Children's Home run by Action for Children Services Ltd in Buckinghamshire

Unique reference number SC424089 Inspection date 26/05/2011 Inspector Anna Williams Type of inspection Full Provision subtype Children's home

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Date of last inspection 14/03/2011 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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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 to assess the effectiveness of the service and to consider how well it complies with the relevant regulations and meets the national minimum standards.

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About this inspection

The report details the main strengths, any areas for improvement, including any breaches of regulation, and any failure to meet national minimum standards. The judgements included in the report are made against the Inspections of children’s homes – framework for inspection (March 2011) and the evaluation schedule for children's homes.

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The inspection judgements and what they mean

Outstanding : a service that significantly exceeds minimum requirements Good : a service that exceeds minimum requirements Satisfactory : a service that only meets minimum requirements Inadequate : a service that does not meet minimum requirements

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Brief description of the service

This is a short breaks service for young people aged five to 17 years which is run by a national children's charity. The service can accommodate up to a total of 14 young people of either sex. The young people's needs range from moderate to severe learning disabilities, including physical disabilities and/or complex multiple needs. Many of the young people who use the service display challenging behaviours associated with their disability. The service provides for a significant proportion of young people in need of nursing input, as well as social care support. The service provides a flexible range of residential support packages tailored to the needs of individual young people and their families.

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Brief description of the service

The single storey home provides accommodation in two separate units. There is specialist equipment to meet the increased range of complex physical needs. There are seven single bedrooms in each unit, some of which have been specially adapted to enable hoisting within them and in linked bathrooms. The building has its own secure and spacious garden areas with lawns and play equipment, which provide young people with a variety of outdoor experiences.

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Brief description of the service

This resource has been a short breaks service on this site for a number of years. This is the first inspection of the service since the national charity took over the contract to run the service in 2010.

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Overall effectiveness

The overall effectiveness is judged to be satisfactory .

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Overall effectiveness

Young people benefit from a home that provides a safe and homely environment. The building has been adapted to meet the individual needs of young people who visit. A particular strength of the home is the child friendly environment with an abundance of play facilities and resources. Young people are supported to access a variety of social and leisure opportunities during their stays. Staff respond professionally and appropriately to unexpected behaviours, and maintain a consistent approach by undertaking regular behaviour management training. Young people are happy and settled in their environment and it is apparent that they benefit from positive and relaxed relationships with members of staff. Positive feedback has been received from placing authorities and parents in relation to the care and support which the service offers young people.

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Overall effectiveness

Areas of shortfall identified during the inspection include limited opportunities for young people to share their views and feelings about the running of the home. Currently the children's guide does not include additional information about the complaints procedure and how to access an independent advocate, impacting on children’s independent access to external support. The registered manager does not currently ensure that the complaints log is regularly monitored to make sure matters are dealt with promptly and there is a clear record of any action taken and the outcome of any investigation. There is a lack of clarification for staff with regard to a number of issues such as an area of medication administration to avoid any confusion, the access to and use of which safeguarding policy within the home and clear guidelines for staff on the higher line management structure of the home. Risk assessments for the general premises and for individual young people have not been

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Overall effectiveness

reviewed for some time, impacting on the safety of young people if staff refer to out- of-date information. There are no written development plans with goals and objectives for improvement for staff to work towards.

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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 person(s) must comply with the given timescales.

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Reg. Requirement Due date

(2001) ensure that the children's guide includes a summary of the complaints procedure for the home and the address and telephone number of Ofsted (Regulation 4 (3) (b)(c)) 29/08/2011

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Reg. Requirement Due date

(2001) ensure that a written record is made of any complaint, the action taken in response and the outcome of the investigation (Regulation 24 (5)) 29/08/2011

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Reg. Requirement Due date

(2001) ensure that all the matters set out in schedule 6 are monitored by the registered person, in particular the record of complaints (Regulation 34 (1) (a)) 29/08/2011

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Reg. Requirement Due date

17B (2001) ensure that within 24 hours of the use of any measure of control, restraint or discipline a written record is made in a volume kept for the purpose of which shall include all the matters laid out in regulation (Regulation 17B (3) (a - i) and Regulation 17B (4) (a)(b). 29/08/2011

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Recommendations

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

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Recommendations

 review the children's guide to include how children can find out their rights, how a child can contact their independent reviewing officer, the Children's Rights Director, Ofsted, and how to secure access to an independent advocate (NMS 13.5)  ensure that the registered person has a written development plan, reviewed annually, for the future of the home, either identifying any planned changes in the operation or resources of the service, or confirming the continuation of the home's current operation and resource (NMS 15.2)  ensure risk assessments of the whole children's home environment are carried out to identify any potential sources of harm to the children and are recorded in writing and are regularly reviewed (NMS 10.8)  ensure that within the recruitment process telephone enquiries are made as well as obtaining written references (NMS 16.1)  ensure all staff and the registered person understand to whom they are

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Recommendations

accountable (NMS 19.2)  ensure that where children with disabilities have specific communication needs the registered manager makes arrangements to support their communication, so that they are able to make their views known about the running of the home (Volume 5, statutory guidance, para 2.25)  ensure a risk assessment is completed which covers the securing of the external doors, and the securing of the inner doors between the units, and any other restrictive security measures which are present within the home (Volume 5, statutory guidance, para 2.108)  ensure the home's safeguarding policy reflects the requirements of the Local Safeguarding Children Board (LSCB) of the area in which the home is situated and that access to the LSCB's procedures and Working Together (2010) is easily available to all staff (Volume 5, statutory guidance, para 2.71)  ensure prescribed medication is given in accordance with the prescription. (NMS

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Outcomes for children and young people

Outcomes for children and young people are good .

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Outcomes for children and young people

The primary responsibility for supporting health care needs remains with parents as young people stay for only short break placements at this home. Health care needs are identified and are reflected into individual health care plans. The service works closely with health care nursing staff, who work directly within the home, and who provide guidance for staff when required. The service closely monitors young people's health during stays and responds promptly to any emerging health concerns.

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Outcomes for children and young people

Young people and staff generally eat together around large dining tables, which promotes a positive social occasion. Young people are provided with a balanced and varied diet which reflects their needs and personal preferences. Dietary restrictions and needs in relation to young people's health, culture and religion are identified and supported by the service. Staff encourage young people to make healthy choices at meal times.

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Outcomes for children and young people

Young people are supported to access activities in the local community, and encouraged to learn and try new things when visiting the home. Comments from parents include ‘My child can do arts and crafts and play with a good range of activities in the home. He gets to meet other young people and interact with them, which is good for his social skills’ and ‘My child has been to the cinema and been shopping on the bus, which my child thinks is great fun’.

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Outcomes for children and young people

Young people's educational needs are supported. As this is a short breaks service the primary responsibility for young people's educational planning and support remains with the parents.

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Quality of care

The quality of the care is satisfactory . Young people respond well to an experienced and committed staff team. Care is provided in a respectful way and staff are sensitive to young people’s privacy and dignity. Comments from parents include, ‘staff seem friendly and helpful’, and ’My child has good relationships with all the staff’.

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Quality of care

There are some views sought of young people to influence the running of the service, individual choice is established in relation to food and activities. Various methods of communication are used by the young people and staff have sufficient knowledge to ascertain the views and feelings of young people about the service, however these views are not being recorded or reflected upon in ways to improve the service.

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Quality of care

Arrangements for storing with medication are sound and are managed by trained and experienced staff. There is a clear audit trail of medication coming into and out of the service. Some young people have complex health care needs and these are understood and well managed by staff, including registered nurses. This supports parents and carers in the knowledge that their child is being cared for by competent, medically trained staff.

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Quality of care

However, at times there is some confusion between parents and staff about the home's policy on medication as labels being accepted by the service do not alwayst match the current prescription. Children’s Home Regulations and national minimum standards state that all medication must be administered in accordance to the prescription. This can happen when a young person's medical needs change suddenly, and there has been little time to change the pharmacy labels to match before the start of a short break. Some parents report that they have been given different responses by different staff to what the service finds acceptable in this instance. Some parents report being worried that each visit they may get a different response and be asked to come to the service and administer the medication themselves to their child, which can be unsettling for the young person involved, and parents feel it then means less of a complete break for them.

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Quality of care

The property is decorated, maintained and furnished to a good standard and has overhead tracking installed and specialist equipment to assist in delivering personal care needs. Young people can take part in a range of activities and the premises have a wide range of indoor and outdoor space. The secure gardens have planting areas for vegetables and flowers, and large grounds for young people to play football or be active in. There is an appropriate range of indoor resources to stimulate young people for example, arts and craft, music and games. A sensory room provides stimulation with light, sound and texture, which promotes sensory development. There is a large soft play area for the young people to explore. In the lounge areas there is access to televisions, computers, and DVD players. Comments from parents include ‘The building always looks nicely maintained and clean. It is a safe environment for my child, where they can safely have some freedom to explore and

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Quality of care

The home has a complaints procedure that is presented in an accessible format in an attempt to ensure that it can be understood by the young people who access the service. The home maintains a log of complaints, and there are five entries for 2011 which are all concerns raised by parents. The log book entries do not demonstrate what action was taken in response to these concerns, or what the outcome of any investigation was. There were two further records seen which indicated that parents had contacted the service to raise questions about the quality of care, however these two sets of concerns were not logged in the formal complaints record. Consequently, it is unclear if parents raising anxieties about the quality of care for their children have been given a clear and appropriate response, and how the service has taken account of and acted upon lessons learnt from any worries raised.

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Quality of care

Young people receive a sound level of support. Individual support needs are set out clearly in placement planning documents, which also provide an adequate level of guidance to staff.

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Safeguarding children and young people

The service is satisfactory at keeping children and young people safe and feeling safe. Young people are cared for in a physically safe environment. Parents state that they feel that their child's safety is given a high priority. The building is kept secure through the use of a key fob system on exit doors, and within some internal areas. There is no risk assessment in place which evaluates the securing of the identified doors and internal spaces, whilst recognising the need to allow the young people as much freedom as possible, consistent with the overall need to keep young people safe.

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Safeguarding children and young people

Staff receive training on safeguarding and they recognise the particular vulnerabilities relating to the diverse needs of young people with disabilities and take appropriate action to address them. However, staff spoken to were unclear about which safeguarding policy was in use at the home, as the previous county council policy was referred to by some staff, and other staff were referring to the overall charity safeguarding framework. This means that staff may refer to out-of-date or inappropriate safeguarding policy and procedure, which in turn could lead to confusion. The Local Safeguarding Children Board policy and procedures and Working Together (2010) were not available to staff to refer to and inform safeguarding practice, however staff were able to describe appropriate actions to take in a safeguarding scenario on shift. However, staff spoken to were unclear about the higher management structure following recent staff changes, and were not

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Safeguarding children and young people

clear as to the correct line management approach to take a safeguarding concern about the registered manager was raised.

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Safeguarding children and young people

Behaviour is well managed. Groups of young people receiving care are planned to reduce the potential that challenging behaviour may distress other young people. Known behaviours, possible triggers and behaviour management strategies are set out in individual behaviour management plans. A small number of physical interventions and sanctions have been used this year, and these are recorded by staff in bound log books. However, the records do not contain all the information which is required by Children's Homes Regulations, and this makes it difficult for the registered manager to monitor the effectiveness of measures of control and look for patterns and trends.

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Safeguarding children and young people

Bullying is not seen as an issue at this home. Staff work hard to create a happy and friendly atmosphere. Staff support young people to form friendships and interact safely during their visits.

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Safeguarding children and young people

Written procedures are in place for responding to incidents if a young person is missing from the home, although there have been no related incidents. Staff are aware of procedures to be followed in the event of this occurring and exit doors are protected.

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Safeguarding children and young people

Young people are safeguarded by the staff recruitment procedures. However, it is not clear if it is at a national recruitment level that telephone enquiries are made to verify written references, or if this is the responsibility of the registered manager of the home directly. This had not been completed for the most recently recruited member of staff, impacting on the thoroughness of the recruitment procedures. Staff are aware of their responsibilities to monitor and manage visitors to the home to ensure all young people are kept safe.

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Leadership and management

The leadership and management of the children's home are satisfactory . The environment is well maintained and issues of health and safety are monitored. Regular servicing ensures the safety of appliances such as hoists, adaptable beds, electrical appliances and the fire detection system. Fire drills are carried out routinely and involve young people and responses to unplanned drills are effective in practice. Fire safety is enhanced by ensuring that all staff attend fire safety training. Risk assessments are in place with regard to the whole home environment and grounds, as well the individual needs of the young people. However, a large number of the risk assessments in place were completed a significant time ago, and they have not been reviewed and signed since. Consequently staff may be referring to out-of-date information on a young person, or an activity, impacting on the safety of young people.

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Leadership and management

Young people's privacy is protected by ensuring that confidential records are kept in locked cabinets with restricted access. There are regular visits under regulation 33 of the Children's Homes Regulations, and the registered manager undertakes regulation 34 checks on a regular basis. However, the regulation 34 checking system does not indicate that the complaints log is monitored on a regular basis; this means that concerns may not be acted upon promptly, potentially impacting on the quality of care of young people

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Leadership and management

Young people and families are provided with written information about the service which summarises appropriately details from the home's Statement of Purpose. Information for young people uses simple language and symbols. However, the children's guide does not contain some required information such as a summary of the home's complaints procedure, information on how young people can find out their rights, how a young person can contact their independent reviewing officer, the Children's Rights Director, Ofsted, and how they can secure access to an independent advocate.

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Leadership and management

Young people are supported by an experienced and knowledgeable staff team. The home is managed by a registered manager who is supported in her role by further management staff for the two separate units. There is a core of very experienced staff working in the home who know the young people well and are able to support and guide less experienced staff.

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Leadership and management

Staff receive regular training to enhance their individual skills and to ensure they meet the needs of the young people accessing the service. Staff receive regular individual supervision from senior staff. The Statement of Purpose states that staff teams will have a monthly staff team meeting which will focus on the needs of the young people accessing the service. This has not been occurring on a monthly basis for the past six months. Staff have however had opportunities to meet as a group to discuss the transition to new contracts and changes to the service in general. Opportunities for staff to meet and discuss as a team, strategies for supporting young people in their day-to-day work specifically, and sharing good practice has not been frequent.

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Leadership and management

The past six months has been a period of change for the staff who work at the service and for the management team. The staff have been working hard to try and achieve consistency for the young people who have continued to access the service. Some shortfalls within the service have been identified within this report, and a clear development plan for the service which recognises strengths and weaknesses, and identifies goals and objectives for improvement are not in place for all staff to work towards.

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Leadership and management

Equality and diversity practice is good .

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