Children's Home run by Barnardo’s in Oxfordshire

Unique reference number SC013144 Inspection date 15/10/2012 Inspector Bridget Goddard Type of inspection Full Provision subtype Children's home

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Date of last inspection 26/03/2012 Website: www.ofsted.gov.uk

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Brief description of the service

This residential short-break service caters for up to six children or young people at any one time. 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.

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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 good .

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Overall effectiveness

This is a good home which demonstrates very good practice across the board. Young people clearly enjoy and benefit from their stays, and staff understand young people and their often complex needs very well. The home is well-maintained and equipped both inside and out. Young people are kept safe by individualised risk assessments and careful attention to health and safety matters.

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Overall effectiveness

Young people's health needs are particularly well met, with very good medication practice and clinical training opportunities. The home has a relaxed atmosphere, and behavioural problems are rare with minimum focus on restraint and sanctions. Staff are very skilled at managing young people in a positive manner.

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Overall effectiveness

The home has detailed individual profiles on young people, but has not yet consistently developed these for reviews of young people’s care or to routinely inform improvement. Social workers and parents think highly of the care the home offers, but their views are not yet systematically gathered to assess impact and inform improvement.

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Overall effectiveness

Staff are well supported by a strong and respected management team and receive regular supervision and training. This is usefully supplemented by regular team days which offer training updates and valued opportunities to discuss young people in depth. The home is encouraging staff to consult with young people at the beginning and at the end of a stay, and young people recently gave valuable feedback about the garden refurbishment.

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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 home assists the child to put forward their views, wishes and feelings in each review process, and helps to ensure these are fully taken into account (NMS 25.4)  ensure that the wishes, feelings and views of children and those significant to them are taken into account in monitoring staff and in developing the home. (NMS 1.7)

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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

Young people are given very good support to develop a positive self-view and grow in confidence. Some young people proudly show off the new manicures they have had at the home, and one parent said that their child has 'grown in confidence' since being in the home. Many young people enjoy being involved with messy arts and crafts resources such as finger painting. Some young people's work has been chosen to represent a month in a national calendar.

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Outcomes for children and young people

Young people have very diverse needs and skills and plans for them reflect their individuality. Some young people enjoy accompanied visits to shops or youth clubs, and other young people enjoy staying in the home and being part of the comfortable buzz of people around them. Some young people achieve independence skills such as contributing to their personal hygiene, or making simple snacks in the kitchen.

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Outcomes for children and young people

Young people are encouraged to make some choices about their everyday life, no matter what their communication methods may be, and their choices are followed wherever possible. For example, some young people make it clear that they do not like a food by closing their mouth and turning away, while others write to the manager asking for particular dvds and games. Both types of preferences are detailed in individual profiles and respected.

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Outcomes for children and young people

Young people's health needs are very well promoted. There is an effective partnership between nursing and care staff and a meticulous approach to meeting individual health care needs. The home is a key player in the 'team around the child' and works closely with parents and external medical staff to ensure young people's well-being is maintained. Young people are often transported to and from the home by school transport. As such, their school attendance is good and their achievement is in line with their peers. Most young people live at their family home for the majority of the time and so their parents retain the main responsibility for their school attendance and achievement.

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Quality of care

Social workers say that: 'Staff know the young people very well.' They understand young people's complex needs and communication patterns. Parents say staff: ‘Know by his expressions when he is beginning to get anxious and they talk to him a lot and reassure him.' Everyday interactions between staff and young people are relaxed, friendly and warm. These good quality relationships mean that negative behavioural issues are rare, and so there is a positive and happy atmosphere in the home.

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Quality of care

Each young person receives highly individualised care, including behavioural strategies based on positive reward and distraction. For example, some young people have objects of reference like favourite toys or a bath sponge to help calm them when getting upset. Other young people have 'now and then time-lines' with symbols demonstrating the next activity, which helps minimise the stress of unexpected transitions for them. These strategies help young people to continue enjoying their stay.

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Quality of care

Young people communicate in a range of ways. Some use electronic devices, others visual symbols and some body language. A minority of young people communicate by writing or speaking. There is a communication whiteboard and a participation whiteboard which are personalised each day according to the activities and views of young people who are staying. Staff are strongly encouraged to routinely use these resources, and increasingly do so. This is well supported by a very recent addition to the daily recording sheet which asks for confirmation of their use.

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Quality of care

Young people's views are actively and imaginatively sought on key changes to the home. For example, the home has recently had a comprehensive garden refurbishment. Young people were fully involved in the design options: some voted on pictures, others picked images of favourite activities from magazines, and some did drawings of features they wanted. The most wanted feature was a wheelchair track, and this is now in place.

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Quality of care

Each young person has a highly personalised 'My profile' which elaborates on their basic care plan. This is written in the first person and draws a vivid picture of each young person's needs, preferences and personalised outcomes. Social workers say they like these profiles and find them useful: 'You can recognise the child you know from them.’ The profile is a living document, drawn up initially with parents, and then added to as the young person settles in. However, this important profile is not consistently built on and used to inform reviews of young people’s care. This means that young people do not always have opportunities to contribute their views and feelings at their reviews in whatever way suits them best.

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Quality of care

Many young people using the service have significant and complex health needs, and some have deteriorating or life-limiting conditions. Nursing staff take responsibility for overseeing medication and updating staff on necessary medical procedures. Staff are carefully trained and assessed and there are always two staff administering and checking medication. Medication practice is highly effective, and very well managed.

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Quality of care

Nominated staff carefully plan young people's stays. Their detailed knowledge of each young person means that grouping of young people is generally very successful. Some young people enjoy a range of activities in the community, while others prefer to watch dvds, or use the home's jacuzzi, chair pods or sensory room. Staff sometimes mix young people who are wheelchair users with young people who are more mobile, as some get great pleasure from watching each other. On other occasions, they put together young people who like a noisier environment, or those that know each other from school. Parents say that it is an opportunity for their child to have: 'A sleepover with friends which is an opportunity they otherwise wouldn't have.'

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Quality of care

Staff address equality issues in other ways as well, for example by persisting in finding safe ways to take young people into community activities. This means that disabled young people can access similar opportunities to non-disabled young people. Staff are a diverse group in age, gender, ethnicity and disability, broadly reflecting their community. They reflect their diversity in daily living at the home, for example offering a wide range of home-cooked food which reflects both individual, religious and medical preferences.

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Quality of care

The home is well located and maintained to a high standard. There is an excellent range of all-weather activities in the garden area, and accessible and comfortable spaces internally, offering a very good range of choices for young people.

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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

Young people demonstrate by their relaxed and trusting behaviour that they feel safe with staff. Parents refer to their child's growing excitement and happy face as they arrive at the home. Parents also say that they do not have to worry when their child is staying at the home. One parent said: 'There are very few places I would send my child to, but I totally trust them there.'

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Safeguarding children and young people

Staff receive good safeguarding training, and social workers think that they make effective judgements about whether to deal with concerns themselves or to pass them onto social workers. Staff use positive behaviour strategies based on distraction and reward. These are highly effective as demonstrated by the home's nil use of restraint. Social workers refer to 'young people being managed well'. Sanctions are also used very rarely. This all helps to promote young people's safety and well-being. Good staff ratios, appropriate security and vigilant staff attention mean that ambulant young people are very unlikely to go missing. However, the home has a protocol with local police regarding this and each young person has a personalised missing description and process. Very good attention is paid to fire safety with regular drills and evacuations, and routine creative training to keep people alert. Each young person has an individualised evacuation plan in case of an emergency.

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Safeguarding children and young people

General health and safety checks are reliably carried out, and there is an annual thorough audit of all such matters. This careful attention to detail ensures that young people are kept as safe from accidental harm as possible.

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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. References are followed up by telephone checks. 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 premises have appropriate security with key fob access on the front door. Staff can also set alarms on individual bedroom doors in line with individual care plans. This promotes 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 good .

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Leadership and management

The home is effectively and efficiently managed by a respected management team. Parents comment: 'Management is very efficient and on the ball, with bookings being received well in advance.' Social workers find that staff have: 'A non-defensive approach and always willing to look at how things could be improved'. Social workers also appreciate: 'The approachability of staff and their non-bureaucratic and flexible approach.' These positive comments reflect well on the skills of a strong leadership and management team.

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Leadership and management

Staff have regular supervision which is well recorded and appropriately signed and dated. Staff value this opportunity to reflect on their practice, describing it as an opportunity to 'talk about difficult things'. Mandatory training is routinely held. It is supplemented by more specialist inputs, for example on understanding autism, which are creatively sought from suitable sources. This provision of high quality supervision and training helps ensure that staff are fully equipped and supported to provide good quality care to young people. Monthly team days are held updating staff on key areas, and providing valued opportunities to discuss young people's needs as a team. This helps promote a consistent approach to young people's care.

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Leadership and management

There have been no concerns or complaints since the last inspection. The home has further promoted young people's welfare by fully meeting the requirements and recommendations from the previous inspection. The home has a suitable statement of purpose and parents, staff and other professionals are clear about the services and facilities provided.

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Leadership and management

Monitoring visits by the registered provider are effectively completed in a timely manner, and include focused attention on young people. The manager also routinely audits young people's files and other key documents. This is effective in ensuring a generally good standard of record keeping. Records are kept securely and are clear and up-to-date. The manager also routinely consults with young people, for example over such issues as the garden refurbishment. She also ensures that there is a space on the booking form for parents to give their views on the home. However, although there is an appropriate development plan in place for the home this is not informed by systematic feedback from key parties. This could help evidence the impact the home is having and inform possible improvements.

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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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