Children's Home run by Keys Direct Care Limited in Norfolk

Unique reference number SC450994 Inspection date 20/01/2014 Inspector Stephen Halliley Type of inspection Full Provision subtype Children's home

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Date of last inspection 03/04/2013 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 is owned by an independent provider. It is registered for four children with emotional and/or behavioural difficulties (EBD).

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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 some significant progress while living in this home. Particular areas of note are educational attendance and achievement, a developing understanding of their own health needs and the forming of safe, strong attachments to the adults who work with them.

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Overall effectiveness

Relationships with staff are good and young people are fully aware of the fact that their safety and well-being is central to the work staff undertake. Young people and their social workers are clear that young people are safe while living in the home. There is, however, still a propensity for young people to abscond from the home when they are unhappy or wish to see friends. This has significantly reduced for all young people when compared to their behaviours before moving here. The home work consistently with young people to address this behaviour and there are very robust systems in place to try and facilitate the prompt and safe return of young people to the home when they go missing. A good range of inter-agency working also supports plans to help young people understand risk and keep themselves safe.

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Overall effectiveness

On a day to day basis young people are cared for in line with individualised and detailed care plans. This ensures their specific needs are met and targets achieved in line with more longer term plans. There is good planning for moving on and young people develop a range of life skills to support them when this time comes.

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Overall effectiveness

The Registered Manager is fully aware of the strengths and weaknesses of the home and there is a full development plan in place to continue to promote improvement. This has included providing additional training for staff to ensure they have the specific skills and knowledge necessary to work with a group of young people with very complex needs and behaviours.

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Overall effectiveness

While the general level of care is very high and a warm, nurturing environment is provided which the consultant therapist says 'allows young people to be teenagers' a number of shortfalls were noted which result in this home being judged to provide an adequate service at this inspection.

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Overall effectiveness

Shortfalls were noted with regard to promptly sending notifications of significant events to Ofsted and the consultation process around monthly monitoring of the home. There were also issues linked to recording of restraints, administration of medication and ensuring health and safety procedures are followed at all times. Minor shortfalls were also noted relating to the accuracy of monitoring reports, the use of the visitors book and the untidiness of the external areas around the building.

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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

17B (2001) ensure that within 24 hours of the use of any measure of control, restraint or discipline a written record is made in a volume kept for the purpose which shall include the date on which the measure was used and confirmation staff have been spoken to about the use of the measure by a person authorised to do so (Reg 17B (3) (d) (h)) 28/02/2014

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Reg. Requirement Due date

(2001) ensure that any medicine which is prescribed for a child is administered as prescribed and that a written record is kept of the administration of any medicine to any child; ensuring this includes when medication is refused in order to ensure it was offered in line with the prescription (Reg 21 (2) (b) (c )) 31/01/2014

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Reg. Requirement Due date

(2001) ensure that all parts of the home to which children have access are so far as reasonably practicable free from hazards to their health and safety (Reg 23 (a)) 28/02/2014

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Reg. Requirement Due date

(2001) ensure that any events listed in column 1 of the table of Schedule 5 are notified without delay to Her Majesty’s Chief Inspector (HMCI) (Regulation 30(1)) 28/02/2014

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Reg. Requirement Due date

(2001) ensure the person carrying out the visit interviews, in private, such of the children accommodated there, their parents, relatives and persons working at the home as appears necessary in order to form an opinion of the standard of care provided in the home. (Reg 33 (4) (a)) 28/02/2014

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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 the home provides a comfortable and homely environment and is well maintained and decorated. This relates specifically to the exterior of the building (NMS 10.3)  ensure all staff's work is consistent with regulations, national minimum standards and the home's policies and procedures; specifically ensuring visitors are signed in and out of the home (NMS 21.3)  ensure visits to the home carried out under Regulation 33 include relevant checks set out in regulations and guidance and checks of any disciplinary measures and use of restraint; specifically that the restraints and notifications mentioned in the reports accurately reflect records found in the home. (NMS 21.7)

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Outcomes for children and young people

Outcomes for young people are adequate .

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Outcomes for children and young people

Young people have made significant progress in terms of their educational attendance and achievement, awareness of their background and understanding of why they are living in this home. While there is a level of emotional resilience and maturity being developed by young people this is not evident in many of the behaviours they exhibit; constant demands for staff attention, resorting to inappropriate behaviour when requests are not immediately responded to and refusing to return to the home following minor disagreements despite restorative meetings having successfully taken place. While the home provide the nurturing and caring environment young people need in order to develop trust and belief in themselves and others, work around developing self-confidence and emotional maturity continues as part of care and placement plans.

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Outcomes for children and young people

Young people's health and well-being is given a high priority in this home and they are involved in planning healthy menus and activities to support their living a healthy lifestyle. Young people are beginning to develop an understanding of the need to take responsibility for their health needs. They actively arrange some of their own appointments and attend all regular appointments made for them with dentists, opticians and doctors. However, young people continue to smoke, occasionally use alcohol and talk of being sexually active when absent from the home, all of which pose additional risks to their physical and emotional health. Ready access to a therapeutic consultant and child and adolescent mental health services (CAMHS) supports young people's emotional and psychological needs. Young people are becoming more understanding of the benefit of this input and are accessing these services more willingly than they may have done in the past.

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Outcomes for children and young people

Attendance levels at school and college are vastly improved for all young people since they arrived at the home. However, there has been a dip since the Christmas holiday and young people are not consistent in their attitude towards education. Some significant achievements have been made such as maintaining mainstream educational placements and accessing college courses evidencing the benefit of attending their education regularly. Staff are consistent in giving young people the message that their education is important.

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Outcomes for children and young people

Young people undertake a range of household tasks and develop independent living skills through following a four stage independence plan. Some young people are rightly proud of the progress they have made in developing these skills and understand how they should help them when they move on from this home. Young people are involved in voluntary work, attending the gym and in performing with a local orchestra. This supports their ability to manage themselves appropriately in a range of social situations and contributes their improving self-esteem.

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Outcomes for children and young people

Young people all have highly individualised home contact arrangements. These are pro-actively supported and facilitated by the home ensuring young people are able to maintain important relationships and their place in their families.

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Quality of care

Young people's relationships with staff are positive. These have developed through the consistent efforts of staff to ensure young people know they are cared for and will be kept safe. Though young people are very demanding of staff and often quite abusive they have clear relationships and attachments which they may not previously have had with adults in their lives. This is evidenced by the fact that young people ring the home and make contact with staff while they are absent to let staff know they are safe. Relationships within the young people's group very greatly. They can be extremely supportive of each other at times but lack any degree of empathy regarding each other's needs at others.

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Quality of care

Young people play a full role in the day to day running of this home. Aside from helping plan menus and activities they have been very involved in the decoration of their bedrooms and in the planning for the current redecoration programme throughout the home. Regular group meetings are held and staff clearly respond to suggestions and requests from young people. Staff are very clear when it will not be possible to act upon their wishes, explaining the reasons why, including expectations of behaviour, linking consequences to actions and any time restrictions which make requests impractical. This approach is designed to help young people understand how their behaviours impact on their opportunities and also to plan ahead as they will need to do should they move from here to a semi-independent living environment.

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Quality of care

All young people have individualised care and placement plans in place. Internal plans are based around placing authority plans put in place following young people's statutory reviews. Young people attend these meetings and express how they feel and their wishes for their future. This ensures they are fully involved in the process of decision making which will affect their daily lives. Internal plans are regularly updated and all staff are fully aware of these to ensure a consistent level of care is provided to all young people.

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Quality of care

Young people's improving attitude and acceptance of support from CAMHS teams and therapists working with the home is ensuring their emotional and psychological health needs are well met. Physical health needs are well met in the main and this includes making emergency appointments if required and following this up with hospital visits if this is felt necessary to fully explore behaviours or illnesses. Within the home there is a clear policy for the administration of medication and all staff have attended training in this area. However, there are some gaps in the recording of the administration of medication, specifically recording when medication has been offered but refused by a young person. By omitting this recording the home are unable to evidence the medication was offered at the correct time. Additionally one young person's medication had run out while she had been absent from the home and a repeat prescription had been delayed in being ordered. This means that for

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Quality of care

several days the home were unable to provide the young person with her medication as per her prescription. This is a significant shortfall when set against the high level of time intensive and highly personalised care provided by staff to all young people in the main.

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Quality of care

Young people's education is given a very high priority by staff. They have been supported to find the right college courses, are transported to and from school where no other means of travel are available and staff do not readily accept young people's refusal to attend education putting home based education in place if young people do not go to school as expected. Staff also work very closely with education authorities and local schools to ensure young people's places are maintained wherever possible. In order to do this they work well with young people to address issues, attend meetings to find new solutions to problems and listen to young people's thoughts and feelings about their courses and to remove all obstacles to a young person's education they are able to.

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Quality of care

This home is benefitting from a programme of redecoration to ensure it remains light, warm and welcoming. A new maintenance system has been put in place within the organisation to make sure issues raised by homes are responded to promptly. Unfortunately the area outside the home, especially around the front door, is strewn with cigarette butts and this does not provide a good first impression to visitors.

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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 say they feel safe in this home and are very aware of the work staff do to make them safe. They talk of the work staff do to make them understand the risks they put themselves at when they abscond but this does not prevent them from going missing from the home at times.

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Safeguarding children and young people

Young people often move to this home with a history of regularly absconding and putting themselves at risk of sexual exploitation. Young people engage with external agencies to look at the risks of this type of behaviour and are beginning to form an understanding of how they are better able to keep themselves safe. Through a consistent staff approach young people have been supported to significantly reduce the number of times they go missing from the home. There have been 26 instances of young people being missing since the last inspection in April 2013 though many of these have been for very short periods. All staff are very aware of their responsibilities should young people go missing. They are proactive in following young people whenever possible, make regular contact with all known associates of young people and unfailingly attempt to contact young people and drive around areas they are known to frequent. A clear protocol in place with local police

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Safeguarding children and young people

alongside individual protocols for young people with police departments in their home authorities ensures a joined up approach to try and facilitate a prompt and safe return to the home.

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Safeguarding children and young people

A range of health and safety checks in the home, including regular fire drills, ensures young people are kept safe from accidental injury. However, there was a recent incident involving the misuse of a cleaning product which resulted in an ambulance being called to the home. The registered manager has responded to this quickly by instigating a new procedure for signing products in and out of the COSHH cupboard to ensure this cannot be repeated.

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Safeguarding children and young people

There have been 52 uses of physical restraint since the last inspection. Records indicate these have been necessary to keep young people and staff safe. Records are generally clear and well detailed however one restraint record does not include the time of the incident. Following restraint many debriefs of staff have been carried out only by those involved in the incident. This does not allow for an objective view of the restraint, for any issues to be analysed and potentially for lessons to be learnt. More recently this debrief has been carried out by the Registered Manager or by the oncoming senior member of staff to ensure an impartial discussion takes place led by a member of staff who was not involved in the incident.

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Safeguarding children and young people

Young people are protected from the potential of abuse or harm by staff who work with them as these staff are rigorously checked and vetted before they can commence employment. Visitors who are unknown to the home routinely have their identity checked to verify their right to visit. However, visitors are not always asked to sign in the visitors book or to sign out when they leave. This is a potential safeguarding issue should there be an emergency situation in the home.

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Safeguarding children and young people

All staff have received safeguarding training ensuring they understand their responsibilities and responses should an allegation or disclosure of harm or abuse be made. Recent incidents within the home have been notified appropriately and full and complete investigations carried out. The Registered Manager is fully aware of when these incidents need to be referred to outside agencies such as Ofsted, children's safeguarding boards or local authority designated officers. This has ensured all complaints or concerns raised have been thoroughly addressed and resolved to the satisfaction of all concerned.

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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

This home is managed by an enthusiastic manager dedicated to providing the highest quality of service to young people. Her positive approach is mirrored by the staff team who are committed, flexible and completely focussed on supporting young people. The complex needs of young people are at the heart of practice, however monitoring of the home has slipped in some areas as reflected in the requirements and recommendations made within this report.

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Leadership and management

The home is able to demonstrate continued development since the last inspection. The five recommendations made at that time have all been fully addressed. The home has been running at capacity for some time now and paperwork has been streamlined and improved to make them more user friendly. Additionally the organisation has set up its own 24 hour bullying hotline to sit alongside those helplines offered by national charities. This has not yet been used by young people in this home but it is a recognition that bullying has occasionally been an issue and offers young people an opportunity to resolve issues quickly with an adult they know and trust but who does not work in the home.

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Leadership and management

The Statement of Purpose has recently been updated and reflects the aims of the home and how they will meet the needs of young people. Young people themselves have a welcome booklet on arrival and a copy of this is kept on file so they can refer to it at any time should they wish to do so.

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Leadership and management

The Registered Manager monitors records held in the home on a regular basis and compiles reports to show how improvements could be made. This has not been sufficiently robust as to pick up issues around medication recording or to fully address the insufficient use of the visitors book though this has been noted. This monitoring is supported by monthly visits to the home undertaken by the provider to assess the quality of care provided and inform future development. These visits have regularly involved staff and young people living in the home but have not involved parents or placing authorities in order to obtain a full well-rounded view of the service provided. Additionally there have been inconsistencies in some reports in regard to them not accurately reflecting the number of restraints or notifications made by the home. There have also been two notifications of significant events which were not completed and forwarded to Ofsted in a timely manner. This all

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Leadership and management

results in Ofsted, as a regulator, receiving inaccurate information about what is happening in the home.

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Leadership and management

The Registered Manager is fully aware of the strengths and comparative weaknesses of her home. She says strengths include 'the consistency and resilience of the staff team, the joined up work we do with our therapeutic consultant and CAMHS and the way staff think for themselves and introduce small improvements to recording and systems themselves'. She feels comparative weaknesses include 'the fact this remains a fairly new staff team who are bedding down into a fully occupied house and the need for them to develop a complete understanding of the roles of other professionals and how these impact on our young people'. There is a clear development plan in place to support staff to fully understand their own roles and that of other professionals as well as drive the service forward.

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Leadership and management

This home is well staffed and there are plans to increase the staffing levels following a recent recruitment drive. All staff receive regular supervision and state this provides 'excellent support, pushing you to use your initiative, abilities and awareness rather than relying on others.' All staff also receive a range of mandatory training; safeguarding, behaviour management, health and safety, first aid, and fire safety, and these are regularly updated. All staff have also attended child sexual exploitation training and training in working with young people who self harm. This ties in with the managers stated development of the home to provide specialist support for young people at risk of sexual exploitation.

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Leadership and management

Young people's records are complete and stored securely. Young people have access to these when they wish and are able to gain a complete and detailed understanding of their time in the home from reading these records.

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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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