Children's Home run by Barnardo’s in Oxfordshire

Unique reference number SC069128 Inspection date 17/12/2010 Inspector Michael Williams Type of inspection Key

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Date of last inspection 29/06/2010 Website: www.ofsted.gov.uk

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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 Crispins, 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.

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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.

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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

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Brief description of the service

The service is provided by a national charity for vulnerable children and young people. Its introductory information on the service describes it as: 'Providing residential short break care and domiciliary care to disabled children and young people between the ages of five and eighteen.' Its domiciliary care service is inspected by the Care Quality Commission. The service is provided in partnership with a county council and a county primary care trust. Children and young people can therefore be provided with care and health packages. Most of the children and young people using the service have complex health needs or are on the autistic spectrum and have associated challenging behaviour. The service is located in a residential area of a city.

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Brief description of the service

The service opened in February 2007 and caters for a maximum of six children and young people at any one time, including one emergency bed. Five children and young people were staying overnight at the time of this inspection, and five staff were caring for and working with them.

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Summary

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

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Summary

This inspection was announced shortly beforehand to ensure that the service was open. It was a full inspection of all the key national minimum standards for children's homes. Its key findings are that out of the five outcomes for children, one is outstanding and the remainder are good. In addition, the organisation outcome is good and the promotion of equality and diversity is outstanding. Therefore the overall quality rating is good.

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Summary

The outstanding aspects of the service are: the help provided to young people to be as healthy as possible; the child-centred nature of the service; the support provided to young people with communication difficulties; and the promotion of equality and diversity with disabled young people. Nurses form part of the project's management and care staff and non-nursing staff are well trained in health procedures. Young people's bookings come first, and staffing and meals are arranged around them. As a result, bookings occasionally have to be cancelled when the staffing required cannot be arranged.

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Summary

Good aspects of the service include: the individualised care and support provided to young people; the safeguarding of their welfare; the management of their behaviour; the robust vetting of staff; the communication and partnership between the home, the young people, and their parents and carers and schools and colleges; the quality of the home's leadership and staffing; and the quality of the staff training. These findings concur with comments made by a parent and an external health professional. The former commented that their child is always very happy to go to the home and that they clearly enjoy their time there and look forward to their visits. They added 'that the respite provided by the home is invaluable to their child and to the rest of the family.' The latter commented that 'This is a hugely valuable service to the children and families they support.'

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Improvements since the last inspection

The last inspection in June 2010 did not make any actions or recommendations to secure future improvement.

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Helping children to be healthy

Young people enjoy healthy, nutritious meals that meet their dietary needs. Young people's individual food and drink needs are identified and met. They are identified in their 'My Profile' and 'About Me' information and met by staff. In September 2010, the home's kitchen received a very good food hygiene rating from the county council. At the time of this inspection, the post of cook at the home became vacant and the home started the process of recruiting to it. In the meantime, the home was filling this vacancy with an agency cook and staff on duty. A parent commented that staff 'take pains to provide healthy food and to balance the needs of their different visitors', sometimes by taking children out for meals.

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Helping children to be healthy

Young people's good health is promoted as their health needs are very well identified and appropriate action is taken to meet them. Each young person's health needs are clearly identified and recorded, and known to staff on duty. Staff are well trained to meet young people's health needs, and work closely with external health professionals because of the complexity of some of the young people's health needs. One external health professional commented: 'We all work closely following the shared care protocols which help us manage care following the same safeguards.' These protocols provide consistent practice across different settings for children with complex health needs. The home has a new post of senior nurse, and they co- ordinate training for the home's care staff in the use of some of these clinical procedures. However, the highest level procedures can only be carried out by the home's nursing staff.

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Helping children to be healthy

Young people's health needs are also promoted, and their welfare safeguarded, by staff following the home's policies and procedures for administering medicines, and providing first aid and minor illness treatment when necessary. The charity's medication guidelines have been supplemented by local guidelines for the management of medication, to better meet the specific needs of the young people using the service. The plan for each shift at the home includes who is checking medication brought in with young people and who is giving it to them. Medication is securely stored in the home's medication room and administered by nursing staff and care staff who have been assessed as competent to do so. The administration of regular and as required medication is recorded and included in young people's individual case files. The home is now also keeping their own record of this information.

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Helping children to be healthy

The senior nurse explained that the home addresses young people's health needs across the board, focusing not just on health tasks but on meals, exercise and activities as well, and not just on physical health, but on mental and emotional health as well. This was observed to be the case during this inspection.

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Protecting children from harm or neglect and helping them stay safe

Young people's privacy is well respected. The home has a quiet lounge that young people can use, for example to meet visitors, as well as an activity lounge. Each young person has their own bedroom where they can spend time on their own and they can lock their bedroom if they are able to, although staff can still open the door in an emergency. Staff at the home follow guidelines for good practice in the intimate care of young people. Following the recent appointment of male care staff, the staff team were looking into the issue of male staff giving personal care to female children.

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Protecting children from harm or neglect and helping them stay safe

Parents know how to and young people feel able to complain if they are unhappy with any aspect of living in the home. The home's entrance has a provider leaflet on 'Your right to be heard', that includes information on making a complaint about the service. As many of the young people at the home are non-verbal, either their link workers who know them well or their parents can complain on their behalf if they detect they are unhappy. Since the last inspection, one complaint has been recorded that was effectively resolved, and the manager was dealing with a complaint received just before this inspection.

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Protecting children from harm or neglect and helping them stay safe

Young people are protected from abuse and an appropriate response is made to any allegation or suspicion of abuse. The home follows their provider's protocol for safeguarding and protecting children. For example, safeguarding is a set agenda item at staff team days and in staff supervision. The acting manager provides a safeguarding link between the county council the provider is in partnership with, the Local Safeguarding Children Board and the provider's regional safeguarding group. As part of their induction, new staff are required to either undertake on-line safeguarding training or complete a safeguarding induction workbook.

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Protecting children from harm or neglect and helping them stay safe

Young people are protected from bullying. It is countered in part by staff at the home working on at least a one to one basis with young people, and by the attention paid to booking the right mix of young people to stay together. Any instance of direct intended aggression by one young person towards another results in them not receiving residential short break care together again. The high ratio of staff to young people, coupled with the young people's disabilities and the mechanism for opening the home's external doors, means that since the home opened there has only been one instance of a young person being absent from the home without consent.

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Protecting children from harm or neglect and helping them stay safe

Young people are assisted to develop socially acceptable behaviour, through encouragement of acceptable behaviour and constructive staff response to inappropriate behaviour. If necessary, young people have an individual behaviour management plan. It includes details of their behaviour and approved responses, such as the approved physical intervention technique to be used 'as a last resort when all other diversionary tactics have been tried.' The home follows their provider's protocol for reporting accidents, incidents, and measures of control and physical interventions used. Any incidents that involve staff using physical intervention and measures of control are then recorded as required in a volume kept for that purpose. The home's record of physical interventions, from the beginning of September 2010, includes one entry. Since the last inspection, three measures of control have been used and recorded. A parent commented 'I know that the staff

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Protecting children from harm or neglect and helping them stay safe

sometimes have to cope with challenging behaviour. My impression is that they do this well and fairly.'

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Protecting children from harm or neglect and helping them stay safe

Positive steps are taken to keep young people, staff and visitors safe from the risk of fire and other hazards. The home completes and records an assessment and planning profile for each young person, looking at key factors, such as their behaviour and communication, and action that can be taken to reduce unnecessary hazards. A fire safety consultant completed a fire risk assessment for the home in October 2010 and the home has acted on its significant findings. The weekly fire alarm test was carried out during this inspection, and the home carries out monthly fire drills. Each young person has a personal emergency evacuation plan that addresses evacuation procedures at night.

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Protecting children from harm or neglect and helping them stay safe

There is careful selection and vetting of all staff working with children in the home. Staff at the home employed by the charity have been subject to the charity's robust recruitment and vetting procedures. Staff recruitment records are not held at the home but at their head office. They include all of and often more than the information required in respect of people seeking to work at a children's home. For example, generally more than two written references are sought, to cover the applicant's past five years, and these are often verbally verified. The home retains confirmation that the staff recruitment agency has carried out the checks required on agency staff who work with children in the home.

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Helping children achieve well and enjoy what they do

Young people receive good individualised support to meet their particular needs. They receive this support both internally, from staff at the home and their link worker in particular, and externally, from specialist professionals such as physiotherapists and speech and language therapists. Staff at the home work in close partnership with parents, carers and other professionals to meet the assessed needs of each individual young person. Young people's educational attainment is promoted and supported when they are at the home. All young people using the home attend school or college during term time. Therefore young people's link workers develop close working relationships with their schools and colleges. Each young person has their own home-to-school book, which facilitates two-way communication between the home and young people's schools or colleges. An external health professional, from a school attended by some

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Helping children achieve well and enjoy what they do

of the home's children, commented that 'The Home/School diaries and All About Me book also enable communication between them and the home.'

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Helping children make a positive contribution

Young people at the home are appropriately placed there. They have their needs comprehensively assessed, project care plans outline how their needs will be met, and these plans are effectively implemented in practice. As most of the young people using the project have communication difficulties, effective methods of communication are a major element of each young person's placement plan, so that the home can support them to become as active as possible in making decisions about their lives. A parent commented 'We know that the staff go to great lengths to accommodate our child's needs.' An external health professional commented that their service and the home 'have worked hard this past year to support each other with information sharing and planning the care plans for the children.'

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Helping children make a positive contribution

Young people's needs and development are reviewed regularly in the light of their care and progress at the home. Review arrangements are detailed in the home's Statement of Purpose. They include statutory, internal and school reviews, and 'Whenever possible the child/young person will be included in part or all of the review with their parents/carers. If this is not possible every effort will be made for a child's views to be sought before the meeting so that they can be raised on the child's behalf.' An external health professional commented that 'Regular meetings take place for individual children and there are reciprocal invitations from all services [working with the children] to attend meetings, obviously with parents' permission.'

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Helping children make a positive contribution

The home's Statement of Purpose has a section on 'Contact/Receiving Visitors' where it states that 'The short-term nature of the care provided means that contact is not generally an issue for our children.' Nonetheless, even during their short stay young people's permitted contact with their families and carers is maintained by arranged visits, telephone and email.

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Helping children make a positive contribution

Young people are able to move into and leave the home in a planned and sensitive manner. The home pays a great deal of attention to the combination of young people resident for short breaks, both during the school term and school holidays. Bookings are carefully made, with friendships and safety in mind. Young people leave the home with a helpful report of their stay for their school or college and their parents and carers, to help ensure good communication and continuity of care. The home also provides an emergency care service for young people both known and unknown to the home. In February 2010, the home received very positive feedback regarding their emergency placement of a young person not previously known to them.

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Helping children make a positive contribution

The home actively seeks the opinions of young people, and their families and carers, on the way the home is run, and its systems for doing this reflect the young people's differing communication needs. The home's consultation with young people and their parents and carers is often linked to young people's reviews. Given the communication difficulties of most of the young people using the home, the home's communication with their parents and carers is vital. The home's effective 'Links with parents' are therefore detailed in its Statement of Purpose. A parent commented that their communication with the home 'is good'.

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Achieving economic wellbeing

In terms of preparation for leaving care, the needs of the children and young people using the project are such that they will always continue to need some level of care. Nonetheless, the project actively encourages young people to increase their independence skills. An external health professional commented that 'The respite for the older children is particularly valuable to allow them to identify with their growth into teenagers', adding that this is one of the ways that they are helped to develop independence. The home helps young people move on to their adult service by handing over their information, liaising with their transition social worker, and gradually preparing them for their move.

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Achieving economic wellbeing

Young people enjoy homely accommodation, decorated, furnished and maintained to a high standard, and providing adequate facilities for their use. The home's guide for children and young people has pictures of the rooms where they can play and relax, garden and outside play areas, bedrooms and bathrooms, and kitchen and dining room. However, in June 2010 the home's acting manager presented a buildings report to the charity's properties department to highlight the environmental difficulties that have come to light since the home has been operating, and which need to be overcome to secure future improvement. The service is now in the process of overcoming these difficulties.

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Organisation

A clear, comprehensive statement of how the home operates is available for those needing this information. It was last reviewed in September 2010 and includes all the information required. An accompanying guide for children and young people, in a suitable communication format, is also available.

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Organisation

Young people receive the care and services they need from staff who have relevant qualifications and competencies. Staff are sufficient in numbers and experience, and they are well trained. The home's Statement of Purpose includes information on the staff team, staff training and the staffing policy. The majority of the staff have a relevant qualification, for example, in nursing, social work or the relevant National Vocational Qualification in caring for children and young people. Care staff include residential project workers and nurse residential project workers. Care staff regularly participate in relevant training to ensure that they can continue to meet young people's needs, in areas such as health, safety and safeguarding.

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Organisation

Young people enjoy the stability of an efficiently run home. The home is well managed by a seconded children's services manager, who is qualified in both learning disabilities and children's nursing, and will permanently occupy this post in January 2011. They are in the process of applying to Ofsted to become the Registered Manager of the home. They are ably assisted by a deputy children's services manager and two senior project workers, one of whom is a nurse.

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Organisation

The promotion of equality and diversity is outstanding. It forms part of the home's Statement of Purpose and is part of the safeguarding induction workbook for staff. The home is involved in enacting its charity's vision for work with Black and Minority Ethnic Communities. The home's promotion of equality and diversity is most evident in the work that they do with severely disabled children and young people and their associated significant needs: promoting their dignity and rights, and their inclusion in their local community and wider society.

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Organisation

The care of young people using the project is monitored and continually improved in the light of information about how it is operating. The manager routinely monitors the matters required, for example, by reviewing and signing incident records and by holding monthly senior staff meetings. This internal monitoring is supported by monthly provider monitoring visits. These visits focus on the Every Child Matters outcomes for children and report any actions recommended and on the status of previous actions. Together this monitoring helps to continually improve the provision for young people.

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Organisation

Young people's needs, development and progress are recorded to reflect their individuality. Young people's individual case files include all the information required. To facilitate shift planning and day to day care, on each shift staff are assigned responsibility for a particular young person and asked to sign that they have read their profile. This helps to ensure that staff meet young people's individual needs and can report on their individual progress.

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