Children's Home run by Liverpool City Council in Liverpool

Unique reference number SC035969 Inspection date 22/05/2012 Inspector Denise Jolly Type of inspection Full Provision subtype Children's home

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Date of last inspection 24/02/2012 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 children's home is managed by a local authority providing short-term breaks for children between the ages of eight and 19 years. The home cares for up to seven children with learning disabilities and physical disabilities at any one time. Many of the children use non-verbal methods of communication.

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The inspection judgements and what they mean

Outstanding : a service of exceptional quality that significantly exceeds minimum requirements Good : a service of high quality 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 inadequate .

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Overall effectiveness

Staff offer care on a day-to-day basis that recognises most needs of young people. Young people say they like coming to the home and are confident in their relationships with staff. Families and social workers appreciate that staff are motivated to do their best for young people and value the service that is provided.

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Overall effectiveness

However, inadequate planning lacks personalised programmes of care for specific needs such as epilepsy, communication, and continence. This fails to acknowledge risks associated with child protection needs. Consistency of approach to daily support routines is limited by staff who do not provide written plans of care that incorporate the views of young people. Some resources, such as an adapted minibus and a multi-height bath are broken. This limits opportunities for activities or safe care practice to take place.

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Overall effectiveness

Staff are committed to providing improved outcomes for young people, but their effectiveness is reduced by lack of training, knowledge and understanding of systems necessary to promote young people’s safety, welfare, rights and dignity. For example, not all young people benefit from an individual behaviour and risk management plan. Additionally, staff do not maximise opportunities for young people to experience independence in decisions about their everyday routines. For example, staff do not present choices at mealtimes, or in activity planning, to encourage young people to express their opinion.

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Overall effectiveness

Inadequacies in administration of medication, assessment of risk and failure to respond effectively to child protection concerns means young people live in a home that fails to promote their safety and wellbeing. Following a year that included the absence of the registered manager for many months, systems for monitoring the conduct of the home are poorly maintained. Regulation 33 visitors do not consult with families to inform their view of the home. This means that managers do not know all the strengths and weaknesses of the service. They do not have complete development plans in place. Consequently, actions to secure improvement do not address key areas of weakness.

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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 placement plans are prepared in consultation with the child's placing authority and set out in particular, how, on a day to day basis, he will be cared for, and his welfare safeguarded and promoted in the home (Regulation 12 (1B) (a)) 20/07/2012

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Reg. Requirement Due date

(2001) implement a written policy which sets out the procedure to be followed in the event of any allegation of abuse or neglect, including the prompt referral to the local authority (Regulation 16 (1)(b) and (2)(b)) 07/07/2012

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Reg. Requirement Due date

(2001) implement the procedure which provides for a written record to be kept of any allegation of abuse or neglect, and of action taken in response, and considers the measures which may be necessary to protect children; in particular, conducting assessment of risk (Regulation 16 (2) (d) and (e)) 07/07/2012

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Reg. Requirement Due date

17A (2001) ensure that restraint is only used for the purpose of preventing injury or serious damage to property (Regulation 17A (1)(a) and (b)) 07/07/2012

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Reg. Requirement Due date

17B (2001) ensure that records confirm the manager speaks to (or considers the perspective of) any child involved in restraint or other sanction (Regulation 17B (3) (h)) 07/07/2012

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Reg. Requirement Due date

(2001) store medicine in a secure place to prevent any child having unsupervised access to it (Regulation 21 (2)(a)) 07/07/2012

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Reg. Requirement Due date

(2001) ensure that all staff to receive appropriate training; in particular, regard to child protection and the health and medication administration needs of children (Regulation 27 (4)(a)) 07/07/2012

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Reg. Requirement Due date

(2001) ensure that the person carrying out the Regulation 33 visit shall interview such of the children, their relatives, and persons working at the home as appears necessary in order to form an 20/07/2012 opinion of the standard of care provided in the home (Regulation 33 (4)(a))

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Reg. Requirement Due date

(2001) establish and maintain a system for the manager to improve the quality of care provided in the home (Regulation 34 (1)(b)) 20/07/2012

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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 children receive personalised care that promotes all aspects of their individual identity, specifically in supporting communication and intimate care (NMS 2.1)  provide children with choice in the food that they eat (NMS 2.4)  enable all young people to communicate their views on all aspects of their care and support by providing appropriate communication equipment for their use (NMS 1.3)  ensure that the home has any equipment needed to provide appropriate care for children, in particular, repair faulty equipment, and make available appropriate communication systems for children to use (NMS 6.16)  ensure that children are able to enjoy their interests, develop confidence in their skills, and engage in leisure interests, in particular regard to play equipment in the home and appropriate transport to facilitate community access (NMS 7)  ensure that where any sanctions or restraints are used, children are encouraged

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Recommendations

to have their views recorded in the records kept by the home (NMS 3.18)  ensure that medicines are administered in line with an agreed (and medically approved) protocol, particularly for rescue medication (Volume 5, statutory guidance, paragraph 2.53)  ensure that the specific responsibilities of the registered provider, for the day to day health of children placed with them, are set out in the health section of the child's placement plan (Volume 5, statutory guidance, paragraph 2.46)  ensure that there is a good quality learning and development programme so that staff are equipped to meet the needs of children and purpose of the setting and that the programme is evaluated for effectiveness at least annually. (NMS 18.1 and 2)

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Outcomes for children and young people

Outcomes for children and young people are adequate .

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Outcomes for children and young people

Young people, parents and social workers are positive about the short breaks service the home offers. Young people say staff help them to be happy whilst they are at the home, were observed to support young people’s participation in daily living activities in a sensitive manner. Young people say they enjoy time at the home, and look forward to their visits. When able, young people share their experiences with their families once they return home and appear to appreciate such activities as trips to leisure parks, or baking sessions.

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Outcomes for children and young people

Young people appear to be aware that the home offers a short break away from home. They seem to be relaxed about their visits. Some young people confirmed that they would see their families again at the end of the week. They talk to staff about their important relationships. This helps young people to develop emotional resilience to manage separation from their main carers. Most parents say that effective communication from staff helps their children to maintain attachments. This supports the individual aspect of each young person’s identity.

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Outcomes for children and young people

Young people receive care from staff who recognise their major health needs. Although some care plans do not identify specific practices to improve consistency of approach, young people benefit from staff that are motivated to provide sensitive and respectful health care. This maintains satisfactory outcomes for young people, and meets their basic health care needs. When necessary, young people’s health is promoted by staff supporting them to attend essential medical appointments.

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Outcomes for children and young people

Young people do not benefit from a safe and well-managed medication system. There are shortfalls in storage and administration of medicines as well as in healthcare planning, which means that young people may not have prompt access to appropriate staff intervention in a medical emergency such as asthma or epilepsy.

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Outcomes for children and young people

Young people with special communication needs do not always have their views heard. This is due to limited staff training in specialised communication systems.

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Outcomes for children and young people

Some placement plans provide insufficient information to enable young people to benefit from consistent practice that allows their life chances to improve. This means that young people do not progress in all aspects of their lives, such as their ability to communicate their views.

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Outcomes for children and young people

Young people attend their individual schools during their short break and benefit from effective liaison between school and staff. Some young people receive continuity in some aspects of education and care, such as independence skills activities or pathway planning. This improves their ability to make a positive contribution by practising such skills as cooking during their short breaks.

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Outcomes for children and young people

Staff are keen to provide interesting and developmental activities for young people. However, young people’s participation in a broad range of experiences is currently limited by lack of resources. For example, there is no garden play equipment for young people to enjoy during good weather. The home’s minibus has been in need of repair for some time. This means that community-based activity is limited to trips to the local park and shops for the majority of outings. Managers have provided arrangements to access appropriate transport at weekends when staff plan to take young people out. Nevertheless, young people currently have less opportunity to experience different activities, or make a positive contribution to the wider community.

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Outcomes for children and young people

Young people enjoy mainly good relationships within a diverse social group. They are tolerant of the needs of others. For example, young people happily share belongings and wait patiently when others require the attention of staff. These skills enhance their life chances, because young people see themselves as part of a community, rather than as isolated individuals.

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Outcomes for children and young people

Most young people are cared for in line with regular placement review outcomes. However, some young people, especially those in transition to adult services, do not benefit from joint professional planning and review. Managers persist in requesting meetings to review placement needs, but this is not always successful. This prevents staff from contributing to young people’s transition plans. It also reduces the information available to identify young people’s independence needs appropriately.

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Outcomes for children and young people

Although there are shortfalls in storage of medication and a lack of direction in how to respond to medical emergencies, effective staff supervision ensures that outcomes for young people are adequate.

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Quality of care

Staff support young people to maintain good relationships with each other. Staff organise the layout of the home to give young people the opportunity to find a quiet place, as well as be sociable. Young people can move freely in the environment. Staff meet to discuss ways of supporting young people who are not comfortable during their visit. They are proactive in responding to young people who express anxiety during their stay. Staff and parents work together to improve emotional well-being, for young people to feel more secure and continue to enjoy their short breaks.

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Quality of care

Staff consult some young people, particularly those who have verbal language skills, about everyday decisions such as choosing activities. The staff’s knowledge and understanding of augmentative communication systems, for example, the picture exchange communication system, is limited. Instead, staff interpret immediate wishes and feelings based on behaviour and gesture. For example, at mealtimes, young people are presented with food chosen for them by the staff. This means that young people with communication difficulties cannot effectively make their voices heard. The loss of visits from independent advocates has also reduced opportunities for young people to have their experiences and wishes represented to staff for consideration. Staff do not formally evaluate young people’s contributions in meetings, in order to inform their delivery of service. This limits the staff’s ability to reflect views of young people in the development of the service.

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Quality of care

Key workers prepare placement plans of varying quality. Information gained from families is not always included in sufficient detail in the plan. Shortfalls include information or instruction that is out of date, or is in conflict with advice from medical professionals. Some young people’s plans have critical elements missing, such as behaviour support programmes. This means that staff act inconsistently in caring for young people, because they do not have routine access to all necessary information to support those with complex needs.

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Quality of care

Some young people do not benefit from clearly identified plans to support and manage significant health needs, such as brittle bones or mobility support. Additionally, staff do not always identify barriers to young people being able to participate in everyday life, such as communication needs. Consequently the effectiveness of staff intervention strategies are not monitored against principles of equality and diversity. This prevents a complete picture of the needs of young people and limits young people’s integration to mainstream experiences. Some young people's views are not routinely included in reviews of placement needs. This means that they experience minimal participation in planning their futures.

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Quality of care

Despite frequent review of records and systems, arrangements for managing medication are inadequate. Not all medicines are locked away. Contrary to organisational policy, staff administer medication without an appropriate pharmacy label. Labels are necessary to confirm the identity of the young person for whom the medicine is intended and also the correct dose. Staff use a complicated cross referencing system for administration of medication, that further increases the risk of human error. Subsequently, young people’s health may be compromised, as they may not receive medication in line with the doctor’s instructions.

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Quality of care

Young people have their health placed at further risk because health plans do not include clear instructions for staff in specific medical emergencies, such as prolonged seizures or asthma episodes. Staff say that they have not received up-to-date training in procedures to support safe administration of medicines, or specific health needs such as epilepsy. This reduces their ability to maintain the health and welfare of vulnerable young people.

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Quality of care

Staff liaise with one of the schools attended by young people, and this improves understanding of issues affecting them. However, staff have not incorporated school approaches to, for example, programmes for continence support or use of augmentative communication systems. This reduces consistency, and minimises the potential for positive development in the lives of young people.

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Safeguarding children and young people

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

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Safeguarding children and young people

Young people appear safe and happy in the home. Parents and social workers are enthusiastic about the service. They say that staff work hard to maintain good care practice that recognises the needs of individual young people and their families.

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Safeguarding children and young people

Managers conduct rigorous recruitment procedures to protect young people from unsuitable individuals having access to them at the home. Staffing levels are sufficient to maintain the safety and welfare of young people.

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Safeguarding children and young people

Staff are trained in recognised behaviour support approaches that include physical management of young people, to ensure their safety and wellbeing. Staff seldom use restraint and sanctions. However, managers do not monitor incidents of restraint effectively and do not recognise when staff use such measures to enforce compliance with their wishes. Additionally, staff do not gather the views of young people following incidents of restraint, although this was recommended to improve practice at the last inspection. This means staff do not adequately promote the rights of young people, or help them to develop an awareness of the impact of their behaviour upon their life chances.

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Safeguarding children and young people

Managers do not maintain adequate oversight of staff knowledge and practice in child protection, and do not ensure any allegation made by young people is reported immediately. Young people do not have their allegations investigated in good time by appropriate protection professionals, and as a result, any risks are not recognised and minimised. Additionally, managers do not act quickly to address failure of other professionals to report allegations against staff. This places young people at further risk of harm, particularly when managers do not conduct thorough risk assessments to protect both staff and young people.

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Safeguarding children and young people

Records are not available in the home to inform relevant personnel of the progress of any allegation. This reduces the effectiveness of any measures identified to protect young people. Managers have requested training and greater clarity in procedures to be followed in the event of an allegation against staff. Current policies and procedures available in the home do not reflect statutory guidance. This prevents managers from undertaking a clear course of action within short time scales. This means that young people live in a home where their safety and welfare is not promoted at all times.

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Leadership and management

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

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Leadership and management

Managers lead a qualified and experienced staff team that provides a service valued by young people, parents and social workers. Formal concerns and complaints are not a feature of the home. Managers are working to reintroduce consultation with parents and young people to elicit their views, to inform development of the home. Social workers say staff are always willing to listen to suggestions. They work hard to improve the service they offer to young people.

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Leadership and management

Managers have not adequately addressed two recommendations from the last inspection. Staff do not record the views of young people following sanctions and restraint. This prevents a complete picture of the intervention and reduces opportunities for restraint practice to be fully scrutinised. Secondly, although the administration and dose of drugs are recorded, there are inadequacies in the system, such as bottles without pharmacy instructions and a practice of covert medication administration that continues to place the health of young people at risk. Managers do not effectively monitor the quality of care, as evidenced by the number of issues identified during this inspection. Managers do not evaluate records, for example, of significant events or staff training needs, to formally demonstrate the impact and value that living at the home has had on young people. As a result, they have an incomplete picture of the strengths and weaknesses of the home. For

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Leadership and management

example, essential documentation such as behaviour support plans and associated individual risk assessments are missing from some records for young people. Managers do spend time with young people, but do not routinely follow up any concerns raised by staff in daily logs of the conduct of the home. Staff participate well in staff meetings to focus on the needs of young people. However, minutes of staff meetings are not circulated promptly, to promote staff awareness of identified shortfalls. Staff say that matters arising from staff contributions are not regularly incorporated into any plans to improve the quality of care.

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Leadership and management

Managers have begun to compile a development plan for the home, in consultation with staff. As yet, young people and other stakeholders have not been consulted. Managers have not maintained structures for communicating with stakeholders, or monitoring the administrative systems of the home, such as staff training records. This prevents a complete picture of the development needs of the home. Additionally, managers have not published actions to address all shortfalls identified. This limits development of the service, and for example, prevents a targeted training plan to meet the professional needs of staff. Vulnerable young people are not car ed for in ways that promote their development and independence.

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Leadership and management

Staff keep daily records about the experiences of young people at the home. Key workers collate information from daily records of young people’s experiences, to present to reviews of placement. However, managers are concerned that the quality of this information is variable, and does not present a complete picture of how life has improved for young people because of planned interventions. This means young people do not benefit from care that is evaluated for its effectiveness.

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Leadership and management

Most staff say that they receive regular supervision. However, supervisors fail to address promptly any shortfalls in staff care practice and professional knowledge, such as ineffective key working or poor awareness of child protection procedures. This means young people do not receive a service that reflects a commitment to meeting all their identified needs.

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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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