Children's Home run by Creating Care Choices Limited in Lewisham

Unique reference number SC025657 Inspection date 06/06/2013 Inspector Angus Mackay Type of inspection Full Provision subtype Children's home

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Date of last inspection 30/10/2012 Website: www.ofsted.gov.uk

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Brief description of the service

This privately run children's home is registered to provide care and accommodation for up to three children on short break arrangements and no more than four young people resident in the home. The home is registered to care for children and young people who may have learning disabilities and/or physical disabilities. However, the building is not fully accessible or adapted, meaning that placement of children and young people with significant mobility problems would not be appropriate.

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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

The home has made considerable progress in all areas since the appointment of the new manager but practices have yet to be fully embedded. One social worker said, ‘The home has improved and is now very good, there is a lot of emotional warmth there.’ In particular staff have improved their engagement with young people supported by supervision, training and on task guidance, provided by the manager.

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Overall effectiveness

Young people show improvement in their own personal care, mental health, behaviour and engagement with education programmes. Common comments from parents and social workers of children resident in the home describe young people as being, ‘happy, contented and always clean and immaculately dressed.’ One parent of children using the short stay service said of the home, 'There have been a lot of changes since the new manager came. She has changed it to a real home-from- home. It is not like an institution it is like a replica of home.'

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Overall effectiveness

The manager provides strong leadership and support to staff and is highly thought of by staff and visiting professionals. Staff in the home and social workers say, ‘the manager brought about the improvements in the home.’ Young people enjoy being in the home and parents and social workers confirm they feel safe there. Care plans and risk assessments provide clear guidance to staff on how to assist young people in making progression with their communication, engagement in decision making, development of life skills, social engagement and interpersonal behaviour.

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Overall effectiveness

The manager’s initial development plan for the home has addressed a number of shortfalls in the service, including fire safety, training, and recording of medication and the lack of control of financial planning from within the home. A major issue is the inadequate fire detection system and safety measures which the manager is addressing.

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Overall effectiveness

The manager does not currently have a budget for the home which impedes the development of the children’s life skills, hampers planning of activities, training, refurbishment and provision of fresh healthy meals. The manager identified a need to change the way of recording some medications. Staff who are not appropriately qualified are working towards the level 3 Children and Young People’s Workforce Diploma. Recommendations and requirements for improvement have been raised to ensure improvements are embedded into practice and that other actions are implemented to improve the safety and quality of care for young people.

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Statutory Requirements

This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Children's Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must comply with the given timescales.

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Reg. Requirement Due date

(2001) ensure that children accommodated in the children’s home are provided with food which is properly prepared, wholesome and nutritious; is suitable for their needs and meets their reasonable preferences and is sufficiently varied. In particular provide an allowance which enables the purchase of good quality food and for children and staff to shop together (Regulation 13 (a)(ii)(iii)(iv)) 04/09/2013

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Reg. Requirement Due date

(2001) take adequate precautions against the risk of fire, including the provision of suitable fire equipment (Regulation 32(1)(a)) 04/09/2013

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Reg. Requirement Due date

(2001) make suitable arrangements for the recording of medicines received into the children's home, in particular any controlled drugs (Regulation 21(1)) 04/09/2013

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Reg. Requirement Due date

(2001) ensure that the children’s home is carried on in such a manner that as is likely to ensure that the home will be financially viable for the purpose of achieving the aims and objectives set out in the Statement of Purpose. In particular that staff have specific budgets allocated to them in relation to the routine maintenance of the home and resourcing of leisure activities. (Regulation 36 (i)) 04/09/2013

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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 the home provides a comfortable and homely environment, with particular regard to young people's bedroom furniture ( NMS 10.3)  ensure that all existing care staff attain a minimum level 3 qualification or are working towards the level 3 Children and Young People's Workforce Diploma within 6 months of conformation of employment.(NMS18.5)

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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

Outcomes for young people have recently improved significantly but these changes have yet to be firmly and consistently embedded in practice. Young people make good progress in developing emotional resilience and in forming positive relationships, with staff, and with other young people and their families. Staff assist young people in maintaining or creating contact with their extended families. This helps young people gain an understanding of their background which supports their emotional development. One social commented on a family visit organised and supervised by the home, ‘the young person was taken on a visit organised by the home to see extended family. The pictures from this were lovely and captured the joy of that moment in time. The young person is doing a life book and this is ideal to include.’ Young people gain a clearer idea of their extended family and, with staff support, manage the conflicting emotions they experience in these contacts.

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Outcomes for children and young people

Young people make good progress in relation to their health, including mental health. There is clear evidence of a reduction in psychiatric symptoms directly related to work done by the home. Young people show improved concentration, better sleep patterns, reduction in soiling or wetting and a significant reduction in aggressive patterns of behaviour. A mental health consultant said of the home,’ it is now operating as a functional family.' The result is young people who are happy and make significant progress in their personal development.

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Outcomes for children and young people

Young people engage in a range of activities, which are designed to provide entertainment, learning and the progression of life skills. There has been considerable improvement in the range of activities on offer and young people’s boundaries and expectations of what they can achieve have been successfully challenged. However, the lack of an identified budget that staff can work to prevents a planned and full programme of activities being offered.

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Outcomes for children and young people

Nevertheless, as a result of the resourcefulness of the manager and the staff, young people are being taken out into the community more and this is helping them improve their confidence and self-esteem by using public transport. Young people have successfully engaged in shopping trips, swimming, bowling and other more challenging trips out. This has improved their social networks, motor skills and confidence in public places.

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Outcomes for children and young people

Within the home young people engage in self-help and life skills which are challenging but achievable for them. Young people are now able to dress themselves, make beds, use the toilet appropriately and assist in cooking and baking. This has encouraged their sense of belonging within the home and improved their confidence, self-esteem and competence in personal care. One social worker said, 'parents are all happy with the progress their children are making in the home.'

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Outcomes for children and young people

All young people engage in full-time education. They make progress in relation to their starting points and staff liaise closely with their schools to support this progress. The home photograph and display young people’s school work and activities; providing an excellent visual record for them to enhance life story work. A mental health specialist said of one young person’s progress educationally and socially,’ his self-esteem is going up and up.’ The maintaining of detailed visual records aids parents and social workers in sharing important life experiences and developments the young people make.

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Outcomes for children and young people

Young people in the home have differing communication methods and staff have formed close links with schools and parents to learn these methods. Young people benefit from this co-ordinated response improving their influence in the home, and by having more opportunities to practice decision-making.

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Quality of care

Young people have good relationships with staff. They show affection towards staff and get excited when staff arrive at the home. Staff engage positively with young people but are also aware of when they require quiet space with less engagement. Staff were observed singing and dancing with young people; which created a very happy atmosphere and a lot of laughs for the young people.

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Quality of care

Parents and social workers are very positive about the care provided. Comments from parents and professionals include; ‘When the children arrive they are really excited to be there and rush in all smiles. They are very happy when they come back as well which tells me they have enjoyed themselves;' ’ The manager has a deep caring for my child’; ‘I am impressed with the staff I am always warmly greeted.’

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Quality of care

Young people’s views and wishes and feelings are actively sought. Staff have developed skills at involving the young people in making choices about their own care and in the running of the home, including those young people who are non- verbal. A social worker commented on this improved engagement of young people in choice, ' the bedroom is a completely different room; the young person took my hand and took me to see her new bed linen she had chosen. They are bringing out more in the young people by involving them in the running of the home and making choices.' Staff are skilled at interpreting each young person’s communication technique including body language and behaviour to aid them in doing this. Examples of this are where young people are involved in choosing, clothing, activities, décor for their rooms, when they receive personal care and their participation in staff recruitment.

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Quality of care

As well as individual choices young people now use group meetings to share decision-making. Staff say of these meetings,’ Group meetings with young people have been good; there is a lot of fun in them. We play some games and use these to relax them and help communicate messages and help them express their views.’ As a result young people learn how to make decisions appropriately and are proud of their appearance and that of their rooms and the home.

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Quality of care

Behaviour management plans focus on reinforcing positive behaviours and are highly individual; reflecting the specific needs of each young person. Positive behaviour is reinforced by a range of means, including verbal praise, clapping and through a very visual reward chart. Sanctions have not been used but staff convey expectations or disapproval to young people which are responded to appropriately. Staff are skilled at managing difficult behaviour and are guided by well-constructed placement plans. A social worker said of staff, ’Staff have a good grasp of young people’s behaviour and how to gauge it. I witnessed the home dealing with things which are behavioural problems at home and at school. Here the problems are addressed and the young people are like different children. Young people are more engaging more co- operative.’

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Quality of care

The manager has increased the competency of staff in engaging with young people by some innovative initiatives such as bringing in a play therapist. Staff say of the training, ‘The play therapist session was very good. It was very motivating. We developed an understanding that everything is individual and we have to work with the individual to find out what they like.’ As a result difficult behaviour is reduced and staff actively engage young people in positive ways.

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Quality of care

Young people’s needs relating to their background are identified within their placement plans and addressed by staff in daily living. One parent said,’ the staff are very accommodating and will do things for us. For example, the children are really difficult to get their hair cut but staff will do that for us.’ The staff team is appropriately diverse to meet the needs of the young people and the manager ensures that there is a balance in genders within the staff team working.

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Quality of care

Staff engage young people in expressing choice about meals and provide meals which the young people enjoy, despite the lack of high quality ingredients. One parent saying,’ He is eating well and likes the meals the staff cook for him.’ The staff do an excellent job of engaging young people in preparing meals while maintaining appropriate safety.

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Quality of care

Staff work closely with schools and parents. Young people receive appropriate support and assistance from staff which aids them in maintaining education, including in situations where school has broken down. In these circumstances young people continue to receive education from their school but within the home. This has proved highly successful with young people making accelerated progress without the distractions they experienced in school.

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Quality of care

Staff ensure that all health care needs are met. Health care plans detail actions that staff need to take to meet the individual needs of each young person and identify individual targets to encourage progress. For example, through these, young people improve their personal hygiene, toileting ability and learn about healthy life styles. The staff work closely with parents and schools, ensuring that all parties share a co- ordinated approach to personal needs and health care. Parents comment positively about the joint working one saying,’ we tell them what we do at home and liaise with the home and share ideas. We have discussions about what food we want them to have and things we want them to avoid and they make sure that happens. They send us a report on what they have had to eat. If we have any problems or concerns we know that we can telephone them. They are excellent I have no problems at all with the home.’

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Quality of care

Medication is accurately recorded, stored and issued ensuring the safe care of young people. The manager has identified the need to record controlled drugs in a separate bound and numbered log book but this has not yet occurred. The good management of medication has not been compromised by this omission.

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Safeguarding children and young people

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

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Safeguarding children and young people

The safe care of young people has been enhanced by the manager’s development of an up-to-date safeguarding policy and procedure which she has shared with the local safeguarding team. Young people are protected from harm by the staff team’s application of these procedures. All staff have received training in safeguarding and are able to demonstrate an awareness of the signs and symptoms of abuse. Staff know what to do to keep young people safe in the home and how to respond appropriately to concerns over their safety.

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Safeguarding children and young people

The manager has reviewed all previous staff appointments. All staff previously appointed now have all the required checks and are safe to work with the complex needs of the young people. The manager has put in place a comprehensive recruitment and selection process which complies with all regulatory requirements. The selection process incorporates the responses of the young people to all candidates.

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Safeguarding children and young people

The manger takes a proactive stance on safety issues within the home, ensuring that the environment is safe for children. She has produced a detailed fire risk assessment to support the broader building risk assessment and invited assistance from the local fire safety team in this process. The local fire safety officer has identified significant shortfalls in the fire detection system, fire doors and escape pathway. The manger has put in place measures to provide short term safety for the children, which have been approved by the fire safety officer. The responsible individual has committed to enacting all required measures immediately. Matters in relation to fire safety will continue to be monitored jointly by Ofsted and the fire safety officer.

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Safeguarding children and young people

Staff management of young people’s behaviours has significantly improved leading to there being only two restraints since the last full inspection. Staff communication with young people and their understanding of their needs has been dramatically improved by training and supervision, aiding in the management of the young people’s behaviours. One visiting mental health professional said, ‘The home has done a lot of very good work on the young person’s aggressive behaviour. They have put in place award charts, a visual timetable for him and staff are consistent in their approach with him. This has led to significant improvements and him being very settled now.’ All young people have clear behavioural expectations and clear placement plans detailing how staff can achieve positive outcomes with them. Positive responses to required behaviours are reinforced by the use of a very visual rewards chart. Young people excitedly celebrate each other’s achievements in

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Safeguarding children and young people

Young people enjoy a calm relaxed atmosphere in the home and are able to transfer improved behaviour to other settings. Young people are, as a result, making progress in developing relationships and are more settled and happy in the home.

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Safeguarding children and young people

High staffing levels and close engagement with young people ensures that they do not go missing from the home or on trips. There have been no occasions where young people have gone missing in the last year. The manager ensures that young people's safety is enhanced by the staff application of detailed risk assessments. The staff ensure that they use these risk assessments to support the expansion of the activities programme for young people. One child and adolescent mental health specialist commented, ‘the staff took him shopping although they were aware of the risks associated with this. They have done this carefully managing the risk and moving the young person forward slowly increasing time out and expanding the managed risk incrementally.’ Young people gain from this by increased social mobility and improved confidence in public situations.

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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 Registered Manager was appointed after the last full inspection of the home. She has an excellent understanding of the strengths and weaknesses of the home and has been dynamic in addressing all requirements and recommendations for improvement set at the last inspection; ensuring that young people are cared for by appropriately selected staff who apply safe working practices.

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Leadership and management

The manager has addressed the on-going development of the home in a comprehensive, well-structured development plan which provides a clear pathway to improving the quality of care provided to young people. Many of the initiatives identified in the development plan have been enacted providing a good infrastructure to the home with clear policies, procedures and checks to maintain them. The external and internal monitoring checks required to support this programme are maintained and copies are held in the home, which the manager uses to aid her improvements.

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Leadership and management

The Statement of Purpose and young people's guide have been rewritten and clearly describe the service provided in the home. They are being closely monitored and redrafted by the manager as new initiatives develop the service provided to children.

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Leadership and management

The new manager has put in place a structured programme of supervision and training; improving the skills set of the staff and enhancing their work with the young people. Supervision is of a good quality, regular and is developmental for staff. Staff praised the supervision provided, highlighting how the manager links it to training. For example safeguarding training was covered in supervision and homework given to staff to embed the learning and enhance the safety of young people.

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Leadership and management

Not all staff have an appropriate level 3 qualification and this is currently being addressed as part of the manager's development plan for the home. Other training has been put in place to ensure staff can provide good quality care and to meet the specific needs of the young people. One member of staff commented, ‘We had training from a play therapist which was really good …it was very motivating, and we learned what to do with young people who seem to want to do nothing. We got an understanding of how to do things which are appropriate for each child.’ Other well thought through developmental work includes, linking with a local school to gain staff training in the use of makaton. This has been followed up by support sessions in supervision and staff meetings. Staff were observed using this newly acquired skill to communicate with young people in the home.

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Leadership and management

The manager has organised the restructuring of the young people's files ensuring they contain all necessary information required, in an easy to access format. Files are well structured, comprehensive and give a clear picture of the young person’s history and how to work with each individual. Social workers, parents and other professionals all praise the communication from the home saying staff ensure all events are appropriately shared.

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Leadership and management

Staff ensure that the home is clean, tidy and that all repairs are speedily completed. The manger ensures that all health and safety checks are up to date and any required actions, over which she has direct control, are dealt with immediately. The manager has created a clear financial plan for the home which will ensure the needs of the children are fully met. Currently the system in place does not allow the manager, staff and young people to forward plan activities or enjoy regular access to high quality food.

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Leadership and management

Gradual improvements to the environment cannot be properly planned due to the lack of a clear budget for the home. The responsible individual has committed to providing sufficient funds to provide for this as well as for new furnishings, such as mattresses and bedroom furniture. Despite the difficulties, significant improvements have been made to the environment. One parent commented, ‘The whole house is clean and hygienic I checked the toilets and my son’s room. They were all clean and hygienic.’

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Leadership and management

The manager has developed good working relationships with other professionals to the benefit of the young people. The local community support police have visited and have had positive discussions with the home. A mental health professional praised the work of the home in maintaining complex relationships in one case with a school, a specialist mental health team, children and adolescents mental health service, parents, social worker and disability team social work team. The result of this is a service which is more responsive to the identified needs of the 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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