Children's Home run by Cornwall Partnership NHS Foundation Trust in Cornwall

Unique reference number SC432404 Inspection date 21/03/2012 Inspector Bridget Goddard Type of inspection Full Provision subtype Children's home

p.1

Date of last inspection 08/09/2011 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

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.

p.3

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.

p.3

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

p.3

Brief description of the service

This children’s home is part of a local authority short breaks service for two children with disabilities, complex individual needs and fragile health.

p.4

Overall effectiveness

The overall effectiveness is judged to be satisfactory .

p.4

Overall effectiveness

This is the home’s first inspection. Young people in this home enjoy strong and positive relationships with staff. They receive highly personalised care in a relaxed and warm environment, and are able to access activities and forge new relationships. This means they are having similar opportunities to young people without a disability. Young people's complex, medical needs are well met and this promotes them staying as healthy as possible.

p.4

Overall effectiveness

The home is well maintained and now has adequate staffing to meet young people's needs. Parents are extremely positive about the quality of care the home offers to young people, and the home has effective relationships with key other agencies.

p.4

Overall effectiveness

There are some areas for improvement in relation to staff in supervision and training. This may mean that staff are insufficiently equipped to do all aspects of their job well. Also, fire drills have not been held routinely and there is no written development plan. The running of the home and the quality of care provided is not monitored and as a result the home does not receive regular feedback on its standard of care and compliance with regulations.

p.4

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.

p.4

Reg. Requirement Due date

(2001) ensure, by means of fire drills and practices at suitable intervals, that the persons working at the home and, so far as practicable, children accommodated there, are aware of the procedure to be followed in case of fire (Regulation 32 (1) (e )) 23/05/2012

p.4

Reg. Requirement Due date

(2001) ensure that monthly unannounced visits take place and that a written report is prepared on the conduct of the home and a copy sent to the registered manager and HMCI (Regulation 33 23/05/2012 (2),(3),(4),(5) )

p.4

Reg. Requirement Due date

(2001) ensure that the registered person establishes and maintains a system for monitoring the matters set out in Schedule 6 at appropriate intervals which consults and improves the quality of care provided in the children's home, and are sent to HMCI at regular intervals. (Regulation 34 (1)(a)&(b) (2)(3)) 23/05/2012

p.5

Recommendations

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

p.5

Recommendations

 ensure there is 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 all existing care staff have achieved a minimum level 3 qualification, or be working towards the level 3 Children and Young people's Workforce Diploma which must include mandatory social care units (NMS 18.5)  ensure all staff are provided with regular supervision, and a signed record is kept of these. (NMS 19.4 & 19.5)

p.5

Outcomes for children and young people

Outcomes for children and young people are satisfactory .

p.5

Outcomes for children and young people

Young people staying in the home are fragile health and are making sound progress. Their complex needs and the level of their disabilities mean that they are highly dependent on the support provided by staff. For example, they need support with all their personal care and eating. Young people use wheelchairs and use non-verbal communication, including symbols.

p.5

Outcomes for children and young people

Young people are making solid progress in expanding their experiences of the world, and meeting new people. Despite the challenges young people face as a result of their health needs they access activities in the community. For example, young people enjoy trips to the park, to supermarkets and to the zoo. Staying regularly in this short-break home gives young people valuable opportunities both to spend leisure time with other young people and different adults. A parent said, 'she can't stay with her Granny like the other children, so this gives her opportunities like the others.' This means that the home enables these young people to benefit from a wider range of opportunities than they would otherwise have.

p.5

Outcomes for children and young people

Young people also benefit from the home's strong commitment to their well-being and meeting their needs. For example, the home assists parents in advocating for the best transition arrangements for the young person and in obtaining the right medical supplies. For some young people this means that they now have the right equipment to make them feel comfortable. The home has enabled young people to receive services that best meet their individual needs.

p.5

Outcomes for children and young people

The home works hard to ensure that all young people, including those with a high level of sensory impairment take part in activities that give them pleasure. The home has equipment that projects light shows which young people clearly enjoy. The home also has a supersized, totally adapted bath which means young people can relax painful muscle spasms and engage in water play. Young people enjoy these experiences. These specialist resources are having a positive impact on young people's social and emotional well-being.

p.6

Outcomes for children and young people

Young people are fully supported with their education while they stay at the home. Their attendance and educational achievement remains comparable with their peers. Young people are prepared for a successful transition to adult services by a gradual change in the activities they engage in to develop their skills and interests. For example, the music they listen to may change from nursery rhymes to pop music and they may assist in more craft like activities, like preparing a Mother's Day gift.

p.6

Quality of care

Staff know the young people extremely well and offer highly personalised levels of care. For example, they know that some young people can only go for wheelchair walks on cool days because of issues with their body temperature control. They know that other young people enjoy having their face stroked, and that some can only watch television if the characters are brightly coloured. Staff know which surfaces young people like to lie on; for example for some young people this is a bean bag and for others it is a hard surface. Some young people like to be in the conservatory and touch the guitars, others prefer being near the television or under the light show.

p.6

Quality of care

Staff learn what young people prefer through a careful initial assessment, gathering information from parents and other people in their lives, then by sensitive monitoring of young people's responses. Young people clearly demonstrate by laughter, smiles and excitement that they have positive relationships with staff. Parents confirm this saying that, 'she becomes animated and happy when she is going there.' The staffing levels are high to meet young people’s needs. This enables staff to respond quickly to any signs of unhappiness and put this right, this means that inappropriate behaviour is not currently a problem. Parents are highly positive about the quality of care given in the home. Many parents are initially reluctant for their child to stay overnight, and attend for several short visits first. These same parents now say, 'this is the only place I trust with him. They comfort him, understand him

p.6

Quality of care

and treat him as I do.' Other parents say, 'Nothing is as good as the level of care you get in this home.'

p.6

Quality of care

Information about the home’s complaints procedure is available in formats that young people understand. For example, posters displayed around the home use symbols to show how young people can make a complaint. There have been no complaints from young people.

p.6

Quality of care

All young people do have a short break care plan. This is a highly detailed document covering young people's medical and physical needs and their likes and preferences. For example, it details who likes cuddles. This means that the care plan rightly reflects young people's emotional as well as physical needs. It is routinely reviewed and is well informed because it includes parents’ views and those of other professionals working with the young person.

p.7

Quality of care

Young people’s medical and health needs are well met. They have individualised drug regimes, some require oxygen therapy and all need regular care and maintenance of their feeding tube site. A registered nurse on shift day and night, together with a care worker. The home also has effective working partnerships with specialist community nurses and dieticians. This means that young people's individual health requirements can be consistently met. While the home was closed for refurbishment, staff did placements on a paediatric ward of the hospital which most young people attend. This enhanced staff’s skills and understanding of young people’s needs. As a result young people benefit from staff who are well-equipped to respond effectively to young people's medical needs. All young people have a named nurse and two named care workers. Their responsibilities include implementing care plans, carrying out home visits and reviews. They also make visits to the young

p.7

Quality of care

people's schools to share information and learn how best to care for the young person. This means that there is a consistent approach to the young person's care and that young people's school attendance and achievement is promoted.

p.7

Quality of care

Parents like the fact that the home is situated in the local community near to a school and a park. They feel that this 'integrates the young people into the community.' Parents like the 'homeliness' of the building and are pleased with the improved facilities, for example the conservatory and light show options. The home is well-maintained by a dedicated housekeeper, and contains sufficient equipment and space to effectively meet the needs of young people staying.

p.7

Safeguarding children and young people

The service is satisfactory at keeping children and young people safe and feeling safe.

p.7

Safeguarding children and young people

Young people stay in a safe environment with good safeguarding practices. As a result young people are appropriately protected from abuse. Medication is managed safely. No medication is kept in between young people's stays, and there are clear instructions for parents about changes to medication. All administration of medication requires two signatures, and controlled drugs are separately kept. Parents say that the home is, 'excellent with medication'. The staff attend medical reviews at the school, which keeps them up to date with young people's current medical state and future plans for them. Some young people do have life-limiting conditions and staff use thorough risk assessments to ensure young people get the support they need to promote their welfare, including at night, where some young people require to be checked every fifteen minutes. Records are kept of these checks and the action staff take; for example emergency hospital admissions if they feel it is

p.7

Safeguarding children and young people

necessary. Parents say that the staff are, 'fastidious about medical care'. This means that young people's safety in terms of their medical needs is strongly promoted.

p.8

Safeguarding children and young people

Young people show by their trusting and relaxed demeanour that they feel safe in the home. Staff help to promote a culture of safety by treating young people with respect and dignity. Personal care is done in young people's bedrooms, and usually explanations are given to young people about what is happening to them. Young people are covered as appropriate. Because of hoisting issues, two people are usually involved with most personal care.

p.8

Safeguarding children and young people

Staff are aware of what to do if they have a safeguarding concern and staff have been suitably trained in safeguarding. New staff are carefully vetted before starting work. Young people have never gone missing from this home. The staff are aware of the possibility of bullying and have appropriate responses in place. Small numbers of young people and high staffing ratios mean that bullying is not currently an issue. The home has in place a record of restraint and sanctions book. There are no entries in either of these, and staff confirm that this type of behaviour management has never been necessary.

p.8

Safeguarding children and young people

The home is well-designed to keep young people safe, and where further measures are needed for example, more padding on the bed side, this is detailed in individual risk assessments. Checks on relevant appliances and fire equipment are done routinely, and fire procedures were reviewed in March 2012. However, fire evacuation drills are not taking place regularly to ensure everyone knows what they need to do in case of a fire. The home's policies states that fire drills are done at six- monthly intervals but the last one recorded was in June 2011.

p.8

Leadership and management

The leadership and management of the children's home are satisfactory .

p.8

Leadership and management

The home has a new manager that has not yet been confirmed as the registered manager of this children's home. The manager was previously the deputy at the home and is knowledgeable about the running of the home and young people’s specific needs. Until very recently there have been significant staff vacancies in the service. The manager has covered this staffing gap herself by doing solely care shifts. It is to her credit that families have not seen a decline in the quality of care offered, but there are some shortfalls apparent in the day-to-day running of the home as a result. For example, although care staff have continued to receive regular supervision, nursing staff have not been supervised on a regular basis and not had routine opportunities to discuss their performance and professional development. Also the running of the home and the standard of care provided is not regularly monitored and reviewed by an independent person to ensure young people’s needs

p.8

Leadership and management

are being met. However, the manager has been able to take appropriate steps to monitor the daily quality of care offered to young people. She has picked up on issues relating to specialist feeds, put things right and has advised staff on best practice. The manager routinely observes care given and reads reports on young people. Although she has ideas to develop the home, she has not yet shared these through a written development plan.

p.8

Leadership and management

The home has produced a Statement of Purpose, which satisfactorily reflects its aims and objectives and provides information for parents about what they can expect from the service. The home is adequately resourced, and now has sufficient staff to meet young people's complex needs. Staff have opportunities for training to ensure that they are skilled and knowledgeable and offer safe and responsive care. However, there are a small number of existing staff who have not yet the appropriate child care qualification. This would help ensure that young people are cared for by staff who are appropriately equipped to deal with all challenges.

p.9

Leadership and management

Equality and diversity practice is satisfactory .

p.9