Children's Home run by Action for Children in Surrey

Unique reference number SC013743 Inspection date 21/05/2013 Inspector Emeline Evans / Gavin Thomas Type of inspection Full Provision subtype Children's home

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Date of last inspection 06/02/2013 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 home is run by a charitable organisation and is registered to provide care and accommodation for up to 19 children; 15 children with learning disabilities and up to four places for children with a physical disability. Young people are accommodated in four separate houses; three of which offer residential services and one provides three places for short break care only.

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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

Young people are supported by a committed management and staff team. Staff are child-centred in their approach and consistently concerned with the welfare of the young people. Young people are clearly settled and comfortable in their environment and it is apparent they benefit from caring members of staff who know them well. One parent commented, ‘I am very pleased with what the home offers’, and ‘my son is happy.’

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Overall effectiveness

Young people are making significant progress since their admission and staff support young people to progress in areas such as social development and independence. Young people are making good use of communication systems to express their wishes and needs and positive relationships with external professionals are in place to ensure a holistic approach is achieved. Young people are supported by a staff team who are familiar with their needs and vulnerability. As a result, safety is a central to all aspects of care planning, shift planning and staffing arrangements. Young people enjoy warm and constructive relationships with staff through individualised care.

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Overall effectiveness

The past six months has been a period of change for the staff who work at the service and the management team. The staff and managers have been working hard to try and achieve consistency for the young people. Areas of shortfall were identified within this inspection and are reflected in the overall judgement. The majority of these shortfalls relate to records and ensuring they comply with regulations. A review of the current behaviour management policy is also required and to strengthen current management monitoring systems. In addition, some aspects of safe recruitment practices could not be evidenced for some members of permanent and agency staff. Some recommendations have been re-stated. The management team are aware of the home’s shortfalls and is committed to further improve outcomes for the young people and provide a high quality service.

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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) ensure that within 24 hours the use the any measures of control, restraint or discipline, a written record is made in a volume which includes all details listed in these regulations (Regulation 17B (3i) and (4b)) 28/06/2013

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Reg. Requirement Due date

17B (2001) review the behaviour management policy to ensure it sets out measures of control, restraint and discipline which may be used in the children's home (Regulation 17B (1)(a)(2)(a)) 28/06/2013

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Reg. Requirement Due date

(2001) Obtain for all staff, before they start work at the home, all the information set out in Schedule 2 (Regulation 26(3)(d)) 28/06/2013

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Reg. Requirement Due date

(2001) ensure the registered person reports notifiable events to the appropriate authority without delay (Regulation 30 (1)) 28/06/2013

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Reg. Requirement Due date

(2001) ensure the monitoring of matters set out in Schedule 6 focuses on improving the quality of care and any report in respect of any review conducted is supplied to HMCI (Regulation 34 (1)(a)(2)) 19/07/2013

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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 any strategies to reduce the incidences of any negative behaviour exhibited by a child are agreed by the necessary people and this consent is documented in the child's placement plan (Volume 5, statutory guidance, para 2.88)  ensure risk assessments are carried out on the whole of the children's home environment, to identify any potential sources of harm, with particular reference to areas of maintenance which are outstanding and heating large amounts of oil in kitchen areas (NMS 10.8)  review the children's guide to include how children can contact their independent reviewing officer, Ofsted, and how to secure an independent advocate (NMS 13.5)  devise and implement a written development plan, reviewed annually, for the future of the home, either identifying any planned changes in the operation or resources of the service, or confirming the continuation of the home's current operation and resource (NMS 15.2)

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Recommendations

 ensure that sufficient information (written or electronic) is retained at the home, demonstrating that the recruitment and selection of staff consistently follows good practice, and all applicable current statutory requirements and guidance (NMS 16.2)  obtain further checks as are considered appropriate for staff, who have lived outside of the United Kingdom, before they start work to establish their suitability to work with children (NMS 16.3(f))  provide evidence that all staff have their performance individually and formally appraised at least annually (NMS 19.6)

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Outcomes for children and young people

Young people benefit from individualised support, which helps them grow in confidence and promotes all aspects of their individual identity. Young people make measurable progress in many aspects of their lives. Staff, parents and social work professionals recognise the achievements young people have made and are able to give numerous examples of how young people have developed as a result of their placement in this service. Young people’s self-esteem is developing well because of the child-focused care provided by a staff team who maximise the potential of each young person. Young people have made progress in their behaviour, personal care skills and social interaction. Young people are now able to use the toilet independently and accept and respond to peer interaction. One parent commented, ‘my son’s behaviour has improved because of staff input.’ A social worker also commented, ‘the young person has made great strides over recent months because

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Outcomes for children and young people

Young people’s health needs are fully met. Young people attend regular health appointments and are beginning to cope appropriately with medical check-ups. Healthy lifestyles are promoted according to young people’s ability to understand what is socially acceptable or not. Sexual health and matters relating to puberty are explained to young people as they begin to mature. Young people receive appropriate support from children and adolescent mental health services and specialist health services. Outcomes of all medical treatments are well documented and monitored. This practice ensures individual health needs are identified and a holistic approach is achieved.

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Outcomes for children and young people

Staff fully support young people’s education and young people have excellent attendance at school. Staff ensure there is good communication with schools and attend educational reviews as appropriate. Staff work closely with teachers to ensure consistency is achieved. These relationships help young people to be supported in meeting their individual goals.

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Outcomes for children and young people

Effective communication between staff and parents ensure key messages about the care and well-being of the young people is properly addressed. The home has regular contact with parents through phone calls and communication books. One parent commented, ‘staff communicate well, they include me in the care of my son.’ Individual contact arrangements are suitably supported and facilitated by staff. This ensures that young people maintain contact and attachments with parents, carers and those important to them.

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Outcomes for children and young people

Young people can take part in a range of activities and the premises have a wide range of indoor and outdoor space. A sensory room provides stimulation with light, sound and texture, which promotes sensory development. Young people engage in activities in the community and are encouraged to learn and try new experiences. Staff ensure young people make good use of age-appropriate local amenities such as local bowling, swimming and the local shops. This gives young people the opportunities for social interaction to be further enhanced.

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Outcomes for children and young people

There is a focus on developing young people’s independent skills; this has resulted in young people learning new skills such as shopping, self-help skills and cooking. Young people are developing in this area and this is contributing to enhancing their self-esteem. These achievements are enabling young people to develop new skills in the preparation for their transition to adult life. Staff recognise the progress made in this area and this is reiterated by the young people’s parents.

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Quality of care

The young people benefit from good supportive relationships from committed and attentive staff members. This is validated by the positive regard that young people hold for the staff who support them and equally ratified by the young people’s parents. Comments from parents include, ‘I can’t praise the staff enough’ and ‘staff are excellent.’ Observations were indicative of the trusting and fulfilling relationships established between the young people and staff. Staff are aware of and observe non-verbal communication and are proactive in reassuring young people during difficult times.

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Quality of care

Young people use a range of communication methods including pictures and schedules. Staff are consistent in the use of these aids and adapt and personalise these methods according to the young people’s level of understanding. Young people are supported to make choices in aspects of their care including the activities they take part in and the snacks and meals they eat. Staff will advocate and raise concerns on behalf of the young people. This demonstrates that staff listen to and respond to any concerns young people may have and action is taken to address these. The home is proactive in responding to matters raised by parents and this shows the service’s commitment to act upon comments in order to improve the quality of care.

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Quality of care

Young people’s needs are central in all aspects of care planning. Detailed and comprehensive placement plans are developed. Placement plans take into account the diverse and complex needs of the young people accessing the service including their medical, health and cultural needs and additional support required due to disability. These plans are individualised and enable staff to support young people and understand the possible reasons for negative behaviours. Staff are familiar with young people’s placement plans and these are used fluidly across the shifts. One parent commented, ‘all staff are familiar with my son’s needs.’ This practice ensures consistency in the quality of care is achieved.

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Quality of care

Medication systems in the home are safe and effective. There are a range of medication procedures available to ensure staff are confident in their role. Staff are suitably trained in first aid skills. Some young people have complex health care needs that are managed well by staff. There is appropriate attention provided to any emerging or on-going health or emotional needs. Staff work in partnership with community nurses and other health professionals to ensure continuity of care.

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Quality of care

There are presently four separate houses providing accommodation across the site. Young people receiving short break care are accommodated separately, which does not cause any disruption to the young people resident. Young people enjoy living in a safe and pleasant environment; there are photographs of the young people having fun, displayed around the homes. The home has appropriate specialist equipment to ensure the individual needs of the young people are met, such as adapted baths and ceiling hoists.

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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 routines and structures in place for individual young people support them in feeling safe and comfortable in their surroundings. Young people’s vulnerability is central to all aspects of care planning, risk management and the supervision of young people for off-site activities. Staff interpret young people’s behaviours very well and are therefore able to act upon any instances when young people are worried or upset. This means young people are able to achieve in their personal development as they feel safe. Staff receive training on safeguarding and recognise the particular vulnerabilities relating to the needs of children with disabilities. As a result, staff demonstrate a good understanding of the action to take should they have a concern about a young person’s well-being. The policies and procedures in relation to safeguarding are readily available to staff. The supervision provided from the staffing levels minimises the risk of young people going missing. Procedures are

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Safeguarding children and young people

known by staff if the need should arise.

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Safeguarding children and young people

Care planning documentation clearly identifies risks and preventative measures. These are consistently implemented and keep the young people safe. Staff are knowledgeable about the particular vulnerabilities of the young people and this information is supported with care plans. Staff are vigilant in responding to young people’s gestures and behaviours. Early intervention and re-direction is used and staff attempt to understand how young people are feeling. Sometimes physical intervention is used to prevent situations escalating. A bound volume to record physical interventions is in place. However, this is not being completed within 24 hours after an incident. It also is not being fully completed on all occasions and does not capture all the required information. This makes it difficult to monitor the effectiveness of interventions and look at patterns and trends. Young people have individual behaviour plans in place and the home has a behaviour management

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Safeguarding children and young people

policy in operation. The home currently uses additional forms of control for some young people to safeguard the young person, other young people and staff. This is not detailed in the behaviour management policy. Therefore, this document requires reviewing to include all measures of control, restraint and discipline currently used in the home to enable staff to be aware of correct procedures. These additional behaviour management strategies have not been formally agreed by parents and social workers.

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Safeguarding children and young people

The management confirms there is careful selection of staff working with young people in the home. Currently, evidence of all recruitment checks are retained off site. The team have worked hard to gain the necessary information and ensure information relating to Disclosure and Barring Service checks and references for staff are now contained within the service. Records show all information relating to the recruitment of new members of staff; however there are still some gaps for longer standing members of staff. Where a member of staff has lived outside of the United Kingdom, relevant Disclosure and Barring Service checks are undertaken prior to staff starting work. However, it is not clear if further checks are undertaken to establish their suitability to work with children. The service has used a number of agency staff in recent months. At the time of inspection, the necessary information had not been obtained from two of the employment agencies in relation to

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Safeguarding children and young people

Disclosure and Barring Service checks or photos to show their identity. Therefore, it is not possible to ascertain from records in the home these members of staff’s suitability to work with children and young people.

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Safeguarding children and young people

Young people are protected through the implementation of a range of personalised risk assessments. These risk assessments include young people’s health needs, mobility impairment and environmental factors such as young people’s lack of knowledge around personal safety. Young people know what to do in case of a fire or emergency. Regular health and safety checks of the home are undertaken and maintenance issues are addressed. This ensures a safe environment for everyone living in and visiting the home. However, some areas of maintenance which are outstanding have not been risk assessed. These include, exposed wires and a shower trolley currently being held in an upright position by a plastic bag. During the inspection, in one house a large amount of oil was being heated in a pan for cooking purposes. There are no risk assessments in place to address this and to ensure staff are vigilant and aware of potential risks to ensure they safeguard the young people.

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Safeguarding children and young people

Since the last inspection, the home has been in regular contact with the local fire and rescue service with reference to providing adequate means of escape. There has since been a fire safety audit and appropriate action has been taken by the home.

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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

Since the last inspection, two managers have been appointed. These managers are currently in the process of registering with Ofsted. The managers and staff team are committed and focused on improving the quality of care in the homes. The restructuring of the staff team has been completed and the managers are continuing to identify and redevelop practice and processes. There have been staff shortages in recent months and the management team have had difficulties in recruiting to senior positions within the homes and have therefore taken on additional responsibilities within the staff team. The managers are beginning to work collaboratively to identify areas for development of the service and are enthusiastic about progressing forward. However, formalised plans for development of the service are not presently in operation, therefore the management and staff team are unable to reflect on the progress in the home.

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Leadership and management

A comprehensive Statement of Purpose is in place and has recently been revised. It clearly outlines the aims and objectives of the service. There is a clear emphasis on working in partnership with the young people, parents and professionals to achieve a consistent approach to meet the needs of the young people. Young people are provided with information, which summarises the home’s Statement of Purpose and uses simple language and symbols. However, this children’s guide does not include the correct details for Ofsted. In addition, the children’s guide does not include information on how a young person can contact their independent reviewing officer or how they can secure access to an independent advocate.

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Leadership and management

Changes within the organisation and service have resulted in a number of staff moving on. Recruitment processes are underway to fill vacant posts. In the meantime, young people are supported by regular sessional and external agency staff and the remaining permanent staff. Staff report that they are very well supported by the management team and benefit from regular supervision. However, there is inconsistency in the annual appraisals taking place; some staff have not received an appraisal in the last year. This means that staff performance over the year is not fully evaluated. Staff are suitably trained to meet the needs of the children who access the service. Recent training includes safeguarding and first aid, fire safety and specialist training relating to the health needs of the young people including stoma care, administration of oxygen and gastrostomy feeds.

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Leadership and management

Regular monitoring visits are undertaken via internal and external audits by the service manager and an external visitor. However, internal monitoring does not fully evaluate the service or provide actions for the home. This could mean that shortfalls in the care of the young people are not being recognised and addressed; in addition, the information is not well used to improve the quality of care provided. At present reviews are not being sent into Ofsted. The home received one external complaint sine the last inspection. This was addressed robustly and fully and the service to awaiting the outcome. Following this complaint, procedures have been revised and action plans put in place. This demonstrates capacity to learn from feedback and to make changes in order to improve outcomes for young people.

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Leadership and management

The previous requirements made at the last inspection have been fully met. However, a number of recommendations have been re-stated. These include; to ensure information relating to the Disclosure and Barring Service and references for staff are now contained within the service. The team have worked hard to gain this information however; this has not yet been fully completed. The managers have yet to ensure all staff receive their annual appraisals. In addition, a development plan is not in operation so the team are unable to reflect on progress made within the service.

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Leadership and management

Events that require notification to Ofsted are not always forwarded. These relate to serious illness sustained by a young person in the home. Appropriate action was taken by the home in all instances. Records are clear and comprehensive and contribute to an understanding of the young person’s life. This helps staff in supporting young people to understand their background.

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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 the inspection of children's homes.

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