieter time or to have time alone.

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Helping children make a positive contribution

The provision is outstanding. The manager visits each family and undertakes a comprehensive assessment of a young person before they are accommodated. The information gathered is then used to develop their person centred plan. This and appropriate risk assessments detail their care needs and how they will be met. They are detailed documents which include the manner in which staff are to offer support and what they are to say to the young person; different methods of communication are used as appropriate for the young people. Any religious and cultural needs are identified during the assessment visits and the staff then ensure that these are met. 7 of 10 Inspection Report: SC370703 Good daily records of events and progress are maintained; a monthly summary report is then formulated. These and any additional information contribute to the reviews of care held at least annually. The young people attend wherever possible and if able, are supported to do a

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Helping children make a positive contribution

presentation to promote their views. Family and friends are also invited to a celebration evening at the end of a young person's two term placement. This provides an excellent opportunity for them to demonstrate some of the skills they have learned; they help prepare food and organise some entertainment before being presented with a certificate for all that they have achieved.

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Helping children make a positive contribution

Contact with parents and carers is promoted although as the young people only attend for short lengths of time, there are few instances when contact visits are arranged at the setting.

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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 the transition period before they try an overnight stay is variable, depending on the individual needs of each young person. Information about the unit is available for the young person as well as their parents and they are encouraged to bring small personal possessions with them. Similarly, as the young people get older the work undertaken with them is individualised to provide them with the support they need prior to their move to adult services.

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Helping children make a positive contribution

The staff are alert to the young people's feelings and use different communication systems to enable them to make decisions during their stay. However, records do not always reflect that all the good work undertaken with the young people is being captured. A questionnaire is sent to the young people and to their parents at the end of their educational programme at the unit.

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Achieving economic wellbeing

The provision is good. The young people that attend the unit are not looked after by the local authority; therefore, the promotion of independence and decisions about their move into adult services remain with their parents. However, how a young person can manage when they reach adulthood is integral to how the setting runs. All young people have clear goals which are agreed between a team of professionals, as well as a plan that enables them to achieve.

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Achieving economic wellbeing

The general décor, furniture and furnishings of the unit make it a pleasant and comfortable space that is well maintained and provides very good facilities for the young people. Single bedrooms are provided for them. As the staff cannot guarantee that they are able to stay in the same bedroom at each visit, an extensive range of bedding, lamps and other items are available to personalise them; staff confirm that they support the young people to choose the items that they want for their bedrooms on the first night of their stay. However, the young people's bedrooms are not always as personalised as they could be. In addition, there are times when staff routinely keep all the access doors locked in the unit rather than regularly assessing the risk of each young person absconding and managing those individual circumstances.

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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. Similarly, a young person's guide in picture, symbol and word format is given to 8 of 10 Inspection Report: SC370703 the young people. In addition, the unit has a large display in the entrance area that provides an overview of the home's Statement of Purpose.

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Organisation

A knowledgeable, experienced and qualified Registered Manager continues to lead the staff team; she is supported by two experienced and competent team leaders who deputise for her in her absence. The staff team have a range of skills, qualifications and experience. They ensure each young person is cared for in a holistic way; they are enabled to learn as well as enjoy a wide range of activities. Although less than the required 80% of them have undertaken an NVQ for the Care of Children and Young People at Level 3, a further 11 staff are booked to commence the course in September 2010; this is the earliest opportunity after the completion of their probationary period.

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Organisation

Appropriate numbers of staff are rostered 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 minimal agency staff are used. All new staff undertake a good induction programme; they have access to further training although not all have had the necessary follow-on training to remain up to date. Timetabled supervision provides staff support; good records are maintained and the staff confirm that they find it very beneficial. However, formal supervision sessions are not as frequent for new staff as they should be, although they are also allocated a buddy who they can meet with informally to discuss how things are going; records of these sessions are not held.

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Organisation

Good quality assurance and reflection on practice is fundamental to how the service runs. The required internal monitoring of the care of the young people and the unit's performance against its Statement of Purpose is undertaken. Similarly, monthly visits to comply with regulation 33 are made, documents are sampled, signed and dated and a report produced.

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Organisation

The promotion of equality and diversity is excellent. 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 within their own case files which make-up a record of their history and progress. These are well managed and stored securely. The young people can request to see the information and to learn about the content, 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

24 September 2010 maintain an accurate and up to date record of measures of control used, as set out in regulation (Regulation 17) 9 of 10 Inspection Report: SC370703 24 September 2010 ensure by means of fire drills and practices that the persons working at the home are aware of the procedure to be followed in the case of fire (Regulation 32(1)(e)) 29 October 2010 ensure all staff receive appropriate training, supervision and appraisal. (Regulation 27(4))

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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 a written record is kept of all medication given to the young people (including dosage) which is signed for by the responsible member of staff. In addition, ensure controlled drugs are regularly monitored by an appropriate designated senior member of staff (NMS 13.2) • ensure that there are records to confirm that any concerns raised by the young people are investigated (NMS 16) • confirm that each visit to fulfil regulation 33 includes checks on the records of disciplinary measures and use of restraint. Similarly, that the manager regularly monitors the books (NMS 22 and 32) • ensure the young people are able and encouraged to personalise their bedrooms (NMS 24) • ensure that physical restrictions within the unit are used only in relation to a young person where the restriction has been agreed within their placement plan and only where necessary

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Recommendations

to satisfactorily safeguard and promote that young person's welfare. Such restrictions for one young person do not impose similar restrictions on other young people. (NMS 23.5) 10 of 10 Inspection Report: SC370703

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