Children's Home run by Kent County Council in Kent

Unique reference number SC403850 Inspection date 17/07/2013 Inspector Sophie Wood Type of inspection Full Provision subtype Children's home

p.1

Date of last inspection 21/02/2013 Website: www.ofsted.gov.uk

p.1

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.

p.2

Brief description of the service

This is a council-run, short-break service for children and young people. The home caters for up to six young people living with learning and/or physical disabilities. This includes young people with complex needs and those on the autistic spectrum.

p.3

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

p.3

Overall effectiveness

The overall effectiveness is judged to be good .

p.3

Overall effectiveness

Children and young people benefit from using a respite service which recognises and provides for their unique and individual needs. Short break care plans accurately reflect children's unique personalities; however, some more details in respect of their cultural and identity traits would improve the quality of these documents further. There are a number of children and young people with additional complex care and medical needs. In some cases, such conditions have been life-limiting. The service mantra of being 'children first' comes to the fore in this regard. Children enjoy their time here and staff focus very strongly upon creating a happy, relaxed and busy time.

p.3

Overall effectiveness

A strong emphasis upon the quality of the premises ensures children's surroundings are safe, secure and very well equipped. The recent staffing restructure, which has removed a number of qualified nurses, has been supported through some additional training provision in an attempt to ensure the quality of the care provided remains good. However, some shortfalls are found with regards to recruitment practices and a requirement is made to address this. The service is also asked to monitor the staffing changes in order to monitor the impact on the running of the home and quality of care provided.

p.3

Overall effectiveness

The service actively seeks the views and opinions of the children, their parents and carers to directly impact upon care planning and service delivery. Consultation methods are creative and specifically tailored to ensure everyone has a say. Children are effectively and patiently supported to achieve their goals and targets, and these are regularly reviewed. Children achieve and develop socially, behaviourally and emotionally as a direct result of the efforts and skills of the staff team. Parents and carers commend this aspect and know they can rely on the staff team to work consistently with them.

p.3

Overall effectiveness

Children and young people are happy and confident when using the service. They are familiar with the physical layout and the daily routines. This feels safe. Meticulous planning ensures the groups of children using the service are well-matched in terms of their needs, personalities and friendships. Relationships with staff are comfortable, secure and easy going. There is frequent laughter to be heard throughout the day and evening.

p.4

Overall effectiveness

Leaders and managers have responded positively to the requirements and recommendations made from the previous inspection. Improvements to safeguarding practices and procedural guidance for staff, including training, means safer practice is being delivered to the children. The Registered Manager has also strengthened monitoring systems. These are more evaluative and enable weaknesses to be readily identified and acted upon. There are some gaps however; in terms of looking at the wider picture of safeguarding incidents. These are well managed as they individually occur but there is a current absence of examining these more widely to identify any potential patterns and trends.

p.4

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.

p.4

Reg. Requirement Due date

(2001) ensure the registered person does not- (a) employ a person to work at the home unless that person is fit to work at a children's home and for the purposes of paragraph (1), full and satisfactory information is available to him in respect of each of the matters specified in Schedule 2. (Regulation 26 (3)(d) Schedule 2) 30/08/2013

p.4

Recommendations

To improve the quality and standards of care further the service should take account of the following recommendation(s):

p.4

Recommendations

 ensure that children receive personalised care that promotes all aspects of their individual identity and are treated as an individual rather than a member of a group. This recommendation is made within the context of providing greater detail within the individual and cultural identity sections of care plans (NMS 2.1)  ensure the manager regularly monitors, in line with regulations, all records kept by the home to ensure compliance with the home's policies, to identify any concerns about specific incidents and to identify patterns and trends. This recommendation is made with regards to maintaining an overall chronological log of all safeguarding and welfare concerns (NMS 21.2)  ensure the overall number, competence and deployment of staff, both as a staff group and on individual shifts, can fulfil the home's Statement of Purpose and meet the individual needs of all children resident in the home. This

p.4

Recommendations

recommendation is made within the context of monitoring the impact of the reduction of qualified nursing staff. (NMS 17.1)

p.5

Outcomes for children and young people

Children and young people using this service enjoy positive experiences during their stays. Their visits are subject to careful planning and this ensures they routinely use the provision alongside their peers and friends. Meaningful friendships develop over time because staff keenly monitor how well children and young people get along with each other. This aspect is then factored into the planning of future stays. Notwithstanding, a flexible approach towards requests from parents and placing social workers means that children and young people also use the service when they and their families need it the most. Comments from social workers include, 'this on- going placement has held the family together' and 'using this service has prevented the need for care proceedings.'

p.5

Outcomes for children and young people

Children and young people enjoy using the service because they are introduced to it with great care and understanding. Introductions are individually tailored, taking into account their own unique needs. They settle quickly. This is endorsed by parent comments including, 'my child looks forward to their visits. It is like an extension to the family.'

p.5

Outcomes for children and young people

Children and young people know that they are highly valued by the staff. Relationships are solid. Children and young people engage in much fun and laughter. Signs of anxiety and upset are very well read by staff who know children well and intervene quickly. This results in happy and confident children taking full advantage of the wide and stimulating activities which are routinely on offer. Their growth and development is actively encouraged through the pursuits they enjoy; such as messy play, table top games, imaginative play, outdoor games and exploring their wider world by using public transport to visit places of interest. The most recent example of this included a trip to the Houses of Parliament.

p.5

Outcomes for children and young people

Children and young people enjoy good general health while using the service. They learn to take appropriate responsibility for their own health needs. Routines and consistent approaches teach children to practise good hygiene, such as hand washing and maintaining their own personal hygiene needs as independently as possible. A good number of children make great progress in terms of developing a more adventurous approach to mealtimes as well as eating out socially. This impacts positively upon their nutritional needs. Parents say, 'my child eats a much better variety of foods since coming here.'

p.5

Outcomes for children and young people

During term-time, children and young people benefit from structured routines. They continue to attend school and enjoy telling staff about their day upon their return. There are examples of children without a school placement being provided with additional day-care by the service. This has brought tremendous benefits and ensured their educational needs continue to be nurtured. One parent comment includes, 'my child can't access school due to a mental breakdown…..thank God for this service…where my child is helped with their speech, health and social development.'

p.6

Outcomes for children and young people

Children and young people develop independence and life skills because staff feed their confidence. Elaborate praise and encouragement sees positive results. Children and young people are frequently realising and achieving their targets and goals agreed through regular care planning.

p.6

Quality of care

Children and young people have a very real say in terms of service delivery. Consultation mechanisms are creative, targeted and reflect the unique communication needs of the children and young people. Staff give children the time and resources they need to make their views and opinions known. Feedback from individual and groups of children directly influences care delivery. Examples include activity provision, meal choices, and how individuals prefer to be supported with their own unique care needs.

p.6

Quality of care

Written care plans include very clear details of children's own likes, dislikes and preferences. Parents and carers contribute to these documents and confirm their accuracy at each care episode. Review meetings are also used to ensure these plans are routinely updated. Such plans accurately describe the style and type of care delivery that is required; however, greater detail within the personal identity and cultural needs sections would provide more personalised guidance.

p.6

Quality of care

The quality of care delivery is being closely monitored by the Registered Manager. This aspect has been more keenly targeted since the service's previous inspection. Direct observations of care practice regularly occurs and this includes evenings and night-times. Such diligence reassures the Registered Manager that short break care plans are being adhered to. It also highlights where areas within such plans may need to be reviewed or staff members need additional guidance.

p.6

Quality of care

Complaints material is user-friendly and readily available to children and young people. In addition, the service routinely canvasses parents and placing authorities for their views about the quality of the service provision. The feedback received is largely very positive and has resulted in a culture whereby informal resolution usually prevents the need to formally complain. One such complaint against the service remains on-going and is now being managed at a senior level. More locally, the service is able to demonstrate its own transparency when this issue was first raised.

p.6

Quality of care

The Registered Manager takes great care in planning children's stays at the service. Given its nature and catchment area, it is usual that new children and young people are frequently being referred for respite care. Daily care records are diligently maintained and monitored by the Registered Manager to determine how well each group of children has got along during their stay. This information is carefully considered when planning the next round of stays and ensures young people are given the opportunity to use the service alongside their friends and those they are forming positive attachments with.

p.7

Quality of care

Recent organisational changes have created a clear change of direction in terms of the governance of the service. In a practical sense, the partnership between the health and local authority has changed, resulting in the re-structuring of the staff group. The amount of registered nurses, qualified in the field of learning disability, has significantly reduced. However, the overall number of staff available remains unchanged. The post of nurse educator has been created and this individual is delivering teaching, guidance and oversight for the care team and two newly appointed health care workers. Children and young people are continuing to receive the health-care they need. Staff have received appropriate training to ensure this; for example, managing diabetes. It is too early to accurately measure the impact of these changes. While it is recognised that specific medical procedures can be appropriately delivered as they would be at home, the previous nursing complement

p.7

Quality of care

brought an added layer of expertise and understanding in respect of the range of additional disabilities that many of the children have. These are not entirely medical. It is therefore recommended that the service stringently monitors the impact of this change to ensure children and young people continue to receive the level of service they have been used to.

p.7

Quality of care

Children and young people regularly attend their current school while staying at the service. Indeed, absences are extremely rare and only occur in understandable circumstances, such as ill health. Strong links exist between the service and the schools attended. Individual short break care plans demonstrate how the school and the service work together in terms of targets and goal setting. This ensures children and young people are focusing on the same areas and such consistency brings positive results. Care files hold up-to-date school reports and educational review meeting minutes. The service's commitment to supporting the educational needs of the children is further demonstrated by ensuring a staff member of the service is always in attendance at education review meetings.

p.7

Quality of care

Children and young people enjoy the spacious, well-maintained premises of the service. Furnishings and fittings are of exceptionally good quality and all necessary specialist equipment is safely maintained and regularly serviced. Children and young people stay in comfortable surroundings which protect their privacy; security measures are appropriate and openly shared with parents and social workers.

p.7

Safeguarding children and young people

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

p.8

Safeguarding children and young people

Children and young people say they feel happy and safe when using the service. Their relationships with staff are relaxed and comfortable; children confidently approach staff members to make requests, to engage in activities and to ask for assistance when they need it. They demonstrate ease and confidence around the staff and are openly demonstrative with affection.

p.8

Safeguarding children and young people

Parents and carers speak positively about the safety of their children and attribute this to precise shared care planning. Staff know the children well and idiosyncratic, and challenging behaviours are well-captured in this process. Parents and carers are confident that staff understand how to manage the particular difficulties and needs of their child. The premises, routines and activities are well-prepared to provide the safe environment each child needs.

p.8

Safeguarding children and young people

There are examples whereby children and young people's choices may present risks in terms of their own welfare and safety. Clear, prescribed behaviour management guidance is factored into individual short break care plans. These are produced in consultation with parents and social workers. Such guidance frequently identifies the potential risks and how staff can de-escalate, distract and demonstrate to children why some of their choices simply cannot happen.

p.8

Safeguarding children and young people

Social workers provide positive feedback with regards to the safeguarding practices of the service. They confirm that reports and concerns are swiftly shared. The service is a valuable partner in terms of multi-agency working. Accidents and injuries do occur at the service. These are diligently recorded and appropriate remedial action reduces the risks of reoccurrence.

p.8

Safeguarding children and young people

The Registered Manager adopts a robust approach towards reflective practice and implementing lessons learned. A serious safeguarding incident which occurred last year has resulted in a review of all children's individual behaviour management plans. The service's own safeguarding policy and procedure has been reviewed for accuracy. Safeguarding training for staff has been revisited to ensure everyone is up- to-date and care practices are being tightly monitored.

p.8

Safeguarding children and young people

Records of any child protection concerns or welfare issues are clearly recorded and swiftly shared with the local authority. Such examples of individual pieces of work demonstrate how each situation has been managed and shared. However, the Registered Manager does not currently have a system to bring all such incidents together to assist with wider oversight and monitoring to look for patterns and trends. A recommendation is made to implement such a chronology to provide additional safeguards.

p.8

Safeguarding children and young people

The use of physical restraint techniques are rare and this is another area which has been reviewed. Staff understand how and under what circumstances, such techniques may become necessary. This aspect of staff's work has been a clear topic through recent staff meetings. Dedicated recording logs for physical restraints and sanctions contain all of the required headings and staff know how to complete these.

p.8

Safeguarding children and young people

There have been no incidents of children being absent or missing. High staffing ratios provide excellent supervision levels and the building is appropriately secure. The use of security-coded doors and restricted access areas is openly advertised and agreed with social workers, parents and carers. The service is signed up to written protocols with the police and local authority in the event of children going missing. The service's guidance is explicitly clear in the event that any child deemed to be missing would be viewed as extremely vulnerable and given top priority in terms of the action to take.

p.9

Safeguarding children and young people

The recruitment practice of the service is generally sound and serves to protect the children and young people. Staff do not begin to work at the service until all of the required checks and references are returned. Currently, the human resources department uses a different reference request form for internal and external candidates. This results in one format asking a referee less clearly about a candidate's suitability or reason for leaving their previous employment. One example was also found where an applicant's work history was not robustly scrutinised. Such shortfalls present potential risks to the reliability and safety of the recruitment procedure.

p.9

Leadership and management

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

p.9

Leadership and management

The service benefits from being led by a suitably qualified and experienced permanent Registered Manager. Senior team leaders also possess the qualifications they need and lines of accountability and responsibility are very well understood. Direct care staff also receive the training they need, covering all areas of their roles and responsibilities. The needs of the children and young people are being effectively met.

p.9

Leadership and management

Recent staff re-structuring, in the form of losing a number of qualified nursing posts has been carefully considered and used to reliably inform the continued training and support needs of the remaining team. A nurse educator and two health care workers have been recruited. Specific training, relating to individual children has been delivered in a timely way to ensure such children's next planned stays are not disrupted.

p.9

Leadership and management

This change was an anxious time for the remaining team. However, they express a very positive attitude with regards to their recent training and the continued oversight of the nurse educator who is based at the service. Individual supervision meetings and team meetings, including separate ones for night care workers, are being well used by the Registered Manager to continue to support the team during this transition.

p.9

Leadership and management

The service responded swiftly and openly to the shortfalls identified from the previous inspection in February 2013. The service took immediate appropriate action following an incident of the inappropriate use of a physical restraint. However, the subsequent inspection identified shortfalls in respect of physical restraint guidance and records and also identified shortfalls in terms of an area of the child protection policy.

p.9

Leadership and management

The service's response has been diligent and robust. Internal investigations, including an action plan have been returned to Ofsted and the impact upon practice has resulted in tighter monitoring, a review of training needs and a greater emphasis placed upon reflective practice. There have been no complaints received by the service since the last inspection. The complaint relating to this particular incident remains current and is being managed at a senior level, in conjunction with legal proceedings.

p.10

Leadership and management

Monitoring systems, used by the Registered Manager and the Regulation 33 visitor have improved considerably over recent months. These contain good details of evaluation which demonstrates the closer scrutiny of records and practice. The Registered Manager has a better idea of areas of potential weakness and she reports clearly on how she intends to continue to develop and improve the service in response to these findings. She keenly focuses upon consultation with children and young people in this regard. This practice ensures their views and opinions are expressly influencing service delivery.

p.10

Leadership and management

The addition of a permanent handy person is having an immediate positive impact upon the quality of the physical environment. Maintenance reporting systems are clear and result in swift action being taken. Furnishings and fittings are of very good quality and the substantial sized grounds are safe and very well used and enjoyed by the children. Specific pieces of equipment are purchased and maintained; some at high financial cost, to ensure individual children have the resources they need during their stay.

p.10

Leadership and management

Social workers and family members express their clear understanding of the aims and objectives of the service. These are accurately described within the Statement of Purpose. A number of parents and social workers further state that the service actually provides more than it describes, making particular reference to its role in 'keeping a family together.'

p.10

Leadership and management

Care records are well-ordered and confidentially stored. These are monitored on a regular basis and routinely checked and endorsed by parents and carers. Daily care logs are evaluative and give a very clear description of each child's time at the service. Review meeting minutes are a good source of information in describing children's progress. Their achievements are clearly recorded and new targets are quickly agreed so as to encourage their continued growth and development.

p.10

Leadership and management

The service works well with associated external agencies. It enjoys a very positive relationship with children's social workers and maintains particularly strong links with health care professionals and colleagues in the education sector. Its communication with Ofsted, in terms of notifications and information sharing is open and transparent.

p.10

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.

p.12

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.

p.12