Children's Home run by Barnardo’s in Oxfordshire

Unique reference number SC069128 Inspection date 23/04/2012 Inspector Maire Atherton Type of inspection Full Provision subtype Children's home

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Date of last inspection 13/03/2012 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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Brief description of the service

The service caters for a maximum of six children and young people at any one time, including one emergency bed. It provides a residential short break service and a domiciliary care service that is inspected by the Care Quality Commission (CQC).

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Brief description of the service

The service is provided by a national charity in partnership with a local authority and a 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. At the time of this visit there were 43 children and young people receiving a short break service.

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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 Adequate : a service that only meets minimum requirements Inadequate : a service that does not meet minimum requirements

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Overall effectiveness

The overall effectiveness is judged to be good .

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Overall effectiveness

Children and young people using this service have individual care patterns and experience positive outcomes. A parent described the home as 'celebrating uniqueness'. The service focuses on ensuring that children enjoy their time in short breaks, have fun and are supported to learn new skills. Staff make certain that children's individual needs, including complex health care needs, are well are met and their dignity is maintained. Children are very happy in their environment and staff enable children and young people to exercise choice in many aspects of their daily life through the use of alternative methods of communication.

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Overall effectiveness

The practice in the home remains child centred, staff are deployed in accordance with the needs of those staying overnight and activities offered each evening reflect their interests and desired outcomes. Complex health, communication and behavioural needs are not seen as barriers to success or development.

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Overall effectiveness

Children and young people benefit from a home that provides a safe, child-friendly environment, adapted to meet the individual needs of the children and young people. Staff are proactive in the promotion of health and safety in the home. A real strength of the service is the stability and experience of the staff team together with the support from the Registered Manager and the senior management team.

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Overall effectiveness

The areas identified for improvement in respect of training and supervision mainly lie with the registered provider as they are outside the control of the Registered Manager, as are any changes to the admission criteria for the home. These are not currently having an impact on outcomes for children but may do in the future. Shortfalls for the manager to address primarily relate to records.

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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) review the criteria for admission to the home to ensure that all those receiving short breaks are enabled to reach their full potential (Regulation 4 (1)Schedule 1 (9)) 31/07/2012

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Reg. Requirement Due date

(2001) ensure that reports of reviews conducted for the purpose of improving the quality of care are supplied to the Regulator (Regulation 34 (2)) 30/06/2012

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Reg. Requirement Due date

(2001) ensure that all staff attain qualifications appropriate to the work they perform and that there is a formal arrangement for clinical supervision of the Registered Manager (Regulation 27 (4)(a)(b)) 31/10/2012

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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

 ensure that the care plans contain all the detail observed in practice (NMS 2.1)  ensure that the induction process for new staff incorporates the Children's Workforce Development Council's induction standards (NMS 18.3)  obtain copies of minutes of reviews held for children and young people (NMS 25.8)

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Outcomes for children and young people

Outcomes for children and young people are good . Children and young people are very well supported to develop and maintain a positive self-view. They grow in confidence, for example through using mobility aids with style and building up speed to enable access and participation throughout the building. Children develop and maintain effective communication skills which enable them to make choices in their day-to-day living experiences. Meal times are social occasions which are enjoyed by all; even those who are not eating choose to stay and enjoy the experience. Children’s individual preferences and dietary requirements are catered for in addition to the daily menu which offers balanced options at meal times.

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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. The health of children and young people is exceptionally well promoted. This is achieved by close working between the nursing and social staff and the detailed individual health care plans. Staff assiduously monitor children's and young people's health and well-being and respond promptly to any emerging health concerns.

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Outcomes for children and young people

As this is a short-breaks service, the primary responsibility for their children’s education remains with the parents. While at the home attendance at school is well supported, for example a nurse accompanies a young person in a taxi. Staff regularly attend school reviews and support children and young people in their learning by offering a range of activities and resources, both on site and in the local community.

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Outcomes for children and young people

Staff work in partnership with parents and professionals to assess children's needs prior to accessing the service and develop the care plans on the basis of the assessment. Transition arrangements, which include visiting the service to meet staff and joining in with activities before building up to an overnight stay, are flexible and tailored for each individual. This helps to develop the confidence and trust of both children and their parents in the staff. The home was able to accommodate a request by a parent to stay overnight too, within carefully risk assessed and agreed protocols. The service demonstrates a flexible approach to accommodating both emergencies and requests for specific stays, while striving to maintain a balance of need and an appropriate peer group.

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Outcomes for children and young people

Children and young people enjoy coming to the home, a parent said 'my child shows pleasure when she knows she is coming.’ A child said 'this home is the best.’ Children and young people improve their communication skills using a variety of verbal and non-verbal communication methods. There are positive, warm and inclusive relationships between the children and young people themselves and the staff team. Children and young people confidently approach and engage with staff. There is a good sense of fun and enjoyment evident in the interactions that take place. Independence skills are promoted where possible, such as opportunities to prepare snacks and drinks in the kitchen.

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Quality of care

The quality of the care is good . Children and young people enjoy warm relationships with staff. There is a great deal of laughter and fun in the interactions. Children and young people approach staff confidently in the knowledge that they will be listened to and their wishes acted upon where possible. Staff engage positively with young people. They explain things clearly and when they cannot do the things asked for say so in a way that children understand and accept. For example the boiler failed in the evening and so it was not possible for young people to have a bath. Staff took time to explain the situation to each young person according to their individual communication methods. The young people showed that they understood there was a problem and accepted the other choices offered, including the use of the Jacuzzi instead.

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Quality of care

Staff seek the views of children and young people frequently and provide choices that are offered in a meaningful way, using appropriate verbal skills and alternative methods of communication. This ensures everyone can make choices during their stays about meals, drinks, snacks, activities, the room they are in and personal care needs, for example. Staff are observant of non-verbal communication and respond promptly to any sign of distress or upset; this demonstrates sensitivity and a good understanding of the needs of the children and young people.

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Quality of care

Each child or young person using the service has an individual profile. These are well personalised and outline the care needs, including those arising from faith and culture; risks, wishes and individual outcome targets. Not all contain the level of detail seen in practice, for example how to support when transferring from a wheelchair or in one instance how to distract from a particular negative behaviour. Parents, key workers and significant others are fully involved in the development and review of care plans which are regularly updated.

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Quality of care

The majority of the children and young people using the service have significant and complex health care needs, some with life limiting and deteriorating conditions. These needs are understood and very well managed by staff who promote and maintain respect and dignity for all children and young people at all times. The arrangements for dealing with medication are strong and are effectively managed by trained and experienced staff, including registered nurses, in accordance with agreed nursing protocols. Parents and carers are confident that their child is being cared for by competent, medically trained staff. The manager is not happy with the current arrangements for the out of hours medical support and is submitting a complaint about a particular event. This will be used to present a case for alternative arrangements to the Commissioners of the service. Due to the increasing medical interventions required the manager and responsible individual are actively reviewing

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Quality of care

the guidance relating to the dual registration of the service with Ofsted and the Care Quality Commission.

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Quality of care

Staff have established good links with schools and have a member of staff who attends multi disciplinary meetings quarterly to promote effective communication. The links with school nurses are also valued as they support continuity of care for the children and young people. Staff support the education of young people by listening to some reading and engaging others in looking at books and talking about the pictures.

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Quality of care

Children and young people take part in a wide range of activities. There are opportunities both indoors and out for play, exercise and learning. The secure garden has had new swings installed and children can use the outdoor toys which include bikes and a go-kart. Inside the house there are the five activity rooms that include a Jacuzzi, ball pool room, multi-sensory room; TV and a computer with a touch screen monitor. There are a variety of resources within the home for arts and craft and music and games. Offsite activity, such as trips to the parks and shops, mainly take place at weekends when staff can plan and co-ordinate the complex medication and feeding regimes more easily. One parent appreciated the development of friendships outside school and reported that her child 'liked the adventure of coming here.’

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Quality of care

The property is decorated, maintained and furnished to a good standard. Children have their own bedroom when staying, and one bedroom has en-suite facilities. The home has appropriate adaptations to ensure the individual needs of children accessing the service are met, such as overhead tracking, specialist beds and adapted baths. There are good systems that ensure that maintenance issues are addressed promptly, a plumber repaired the boiler at nine o'clock in the evening, within two hours of the fault being reported, so there was hot water available in the morning.

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Safeguarding children and young people

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

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Safeguarding children and young people

Children and young people say they feel safe in the home and this is reflected in their happy faces. Parents are confident that staff promote their children's safety and give examples of how this happens in practice, for example through the use of risk assessments and the security of the building.

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Safeguarding children and young people

Staff receive regular training on safeguarding and are knowledgeable about the particular vulnerabilities relating to the diverse needs of young people with disabilities and take appropriate action to address them. Staff know what to do in the event of safeguarding concerns and have a good understanding of their respective roles. Allegations are managed well.

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Safeguarding children and young people

There is careful planning of the groups of children receiving care at any one time to achieve a good level of compatibility and reduce the potential for challenging behaviour that may distress other children. A parent said 'safety of all the children is a strong concern of staff.’ Staff are vigilant in their supervision of children and young people and the care they provide is directed by clear behaviour management plans. This ensures that young people interact safely and successfully minimises the opportunities for children to go missing or any behaviour that could be interpreted as bullying to occur. Staff are trained in an approved behaviour management technique with a clear emphasis on distraction and diversion. Staff use these tactics to good effect, there have been no incidents of physical interventions or sanctions imposed since the last full inspection. Children and young people are also aware of the safety

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Safeguarding children and young people

of others, saying 'careful' and 'look out' when playing energetically in the ball pool.

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Safeguarding children and young people

There is a robust recruitment process which ensures all necessary checks are completed prior to a member of staff starting work. Visitors are checked upon arrival, sign the visitors’ record and are supervised on site as appropriate.

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Safeguarding children and young people

The home provides children and young people with a physically safe and secure environment. The servicing and maintenance of services and specialist equipment, fire alarm tests and drills take place as required and are recorded. Accidents are infrequent. Staff are vigilant in ensuring that any hazards are dealt with promptly, securing a blind cord for example thus removing the potential for an accident to occur. Staff have the facility to set alarms on individual bedroom doors in accordance with the care plans. This serves to promote choice and privacy for young people while also providing an additional safeguard.

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Leadership and management

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

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Leadership and management

The home's established management team is skilled and experienced and delivers effective leadership of the home, ensuring the delivery of good quality care that meets the individual needs of those receiving short breaks at the home.

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Leadership and management

There is a robust procedure for addressing concerns or complaints that is implemented in practice. The manager is always looking to improve the service and views concerns as opportunities to drive improvement. The one concern raised since the last full inspection has been fully addressed to the satisfaction of those involved. The manager has an open-door policy and parents report good systems of communication with the staff team.

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Leadership and management

The home has a Statement of Purpose that details the aims and objectives of the home and the services and facilities it provides for severely disabled children and young people who are assessed as having significant need. Admission to the short break service is through the 'Priority Panel' following an initial assessment. The manager sits on this panel which comprises representatives from a number of child care agencies. The home's management have observed that an increasing number of children and young people with complex health needs are being referred to their service. It is becoming more difficult to achieve balanced groups so as to provide opportunities to stretch those children and young people who could realise a greater degree of independence, by leaving the kitchen unlocked for example. Any changes to the admission criteria have to be agreed by the Commissioners of the service.

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Leadership and management

Children and young people are supported by an experienced and knowledgeable staff team, including a group of bank staff who work on an as and when basis. Staffing levels reflect the needs and the number of children and young people staying for short stays. Staff work well together and there is a good team spirit which has a positive impact on children. Staff are well supported by senior staff and benefit from the structured daily handovers and monthly staff meetings. Staff receive regular supervision and an annual appraisal. The manager is a registered nurse and the previous arrangements that were in place to provide her with clinical supervision have come to an end. The manager has established an informal arrangement in the interim but this is insufficient.

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Leadership and management

Staff access a wide variety of training courses to enhance their individual skills and to ensure they can meet the needs of those accessing the service. However there have been ongoing difficulties for a number of staff in achieving a level three qualification due to issues outside the control of the home. In addition staff who do not qualify for funding for the level three qualification because they hold higher qualifications are not funded by the charity to obtain them even though the qualifications they hold are not relevant to the work they are engaged in. There is an established induction process for new staff, however it is unclear if this incorporates the Children's Workforce Development Council's induction standards.

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Leadership and management

The manager undertakes regular monitoring of the home as required and monthly external monitoring visits are carried out by the registered provider visitor, which include consultation with and observation of children and young people. The charity has recently introduced a service quality assessment and improvement tool to be undertaken by the assistant director in conjunction with the manager. There is no system to ensure that reports of reviews conducted for the purpose of improving the quality of care are supplied to the Regulator. There were no recommendations or requirements made at the last inspection.

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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. Records are well maintained and provide a clear picture of a child's stay in the home, their achievements and progress. One parent was very appreciative of the detailed notes provided. Reviews take place as required and the link worker takes their own notes of the discussion, but the home does not always get a copy from the independent reviewing officer, despite requests.

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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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