Children's Home run by Cornwall Partnership NHS Foundation Trust in Cornwall

Unique reference number SC432404 Inspection date 30/07/2013 Inspector Paula Lahey Type of inspection Full Provision subtype Children's home

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Date of last inspection 28/02/2013 Website: www.ofsted.gov.uk

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Brief description of the service

This children’s home is part of a local authority short breaks service for up to two children with disabilities, complex individual needs and fragile health.

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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 good .

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Overall effectiveness

This home provides a good quality short break service for children. The service’s mission statement is described as ensuring those using the service are treated as children first irrespective of any additional disability or difficulty. This ethos is embedded within practice. There is effective promotion of equality and personalisation, and children are valued and respected. One parent wholeheartedly agrees with this and said, 'the children ALWAYS come first; everything this home does is geared towards the happiness and well-being of the completely dependent children.’

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Overall effectiveness

Children enjoy visiting the home and benefit from joining in with a range of activities that support their physical and emotional well-being. The holistic approach to care planning ensures that children’s needs are appropriately assessed and met in practice.

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Overall effectiveness

Children benefit from a well-directed, suitably trained and supported staff team. The team are experienced and suitably skilled at supporting children with disabilities and complex health needs.

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Overall effectiveness

Safeguarding children is given a high priority. Staff recognise the diverse needs of children and how their circumstances have made them vulnerable and staff are diligent at protecting them. Health and safety policies, systems and risk assessments are effectively implemented in practice.

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Overall effectiveness

An experienced manager has recently taken on the leadership role for this home and submitted an application to register with Ofsted. An additional person is also due to submit an application in order to cover a planned period of extended leave for the current post holder. The service demonstrates a good capacity to improve. Previous requirements, recommendations and internal development plan actions have been suitably addressed. The new manager has implemented changes to some systems and structures and is proving to have a positive impact on the direction of the service.

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Overall effectiveness

Following this inspection, three requirements and three recommendations have been made. Shortfalls do not negatively impact on the outcomes for children and primarily relate to embedding current systems and ensuring documentation supports the actual practice being delivered.

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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) notify the HMCI of any such revision of the statement of purpose within 28 days. In particular ensure that the ratification of the updated document takes place in a timely manner and is provided to Ofsted (Regulation 5 (b)) 12/10/2013

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Reg. Requirement Due date

(2001) ensure that is any of the events listed in column 1 of the table in Schedule 5 takes place, the registered person shall without delay notify the persons indicated in respect of the event in column 2 of the table. In particular ensure that Ofsted is notified of significant incidents (Regulation 30 (1)) 12/10/2013

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Reg. Requirement Due date

(2001) ensure that the person carrying our Regulation 33 visits, inspects the records of any complaints. In particular ensure that the report provides evidence that these records have been inspected. (Regulation 33 (4)(b)) 12/10/2013

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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 that the home provides a comfortable and homely environment. In particular review the storage of personal protective equipment to ensure it does not lead to an institutional feel (NMS 10.3)  ensure that risk assessments are carried out to identify any potential sources of harm to the children and are recorded in writing. In particular complete a risk assessment to confirm the deployment of staff when there are only two on duty (NMS 10.8)  ensure that there is a record in the home of all the recruitment and vetting checks which have been carried out on those working for the home. (NMS 16.3)

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Outcomes for children and young people

Children benefit from a positive short-break visit to this home. They are warmly welcomed into the home and staff spend quality time settling the child, making sure their needs are met and that they are content. As a result, children quickly settle into their environment and routines, demonstrating that they feel comfortable and secure. This also supports the development of their confidence, self-worth and resilience. Parents agree with this and told the inspector that their children are happy and confident during their short-break visit.

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Outcomes for children and young people

Children enjoy positive relationships with carers. Staff present as caring, nurturing and respectful of children. Children demonstrate feeling secure in the care they receive. They benefit from spending quality time with people who clearly care about them and know their individual needs well. Children’s physical and personal care needs are met with respect and this promotes their dignity and self-esteem.

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Outcomes for children and young people

Children’s individual health outcomes are very well met. The staff team monitor children's physical condition closely and provide clear evidence of current needs and presenting behaviours to their families and health professionals. Children benefit from this, and as a result, their health is appropriately maintained and promoted.

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Outcomes for children and young people

Children enjoy their visit to the home. They have fun and plentiful opportunities to engage in purposeful and stimulating activities with their friends and adults known to them. Children make good use of resources in their local community, including regular visits to the library, parks, shops and leisure services. This promotes their social skills and interaction with peers. Engagement in the activities provided has helped children to develop their sensory awareness skills, their understanding of their environment and their communication and physical abilities.

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Outcomes for children and young people

Children are supported to express their personal preferences and choices. Children rely on adults to interpret their reactions to events and people. Key workers liaise with families and spend time observing children’s facial expressions, vocal sounds, and body language to help determine their preferred likes and dislikes. During the inspection children were helping external professionals to choose sensory equipment for use in a local toy library. This is of benefit to the direct development of the home and supporting the local community.

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Quality of care

The quality of the care is good . Children benefit from strong, positive relationships with carers. Staff place children at the centre of their practice and this is evident in their interaction with them. Children receive comfort, care, and attention from a team who clearly enjoy their work.

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Quality of care

Detailed and informative care plans are in place for each child. The views of families and others involved in the care of children are regularly sought and fully incorporated into these documents. Staff understand children’s individual needs, likes, dislikes and personal preferences well and ensure they are met during their visit. Individual goals are set for each child and children make progress towards meeting these.

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Quality of care

Children have complex communication needs. Staff are alert to monitoring their responses and non-verbal cues regarding their likes, dislikes and emotions. Any signs that children are becoming distressed, unhappy or are feeling unwell are responded to promptly and with sensitivity. Children demonstrate that they feel cared for and safe.

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Quality of care

Good links are established and maintained with children’s schools. The staff team transport children to and from school and ensure that key information about children is shared.

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Quality of care

The responsibility for children’s health remains with parents. However, during their visit, children’s health needs are met exceptionally well. Nursing staff work alongside the well-trained and skilled care team. This ensures children’s health needs are effectively monitored and addressed. The team demonstrates competence and confidence at supporting children’s complex medical needs.

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Quality of care

Children enjoy a wide range of activities and opportunities during their short-break visit. The home is well resourced with a range of sensory toys and equipment. The service is seeking funding in order to improve the garden area and make it more stimulating and accessible to children. Children’s views have been incorporated into the development plan for the garden.

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Quality of care

Children are provided with a bright, spacious, clean and well-maintained home. In recent months staff have worked hard to make the communal areas more child friendly and homely. This has included ensuring that toys are readily accessible and there are displays of children's artwork and photographs. A recommendation has been raised to ensure that the bathroom and bedrooms also benefit from the ‘homely’ improvements. Currently gloves and plastic aprons are on full display in these rooms and detract from the otherwise pleasant and inviting environment.

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Safeguarding children and young people

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

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Safeguarding children and young people

Children are supported to stay safe during their visit. Children’s safety is considered a high priority in all areas of the service. This includes detailed risk assessing of specific needs and activities, appropriate monitoring of visitors in the home and regular servicing of utilities. Health and safety, including infection control, food hygiene and medication management, are diligently governed. Parental feedback given as part of the inspection confirms that children’s safety is given a high priority. One parent said, 'this home is part of a very small group that we trust to care for our child overnight or longer, which is of great importance to us as a family.’

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Safeguarding children and young people

There is good understanding of each child’s individual needs. Staff recognise how the diverse needs of children with disabilities make them vulnerable to harm and they are diligent in protecting them. Children demonstrate feeling secure in the environment and the relationships they have with carers. Staff are vigilant at monitoring children’s physical and emotional well-being and respond promptly and sensitively to early signs of distress, anxiety and discomfort.

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Safeguarding children and young people

Staff spoken with were clear about their safeguarding duties and understand how to manage any protection concerns about children. Staff have regular child protection training which includes supporting children with disabilities. The manager has safeguarding supervision with a child protection lead within the health service, thereby ensuring the effective management of any presenting concerns. Referrals are made appropriately and promptly.

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Safeguarding children and young people

Children do not generally exhibit behaviour that challenges or poses a risk to themselves or others, such as going missing, harming others or bullying. Sanctions and restraint are not used; however, there are suitable policies and staff are trained to deal with these situations. Staff support children physically and therefore undertake training in delivering personal care and moving and handling. Detailed care plans, risk assessments, and emergency protocols are in place and guide staff in their direct care of children.

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Safeguarding children and young people

New staff do not start work in the home prior to the completion of satisfactory disclosure checks and references; records of this are held centrally. However, full details of the checks are not currently held in the home; the manager is addressing this. At the time of inspection this work was not fully completed, and therefore a recommendation is raised.

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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 has recently retired. An experienced Registered Manager of another home run by the same organisation has taken on the leadership role for this home; this manager is due to undertake a period of extended leave. An additional manager has been identified to take on the role in the intervening period and is due to submit an application to register with Ofsted.

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Leadership and management

The current manager has recently revised the Statement of Purpose. This document has not been ratified by senior managers or submitted to Ofsted. Senior staff said that it often takes some time for changes to policies and documents to be ratified by the organisation. It is important that the revised Statement of Purpose is available promptly following revision, in order to provide current information about the service to those seeking placements.

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Leadership and management

Systems are in place to support the monitoring and oversight of the service. Managers carry out regular analysis and review of incidents, complete routine Schedule 6 audits and undertake monthly Regulation 33 monitoring visits. Appropriate action is taken in respect of identified shortfalls. Recently this has included a full review of the medication systems.

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Leadership and management

Managers demonstrate a good understanding of the home’s strengths and areas for improvement. Development plans are acted upon. An example of improvement is the setting up of a dedicated arts and craft room which children use during their visit. Improvements have also been made to the physical environment to ensure it is more child friendly and less clinical. Children positively benefit from these improvements to the quality of provision. Since the last inspection the home has run a coffee morning for parents and professionals. This has helped stakeholders to understand the purpose of the service, strengthened relationships and provided opportunities for formal consultation. Stakeholders’ views have been acted upon.

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Leadership and management

Appropriate action is taken to resolve the small number of concerns and complaints that have arisen since the last inspection. Incidents are investigated and a suitable resolution determined. The responsible individual reviews individual incident and complaint records but does not utilise the Regulation 33 reporting system to evidence this oversight.

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Leadership and management

Children benefit from a well trained, suitably skilled and experienced care and nursing team. Parents describe the staff as, ‘dedicated, friendly, approachable, helpful, professional, very kind, thoughtful and excellent.’ Specialist training to ensure staff can meet the individual needs of each child supplements mandatory training such as child protection and first aid. Staff receive regular supervision and their performance is reviewed. Staff team meetings are held and allow time to discuss each child accessing the service. As a result staff feel well-guided and supported in their role.

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Leadership and management

A qualified nurse formally leads each shift. Experienced care team members support them. Each member of staff works a mixture of day, evening, and waking night shifts. This ensures that children are supported at all times by staff who they feel secure with and who have a good understanding of their individual needs. Children are provided with one-to-one support; the nurse is in addition to this ratio. In recent months staffing levels have been affected by some long-term sickness and staff secondments. Managers and the team have considered the implications of some shifts having two staff and have taken some remedial actions. Managers are yet to formalise these plans into a written risk assessment to ensure the consistent deployment of staff during these periods.

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Leadership and management

Managers ensure prompt action is taken in response to any significant incidents that involve children. This includes management of complaints and safeguarding incidents and keeping families and other agencies informed. However, Ofsted has not been notified of two incidents that have arisen since the last inspection.

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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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