Coniston House

Unique reference number SC379123 Inspection date 19/12/2013 Inspector Mark Ryder Type of inspection Full Provision subtype Children's home

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Date of last inspection 27/03/2013 Website: www.ofsted.gov.uk

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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.

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Brief description of the service

The home offers placements for up to five young people who may have a combination of mental health, psychological, emotional or complex care needs that present challenging behaviour. The service is designed to offer medium- to long-term care placements.

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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

This home provides young people with stability and support to develop into adulthood. Outcomes for young people are mainly positive and enabling. Young people say they feel safe at this home and that staff are respectful and value their opinion. The young people have all made progress and feel that their lives are much more stable since living at the home. Relationships between staff and young people are based on good parenting skills and an awareness of mental disorders and emotional and behavioural difficulties.

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Overall effectiveness

However, the safe storage of medication is poorly organised and has a direct impact on the judgement within quality of care outcomes. Whilst no young people have been put at risk there was the potential for this. Care plans are well written and provide useful information to help staff care for young people well. Assessments accurately reflect the level of risk for each young person.

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Overall effectiveness

The Registered Manager recognises the strengths of the service and has some appreciation of the weaknesses. However, a statutory requirement has been made to further improve the monitoring of the home. There are a further three other statutory requirements made as a result of this inspection including improving the safe storage of medication and updating the statement of purpose and young person's guide. A requirement has also been made for the provider to confirm agreement for the continued use of electronic internal door alarms that are activated throughout the day or night. None of the above requirements impact negatively on the present safety and welfare of young people however.

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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 statement of purpose includes a description of any electronic or mechanical means of surveillance of children which may be used in the children's home (Regulation 4 Schedule 1 (19)) 16/01/2014

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Reg. Requirement Due date

(2001) make suitable arrangements for the recording, handling, safekeeping, safe administration and disposal of any medicines received into the children's home (Regulation 21 (1)) 16/01/2014

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Reg. Requirement Due date

(2001) ensure that electronic or mechanical monitoring devises (namely bedroom door alarms) for the purpose of safeguarding and promoting the welfare of children accommodated, the child's placing authority consents to the use of the measure in question and that it is provided for in the child's placement plan (Regulation 22 (a)(b)) 16/01/2014

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Reg. Requirement Due date

(2001) improve the monitoring as set out in schedule six in reference to visitors to the home and medicines stored in the home. (Regulation 34 (1) schedule 6 (9)(14)) 16/01/2014

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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 sanctions and rewards for behaviour are clear, reasonable and fair and are understood by all staff and children (NMS 3.8)  ensure a children's guide includes how young people can find out their rights, how a child can contact their independent reviewing officer (IRO), the children's rights director and Ofsted if they wish to raise a concern with inspectors. (NMS 13.5)

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Outcomes for children and young people

Young people make good progress at this home which continues to provide them with opportunities to develop into adulthood appropriately. Young people are resilient and have a good understanding of their own behaviours and emotional states. Self- reflection is promoted. A young person commented that this is the best home they have lived in and that they feel happy about their future.

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Outcomes for children and young people

There has been significant progress in the stability of young people with regards to their mental health and anti-social and risk taking behaviours since living at this home. Improvements have included young people being able to function well out in the community independently of staff. As a result young people have better life chances when planning to move from this home.

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Outcomes for children and young people

This is a home with high aspirations for each young person. Young people have good educational, training and employment prospects. They are actively encouraged to do well and as a consequence they have gained placements in work and colleges. For young people who are reluctant to attend school, a home tutor visits and helps them to engage in education. An education timetable provides structure to the day which young people contribute to and work within. Young people are aware of the commitment by staff to promote their education to attend school, college or work placements.

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Outcomes for children and young people

Young people are aware of the health risks from risk taking behaviours. They make lifestyle choices that improve their health and wellbeing. For example, young people have reduced their level of smoking, eat more healthily and say they have stopped taking illegal drugs.

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Outcomes for children and young people

Young people enjoy positive and rewarding contact with their families. The home has a separate lounge to help facilitate this whilst not impinging on the privacy of others. Parents are welcome to visit the home and are made welcome. A parent said 'this is a good home for my child. The staff have really helped'.

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Quality of care

Whilst staff provide young people with a quality of care that supports their development, this is undermined by the arrangements for dealing with medication which is not considered safe or effective at this home.

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Quality of care

There are serious failures in the process in appropriately managing medication. Medication storage is poor and lacks rigorous oversight by senior staff to be considered suitable. For example, medication that is required to be kept refrigerated was stored in a fridge that was not switched on and was not locked. Similarly, medication was found in a locked cabinet that staff were unaware of, was not labelled and it was unclear who it was prescribed for. This results in a system that has the potential to be unsafe for young people who all require medication to control and support their moods, insulin levels, mental health and sleep patterns.

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Quality of care

Staff encourage young people to live healthy lifestyles which includes reducing smoking and eating healthily. Young people attend health appointments and, when required, to accident and emergency departments at the local hospital. There is a close link with the local child and adolescent mental health services which support the young people with their mental health. A psychotherapist, employed by the organisation, provides regular sessions with young people as well as consultation with the staff team. Young people have benefited from the therapy offered which has had a positive impact on, for example, reducing self- harming behaviours.

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Quality of care

Staff have positive and caring relationships with the young people. They are role models that promote suitable behaviour and are supportive and inclusive in their interactions with young people. This is acknowledged by young people themselves. Young people benefit from the stability of the staff team and as a consequence there has been a reduction in anti-social behaviour. However, the use of sanctions is not always consistent and reasonable. For example, young people have been previously given multiple sanctions for the same incident. This has the potential to be confusing and difficult for young people to understand.

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Quality of care

Placement plans reflect the individual needs and interests of young people. This includes comment on young people's cultural requirements and religious views. Plans are signed by the placing authority social workers to confirm their agreement. However, there is currently no consent by the placing authorities for the use of electronic internal door alarms to monitor movement by young people.

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Quality of care

The views, wishes and feelings of young people are regularly taken into account when decisions are being made about their day to day lives and future plans. For example, young people attend their own statutory reviews and are able to contribute to the discussions about their lives. Equally, young people attend their own weekly meetings where requests, ideas and grievances can be aired. A record of these meetings, together with a record of the action taken by the acting manager, demonstrates that young people are listened to and valued.

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Quality of care

Staff promote young people's interests and hobbies. For example, young people enjoy horse riding, photography and art work. A young person confirmed that they enjoy their leisure activities and are pleased that staff have taken an interest in what they do.

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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

Young people say that they feel safe and well cared for at this home. They have positive relationships with staff who they say they can talk to. The atmosphere within this home is relaxed and good natured. Staff are aware of how to appropriately respond to young people's behaviour and have the skills to reduce tension.

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Safeguarding children and young people

Behaviour management strategies are effective. For example, young people do not often present self-inflicted injuries and threatening behaviour. The consequence of this is that the use of physical intervention has reduced. Risk assessments are regularly reviewed and changed when required. Assessments on compatibility of young people when they are first considered for placement are carefully evaluated in the interests of safety and welfare.

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Safeguarding children and young people

Safe recruitment processes provide young people with staff who have been suitably checked and vetted. Young people also contribute to the recruitment process and are able to speak with candidates in a controlled environment. This enables young people to have a significant part in the selection of suitable care staff.

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Safeguarding children and young people

The frequency of when children go missing from this home has reduced. Young people respond positively to their free time and say they enjoy living at this home and do not want to run away. Staff take action to minimise this risk and have worked effectively with the police when young people have gone missing. A local protocol with the police is available to staff and has recently been updated. Missing person records are regularly reviewed and monitored.

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Safeguarding children and young people

Care plans clearly reflect the safety and interests of young people. The records identify behaviours that are of concern and how the staff hope to keep them safe. Young people are actively involved in their risk management plans. This has resulted in young people themselves understanding the consequences of their own behaviour.

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Safeguarding children and young people

Young people say that there is no bullying at this home. Young people generally enjoy each other's company and get on well. The acting manager and staff encourage young people to sit down together for an evening meal. This generates a sense of belonging and enables staff to observe group dynamics.

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Safeguarding children and young people

The home's electrical and gas installations are regularly serviced. Fire safety is tested weekly and drills to evaluate the home are completed with young people and staff. Staff and young people are aware of the fire safety procedures.

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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 home is run by an acting manager who is yet to be registered for this position, although the Registered Manager visits regularly and remains accountable for the operation and practice of this home. The acting manager is in the process of applying for registration.

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Leadership and management

There were no requirements and recommendations made at the last inspection. The leaders and managers of this home provide an adequate level of monitoring and oversight. However, monitoring is not considered robust as it does not identify and continuously promote improvement over a sustained period of time. For example, poor procedures for the safe storage of medication and a lack of rigour in checking the visitors signing in and out book undermine the quality of care for young people.

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Leadership and management

The managers are aware of their strengths and have some appreciation of the areas for further development. The staff actively promote consultation with young people, parents and other stakeholders. This results in a service that values feedback and develops practice accordingly. For example, the weekly meeting for young people provides opportunities for them to express their views and for staff to act on all reasonable requests.

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Leadership and management

Leaders and manager's promote regular positive contact with other agencies, such as placing local authorities, health services and education providers. This enables staff to effectively liaise with such services to provide young people with further support.

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Leadership and management

The acting manager supports staff and the organisation provides suitable training opportunities. New staff receive weekly supervisions and work through an induction programme. All mandatory training, such as safeguarding and the safe use of physical restraints are completed promptly. For more established staff, there are regular refresher training to further develop core skills and knowledge within their role. A member of staff said that they could not fault the training that is provided at this home.

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Leadership and management

The statement of purpose reflects the aims and ethos of the home and is available to young people, parents and placing authority social workers. The statement, however, does not include the use of electronic door alarms. This omission means that placing authorities are not aware that the home uses such devises when they first place young people to this home.

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Leadership and management

Staff provide young people with a guide to the home when they first arrive. However, the guide does not include the contact details of their IRO, the children's rights director or Ofsted if they wish to make a complaint. Whilst young people have not identified this as a particular concern, the guide currently does not meet national minimum standards in the information recommended for all young people in placement.

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Leadership and management

The home is adequately resourced and provides a suitable and safe living environment. Records, such as weekly reports to placing social workers, provide an accurate and clear overview of, for example, each young person's activities, observation of presenting behaviour and development in training, education or work places. Social workers confirm they receive such reports and that they are useful and informative.

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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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