Children's Home run by The Together Trust in Stockport

Unique reference number SC008575 Inspection date 11/09/2013 Inspector Jacqueline Malcolm Type of inspection Full Provision subtype Children's home

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Date of last inspection 05/02/2013 Website: www.ofsted.gov.uk

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Brief description of the service

The home is owned and run by a private charitable trust. It provides residential care for up to five young people, who have a physical and/or learning disability.

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The inspection judgements and what they mean

Outstanding : a service of exceptional quality that significantly exceeds minimum requirements Good : a service of high quality that exceeds minimum requirements Adequate : a service that only meets minimum requirements Inadequate : a service that does not meet minimum requirements

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Overall effectiveness

The overall effectiveness is judged to be adequate .

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Overall effectiveness

Young people make measurable progress as a result of living in a supportive home. They are cared for in accordance with their individual placement plans. This stimulates stable relationships, which help young people feel safe enough to express themselves in their own unique ways. Safeguarding is a high priority at the home. This ensures young people's security and protection. However, some behaviour management strategies are excessive. This means that restrictive physical interventions with some young people result in their dignity and safety being compromised.

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Overall effectiveness

The home consistently challenges barriers to young people’s progress irrespective of their disability. This helps young people to develop in confidence and integrate successfully into the community, which enhances their quality of life. Anti- discriminatory practice is well integrated into young people’s daily lives and their wishes and feelings are appropriately responded to. This enables staff to sensitively engage with young people, which promotes their individuality.

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Overall effectiveness

Parents and professionals value the services provided to young people. One parent says, ‘the way staff treat my daughter is good. The education she receives at school is good. I am pleased the staff take her out on holiday.’

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Overall effectiveness

The home is suitably managed. However, there are shortfalls in respect to management oversight, behaviour management, promoting young people’s dignity and privacy, staffing, night-time fire procedures and the quality and accuracy of some records.

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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 the children’s home is conducted so as to promote and make proper provision for the welfare of children accommodated there and make proper provision for the care, education, supervision and, where appropriate, treatment, of children accommodated there. This specifically relates to restrictive behaviour management practices in the home (Regulation 11 (1) (a) (b)) 31/10/2013

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Reg. Requirement Due date

(2001) ensure suitable arrangements to ensure that the home is conducted in a manner which respects the privacy and dignity of children accommodated there. This specifically relates to restrictive behaviour management practices in the home (Regulation 11(2)(a)) 31/10/2013

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Reg. Requirement Due date

17B (2001) ensure that where a measure of restraint is used on a child the record under paragraph (3) must include the duration of the measure of the restraint; and details of any methods used to avoid the need to use that measure (Regulation 17B(4)) 31/10/2013

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Reg. Requirement Due date

(2001) ensure that there is at all times a sufficient number of qualified, competent and experienced persons working at the children's home, including in meeting any needs arising from any disability. (Regulation 25(1)(a)(b)) 31/10/2013

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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 visits under Regulation 33 inspect compliance with regulations, systems and processes and the person making the visits will wish to be satisfied that the home has an effective approach to behaviour management (Volume 5, statutory guidance, paragraph 3.12)  ensure that children’s emotional and behavioural needs as set out in their care plan does not compromise their privacy and dignity (NMS 3.7)  ensure that the home regularly reviews incidents of challenging behaviour, examines trends or issues emerging from this, to enable staff to reflect and learn to inform future practice (NMS 3.22)  improve the quality and adequacy of record keeping and take action when needed. (NMS 22.1)  ensure that staff and children are familiar with the emergency escape plan and have practised so they know what to do in an emergency. This specifically relates to night-time staff. (NMS 10.9)

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Outcomes for children and young people

Young people make good progress in their education, health and develop good levels of resilience. Young people achieve improvements in the management of their behaviour. However, some young people have not been consistently afforded privacy and dignity and appropriate supervision when their behaviour escalates. This does not promote their self-esteem. Young people have developed a trusting bond with staff who care for and about them. They are settled in the home and with support, young people develop a range of independence skills, such as showering, shopping for clothing, food and personal items. This helps young people to develop their confidence and learn new and exciting skills.

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Outcomes for children and young people

Young people benefit from exceptionally good, efficient and consistent health care. All young people are registered with primary and specialist health care services that target their specific complex health needs and needs. Their good health is maintained because they attend health appointments and respond to home visits by health professionals. Young people eat healthy, balanced home-cooked meals that meet their cultural needs and choices. This respects their wishes and preferences.

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Outcomes for children and young people

Young people have an excellent record of school attendance. They really enjoy school and make steady progress that is compatible with their needs. This helps young people overcome barriers to their education. Young people’s participation in local community activities, such as visiting the library, swimming, walks to the local park and dining out stimulates their enjoyment and involvement in community life. They also engage in home-based activities. For example, playing musical instruments and listening to music, playing games, using the I Pad and relaxing in the sensory area. Holidays away provide new, exciting and enjoyable experiences.

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Outcomes for children and young people

Young people benefit from contact with their family, friends and significant people in their lives. This ensures that they sustain good links with the people who have their best interests and may act as their advocate.

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Quality of care

Young people enjoy positive, caring and nurturing relationships with staff. Staff show huge amounts of affection and attention towards the young people and place their needs at the centre of their daily practice. This provides a positive basis for the good quality of care that young people receive at the home. Parents and professionals, such as social workers and independent reviewing officers comment positively on the quality of care that the home provides. Parents say, ‘I think they do well with him’ and ‘they do their best.’

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Quality of care

The staff team have an exceptionally good knowledge of the young people, their disability and associated needs and personalities. This ensures that most young people are appropriately cared for and supported. Young people have preferred communication methods, such as Makaton and picture exchange communication (PECS). This helps them to express positive and negative wishes and feelings that are appropriately acted on. This ensures that young people are listened to. Young people have information about the complaints procedure, which is designed in a format that young people understand. The communication between the home and parents is good and take place in a range of ways. For example, face-to face and telephone contact regular reports and meetings. This ensures that parents and carers remain involved in their child’s life and have a say in their care and treatment. Professionals, such as young people’s social workers express satisfaction with the

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Quality of care

standards of communication. One social worker said that they have ‘a very good, open and friendly relationship with the home.’

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Quality of care

Young people are proficient with using technology, such as the I Pad, which entertains them for hours. The device has also been an exceptionally good way of showing in words and pictures at statutory reviews the progress that young people make. Staff are constantly looking at new ways of improving communication and they are observant and sensitive to young people's changing moods and expressions. Staff act accordingly, which values young people.

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Quality of care

Person-centred care planning enables young people, their families and professionals to have their views and preferences explored and recorded. This enables their involvement in the care planning process, which makes them feel confident about young people's quality of care. Placement plans take into account young people's cultural background and personal identity. This is positively addressed on a daily basis. For example, young people from minority ethnic communities benefit from good hair and skin care routines and culturally appropriate meals. Staff work closely with parents and their contributions ensure that young people’s identity and heritage needs are respected and positively promoted.

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Quality of care

Staff place a high value education and place a great emphasis on young people’s school and college attendance. Young people attend their educational provisions and enjoy the experience. Good communication, such as the use of daily home and school book ensures that staff and teachers are familiar with incidences that may impact on the young person behaviour.

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Quality of care

Young people live in a healthy environment where their holistic health needs are highly prioritised and met. This is specifically highlighted in the reduction of incidents of risky behaviours that impact on young people’s health and self-esteem. Excellent relationships between the home and health care services ensure that young people receive prompt treatment and tailored equipment that safeguards their welfare. Young people receive exceptionally good post-operative care from staff and they are making a successful recovery. This demonstrates good levels of resilience. Staff act as strong advocates for the young people and work constructively with health and social care professionals. This ensures that their health needs are met. Safer medication management in the home promotes young people’s good health and well- being.

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Quality of care

Young people live in a welcoming, well-presented home environment, which includes a full range of equipment and adaptations that suite their mobility needs and activities. Young people have their own personalised bedrooms, which suit their individuality. The sensory area provides young people with hours of sensory stimulation. Young people use the interactive garden, where they have opportunities to use the specially designed musical instruments and safe play equipment. A conservatory, recently been built provides additional space that young people use. It is in the process of being furnished. This development further enhances young people’s positive experiences at the home.

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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

Young people's safety and welfare is prioritised by staff who are suitably trained. This helps staff to understand young people’s vulnerabilities and protect them. Higher staffing levels at the home ensure that young people are supervised. This reduces opportunities for young people to go missing from home, experience bullying or other forms of abuse. However, staff are familiar of the procedures to follow to counter these risks. This promotes young people’s welfare. Parents and professionals are of the opinion that young people are safely cared for at the home.

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Safeguarding children and young people

Most young people’s behaviour is generally well managed within comprehensive risk assessments and behaviour management plans. This helps young people to change some harmful, habitual behaviours, such as self-harm. However some behaviour management strategies that have been endorsed by professionals and parents are excessive. This means that on occasion, young people’s liberty has been restricted when their behaviour has become too unsafe for staff to manage. For example, internal doors have been held closed or locked for unclear lengths of time to prevent a young person from entering the communal areas of the home. This results in them being unsupervised and isolated from the rest of the group. On at least one occasion, a young person was left unattended, following a shower. They had no clothes on and were contained in a restricted area following a serious incident without staff supervision. This does not promote their safety, dignity and well-being.

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Safeguarding children and young people

The behaviour management measure does not conform to the home’s behaviour management policy and the incidents are not recorded in the restraint book. This does not comply with the regulations, which means that transparent and safe practice is not assured. Furthermore, the risk assessment regarding this practice is vague with respect to exact timescales. This leaves the staff guidance open to interpretation, which does not promote safe, child-care practices. Young people are protected from unsuitable adults who may cause them harm. This is because robust recruitment procedures are followed. Health and safety checks, including the maintenance of gas and electric appliances reduce the risk to young people’s safety. Regular fire checks ensure that young people can be safely evacuated in the event of a fire. However, not all night staff are familiar with the night-time fire plan. This does not ensure young people's safety in the event of a fire

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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

There are strengths and weaknesses in the home’s leadership and management. The home is suitably managed by an experienced and qualified Registered Manager who is well established at the home. She is suitably deputised and supported by a committed and motivated staff team. The manager knows all of the young people in depth and demonstrates a strong commitment to improving their life chances. She has good leadership skills and a development plan that is followed in practice. This secures good outcomes and enhances young people's quality of care.

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Leadership and management

However, there are shortfalls in an aspect of management oversight and prompt monitoring of some care practices. This relates to how some young people's behaviour is managed and the accuracy and timeliness of records. For example, the excessive behaviour management strategy has not been monitored or evaluated with sufficient rigour. The interventions are not contained in the restraint book and the manager has failed to recognise that the strategy is not in accordance with the homes behaviour management policy. This does not demonstrate close scrutiny of practices and identify weakness, trends and potential for poor and unsafe practice. Regulation 33 visits are regularly conducted, but the behaviour management issue has gone by unchallenged. This means that opportunities for clarity and improvement have been missed. These shortfalls are significant because they show a lack of systematic and good scrutiny of practice.

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Leadership and management

Not all entries in the restraint book are clearly recorded so that they are up to date and legible. The manager has identified outstanding tasks in the restraint book for staff to complete, but they are not responded to with sufficient speed. This does not demonstrate a prompt response to ensure that all records are clear and accurate. Not all statutory review reports are promptly received and requested to ensure clarity of placement plans. This undermines the otherwise good practice with respect to young people’s records.

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Leadership and management

Young people benefit from care delivered by a well-established staff team. However, there is not enough staff deployed in the home to ensure adequate supervision to young people who present with challenging and risky behaviours. This means that some young people who need to be apart from their peers are sometimes left unsupervised. A large number of staff have several years’ experience of caring for young people with disabilities. Most are qualified or are studying towards a recognised childcare qualification, which supports their professional development. New staff are supported and inducted into the home, which helps them to get to know the young people and start to build relationships with them. Regular child focused team meetings, change overs and daily communication about the young people’s progress ensures consistent practice. Staff have access to mandatory and refresher training. This enhances their skills and knowledge base. Staff are well

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Leadership and management

managed and their genuine care for the young people is evident. They are regularly supervised, appraised and feel well supported by the manager. One staff member said that the manager ‘leads by example’.

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Leadership and management

Two requirements made at the previous inspection have been addressed. For example, children, parents and the placing authority are consulted during Regulation 34 monitoring and prompt notifications are made to regulatory body, Ofsted as appropriate. This demonstrates that the home has capacity to improve.

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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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