Children's Home, Residential special school run by Rowden House School Limited in Herefordshire

Unique reference number SC035625 Inspection date 03/02/2011 Inspector Martha Nethaway / Jackie Callaghan Type of inspection Key

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Date of last inspection 11/08/2010 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

This service is a registered children's home that also provides education on site to 44 young people of either gender with special educational needs. The home is registered to accommodate young people between the ages of 11 to 17 years. However, the home can accommodate some young people up to the age of 19. The service comprises of seven separate residential homes with a school, offices and leisure facilities. Living units are self contained, with six homes accommodating up to seven young people and one home accommodating up to two older teenagers. The home is located in a very rural area but reasonably close to several local towns.

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Summary

The overall quality rating is satisfactory.

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Summary

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

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Summary

This was a full unannounced inspection that focused on key national minimum standards. Thirty-three young people were living at the home and many were present during the visit. Young people were observed interacting with staff and participating in their daily routines.

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Summary

Overall, young people receive a satisfactory service. All of the outcome areas relating to health, staying safe, positive contribution, economic wellbeing and organisation have been judged as satisfactory. Real progress has been made to address the management of behaviour with young people and the staffing arrangements. The judgment for enjoy and achieve has moved to good because young people are benefiting from more focused care and support.

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Summary

As a result of this inspection the home has been set one action and seven recommendations. This includes action to be taken to improve the effective management of medication. Similarly, to ensure that health plans for young people are comprehensive at all times. Finally, five recommendations are being repeated which relate to rectifying shortfalls with staff supervision and appraisal of performance.

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Improvements since the last inspection

At the last inspection in August 2010 managers were required to take action on 17 requirements and 18 recommendations. The home has addressed this by taking the following action.

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Improvements since the last inspection

The home has now revised the home's Statement of Purpose.

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Improvements since the last inspection

All young people have in place an individualised placement plan that adequately explains their day-to-day care and how their welfare is safeguarded and promoted.

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Improvements since the last inspection

The home has now removed all electronic monitoring devices such as cameras.

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Improvements since the last inspection

The home has now reviewed its healthy eating programme to include additional training to address obesity and underweight in adolescence. This includes practical training for staff to reinforce best practice models.

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Improvements since the last inspection

All young people have a health care plan that is updated and reviewed.

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Improvements since the last inspection

The home has improved how the nursing team monitor young people who refuse medication.

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Improvements since the last inspection

The home now has a clear system to record all complaints which include the action taken and the outcome of the investigation. The organisation has formally reviewed and updated the policy. There is now a three-stage complaint process.

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Improvements since the last inspection

The home has improved record keeping in relation to physical interventions that take place with young people. The management team now ensure that the home promotes and makes proper provision for the welfare of young people. The home has increased permanent staffing and similarly increased the number of relief staff. Leisure and recreational activities are now more stimulating, such as the introduction of the horticulture sessions.

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Improvements since the last inspection

The home has made significant investment to improve the physical environment with major refurbishment work already taking place. This includes new building work as well. The homes that have been completed have been redecorated with new furniture such as settees and are more homely and personal. This has enhanced the environment for young people to live in. In addition, new roundabouts and play equipment have been installed to enhance the outdoor areas.

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Improvements since the last inspection

The home is now free from offensive odours because there is an extensive programme of cleaning which includes a programme of rotation for deep cleaning.

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Improvements since the last inspection

The home has improved the arrangements for fire safety including regular fire evacuations.

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Improvements since the last inspection

The human resource department has completed a full audit on all staff personal files including agency staff to ensure that all checks are completed.

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Improvements since the last inspection

Of the 18 good practice recommendations made at the last inspection, the home has taken action to address 13 of these. The remainder are to be repeated as part of this inspection.

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Improvements since the last inspection

All staff have received a programme of child protection and safeguarding training.

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Improvements since the last inspection

The policy on behaviour management has been robustly reviewed and is being monitored in terms of staff practice. The use of physical restraint is being actively reduced.

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Improvements since the last inspection

The home has circulated regular newsletters to parents, carers and placing authorities to inform them of the latest review of policies such as child protection, behaviour management and the progress that is being made in the home.

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Improvements since the last inspection

The newly designed physical intervention records now include the recommendation to include the views of the young person.

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Improvements since the last inspection

Staff meetings are now taking place and include clear opportunities to discuss and review the progress of young people accommodated at the home.

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Improvements since the last inspection

The senior management have invested significant resources to improve the professional standards and conduct of staff working at the home. This includes guidance from the human resources department and staff training.

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Improvements since the last inspection

All young people have personalised placement plans that clearly describes how their needs and wishes are to be met.

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Improvements since the last inspection

The home has begun to address the transitional planning for young people and this is being developed further.

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Improvements since the last inspection

The home has a clear programme of professional training in place.

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Improvements since the last inspection

All of the actions taken by the home shows the strong commitment to providing better care and support for young people living at the home. As a result, better outcomes for young people will be achieved. Similarly, staff are being more effectively supported in order for their professional standards to improve.

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Improvements since the last inspection

There are five recommendations that are being repeated because the provider prioritised key areas that required immediate attention.

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Helping children to be healthy

The home is now offering appropriate guidance for staff on the promotion of healthy living and lifestyles. Health issues and medicine is, in nearly all young people’s files looked at, being appropriately recorded. However, there is different practice in some houses that means this is still not being recorded consistently or in one case fully.

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Helping children to be healthy

There are adequate arrangements to ensure that medication is safely administered. However, the current monitoring and auditing of medication is weak as there are discrepancies between what is being recorded as the balance in stock and the actual amount in stock. Also staff are not on every occasion, completing the back of the medication administration chart with the information required when administering medication that is a discretionary dose. As a result, staff are not following the home's stated policy on administering medications safely and correctly and to prevent many common medication errors that compromise the quality of care that the home provides.

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Helping children to be healthy

Young people are being provided with a balanced menu, taking into consideration likes and dislikes. One senior manager commented, 'Food is an area that requires on- going improvement.' As a result, there is significant investment and work being undertaken by the service. The aim is to improve the quality, variety and choice of the food on offer. For example, a recent staff training session concentrated on a basic knowledge about weight management and healthy eating. One member of staff commented, 'This helped staff to increase their understanding of health issues relating to obesity and underweight in young people.' This demonstrates that young people's health problems are being more carefully monitored so that diets provide sufficient energy and nutrition for daily living.

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Protecting children from harm or neglect and helping them stay safe

The system in place to promote the safety and welfare for young people is satisfactory. Staff are provided with a good range of policies that specifically address staff recruitment, counteracting bullying, unauthorised absence, complaints, behaviour management and health and safety. The senior management team are monitoring and helping to improve the overall effectiveness of policies which are implemented in practice. This means that staff practice is being scrutinised and significant changes are emerging. The school continues to work towards providing an environment, ethos and culture that is respectful and responsive to the physical and emotional well-being of young people.

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Protecting children from harm or neglect and helping them stay safe

Young people's privacy and dignity are being respected because staff take reasonable steps to ensure that personal information about young people is protected. Young people are being protected from intrusion by staff practice that is personal and sensitive to the individual. All young people who require personalised support have their levels of needs assessed and staff follow clear steps to ensure that integrity is always protected.

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Protecting children from harm or neglect and helping them stay safe

The school aims to provide a happy, safe and caring environment where young people can learn to communicate with confidence. Parents, carers and other significant stakeholders are provided with a detailed complaints procedure which has been amended since the last inspection. The school has had an increase in the number of complaints but this has been welcomed as it demonstrates that staff and the senior management team are listening very carefully to feedback. The school has in place a transparent process which includes a central register of complaints being kept by the senior leadership team which is being monitored. The senior management team recognise that further work is required to start analysing trends and patterns, and to promote a learning lessons approach to further develop and expand practice at the school.

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Protecting children from harm or neglect and helping them stay safe

The welfare of young people is promoted satisfactorily. The school has in place an effective child protection and safeguarding policy which has been reviewed since the last inspection. The school has completed a full audit of staff practices that both promote and protect the rights of young people. All staff have now attended a revised child protection and safeguarding training course. The school has commissioned the Local Safeguarding Children Board to provide training that is more relevant to young people with autism. The senior management team has reviewed care practice to ensure that good standards are being achieved at all times. This is a systematic change since the last inspection because the home now assesses young people as requiring a range of specialist input from the multi-disciplinary team. As a result, at this early stage the home has seen a drop in the number of referrals to the local safeguarding team.

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Protecting children from harm or neglect and helping them stay safe

Young people are protected because of staff being aware of the recognition of bullying behaviours in young people with autism. All staff are provided with training and the home has in place an effective anti-bullying policy. The aim of the policy is to minimise all forms of bullying through encouraging mutual respect, reinforcing positive behaviours. The home is planning further work in terms of the assessment of young people's compatibility within the group living environment. The anticipated outcome is that young people's needs will be met more successfully because good matching processes related to shared interests and friendships will be fostered.

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Protecting children from harm or neglect and helping them stay safe

All staff have access to guidance and procedures that should be followed when young people go missing or are absent from the home without permission. These events are rare at the home.

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Protecting children from harm or neglect and helping them stay safe

The arrangements and practices for the management of some young people’s behaviour have improved. This is as a result of a combined number of actions. For example, a full review of policy, a full review by the multi-disciplinary team, staff training, improved staff practice, improved environmental management and record keeping. Not all of these are fully implemented yet but there is clear evidence of the commitment and drive of the senior management team. As a result, there are early indications that the use of physical intervention across the home has been significantly reduced as a result of this coordinated approach from the senior management team and with input from the external line managers.

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Protecting children from harm or neglect and helping them stay safe

The health and safety of the whole site reaches a good standard overall. This is because the organisation has effective policies, procedures, monitoring and reviewing that ensures an effective health and safety performance. All young people are provided with personalised risk assessments that are reviewed and monitored as circumstances change. The home now fully complies with fire safety because fire drills are taking place regularly and all young people are being encouraged to participate in fire evacuations. Where young people have been reluctant, there is now a clear strategy which is documented to take effect in the event of emergency.

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Protecting children from harm or neglect and helping them stay safe

The home understands the importance of recruiting and selecting the right staff to work with vulnerable young people. Since the last inspection, the home has changed the structure of the interview process so that the best candidates are being selected. Another area that has been improved is that all agency staff have in place the required levels of checks to work in a children's home. Finally, the home now ensures that all checks are in place for all overseas employees.

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Helping children achieve well and enjoy what they do

Overall, young people are receiving good and improved levels of support. The majority of the young people are provided with one-to-one staffing. The home has improved the arrangements for ensuring suitable, experienced, skilled and competent staff. This has been achieved because the home has allocated designated staff including permanent staff, relief and agency staff to individual houses across the site. Although the system is not yet perfect it is an improvement since the last inspection. Young people are all allocated a keyworker and this role is being actively promoted within the staff teams who are collaborating with young people, families and social workers. This means care plans are being shared so that a cohesive, holistic approach is used to affect positive change and outcomes for young people.

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Helping children achieve well and enjoy what they do

Education of young people is actively promoted as valuable in itself and as part of their preparation for adulthood. Young people's attendance at the school is good. Young people's educational programmes addresses the need to develop the young person as a whole and to help them to reduce their need to use challenging behaviours as a form of communication or as an expression of frustration. Young people's communication skills are given priority with the input of speech therapy to assess young people and focus on developing and using a range of communication methods, for example, Makaton, picture exchange communication system and objects of reference.

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Helping children make a positive contribution

Young people are supported by placement plans which reflect their individual needs. Placement plans include risk assessments which ensure that young people maintain their levels of independence in a safe manner. The plans also address the support necessary for education, relationships and the management of behaviours.

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Helping children make a positive contribution

Young people are introduced to the home in a way that meets their individual needs. Information about the provision is available for young people in accessible formats such as easy read. Young people are encouraged to bring familiar possessions with them and staff help them customise their bedrooms.

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Helping children make a positive contribution

Staff understand the importance to young people of maintaining contact with family and friends. They work closely with placing authorities to ensure that young people are able to keep in touch with people outside the home who are important to them.

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Helping children make a positive contribution

Young people are supported to make choices and decisions which affect their lives. For example, what they wear, what they eat and where they want to go. Staff demonstrate that they value the views and opinions of young people.

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Achieving economic wellbeing

The daily life of the home ensures that young people are able to develop the knowledge and skills which will help them prepare for adulthood. For example, young people are encouraged to keep their own rooms clean and tidy. The provision recognises that most young people using the service require structure and routines in order to flourish. As a result, the provision is now working hard with outside agencies to ensure that the necessary plans are in place to help young people move on in to adulthood in a positive and supported way.

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Achieving economic wellbeing

There is a lot of investment taking place in order to improve the current living facilities and the whole environment. Such improvements, when finished, will provide young people with an appropriate amount of private and communal space. The organisation that owns the service recognises that the current facilities are tired, worn and in need of attention. It is extremely positive that this investment is taking place and shows the strong commitment to the young people currently living here.

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Organisation

The home is in the process of improving the frequency of staff supervision for residential support staff, relief and agency staff. Staff appraisals are not yet fully implemented across the site.

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Organisation

Since the last inspection, a sufficient number of staff are now working in the home to meet the needs of young people satisfactorily. Senior management have ensured that the new residential rota system now serves to support young people more consistently with their care. The fluctuating levels of staffing being used through agency is being monitored carefully on a weekly basis with a clear direction to reduce the use of agency staff at the home. This is because the home is increasing the pool of relief staff and also the school's recruitment drive is aiming to increase the number of permanent staff at the establishment.

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Organisation

The promotion of equality and diversity is satisfactory. Many permanent staff know about young people's needs in relation to their identity and backgrounds. Many staff are aware of how to help and support young people in a fair and non-judgemental way.

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Organisation

The home has a written Statement of Purpose and a young people's guide which are made available to people who need to know about the service. It now contains the important information about who works in the home, their skills, experience and qualifications. The home has dealt with a number of key issues related to staff performance, staff supervision and team meetings. All residential support staff now have one protected day every three weeks where team meetings can take place and they are required to attend. The Registered Manager commented, 'It is openly acknowledged by the home that staff supervision for care managers and deputy care manager is taking place. However, not all residential support staff are yet receiving regular supervision and this is one area that the home is addressing now.' Young people will benefit because staff supervision can improve the way staff work in the homes and communication with young people. One senior manager commented, 'Supervision is

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Organisation

crucial in the development and motivation of staff.'

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Organisation

The home has now developed a new framework for residential learning and development days for all staff. This now includes mandatory training in child protection, physical intervention and fire safety. In addition, there are training sessions being organised for key working, appraisals and specialist learning.

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Organisation

The home continues to receive extensive support from the organisation's external line managers. This includes a full service review and a clear strategy to bring about continued reform and change within the home. This is being progressed at a good pace so that outcomes for young people show improvement. The Registered Manager continues to provide inspiring enthusiasm and is motivated to achieve the highest standards through her practice. This is being translated to the different staff teams and the Registered Manager has an accurate judgment about the strengths of the provision and where areas require advancement.

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Organisation

The quality assurance programme at the home has improved. All care managers are now required to complete an in-depth monthly report which looks at a range of areas that are formally assessed and take action where shortfalls have been identified. For example, this has lead to improvements with the quality of care planning which is a significant improvement since the last inspection.

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Organisation

Young people’s needs, development and progress are recorded to reflect their individuality. The senior management team are monitoring the quality of record keeping to ensure that professional standards are being achieved.

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Statutory Requirements

This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Children's Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales.

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Std. Action Due date

13 ensure that the arrangements for the recording, handling, safekeeping, safe administration and disposal of any medicines received into the children's home is adhered to (Reg 21. (1)) 31/03/2011

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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):

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Recommendations

 ensure that each child has a clear written health plan (within their placement plan) covering NMS 12.2  develop the system of monitoring medication to show in all cases, the amount that has left the home and the balance remaining. NMS 13.2  ensure all staff and others working in the home (including temporary, contracted, seconded and ancillary staff) receive at least one and half hours of one-to-one supervision from a senior member of staff each month (NMS 28.2)  ensure new staff receive one-to-one supervision at least during the first six months of their employment (NMS 28.2)  ensure agency staff and those employed infrequently to cover staff absences receive one-to-one supervision no less frequently than after eight shifts worked in the home (NMS 28.2)  ensure supervision of staff working with children addresses the areas outlined in national minimum standards (NMS 28.4)  ensure all staff have their performance individually and formally appraised at

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Recommendations

least annually by their line manager. The employee’s personal file contains a record of the appraisal showing the level of performance achieved, targets for the coming year and the agreed training needs to be met within the following year as part of the individual’s personal development plan. (NMS 28.7)

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