Children's Home run by Options Autism (5) Limited in Shropshire

Unique reference number SC361167 Inspection date 04/12/2013 Inspector Joanne Vyas / Christy Wannop Type of inspection Full Provision subtype Residential special school (>295 days/year)

p.1

Date of last inspection 11/09/2013 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 setting is an independent residential special school registered as a children's home. The school offers specialised education and care for up to 20 children on a full-time basis, and two children under short-break arrangements. The school cares for children who are diagnosed with an autistic spectrum disorder and associated complex needs.

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 adequate .

p.3

Overall effectiveness

This home continues to make improvements to their safeguarding practice and quality of care. Although these areas remain adequate, the 24-hour curriculum, alongside the improving care practice, enables children and young people to have good outcomes. This home’s ethos is centred around the individual needs and aspirations of the children and young people who live there. They make good progress, especially with regards to their behaviour, communication and educational achievement. The Registered Manager understands the strengths and weaknesses of the service.

p.3

Overall effectiveness

There are a number of shortfalls identified at this inspection, which have resulted in three requirements, and 10 recommendations to improve practice. These include improving the environment, ensuring that all staff follow the behaviour management policy, and that all restraints are recorded. Other shortfalls relate to the management of allegations and concerns, permanent staffing, staff training and professional supervision, confidentiality, risk assessment, records, healthy meals and promptly addressing the views and wishes of children and young people.

p.3

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 physical design and layout of the premises are suitable for the purpose of achieving the aims and objectives set out in the home’s Statement of Purpose. Specifically, improve the environment to meet the needs of children with autism and provide a positive sensory experience in respect of sound and outdoor play (Regulation 31 (1)) 30/06/2014

p.4

Reg. Requirement Due date

17B (2001) prepare and implement a written policy (in this regulation referred to as the “behaviour management policy”) which sets out the measure of control, restraint and discipline which may be used in the children’s home, of which shall include all elements of this regulation (Regulation 17B (1) (a)) 30/12/2013

p.4

Reg. Requirement Due date

17B (2001) ensure that within 24 hours of the use of any measure of control, restraint or discipline in a children’s home, a written record is made in a volume kept for the purpose. (Regulation 17B (3)) 30/12/2013

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 action is taken to address any issue of concern that is identified or which is raised with them. This specifically refers to the slow response to complaints about the provision and addressing concerns such as a breach of confidentiality (NMS 21.9)  ensure the overall number, competence and deployment of staff and number 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 in the home (NMS 17.1)  ensure staff and volunteers are supported and guided to fulfil their roles and provide a high quality service to children. For example, that regular supervision is delivered by appropriately qualified and experienced staff, and that supervision takes account of performance improvements identified by investigations (NMS 19)  ensure the children’s home has a designated person, who is a senior manager,

p.4

Recommendations

responsible for managing allegations. This designated person has responsibility for liaising with the local authority designated officer (LADO) and for keeping the subject of the allegation informed of progress during and after the investigation. This specifically is with regard to ensuring the LADO is provided with a comprehensive outcome of any investigation of allegations made against staff (NMS 20.5)  ensure the home meets the emotional and behavioural needs of children, as set out in their care plan. Children’s privacy and confidentiality are appropriately protected (NMS 3.7)  ensure the home implements a proportionate approach to any risk assessment, for example that makes clear the number of staff needed to safely manage any activity with children (NMS 4.5)  implement a written policy that clarifies the purpose, format and content of information to be kept on the registered person’s files and information to be kept

p.4

Recommendations

on the child’s files. Specifically, ensure that staff make timely, accurate, and reliable records (NMS 22.1)  ensure staff have high quality training to enhance their individual skills and to keep them up to date with professional and legal developments. Specifically, this includes advanced safeguarding for managers and a relevant qualification for staff with health and safety responsibilities (NMS 18.1)  ensure children live in a healthy environment where their physical health is promoted. Specifically, ensure meals are not repetitive and unhealthy where possible (NMS 6)  ensure children’s views and wishes are acted upon, in the day-to-day running of the home and important decisions or changes in the child’s life, unless this is contrary to their interests. (NMS 1.1)

p.5

Outcomes for children and young people

Children and young people make good progress in this home, particularly with regards to their behaviour, communication and educational achievement. A social worker said: ‘This young person has made significant progress in his learning, behaviour and self-regulation.’

p.5

Outcomes for children and young people

It is good that their school is on the same site as their home. This assures increased attendance and attainment and means children and young people benefit from a 24- hour approach to their development. A social worker said: ‘Prior to attending this home the young person did not attend school for over a year. Since being at this home he has achieved over 95%.’

p.5

Outcomes for children and young people

Children and young people have strong relationships with staff in the home and some are able to say they enjoy living in the home. Others demonstrate well-being through improved mood, reduced anxiety levels and increased sociability. A social worker said: ‘The young person settled in residence really well; he’d repeatedly told people that he liked staying there.’ Children and young people have choices and make decisions using a range of communication techniques, such as signing and symbols. Children and young people have a clear voice in the home. A social worker said when asked what the service does well: ‘Listening to the young person, identifying his likes and dislikes when putting together a programme of activities.’

p.5

Outcomes for children and young people

Children and young people keep in touch with important people in their lives. They send birthday cards and have the time they need to speak to and see their family, either at the home or with staff support on home visits or with their families in the community. This may include regular visits to the family’s place of worship or family events such as a christening. A parent said: ‘My son was fantastic on Sunday and so were the staff for keeping him on track. Them being there absolutely made the difference at such a big family event. You know what it’s like; it could so easily have gone the other way.’ This keeps their family in mind and preserves their sense of family identity.

p.6

Outcomes for children and young people

Children and young people are confident that staff are alert to the triggers for their anxieties and worries. Children and young people approaching the age of 18 are given space and help to come to terms with moving on to the next stage of their young adult life. Children and young people have positive, affirming contact with the community and develop meaningful relationships with trusted carers.

p.6

Quality of care

The ethos within this home is centred on each individual young person. Permanent staff know and understand the children and young people well. They help them to occupy themselves with activities that have a range of different purposes and enable different sensory and social experiences. This enables children and young people to explore their environment and expand their horizons.

p.6

Quality of care

External professionals and parents have mixed views of the quality of care provided in this home. All say that staff communicate well with them, but some say staff are slow to respond to requests or suggestions they make. This can be frustrating, especially for some parents. As parents advocate for their children, this means children’s views and wishes are not always promptly acted upon.

p.6

Quality of care

The health of children and young people is adequately promoted. Children and young people have access to a range of healthcare professionals employed by the home, including a consultant paediatrician, a team of nurses and therapy staff. These people provide vital support and guidance to care staff in the promotion of good health. There are effective safe procedures for the handling of medication carried out by competent staff. Children and young people do have access to healthy food and are encouraged to participate in activities which provide physical exercise. However, on some occasions, food can be unhealthy. For example, one young person had chips three times and sausages twice in the same week, as well as a burger. A social worker said: ‘He has put weight on since being at the home. The team are addressing this with him.’ This does not encourage children and young people to eat healthily or expand their repertoire of food. However, other children are learning to

p.6

Quality of care

expand their experience of food and try new, healthy foods and move away from poor eating habits.

p.7

Quality of care

The home provides a clean and reasonably decorated and maintained environment. The school and children’s home are well resourced with a range of sensory rooms providing soft play, sensory stimulation and water therapy. Children and young people have large single en-suite bedrooms which are designed around their autism- specific needs. However, there is an inconsistent approach to the environment between the short-break and long-stay accommodation. This means that children and young people on short breaks benefit from a homely environment, with carpets, curtains, an ordinary television set and ornaments, whereas those in long-stay accommodation have space which appears bare and institutional. Although purposefully designed to promote a ‘low-arousal’ environment which supports children and young people with autism to be calm, other aspects of sensory arousal have not been properly considered. Some areas are very noisy because of the lack of

p.7

Quality of care

soft furnishing and building materials and some sounds of the institution. The excessive sound of keypads clicking, doors buzzing, echoes from hard surfaces, and walkie talkies crackling on and off, can have a direct impact on some children’s anxiety levels. Managers have identified this as an issue and plan to consider noise reduction and sensory overload in the environment. The outside areas are grassed and fenced for children and young people’s safety. Although there is some play equipment and plenty of space, there is minimal large play equipment for use by older young people.

p.7

Safeguarding children and young people

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

p.7

Safeguarding children and young people

Children and young people are generally safe and feel safe. Their autism, heightened awareness and specific anxieties mean that triggers for insecurities are set at a very low threshold. Staff manage children’s worry and stress on an intense level and are acutely aware of the need to keep the environment calm and positive so that children and young people can enjoy life. However, this can sometimes be difficult due to the high level of noise at certain times.

p.7

Safeguarding children and young people

Staff have a better understanding of the home’s safeguarding and whistleblowing procedures. Arrangements for the protection of children are on an improving trajectory, and incidents of abuse and accidents are reducing and becoming better managed. Investigations into allegations or suspicions of harm are handled in conjunction with, and under the direction of, the local authority designated officer (LADO). There is improving practice in the home’s ability to identify and act on safeguarding concerns. However, following a recent concern, there was an unclear conclusion to the LADO about the outcome of an internal investigation. The service also missed an opportunity to follow up staff development points arising from allegations in subsequent staff supervision and performance management.

p.7

Safeguarding children and young people

Children and young people enjoy sound relationships with staff. Staff generally respect children and young people’s privacy. However, staff have inadvertently breached procedures about confidentiality because there has been a lack of clarity about the storing of confidential information on staff personal mobile phones.

p.7

Safeguarding children and young people

Staff promote children and young people’s behaviour in a positive manner. However, not all staff implement the extensive behaviour support plans all the time. Some techniques are not consistent with behaviour support plans, such as use of language and inaccurate counting down to the end of an activity. However, the approaches staff use are effective in promoting positive behaviour.

p.8

Safeguarding children and young people

Restraint is only used in strict accordance with the legislative framework. However, there has been an incident when staff have moved children in a way that is not part of the home’s authorised technique and have not made an accurate and clear recording about this. While there was no harm to any child in this, it means that staff have acted outside of the behaviour management policy and behaviour support plans.

p.8

Safeguarding children and young people

The environment is physically safe and appropriately secure, taking account of children and young people’s extreme vulnerability. Systems for health and safety coordination across the site are improving. New risk assessments for children’s activities are better. However, they do not identify the required staffing levels to ensure children’s safety. The management of children’s activities in practice, however, is safe and does ensure sufficient adult supervision.

p.8

Safeguarding children and young people

Staff working with children in the home are carefully selected and vetted and there is monitoring of such people to help prevent unsuitable people from having the opportunity to harm children. Agency carers are not used if they are unable to demonstrate safe recruitment by their agency.

p.8

Leadership and management

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

p.8

Leadership and management

The home has a newly registered manager who is experienced and qualified. She offers strong, supportive leadership. She recognises the strengths and the weaknesses of the home and strives for continual improvement. The Registered Manager has a range of good monitoring systems in place which are starting to have a positive impact on the effective running of the home.

p.8

Leadership and management

The service has taken action to meet all the requirements and recommendations from the last inspection. There are now more permanent, skilful staff working directly with children. There is now a systematic approach to delivery and monitoring of staff supervision. This means that children and parents can increasingly trust that there are enough familiar, experienced and trained staff of the right calibre caring for children. Record keeping about safeguarding has improved, with clear systems for both staff issues and children. The environment is a safer place for staff and children to be because risk and accidents are reducing. Health and safety systems are now adequate. Quality assurance systems are increasingly rigorous and effective. These actions all contribute to the improved welfare of children and of care that is of an increasingly assured quality.

p.8

Leadership and management

Parents and external professionals agree that generally there is good communication between staff and themselves. Complaints from parents are properly investigated and action taken is appropriate. However, the Registered Manager is slow to respond to parents about their complaints. This may create tension and anxiety for parents. Furthermore, where investigations have revealed issues of a breach in confidentiality, these have not been followed up.

p.9

Leadership and management

The home is now adequately staffed. However, there are still occasions when there can be insufficient permanent care staff to reliably staff the home. Staff work overtime to fill the gaps, and teaching and therapeutic staff also work after their normal working day to support essential care and maintain safe adult-to-child ratios. Although agency staff are used regularly, their use has reduced. Due to the unreliability of some agency staff, ad hoc arrangements are put in place to provide support to ensure children and young people go on outings, staff have breaks, cover domestic tasks, and provide essential extra support during behavioural challenges. The organisation continues to recruit staff to fill vacancies where staff have either left or been promoted. Despite these occasional lapses, there is an improving picture of a stronger staff team. This is due in part because the management is taking effective disciplinary action when they find poor practice.

p.9

Leadership and management

Permanent staff are provided with a good quality induction package and subsequent training. The Registered Manager has plans to further improve the induction package. However, agency staff do not receive an adequate induction or training from the organisation. Nonetheless, the use of agency workers has reduced and the Registered Manager tries to use the same agency workers to ensure their familiarity with the children and young people and the service. Children and young people are increasingly cared for by staff who are properly supported through professional supervision by their line managers. This means that staff have regular formal opportunities to discuss and improve their care practice. However, there can be a lack of consistency in tackling learning points arising from investigations in professional supervision when performance issues have been identified.

p.9

Leadership and management

Although staff do have a range of training opportunities, not all staff are trained in key aspects of their role. For example, senior staff with responsibility for managing allegations have yet to have advanced child protection or designated person training, although this is planned. Additionally, staff who are responsible for coordinating health and safety on site do not have a formal qualification in this aspect.

p.9

Leadership and management

The Registered Manager has uncovered several instances when staff have falsified, or failed to make accurate reports. There continues to be some poor or missing recordings in the huge number of children and young people’s records. Conversely, there is also a tendency to record too much or be repetitive with recording. This can be confusing and time consuming. However, the Registered Manager is taking robust action to address these areas of poor or weak practice and the service has plans to review paperwork systems.

p.9

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.11

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.11