Children's Home, Residential special school run by Cambian Autism Services Limited in Dorset

Unique reference number SC065261 Inspection date 15/10/2012 Inspector Paula Lahey / Maureen Hamer Type of inspection Full Provision subtype Residential special school (>295 days/year)

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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

This national private organisation provides care and accommodation for up to 60 students with autistic spectrum disorder and learning difficulties. It operates as a residential special school which also provides accommodation for a number of students requiring 52 weeks boarding and is therefore registered as a children's home.

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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 adequate .

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Overall effectiveness

This inspection was conducted using the Framework for Inspection and Evaluation Schedule (published February 2012); it is the first time judgements in this service have been made against these grade descriptors. The full inspection was carried out over two days with inspectors on-site on 9 and 10 October 2012. Final feedback was provided on 15 October 2012.

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Overall effectiveness

This service has a number of strengths and areas of good practice. This includes the effective multi-disciplinary team working, the successful ‘waking day’ curriculum and the commitment and enthusiasm of the staff team. This positively benefits young people and supports their development.

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Overall effectiveness

Social workers and families comment positively on the services that are provided and the progress that young people make. Young people have individual objectives to support their personal, social and educational development. The service has a positive impact on supporting young people to achieve these objectives and maximise their potential. Parents say: ‘Since my son started at the school last year, I cannot fault the care and attention that both he and us, as his parents have received from the staff’ and ‘My daughter is very happy and content and looks forward to returning there after a home visit. You couldn’t ask for more.'

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Overall effectiveness

Young people have a wide range of complex needs and communication difficulties; as a result, they may present with high levels of challenging behaviour. The staff team are determined in their commitment to keep young people safe. Their welfare and security is of paramount importance. However, this has resulted in the use of some restrictive practices within behaviour management and the regular use of physical intervention. Monitoring systems have not been utilised fully and gaps in the recording of interventions impede effective analysis. The current behaviour management practices require strategic review in order to identify alternative strategies, reduce the use of restraint and ensure practice remains in line with current statutory guidance.

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Overall effectiveness

Requirements have been made to address shortfalls in the formal supervision of staff and ensuring detailed records are maintained when restraint is used to support medical interventions.

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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

17B (2001) keep under review and revise the behaviour management policy. In particular, review the approaches used in order to identify alternative strategies of dealing with behaviour so as to significantly reduce the use of restraint and restriction of liberty (Regulation 17B (2)(a)) 31/01/2013

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Reg. Requirement Due date

17B (2001) ensure that where a measure of control, restraint or discipline is used the record required under Regulation 17B includes the duration of the restraint, details of de-briefing of a young person and the effectiveness of a sanction (Regulation 17B (3)(a-i)(4)(a-b)) 30/11/2012

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Reg. Requirement Due date

17A (2001) ensure that where a measure of restraint is used on a child accommodated in a children’s home, the measure of restraint must be proportionate (Regulation 17A (2)(a)(b)) 31/01/2013

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Reg. Requirement Due date

(2001) ensure the proper provision for the care, education, supervision and where appropriate, treatment of children. In particular, ensure that records evidence consultation and decisions made when using restraint to administer medical treatment (Regulation 11 (1)(b)) 30/11/2012

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Reg. Requirement Due date

(2001) ensure that all staff receive regular supervision and appraisal, consistent with the organisation policies (Regulation 27 (4)(a)) 30/11/2012

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Reg. Requirement Due date

(2001) ensure that the registered person shall maintain a system for robustly monitoring the matters in Schedule 6 in order to improve the quality of care. In addition, ensure that detailed records are maintained to evidence analysis of trends and patterns of behaviour management. (Regulation 34 (1)(b)) 12/11/2012

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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 decisions about the locking of kitchen cupboards and doors is based on a careful risk assessment that is recorded and allows children as much freedom as possible balanced with the need to keep them safe; this refers to the completion and regular review of written risk assessments with regard to this matter. (Children Act 1989: vol. 5:2.108)

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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 attend the provider's school and are making sound progress towards achieving personalised objectives outlined on their education plan. Individual objectives are carefully selected to enable young people to maximise their communication, social and daily life skills. Young people are actively supported to achieve personal goals, and as such, are making positive progress.

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Outcomes for children and young people

Young people’s communication skills are improving. Some young people are more confidently using picture exchange systems and schedules in order to make choices and talk about their emotions. This in turn, reduces their sense of frustration and anxiety. Some young people are trialling more technical systems such as white boards, iPods and iPads in order to further develop their individual communication abilities.

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Outcomes for children and young people

Young people maintain good contact with their families and those who are significant to them. Creative strategies such as Skype, email, and newsletters are fully utilised to ensure young people can expand their communication method. Documentation provides families with information about their child's progress and weekly activities. Families welcome the newsletters as tools that support their interaction and contact with their child.

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Outcomes for children and young people

Young people’s physical health and self-esteem is promoted. Young people enjoy activities that keep them fit and develop their confidence. The summer camping trip is good evidence of this. Young people’s involvement in the school and local community is encouraged. Some young people deliver local newspapers and have recycling and shredding roles. Additionally, the whole school supports national charities and joins in with community activities such as celebrating the royal events. Good use is made of photographs to provide young people with memorabilia of their time in the service and remember the fun and experiences that they have had. Each young person has an individual life book to store memories and achievements. This enhances their sense of identity. There are some effective strategies in place to support young people to more positively manage anxieties around changes in their routine and/or environment. For

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Outcomes for children and young people

some young people this has resulted in a decrease of self-injurious and physically challenging behaviour. This in turn improves social interactions with family and friends. However, for some young people de-escalation techniques are not always successful and result in the use of restraint or seclusion. The use of these restrictive techniques does not develop enduring emotional resilience of the young people.

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Outcomes for children and young people

Young people have the opportunity to participate in a weekly rota of chores and develop cooking skills. This enables young people to take responsibility for caring for their environment and improve social skills and personal care. Targets are individualised and achievable, ensuring young people experience success. Achievements are celebrated at weekly assemblies and this raises young people's self-esteem.

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Outcomes for children and young people

While there is a positive focus on developing young people’s independence some practices within the living groups do not promote this to its best advantage. For example, in some of the living groups, it is practice to routinely lock kitchen cabinets and on some occasions kitchen doors. Some young people do not need this safety measure and have to refer to staff to unlock these areas. As a result, this does not promote young people's independence as fully as it could and impacts on their right to freedom within the home.

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Quality of care

There is a holistic approach to monitoring and promoting young people’s development. A strong and focused multi-disciplinary approach is enhanced by effective partnership working with families. Focus meetings, ‘E’ clinics and statutory reviews provide the health, therapy, education and care teams regular opportunities to assess young people, devise objectives and review progress. This ensures that young people are provided with an effective ‘waking curriculum’ and a consistent approach to meeting individual objectives.

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Quality of care

Care planning is suitably detailed and provides staff with clear guidance about how to support young people’s individual needs. Plans are regularly reviewed in consultation with families and the multi-agency teams. One family says, ‘our opinions on every aspect of our son's education and care are sought at every opportunity.' Staff observe young people closely to ensure their individual preferences and likes and dislikes are incorporated into support plans.

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Quality of care

The current behaviour management policy promotes the use of positive behaviour intervention and individualised approaches. For the most part this is successfully achieved in practice. Personalised support plans detail proactive strategies and de- escalation techniques and these are subject to regular review and revision. However, in some cases they are not always successful at effecting change. As a result, restrictive techniques to manage young people’s behaviour continue to be employed. There has not been strategic review of these practices in order to develop reduction plans and remain in line with current best practice.

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Quality of care

Young people’s physical and emotional health is well monitored and specialist support is provided by the psychology team and school nurse. Young people are provided with good quality nutritious food. There is good recognition of their individual dietary needs and personal preferences. These are incorporated into menus alongside opportunities to enable young people to experience new tastes. Subsequently young people who previously chose a limited diet have been trying new foods and determining genuine likes and dislikes. Young people are able to influence the running of the school and living groups by a well-established and effective school council. As a result of listening to young people the service has built a cycle track, provided young people with a residential holiday and enjoyed a fun football tournament against peers from a local school.

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Quality of care

Young people are supported to take part in a range of purposeful activities. Whole school development objectives are set which support the planning of activities designed to improve outcomes for young people. This year the focus has been on 'being healthy and keeping active'. In addition, a target in the living groups has focused on promoting young people's musical talents. Young people have enjoyed many activities, some of which include swimming, camping, horse-riding, themed meals out, bowling and karaoke. There is a balanced approach to the risk management of activities. Despite young people’s complex and challenging needs they are appropriately enabled to experience community opportunities in line with their peers. Staff knowledge of young people’s ethnicity, cultural and identity needs is strong, and individual needs are fully addressed in activity and care planning. Families comment positively on how well young people’s individual spiritual needs are

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Quality of care

Young people are accommodated in a number of living groups, both on and off the main site. Young people are grouped depending on whether they stay full time or termly. This supports young people's feeling of security. Young people's areas are personalised according to their individual needs and preferences. The service have made improvements in décor and furnishings this year in order to ensure the environments are homely and purposeful. Continued improvements to bathrooms are currently underway.

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Safeguarding children and young people

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

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Safeguarding children and young people

The service is committed to ensuring the safety of young people, staff and visitors. This view is shared by families and placing authorities. There are effective links with local safeguarding agencies and any concerns about the protection of young people are appropriately shared. Health and safety is effective and conscientiously managed. Damage to property is promptly addressed and ensures the environment is safe and well maintained. Recruitment and monitoring of visitors to the school is robustly managed. These practices ensure the safety and protection of young people. The staff team do promote a service of care and concern and seek to ensure the safety of young people and staff at all times. Young people have a wide range of complex needs; they may present with high levels of challenging behaviour which can lead to self-harm, physical incidents towards others and damage to property. As a result, there is a high use of physical intervention ranging from breakaway

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Safeguarding children and young people

techniques to supine and seclusion. Policies are in place to guide staff that these techniques must only be used as a last resort and/or in an emergency. However, records demonstrate the regular use of door holds and seclusion, and on one occasion, it is not evident that a young person or staff member were at risk of serious harm. This restricts young people’s liberty and is not practice that is supported by current statutory guidance. At the time of inspection the service had not identified other strategies or put in place restraint reduction plans for each young person.

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Safeguarding children and young people

Some incidents of restraint and behaviour management are not comprehensively recorded and this hinders effective monitoring. For example, some incidents are not recorded in the restraint logbook and there are some shortfalls in consistently recording the duration of interventions. There are creative strategies adopted to de- brief young people following interventions, however, records do not evidence this. There is minimal use of sanctions but, records do not verify whether the intervention has had a positive effect in changing a young person’s behaviour.

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Safeguarding children and young people

On occasions restraint techniques are used to support a young person with administering medical treatment. The service ensures this is at the direction of a registered medical practitioner in accordance with protecting the health of young people. However, records are not maintained to demonstrate multi-agency agreement for this or detail how young people are effectively prepared for the intervention.

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Safeguarding children and young people

Staff work in teams that are allocated to each living group. This provides young people with stability and a consistent approach. As a result, staff know young people’s individual needs well and positive relationships have been established and maintained. Staff observe young people closely and support them to develop appropriate interactions with their peers. Bullying and going missing are not issues which affect young people currently, however, suitable policies are in place should the need arise.

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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

There is a suitably experienced and qualified senior management team in place. They provide staff with strong leadership and clear direction. As a result, staff demonstrate a good understanding of their individual roles and corporate accountability to care for young people and maximise their potential. Families agree with this and say, ‘We have always been impressed with the staff and leadership. They are pro-active and champions of their students’ rights.' The Statement of Purpose, prospectus and organisation website provide detailed information about the school and children’s home. This ensures that placing authorities and families are provided with clear guidance about the purpose and function of the provision and the service they can expect to receive. The young people’s guide is produced in an easy to understand document and in a number of different formats to suit individual communication needs.

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Leadership and management

The service has undergone an organisation review this year; as a result, there has been some changes in staff personnel. The staff team have continued to work positively and professionally during this time to ensure minimal impact on the provision for young people. Many young people receive individual support from staff and this positively benefits them. Staff new to the organisation are provided with a comprehensive training programme. This includes mandatory training and shadowing work alongside experienced staff members, and results in staff appropriately inducted into their role. Staff are supported to reflect on their work with young people and use handover, team meetings, focus groups and de-briefings to good effect. However, since the last inspection formal supervision for staff has not been delivered regularly or in line with the organisation policies.

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Leadership and management

There are a number of systems to quality assure and monitor the organisation. This includes Regulation 33 visits, auditing of young people’s files and living group, regular focus meetings and handovers. The Registered Manager ensures there is an audit of the matters listed in Schedule 6 on a monthly basis. However, this system has not been fully utilised in order to demonstrate robust and purposeful review of the behaviour management approach.

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Leadership and management

The service has an understanding of its strengths and areas for improvement and action is taken to address objectives on the development plan. This year the service have improved the recording systems of contact with parents, provided young people with additional communication aids, and refurbished the living areas. These developments positively benefit young people and the quality of provision offered. Actions were taken following the last inspection to address the previous requirement and recommendations; however progress relating to the recording of the duration of restraint has not been sustained consistently. The service is committed to continuing to improve outcomes for young people and the strong leadership team are a driving force behind on-going developments.

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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 and the evaluation schedule for children's homes.

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