Children's Home run by Dorset Council in Dorset

Unique reference number SC032163 Inspection date 22/05/2013 Inspector Jennifer Reed Type of inspection Full Provision subtype Children's home

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Date of last inspection 31/01/2013 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 part of a range of services provided by a local authority. The home is registered to accommodate up to 14 children who have complex learning difficulties and disabilities. The home is in a period of transition and is re-focusing its service. The provision, originally a short break service, is now moving towards meeting the needs of children and young people who require longer term placements. The home currently provides accommodation for nine young people within the four distinct units operating within the home. At the time of the inspection, only one placement is provided as a short break service.

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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

Care practices within the home are underpinned by established policies and systems. Young people receive individualised care that aims to meet their assessed needs and to develop their potential. A range of specialist practitioners and professionals support the home in meeting the diverse needs of accommodated young people.

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Overall effectiveness

The multi-disciplinary plans in place, guide the provision of a focused delivery of personalised care to each young person. Young people have good access to health care services and they are kept safe. They regularly attend their specialist education provisions and receive good support to maintain contact with their families and carers.

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Overall effectiveness

Senior leaders and managers are effectively reviewing the operation of the home, to evaluate the impact of the change of status of the home and the quality of the delivery of longer-term care now being provided to young people. Specific measures have been identified and some action has already taken to bring about improvement in care practices and in outcomes for young people.

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Overall effectiveness

This inspection identified a number of areas for improvement to raise the standard of care provided to young people. These areas of practice are the : competency, accountability and training of staff; provision of regular supervision; the consistency and sufficiency of core staffing; establishment of positive working relationships with all professionals; provision of a homely environment; the review of risk assessments and risk reduction measures; medication procedures; quality of records and the effectiveness of quality assurance monitoring processes.

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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) provide a record of the receipt and disposal of any medicine for any child (Regulation 29 (1) Schedule 4 (5) 28/06/2013

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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

 review the locking of internal doors to individual units to ensure that the liberty of any child is not restricted as a matter of routine or provides any form of secure accommodation (NMS 3.19)  review incidents of challenging behaviour, examine trends or issues emerging from this, to enable staff to reflect and learn and to inform future practice; in particular, review the quality or incident recording (NMS 3.21)  ensure staff encourage children to take appropriate risks as a normal part of growing up (NMS 4.4)  ensure all children develop their emotional, intellectual, social, creative and physical skills through the accessible and stimulating environment created by the home (NMS 7.1)  establish positive working relationships with children's education providers to maximise each child's achievement and to minimise underachievement (NMS 8.4)  continue to redecorate and refurbish the home to provide a comfortable and

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Recommendations

homely environment; remove the staff guidance notices and white boards affixed to walls throughout the home (NMS 10.3)  ensure avoidable risks are removed as is consistent with a domestic setting; in particular, review the storage of equipment and resources in the corridor and in rooms currently not in use (NMS 10.3)  review risk reduction arrangements to ensure these measures to not lead to an institutional feel; in particular, the metal cages fitted to radiators and the locking of unit kitchen doors (NMS 10.3)  progress the review of the home and take action to ensure that the overall number, competence and deployment of staff, both as a staff group and on individual shifts, can meet the individual needs of all children resident in the home; in particular, ensure the core staffing of units is not overly disrupted (NMS 17.1)  progress plans in place to provide staff rotas that include time scheduled to

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Recommendations

ensure handovers are held for each shift (NMS 17.6)  progress the review of staffing to ensure every effort is made to achieve continuity of staffing so that children's attachments are not overly disrupted (NMS 17.8)  enhance individual skills by the provision of training to equip staff with the skills required to meet the needs of the children and the purpose of the setting (NMS 18.1)  ensure all staff are provided with regular supervision (NMS 19.4)  ensure there is an effective system in place to monitor the quality and adequacy of record keeping and take action when needed; in particular, in relation to the updating of key information and the completion of incident reports to stakeholders (NMS 22.1)  ensure entries in records are legible (NMS 22.4)  ensure the result of all statutory reviews and reviews of Placement Plans are recorded promptly on the child's file (NMS 25.8)  consider completing a review of Schedule 6 monitoring at six monthly intervals in

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Recommendations

line with good practice guidance, to identify any trends and issues of concern to inform the continual improvement of the quality of care provided by the home. (CA1989, Volume 5: statutory guidance 3.14)  ensure that everyone working at the home understands their roles and responsibilities and what they can and cannot do and decide upon on their own initiative (CA1989, Volume 5: statutory guidance 3.24)

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Outcomes for children and young people

Outcomes for young people are adequate .

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Outcomes for children and young people

Generally young people appear happy living in this home. One parent said, ‘The home has very friendly, approachable staff. They have a great understanding of my child’s needs.’ Young people are supported to spend time with their families and carers. Staff thoughtfully consider and plan how best the home can provide good support to young people at transition points in their lives. The home's input helps young people to move positively into adulthood. Young people’s health is promoted by the good support they receive to facilitate regular medical checks. They have good access to both universal and specialist health care services to meet their individual health needs. Young people’s individual and special dietary needs are well met. The balanced and nutritional meals help promote young people’s good health. Young people enjoy their meals and they are supported to develop their motor skills to successfully help themselves to food and

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Outcomes for children and young people

Young people have the right to private time and they can make choices about aspects of their daily lives. Staff take account of young people’s diverse abilities, likes and dislikes. This awareness contributes to young people being able to safely spend time doing the things they enjoy; for example, being in the sensory room, going for a walk or attending a school disco. However, adherence to the prescribed interventions outlined in care plans alongside the hierarchical team structure, sometimes reduces the staff team’s ability to make spontaneous decisions in response to young people’s emerging requests and behaviours as they develop.

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Outcomes for children and young people

All young people receive help to increase their levels of interaction and communication with others. The use of the picture exchange communication system supports young people to make their wishes, feelings and choices known to others Young people's personal and social development is increased by the help and support they receive to learn practical and self-care skills. This develops their confidence and independence as they grow into adulthood. However, the embedded considerations of safety, protection and risk assessment within the home limits the opportunities for young people to engage in appropriate risk-taking activities as a normal part of growing up.

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Outcomes for children and young people

Young people do not benefit from the security of always being looked after by staff they know well and trust. This reduces predictability in their home environment, lessens their ability to recognise significant adults in their lives and reduces the likelihood of positive interaction. The inconsistent staffing arrangements are particularly difficult for those young people whose anxiety levels are raised by any change in their routines. These young people are likely to feel less safe. External professionals note how unstable staffing arrangements in units adversely impact on young people in placement. One worker summarised this by saying, ‘the children do not have consistent teams of staff that really understand their specific conditions and how best to interact with them.’

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Quality of care

Multi-disciplinary care plans address young people’s identified needs and provide detailed guidance to staff on how best to support each young person to develop their potential. Parents, social workers and young people contribute to planning. Work has commenced in developing and using a range of suitable materials that with the aim of effectively helping young people contribute their views about the care they receive. It is intended that this information will also inform the development of the home to raise outcomes for young people in placement.

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Quality of care

Other professionals commend the home's key workers for their good understanding of individual young people’s needs. Keyworkers and managers guide other staff in the implementation of plans and behaviour management strategies. Their commitment to providing a consistent approach to supporting young people contributes to enhancing young people’s capacity to achieve, to develop their skills and to increase their independence. However, some external professionals report that the implementation of plans is not consistent. They comment that the specialist advice they provide to the home to improve outcomes for individual young people is not always acted upon by all staff. The lack of positive working relationships between professionals can potentially hinder young people’s development.

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Quality of care

Staff monitor young people’s physical and emotional health and their personal hygiene needs on a daily basis which promotes their well-being. Staff make sure young people receive the health services they need. The Registered Manager has sought the expertise of a local pharmacist to review the administration of medication and medical recording within the home to ensure best practice is achieved. The current arrangements for the receipt of medicines into the home and the disposal of unused medication lacks sufficient detail to assure safeguarding. This has not impacted on children to date.

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Quality of care

Staff support young people, their families and carers to spend time together. Young people's visitors are made welcome in the home. Young people have time to socialise with their peers within the home and by participating in school and community leisure activities. Every young person enjoys a holiday each year. These opportunities enhance young people’s lives and contribute to their personal development, by building their confidence and increasing their interactions and abilities. Young people have some choice in how they spend their leisure time and staff know what young people enjoy and like to do. However, the emphasis placed by some staff on supporting young people to remain calm reduces the provision of a stimulating environment being created within the home.

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Quality of care

All young people regularly attend their external specialist education provision and the ‘home-school’ books provide a daily channel of communication between the two settings. However, ineffective communication and collaborative working arrangements between the home and some education provision is adversely impacting on outcomes for some young people. These young people do not benefit from a holistic approach to meeting their needs when differing approaches and support is provided in each setting. This incongruence has the potential to cause young people to become confused and reduce their rate of potential progress.

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Quality of care

The home has made effort to improve the standard of accommodation provided to young people. However, it is yet to look homely. Risk-reduction arrangements and some fittings and fixtures contribute to the provision of an institutionalised environment for young people to live in.

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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

Staff recognise the vulnerabilities of the young people they look after and a high priority is given to ensuring young people are kept safe. Individual risk reduction measures, risk assessments and behaviour management strategies help staff manage the possibility of risk. Some risks are managed by restricting young people’s access to areas of the home. The balance between risks and protective factors is not always clear within assessments. These documents do not routinely demonstrate creative safeguarding practices that enable young people to take age-appropriate and ability-appropriate risks as a normal part of growing up.

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Safeguarding children and young people

A risk assessment is also completed by young people’s social workers. However, the home does not ensure that they are reviewed at every statutory review to assure their continuing suitability to safeguard and promote young people's welfare. The home risk assesses the need to use surveillance devices to keep promote young people’s welfare. This good practice limits an over-intrusive response to compromising young people’s privacy.

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Safeguarding children and young people

Individual behaviour management strategies contribute to keeping young people safe by staff helping them to self-manage their challenging behaviour. The staff team’s good knowledge of individual young people’s trigger points and patterns of behaviour also helps to manage and reduce possible risks of self-harm. Young people do not go missing from this home. Close supervision lessens any opportunity for bullying to occur.

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Safeguarding children and young people

The home has a clear reporting system in place to identify both known and unexplained injuries young people sustain. This protects young people. Restraints are only undertaken to prevent injury to people for a minimum period of time and minimum force is used. All restraints are accurately recorded and this good practice safeguards young people. Sanctions given are in accordance with care plans; they are usually repetitive in nature and are not evaluated for effectiveness.

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Safeguarding children and young people

Staff complete accident and incident forms and a copy of this record is forwarded to young people’s social workers for their review of the event. Some very minor issues are recorded as an incident. These documents lack sufficient detail about the event and do not identify how the likelihood of a reoccurrence of a similar event can be reduced. Some stakeholders are critical of the quality of the incident forms they receive. Stakeholders commented, ‘incident reports are vague;’ and ‘incident forms need improving. There is often no description of the incident and how it was managed; for example, incident: child became upset at table. Outcome: staff team teach trained.’ This lack of detail and not taking a reflective approach to reviewing care practices weakens safeguarding and reduces opportunities for improving outcomes for young people.

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Safeguarding children and young people

Recruitment and selection processes for new employees are robust.

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Leadership and management

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

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Leadership and management

The home has made a good effort to meet the requirements and recommendations made at the previous inspection and there is evidence of improvement in these areas. Most have been satisfactorily met and there is work in progress to address the remainder. The local authority has undertaken a comprehensive review of the functioning of the home. Leaders demonstrate a good understanding of the current weaknesses in the operation of the home that are identified within this report. An assigned project manager is assisting the Registered Manager through this transitional phase, to make improvements in practice and plan for the future development of the home as a longer term setting.

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Leadership and management

Managers are clear that a defined handover period is required to be on staff rotas between each shift, to ensure sound information sharing and good planning to meet young people’s differing needs and circumstances. This issue is considered within the current review. The insufficient number of staff on duty during weekdays is also of concern. Currently, care staff do not work shifts in the home while young people are out at school. This means that if young people become unwell at school, managers need to contact off duty staff to find someone who is available to collect that young person. Such a delay in responding to young people’s arising needs does not promote young people’s welfare.

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Leadership and management

The home has a stable staffing establishment. However, there is a high level of staff sickness and regular agency workers are employed to provide cover. This means that core staffing arrangements are often disrupted as staff move across units to work. Consequently, young people are not always cared for by a consistent staff team and this impacts on their well-being and disrupts their attachments and security. A professional commented, ‘Because of the lack of consistency in staffing and behaviour management, children often appear anxious because they are unsure of who will be looking after them when they return home; or staff are changed at very short notice or moved to another unit.’ Professional workers also report that inconsistent staffing arrangements negatively impact on the competent implementation of care plans.

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Leadership and management

The competency of staff members in supporting young people is variable. There have been limited training opportunities provided in the past year and this shortfall has not supported the development of the team. Core training is provided; however, the home’s training matrix shows that there has been a two year gap in the provision of child protection training. This is not best practice. Moreover, only a low number of staff hold current first aid certificates to ensure young people receive emergency treatment for minor ailments from a qualified person. Further first aid training is planned for June and July 2013. Staff are now beginning to access on-line training opportunities; however this is very recent development and some staff are yet to commence any training packages. A minority of staff have achieved a level 3 award qualification although several more staff are currently studying for this certificate.

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Leadership and management

Some training is provided to staff in-house and from local practitioners from partner agencies. This helps staff to gain new knowledge and skills. Overall, staff have not had sufficient training opportunities to equip them with the skills they need to meet the needs of young people in placement.

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Leadership and management

Not all staff receive regular supervision to help them provide the best possible care to young people. There is clear evidence that some staff are not aware of their responsibilities and accountability. Senior managers take action to address known shortfalls in standards of behaviour and care, to ensure that young people are safeguarded.

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Leadership and management

The home has established polices and systems in place. However, monitoring is not carried out rigorously to ensure that all records are kept up to date and are legible. For example, risk assessments, the supervision and training matrix. Staff are not proactive in obtaining outstanding review minutes of meetings to make sure that care plans are updated to reflect recent recommendations. This lapse has the potential for young people to ‘drift’ in placement if recommended actions are not known and therefore, not undertaken by the home. Social workers report that there is often a delay in receiving communication from the home about events that impact on young people’s lives. This reduces the strength of a corporate response to concerns and issues, to ensure young people’s welfare is promoted.

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Leadership and management

The Registered Manager regularly undertakes monthly monitoring of the home’s operation and these reports are provided to Ofsted. However, the home is not currently following best practice guidance which advises that a review of practice should be undertaken every six months. This timescale enables the identification of trends and patterns which can be evaluated and used to improve practice and outcomes for young people, and to inform the home’s development plan. Leaders have identified that the quality of monthly reporting by the independent visitor is insufficient to contribute to the improvement of the home’s functioning. A clear report has been drawn up which identifies how this can be satisfactorily addressed to contribute to improving outcomes for accommodated young people.

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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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