Children's Home run by Considerate Care Limited in Liverpool

Unique reference number SC062674 Inspection date 15/01/2014 Inspector Sharon Lloyd Type of inspection Full Provision subtype Children's home

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Date of last inspection 06/03/2013 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 service, run by a private organisation, is registered to care for up to four young people with emotional and behavioural difficulties and or learning disabilities.

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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

External professionals speak highly of the progress children make. One said, ' He's absolutely thriving there' and another said, 'The standard of care is excellent'. Children make satisfactory or good progress in most outcome areas, over time. However, children's challenging behaviour and aggression continue to put staff and others in danger. Shortfalls in children's records mean that some health information is not available and could pose a future threat to children's overall health.

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Overall effectiveness

Staff have good relationships with children and the quality of care is good. External professionals recognise that the home provides stability and 'stickability' for children who have had successive placement breakdowns previously. The home works very well with other professionals and children have support from therapists, heath professionals, the police and others. Children like living at the home. They benefit from clear boundaries and consistency of care. However, the good quality of care is undermined by some behaviour management strategies.

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Overall effectiveness

Good safeguarding measures protect children. No children have been missing from home since the last inspection. Restraint is used for brief periods of time, in accordance with the regulations and children's behaviour management plans. Staff work effectively with the police to reduce criminality and protect children. Behaviour management strategies are agreed in placement plans. 'Time-out' is not always used in accordance with agreed plans and not all measures of control are appropriately recorded or fully evaluated. This increases the risk of subjecting children to excessive sanctions.

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Overall effectiveness

Leadership and management is adequate. The registered manager leads and supports an established staff team who know the children well. The manager receives no professional supervision and this undermines her ability to provide strong leadership and challenge to the staff team. Recommendations from the last inspection have been mostly implemented and this has improved the quality of staff supervision and appraisal and the suitability of the premises. The manager is taking action to address some shortfalls in staff qualifications and refresher training.

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Overall effectiveness

Monitoring of the home is adequate. A new independent visitor appropriately reports on the conduct of the home and the Registered Manager takes action to address any matters of concern and raise standards in the home. There are some shortfalls in recording and some shortfalls in the manager's review of and challenge to practice. Reports do not always demonstrate how reflection following incidents leads to improved practice.

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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, discipline or restraint, a written record is made in a volume kept for the purpose and shall include those matters listed. In particular, record behaviour management strategies including time-out and the removal of a child's toys or personal possessions (Regulation 17B (3)) 07/02/2014

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Reg. Requirement Due date

(2001) ensure that all persons employed by the registered person receive appropriate training, supervision and appraisal. In particular, ensure that the registered manager receives professional supervision (Regulation 27 (4)) 28/02/2014

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Reg. Requirement Due date

(2001) ensure that a written record is made of any complaint, the action taken in response, and the outcome of the investigation. In particular, maintain a record of allegations against staff or others. (Regulation 24 (5)) 07/02/2014

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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 sanctions and rewards for behaviour are clear, reasonable and fair and are understood by all staff and children. In particular, ensure they meet children's emotional and behavioural needs, as set out in their care plan (NMS 3.8, 3.7)  ensure that children's health is promoted in line with the statutory guidance on Promoting the Health and Well-being of Looked After Children. In particular, ensure that all avenues are pursued to obtain children's vaccination histories (Volume 5, statutory guidance, para 2.44)  ensure that children are supported by staff to achieve their educational goals and minimise underachievement. In particular, provide children with support in learning to read (NMS 8.4)  ensure that all existing care staff have attained a minimum level 3 qualification. This was previously the National Vocational Qualification in Caring for Children and Young People and from September 2010 is the Children and Young People's

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Recommendations

Workforce Diploma (NMS 18.5)  ensure that any trends and issues of concern are identified and evaluated to ensure continuous improvement in the quality of care. In particular, ensure effective recording, monitoring and review of incidents and ensure the impact of action taken is evaluated, reported on and used to drive improvement. (Volume 5, statutory guidance, para 3.14)

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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

Children make steady progress towards developing a positive self view. Over time, they begin to build attachments with their peers and adult carers. They begin to develop an understanding of their past experiences, a sense of identity and limited emotional resilience. Children enjoy increasing levels of contact with their family and friends. In some cases, this means contact is re-established after a period of separation and this helps to increase children's sense of self-worth.

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Outcomes for children and young people

Children lead healthy lives. They grow their own vegetables and with encouragement, over time, they develop a taste for a variety of nutritious foods. They steadily and safely reduce their reliance on medication. They refrain from smoking and substance misuse and learn the importance of a healthy lifestyle. They learn how to maintain good sexual health and develop appropriate sexual relationships. Shortfalls in their medication history means that it is unclear whether they have had all recommended immunisations. This could place their future health at risk.

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Outcomes for children and young people

Taking into account their starting points, children make good educational progress. They have 100% school attendance and teachers say some fulfil their potential and exceed their predicted grades. Others struggle to cope in a classroom and this impedes their learning. This means they are not yet making good educational progress.

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Outcomes for children and young people

Children enjoy a range of leisure activities in accordance with their interests. They develop friendships with local children and attend clubs and activity centres where they mix with peers and develop new skills. Some develop strength and stamina through engaging in physical activities such as swimming. Others prefer more sedentary pursuits and do little exercise outside school.

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Outcomes for children and young people

Over time, children reduce their anti-social and aggressive behaviour. Progress with this is variable and can be slow. Some have episodes of regression where they assault both adults and children. This means they continue to present unsafe behaviour around others. They are at risk of offending or re-offending. It places people who are close to them at risk of harm.

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Quality of care

Children talk excitedly about holidays and activities they have enjoyed with staff. They treasure their memory boxes and individualised photograph albums that reflect the time they have lived at the home. Children feel well cared for by the staff team, whom they know well. One said, 'The staff are nice; they look after you'.

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Quality of care

Relationships between staff and children are based on openness and truth. Staff explain the reasons for their decisions and actions. Professionals report that staff provide a warm and nurturing environment. They use humour to assist in reducing children's rising anxieties and challenging behaviour. A key strength of the home is the way staff diffuse children's escalating anxieties and help children to reflect on incidents. One professional said, 'Staff provide safe boundaries. They are very patient and committed'. Children say that staff listen to them and explain things to them. One said, 'If you're upset, you can talk to staff'.

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Quality of care

Staff consult children about a range of issues that impact on their daily lives. This helps children to feel they have some control over their lives. Key worker sessions are held informally. This promotes better engagement from children. There have been no complaints from children recorded. Minor complaints and allegations against staff are common and are addressed but not recorded in the complaints log. This does not demonstrate that the home takes complaints from children seriously.

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Quality of care

Staff contribute to decisions made about children's education and work closely with schools. This supports children to attend and achieve. A teacher said, 'We get full support from the home. All homework is followed up and the child is doing very well'. Staff ensure children arrive at school on time each day and assist with transport, as necessary. Staff encourage drawing and the development of skills such as sewing, gardening and baking. They sometimes support children with reading but this is not routine. This does not fully promote the acquisition of good reading skills.

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Quality of care

Staff ensure that children have access to professional support, in accordance with their individual needs. They work closely with the police, the Youth Offending Service and Child and Adolescent Mental Health Service (CAMHS). They are assisted to manage children's behaviour and understand their emotional and psychological needs through regular advice from CAMHS. They encourage and support children to attend therapy. This enables children to benefit from a range of therapeutic interventions.

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Quality of care

Children enjoy living in a comfortable, homely environment where there is enough space for them to have time apart from each other, should they choose this. Children are proud of their bedrooms, having chosen the décor. Staff ensure that, for the most part, children choose how to spend their free time. Children enjoy spending time alone, playing with toys and electronic games, watching television or listening to music. They also enjoy spending time with staff on simple arts and crafts, baking and playing games. Children enjoy holidays from school where activities are more structured and include outings that provide opportunities for fun and education.

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Quality of care

Each child has an individual placement plan based on the placing authority's plan for the child. These are detailed, regularly reviewed and shared with children. They are supplemented by behaviour management plans and risk assessments that staff know well. There are small discrepancies between the plan and practice. This includes the agreed length of 'time-out' that children spend in their bedrooms when they are showing signs of agitation. It means that records do not accurately reflect practice and placing authorities are not fully informed about the behaviour management strategies being used.

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Quality of care

Children develop self-care and independence skills over time. Staff teach them to cook and carry out basic household tasks and laundering. They encourage children with their personal hygiene and assist them to keep their bedrooms clean and tidy. This is particularly important for those children who need a high degree of nurturing. Staff recognise that some of the children relax better at bedtime when their rooms are tidy and strive to enable this. An external professional commented, 'I can't imagine him getting this level of care in any other setting'.

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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 feel safe and are safe. Staff address bullying robustly and immediately. Staff have a holistic approach to behaviour management. They encourage children to engage in a variety of therapies to help them to manage and reduce their anger and aggression. Staff avoid using restraint to manage extreme behaviour and do so only to prevent injury or serious damage. They take action to protect children and themselves from assault, but assaults on staff continue.

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Safeguarding children and young people

External professionals report that staff have 'stickability' and provide consistency and stability for children who have had a high number of placement breakdowns because of their extreme aggression and challenging behaviour. A typical comment was: 'They are very patient and understanding of all his issues…they keep trying with him'.

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Safeguarding children and young people

On most occasions, restraint is used for a brief period only in accordance with placement plans and risk assessments. It is usually ineffective in reducing children's rising anxieties and aggression. The home turns to the police for assistance with behaviour management when children's aggression is extreme. This is to help children learn there are consequences to their actions. The police provide immediate support as well as on-going advice to children. This is helping to reduce the number of assaults on staff.

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Safeguarding children and young people

The police report that they have no concerns about the home and consider that staff support children very well. They describe this as 'one of the better homes'. The risk of criminalising children is reduced because of the good, pro-active relationship the home has with the police.

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Safeguarding children and young people

Staff use sanctions to deter children from engaging in dangerous or anti-social behaviour. They provide clear boundaries so that children learn what is acceptable behaviour. They use 'time-out' in bedrooms as a behaviour management strategy. The success of this strategy is variable. Where children present extremely challenging behaviour, their personal possessions and toys may be removed from their bedrooms to prevent them from being damaged. Children agree this is a good idea. It is in line with agreed behaviour management plans. However, sometimes toys are not returned to children when they are calm, but are withheld for several days. Children have to earn back their toys by behaving well, sometimes for an unspecified period of time. This strategy is not seen or recorded as a sanction. It denies children access to their own possessions and the opportunity to engage in free play.

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Safeguarding children and young people

Children rarely go missing from this home and none have been missing since before the last inspection. Good procedures are in place to safeguard any child who might go missing and staff are fully aware of these.

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Safeguarding children and young people

Staff know how to respond to any disclosure or allegation of abuse to protect children's welfare. There have been no allegations against staff and no concerns raised about staff practice. Allegations made about adults from other services are appropriately reported to ensure that concerns about practice in other agencies are addressed. There have been no child protection concerns.

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Safeguarding children and young people

Routine health and safety checks ensure that children live in a safe environment. Damage to the premises is discouraged, quickly reported and repaired. Safe and robust staff recruitment processes protect children from coming into contact with unsuitable people.

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Safeguarding children and young people

Risk assessments clearly identify the risks to children and are regularly reviewed. The Registered Manager reports that risk assessments are carried out before children engage in outings and activities outside the home.

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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

A suitable and well-established Registered Manager leads an experienced, stable and well-gelled staff team. Shortfalls identified at the last inspection have mostly been addressed. As a result, staff receive regular supervision and annual appraisal. The manager receives no professional supervision and this undermines her ability to provide strong leadership and challenge to the staff team.

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Leadership and management

Most staff are suitably qualified. Arrangements are in place for those not yet qualified in caring for children and young people to enrol on a suitable qualification in the near future.

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Leadership and management

There is a rolling programme of mandatory training which aims to ensure the staff team's basic knowledge and practice remains up to date. There has been some delay in delivering this training and some staff have not had refresher training in behaviour management for almost two years. Some staff have not had refresher training in First Aid, fire safety and restraint. This undermines the ability of the staff team to meet children's needs.

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Leadership and management

Improvements to the premises mean that the home provides a warm and welcoming environment for children. The manager and staff team care about the children. External professionals speak highly of the quality of care and the commitment of staff. They report that the home works well with them and keeps them informed of children's progress and of specific incidents. The manager seeks the views of children and their social workers to inform the development of the service.

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Leadership and management

Not all additional measures of control used in the home are recorded in the appropriate log and there are some shortfalls in the detail held in daily logs and records of incidents. Similarly, complaints made by children are not always recorded. This means that the home's records do not show that complaints from children are taken seriously. Nor do they demonstrate effective reflection that challenges practice and informs improvements.

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Leadership and management

A new and independent person has been recently appointed to carry out visits on behalf of the provider in accordance with Regulation 33. The report of the most recent visit shows a significant improvement in the evaluation of the conduct of the home, including record keeping. It provides the manager and regulator with a clear picture of some of the home's strengths and weaknesses. The manager acts on recommendations to improve practice.

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Leadership and management

The manager monitors the operation of the home and compiles a review of the quality of care every six months. This is forwarded to HMCI for information. The manager consults with children to inform this assessment. The analysis of the quality of the care lacks depth. It does not demonstrate how the home has improved children's progress as a result of reflection and evaluation of the care provided and incidents that have occurred.

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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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