Children's Home run by Praxis Care in Leicestershire

Unique reference number SC032069 Inspection date 15/09/2010 Inspector Warren Clarke Type of inspection Key

p.1

Date of last inspection 15/12/2009 Website: www.ofsted.gov.uk

p.1

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.

p.2

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 Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop

p.2

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.

p.3

About this inspection

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 outcomes for children set out in the Children Act 2004 and the relevant National Minimum Standards for the service.

p.3

The inspection judgements and what they mean

Outstanding: this aspect of the provision is of exceptionally high quality Good: this aspect of the provision is strong Satisfactory: this aspect of the provision is sound Inadequate: this aspect of the provision is not good enough

p.3

Brief description of the service

This is an independently operated children's home providing respite care for a total of 42 children and young people with learning and other difficulties, but for four at any one time. The children and young people are aged between six and 19 years. Four children and young people were resident at the time of the inspection and they all participated in the inspection.

p.4

Brief description of the service

The home is a domestic bungalow and is set back from a main road of a suburban area. It is on a bus route and close to shops and other amenities. All facilities are on the ground floor and consist of four separate single bedrooms, large dining and sitting areas, sensory room and kitchen. The suitably enclosed outdoor area is equipped with appropriately adapted play equipment and a sensory garden. The home is equipped for children and young people who also have physical disabilities.

p.4

Summary

This is an overview of what the inspector found during the inspection.

p.4

Summary

This unannounced key inspection assessed performance against national minimum standards relevant to the Every Child Matters outcome areas and organisation. The home continues to maintain overall good standards of care for children and young people some of whom have complex difficulties. Quality of care in some areas is exceptional, particularly in relation to health and in the imaginative work done to promote the children and young people's enjoyment. There is a real commitment to ensure the inclusion of the children and young people in community life and to build their capacity to exercise choice and influence their care and plans for their future. This is remarkable because some of the children and young people have significant additional communication needs.

p.4

Summary

Children and young people are at ease in the home and thrive in its outstandingly well planned environment. Parents rate the service very highly. Some believe it offers their children and young people excellent care and is a model of shared care arrangements that benefit their whole family. Two recommendations are made; these are to address, if possible, long travel time to and from school for some children and young people and to ensure a registered manager is installed, as legally required. These issues do not currently have any serious effect on the children and young people's welfare.

p.4

Improvements since the last inspection

At the last inspection two recommendations were made to ensure all staff, including non-care staff, complete safeguarding training and to address occasional lapses in testing the fire alarm at the required frequency. All staff have now completed safeguarding training. The manager says support staff are pleased to have been involved because the training has increased their understanding of the home's safeguarding measures and the role everyone must play in protecting children. Management action has ensured that the fire alarm is consistently tested at the required frequency thus ensuring greater certainty of operational fitness.

p.4

Helping children to be healthy

Staff recognise the importance of food as a significant contributory factor to maintenance of the children and young people's health and well-being. The catering arrangements, particularly communal dining, are used effectively to promote social interaction. For instance, some children or young people are fed artificially, but staff ensure that they too are included at mealtimes. In keeping with the home from home experience promoted, care staff take turns to prepare meals and do this in a kitchen which is properly equipped, domestic in scale and appearance and located such that the children and young people are able to observe food preparation. On occasions some participate in cooking both as an activity and as a means of acquiring useful practical skills. The catering arrangements ensure that the children and young people are provided regular meals of sufficient quantity, taking full account of special dietary needs and the need to provide reasonable choice.

p.5

Helping children to be healthy

Staff manage the children and young people's health care requirements exceptionally well. Sound assessment and care planning systems ensure that resources are efficiently used to provide comfort and promote privacy and dignity for the children and young people with complex health difficulties. This is so successful, it enables each child or young person to benefit from the social aspects of what the home provides. Parents believe this gives them reassurance and indirectly benefits their whole family. Care is individual, holistic and precise. It is informed by parents' suggestions and professional assessments. The home is equipped with all the aids necessary and staff have training to respond appropriately to the children and young people's mobility and communication difficulties. Where a child or young person's condition is likely to cause pain and he or she is not able to make his or her needs immediately known, excellent systems are in place to assess and manage this. All the

p.5

Helping children to be healthy

necessary arrangements are established to ensure the children and young people have access to professional medical treatment when resident at the home and to respond to emergency situations such as epileptic episodes. Community nursing staff, who sometimes augment the care staff, as was the case at inspection, rate highly the quality of service provided.

p.5

Helping children to be healthy

Consistent emphasis is placed on efficiency and safety in administering first aid and medication. Staff complete regular refresher training and competence assessment to carry out these tasks. The necessary authorisation to ensure each child or young person receives medical or dental treatment where necessary is in place. Policies, procedures and practices that underpin care of the children and young people are shown to reduce medication errors and ensure medicines are received, stored and given appropriately.

p.5

Protecting children from harm or neglect and helping them stay safe

The home's recognises to the children and young people's high level of dependency and the need to preserve their privacy and dignity. Resources and care practices are effectively employed to this end. There is much attention to detail in ensuring that all intimate care is conducted in private and in ways that do not avoidably cause embarrassment or any compromise of the children or young people's dignity. Each child or young person is allocated an exclusive bedroom when resident. These rooms are equipped so that any personal care assistance needed, such as with dressing, is conducted in private. Bathrooms and toilets are similarly well equipped to promote the children's and young people's privacy and as much independence as possible. It remains the case that staff are long serving thus know the children and young people well. This means the children and young people always have familiar people to provide their personal care. Staff are bound by a code of conduct which includes

p.6

Protecting children from harm or neglect and helping them stay safe

maintaining the confidentiality of personal information. In this regard, staff act professionally in the secure keeping and sharing of such information.

p.6

Protecting children from harm or neglect and helping them stay safe

The home has a clear complaints procedure used as a formal means for the children, young people, their parents or others to register any dissatisfaction about the quality of service. The procedure meets all the requirements in relation to receiving, considering and reporting the outcome of complaints to complainants. Complaints form part of the information that informs the home quality assurance system and therefore the procedure is diligently promoted. This includes presenting it in illustrated formats relevant to the children and young people's age and understanding. The home is run in an open way, inviting feedback from parents and social workers about the quality of service. Staff are also alert to non-verbal cues of dissatisfaction from children or young people who are not able to make their wishes and feelings known conventionally. These approaches ensure that any concerns are dealt with at an early stage and may account for there being few formal complaints.

p.6

Protecting children from harm or neglect and helping them stay safe

Staff are provided comprehensive training and briefings, which equip them sufficiently to understand the nature of abuse. In place is a clear procedure for the event of any allegation or suspicion of abuse and all of this is aligned with excellent safe caring practices to prevent abuse. For instance, staff do no isolate themselves when with any particular child or young person. There are no current concerns about the children and young people who are completely at ease with staff and comfortable in the home's environment. The child protection procedure has been validated as in accordance with those of the Local Safeguarding Children Board (LSCB) and staff use the LSCB procedures effectively where there are concerns about children and young people's safety.

p.6

Protecting children from harm or neglect and helping them stay safe

The children and young people's disabilities and health problems limit their ability or inclination to bully others out of malice. However, the sound ant-bullying guidance recognises that some children and young people's disability may cause them to behave in ways, which may impact on others adversely. Prior to their admission therefore, the children and young people are assessed, taking account of their vulnerability and compatibility. Staff use this and other information effectively to ensure that scope for bullying or discomfort is controlled. Staff provide a high level of supervision primarily to respond to needs arising from the children and young people's disabilities and health problems, but which also ensures limited scope for unobserved bullying or similar behaviour. Although the children and young people are not able to comment on this aspect of care directly, they indicate no experience of bullying and all present as relaxed and content in the home's environment.

p.6

Protecting children from harm or neglect and helping them stay safe

The overall effective and successful care of the children and young people continues to be provided without any major issues of control and discipline. Staff work skilfully within the behaviour management policy, which focuses primarily on promoting good conduct and helpful modification of any specific behavioural difficulties that may be presented. The policy establishes strict safeguarding criteria to which any disciplinary measures must conform. Recognising that the children's and young people's disabilities may be a factor in any unacceptable behaviour they may exhibit, each individual has an agreed behaviour management plan. The plans highlight specific behaviours that need to be addressed and precise strategies for doing so. In essence, staff mainly focus on engaging the children and young people positively in a wide range of interesting activities rather than being preoccupied with disciplining.

p.7

Protecting children from harm or neglect and helping them stay safe

The children and young people respond well to this approach in which staff continually praise, encourage and reinforce good behaviour. Where it is necessary for staff to respond to unacceptable behaviour, this is by way of skilful and imaginative diversionary and redirection strategies.

p.7

Protecting children from harm or neglect and helping them stay safe

A robust and comprehensive range of health and safety measures is in place which takes account of the vulnerability of the children and young people. Absence of any serious accidents or incidents suggests these measures are successful in protecting the children and young people from harm. Among the measures taken are risk assessment of all areas of the premises and activities involved in the care of the children and young people. Where risks are identified the control measures to reduce or eliminate them are sound. Staff work within a range of health and safety guidelines and procedures for which they are provided initial and refresher training, as in fire safety, lifting and handling and food hygiene. This aspect of the children's and young people's care is rigorously monitored by the registered person and independent health and safety specialists. These measures are complemented by the very good security arrangements to protect the children and young people from

p.7

Protecting children from harm or neglect and helping them stay safe

Children and young people accommodated in the home are properly protected from adults who may be unsuitable to look after them. This is secured by the registered person's thorough approach to staff selection and other measures. All potential staff are vetted by means of references and criminal records check, and are not permitted to commence employment until the registered person is satisfied with the outcome of those checks. Similarly, visitors' access to the home is controlled and they are kept under supervision whilst on the premises. Combined, all these arrangements are successful in keeping the children and young people safe from abuse and harm.

p.7

Helping children achieve well and enjoy what they do

The home succeeds in outstanding measure, in its objective to contribute to enhancing the children and young people's all round development. It provides all the facilities necessary, such as aids and equipment, that ensure there is seamless continuity in meeting each child or young person's needs arising principally from disability and health care requirements. Excellent basic care established, the home's stimulating group living environment provides a wide range of opportunities for social learning. Communal dining and group activities and simply being able to associate with others with similar difficulties, foster inclusion. Staff capitalise well on the children and young people living away from their families, even though for short episodes, to introduces elements of independence.

p.8

Helping children achieve well and enjoy what they do

Staff take particular care to understand each child or young person's circumstances and competently plan care and personal support to meet their individual needs. This is reflected in the effective working partnership with the parents over matters such as health care, religion, culture and mode of communication for those who are not able to communicate verbally. The children and young people continue to exhibit a contented demeanour and respond to staff warmly. They relish the wide range of leisure activities, some challenging, such as horse riding, and are generally supported to live full lives in the creative and stimulating environment. In short, the home contributes excellently to the children's and young people's well-being ensuring that they are not unnecessarily constrained by their disabilities and enjoy a good quality of life.

p.8

Helping children achieve well and enjoy what they do

Effective working partnership of the staff, schools and parents remains a model of working together to support the children and young people. Staff liaise efficiently with teachers and parents ensuring that basic routines are maintained so that children and young people get to school on time with the right equipment. Transport arrangements operate smoothly and where homework is set this gets done. In addition, staff read to the children and young people, and through play, games and generally providing a stimulating experience, encourage learning and fun. However, some children and young people's total travel time to and from school is three hours per day. This means that they have to rise very early when they are resident at the home.

p.8

Helping children make a positive contribution

The excellent care that children and young people are provided with is underpinned by a well established system of assessment, planning and review. This drives the precise and successful care inputs that address needs arising from the disabilities and health problems, but also mitigates these, thus enhancing the children and young people's quality of life. For instance, the needs of those with physical disabilities are appropriately accommodated with a wide range of aids and adaptations and nurses are enlisted to assist with the care of those with complex health difficulties.

p.8

Helping children make a positive contribution

Staff continuous assessment and monitoring of the children and young people's needs, the care given and the progress that is made, continues to be effective. This ensures continuity and consistency of care, particularly for children and young people with complex needs. The circumstances are therefore created whereby with their basic needs being met, the children and young people benefit from other aspects of care. These, the social aspects, promote their enjoyment and well-being and enable them to thrive in the way that they do. The internal review systems together with the statutory process provide effective checks and balances ensuring that any lack of progress or difficulties are quickly identified and addressed. Children and young people comment positively about their care experience in the home and parents similarly observe 'that the service … is excellent'.

p.9

Helping children make a positive contribution

Although the periods when the children and young people are accommodated are short, no more than a week at a time, the home makes proper arrangements for them to maintain contact with their parents. This may be by a visit by parents or by telephone facilitated by staff. Whilst there are no barriers to the children and young people having contact with their friends while resident at the home, such contact is rare because the home is some distance away from most of their local communities.

p.9

Helping children make a positive contribution

Introduction of children and young people to the home is handled with great care and sensitivity. The process takes account of the possibility, that for most, short break care will be their first experience of separation from their family albeit temporary. In all instances their respite care arrangements are established on a planned basis allowing sufficient time for introductions so that there is familiarisation with the people and the environment. Similar care is taken when a child's or young person's respite care is to cease. The thoughtful leaving process takes full account of individual needs and recognises that the home, in most instances, has played a significant part in their lives and that they have established firm bonds over time.

p.9

Helping children make a positive contribution

The principle that all the children and young people are able to communicate in some form is held firmly by staff who take time to establish each child or young person's mode of communication. This is done effectively so that their wishes and feelings can be understood, that they can be consulted and exercise choice. Consultation events are convened, some facilitated by a visiting children's rights officer, as a means of consulting the children and young people and keeping them informed of developments. The outcome of this is reflected in the child-centeredness of all aspects of the home.

p.9

Achieving economic wellbeing

Care practices and the home's resources are productively employed and effective in ensuring that the children and young people's respite care contributes to development towards greater independence. Staff guide and reinforce the children and young people in the acquisition and practice of basic skills such as dressing and toileting, systematically enabling them to try to do more for themselves. Established and effective working partnerships that staff foster with placing authorities, schools and adult services contribute well in the transition from childhood to adulthood. This takes full account of their special needs and ongoing support where needed.

p.10

Achieving economic wellbeing

Children and young people are relaxed, comfortable and thrive in the well equipped, safe and homely environment All areas of the home, including gardens, are appropriately adapted and equipped to meet the children and young people's diverse needs and facilitate the high standard of care dictated by the Statement of Purpose. The building is maintained in sound condition and all its features combined represent a model for the care and treatment of children and young people with special needs in a carefully planned environment.

p.10

Organisation

Parents experience of the service provided and the quality of their children's care is captured thus: 'My child has physical and learning difficulties. Though she has just started at the project when she sees … her object of reference for the project, she is full of smiles. This indicates she is happy and feels secure when she goes to stay.. I was pleasantly surprised … at how homely the project is. I was worried it would feel like an institution, but it was a home from home'. Underpinning this is the clear operational rationale as set out in the Statement of Purpose. This document complies with the relevant regulation. It sets out clearly the principles and methods, and the facilities and services that govern the running of the home and the care of the children and young people. It is relevant to the needs of the children and young people, is current and accurately reflects how the home is actually run. It has been

p.10

Organisation

summarised and presented in appropriate guides for children, young people and their parents. These guides provide helpful information about the general care experience being delivered and what is expected of the children, young people and their parents.

p.10

Organisation

An acting unregistered manager currently provides the leadership of the home under acceptable professional supervision arrangements made by the registered person. The management is competent in that it provides staff in sufficient numbers commensurate with the number of children and their needs. Staff are also efficiently deployed so that on each shift a named member of staff co-ordinates the care of each child to minimise the number of those involved in carrying out intimate care. Additionally, management arrangements ensure that staff are allocated sufficient time to complete necessary administrative duties associated with the care of the children. Deputising arrangements for the absence of the manager are acceptable. The management team ensure that all round communication is efficient. Sufficient time is allocated to facilitate this through formal handover at the end of shifts and regular staff meetings. Children and parents place a high value on the continuity and

p.10

Organisation

consistently precise care that this supports and the reassurance of being kept informed. It has, however, been almost two years since the home had a Registered Manager. Whilst this does not adversely impact on the children quality of care, it is nevertheless a statutory requirement because of the accountability vested in the post holder.

p.11

Organisation

Almost all the care staff are relevantly qualified for their posts and they are provided with appropriate ongoing training to equip them to care for the children safely and competently. This is supported by regular one-to-one supervision and annual appraisal, which successfully maintains the level of staff skill and performance necessary to meet the children and young people's needs.

p.11

Organisation

The manager and the registered person monitor the care of the children and the running of the home on a regular and rigorous basis. The outcome of recent monitoring highlights no worrying patterns in the way the children and young people are looked after or any major issues concerning the running of the home. Where monitoring activity identifies areas where improvements are needed, efficient systems in place ensure they are addressed in reasonable time. This is complemented by the highly developed and embedded strategic planning process that facilitates to good effect consolidation of the home's strengths and promotes continuous improvement in the quality of service. Currently, objectives are set to achieve further improvement in building the children and young people's capacity to participate in the planning of their care and the better capture of evidence of inputs and outcomes in promoting independence.

p.11

Organisation

The promotion of equality and diversity is outstanding. Policy and practices in this area are applied with commitment and success. Staff ensure that the service meets the needs of disabled children and young people to an exceptionally high degree. In doing so regard is, as a matter of course, given to needs arising from the children and young people's religion, culture and individual support requirements. The overall effect is that the children and young people enjoy a range of experiences that contributes to their good quality of life and opens up ambitions beyond the limitations of their disabilities.

p.11

Organisation

The home has good administrative systems including amassing necessary information in order to provide precise care inputs for each child or young person, and for monitoring and reviewing their progress. All such information is efficiently organised into individual files which are structured to enable easy access to particular information.

p.11

Recommendations

To improve the quality and standards of care further the registered person should take account of the following recommendation(s):

p.12

Recommendations

 ensure that the children's Personal Education Plan or placement plan addresses arrangements for travel to and from school so that the time taken is not excessive (NMS 14.4)  ensure that the efficient administration of the home is carried out by someone registered by Ofsted as fit to discharge the duties of the Registered Manager (NMS 34.1).

p.12