Children's Home run by Appletree Treatment Centre Limited in Westmorland and Furness

Unique reference number SC386003 Inspector Gillian Walters Type of inspection Full Provision subtype Children's home

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Registered person Appletree Treatment Centre Limited Registered person address Appletree School Natland KENDAL Cumbria LA9 7QS Responsible individual Clair Ann Davies Registered manager Hazel Lee Date of last inspection 25/09/2013 2 of 12 Inspection date 09/07/2014

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Previous inspection inadequate progress Enforcement action since last inspection none

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Overall effectiveness good

Outcomes for children and young people good Quality of care good Keeping children and young people safe good Leadership and management adequate

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Overall effectiveness

Young people benefit from living in a calm homely environment that provides both nurture and support to enable them to achieve the knowledge and skills that will prepare them for adulthood. Young people enjoy good relationships with staff. They feel safe and have achieved a good sense of belonging within the home. Consequently they are settled and making good progress in relation to their starting points.

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Overall effectiveness

Young people benefit from highly personalised care planning and support that is successful in addressing their individual needs. Staff work in close partnership with placing authorities and a range of professionals ensuring that young people’s behaviours are understood and managed with consistency and sensitivity. Young people have a clear understanding of the homes boundaries and expectations and for the most these are respected. As a result, young people and staff live together quite harmoniously.

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Overall effectiveness

It is recognised by managers that there is still some work to be carried out to further strengthen management and leadership arrangements to secure further improvement in the service. However, since the last inspection managers have successfully addressed significant shortfalls in practice and made good progress so far. 3 of 12 As a result of this inspection, two requirements and three recommendations have been identified to meet required standards and promote improvement. These relate mostly to improvements in recording practice. However, one is directed specifically at improving the home’s ability to evaluate its monitoring activity and using this information to improve the quality of care provided. 4 of 12

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Information about this children’s home

This home is run by a private company and provides care and education for up to four young people. The home is registered to care for young people with emotional or behavioural difficulties.

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Inspection date Inspection type Inspection judgement

25/09/2013 Interim inadequate progress 30/05/2013 Full good 23/01/2013 Interim good progress 31/07/2012 Full good

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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 that a written record is made and that it includes a description of the measure used. This relates specifically to recording the duration of any sanction imposed (Regulation 17B(3)(c)) 29/08/2014

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Reg. Requirement Due date

(2001) maintain for each child who is accommodated a record in permanent form which includes the information, documents and records specified in Schedule 3 relating to that child. This relates specifically to the date and result of any review of the placing authority's plan for the care of the child, 29/08/2014 5 of 12 or of his placement plan. (Regulation 28(1)(a))

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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 implements a proportionate approach to any risk assessment (NMS 4.5)  encourage children to participate in a range of positive activities that contribu to their physical and emotional health (NMS 6.3)  ensure that entries in records are clearly expressed and non-stigmatising. This relates specifically to documenting clear descriptions of behaviour rather than using colloquial terms (NMS 22.4)  ensure that in relation to Regulation 34, a copy of the monitoring report is completed identifying any trends and issues of concern arising from monitorin matters set out in Schedule 6. This relates to providing a report that is evalua in its content and that supports continuous improvement in the quality of care provided. (Volume 5, statutory guidance, paragraph 3.14) 6 of 12

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Outcomes for children and young people good

Young people are currently very settled and enjoying living in this home. For some, the home has provided a long term placement that has enabled them to achieve stability in their lives. For others recently moving into the home, they have experienced a smooth transition and a good level of staff support that has enabled them to settle quickly and form some positive attachments. One young person commented, ‘This is a brilliant home. I really like it here.’ Their Independent Reviewing officer noted, ‘Staff are sensitive to his needs and eager to see him well settled before introducing a new face to the home. He is well supported and encouraged.’

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Outcomes for children and young people good

Young people are positively engaged with their education, having good attendance at school and for some positive experiences in work placements. Young people all benefit from having an individual education programme that matches both their needs and ability. This can include attendance at the provider’s nearby independent school or more community based education with the support of a dedicated education team supplied by the provider. As result, young people’s educational achievements are good in relation to their starting points and in some cases have exceeded expectation. This has had the positive impact of increasing young people’s confidence in their ability and raising self-esteem.

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Outcomes for children and young people good

Young people are well supported to maintain contact with family members that are important to them. Their individual arrangements are clearly documented as part of their placement plan and appropriately supported by staff that assist with transport and supervision arrangements. In most cases this enables young people to sustain and develop those relationships that are significant in their lives.

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Outcomes for children and young people good

Young people enjoy good health and good arrangements exist to ensure that they can quickly access both the routine and specialist health care services that they require. Young people’s health care needs are well understood and overseen by a health care professional employed by the organisation. This ensures that young people’s health needs are well communicated, supported and co-ordinated.

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Outcomes for children and young people good

Young people are learning with the support of staff to develop a range of independence skills that will ultimately equip them for life when they move on from the home. Young people are at different stages of independence in relation to their chronological age. Some are learning to use public transport independently while others are learning some more basic self-care and cooking skills. Young people take pride in their achievements and understand that these skills are going to help them make the transition into adulthood. 7 of 12

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Quality of care good

Young people generally share positive relationships with each other and staff. Staff show genuine interest in young people’s progress and work together as a staff team and with other professionals to understand the range of young people’s needs. Staff are sensitive to the uniqueness of young people’s personalities and as such have a good awareness to tailor their communications for some young people in a way that will best support them and reduce anxiety. This is effective in promoting positive relationships within the home. One young person commented, ‘The staff are good; they are good fun.’ Another said, ‘Staff are alright. Some are better than others.’

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Quality of care good

Young people’s individual records are well maintained and provide clear and comprehensive placement and planning documentation to ensure that young people’s needs are fully identified and addressed during their placement. Young people are encouraged to participate in their care planning and take part in their statutory reviews. Keyworkers are assigned to support young people and spend dedicated time with them. Consequently, young people are well supported to make sense of their lives and contribute their wishes and feelings. One Independent Reviewing Officer commented, ‘Staff prepared well for the review meeting. They supported the young person also to prepare.’

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Quality of care good

It was noted during this inspection that staff at times will describe and record young people’s behaviour using words such as ‘giddy.’ Although this is a term understood by many existing staff, it is not a clearly defined description of a young person’s behaviour. The word can be misinterpreted and mean different things to different people. This does not add value to maintaining the young person’s permanent record.

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Quality of care good

Young people are encouraged to express their views and wishes and good opportunities are available to support them with this. The home seeks and records feedback daily from young people about the quality of their day and uses both keyworker sessions and young people’s meetings to enable young people voice their views and opinions. As a result young people know that their views are important and they can identify ways in which their views have influenced the day to day running of the home. For example young people have recently been consulted about the home’s plan for further redecoration and have contributed their individual ideas about colours and themes.

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Quality of care good

Young people are offered opportunities to participate in a range of positive activities that promote fun, healthy exercise and occasions to socialise with peers. However, some young people choose not to engage with the activities on offer, regularly isolating themselves playing console games in their rooms. Although young people are being allowed to exercise choice in this matter there are no clear incentives in place to offer encouragement to choose from the range of other available activities. This means for some young people, their experiences are limited and they are missing good opportunities to promote their health and well-being. 8 of 12 Young people’s health care needs are well documented and supported. Visits to such as the doctor, optician and dentist are tracked and monitored to ensure any follow up appointments are made and kept. This ensures that young people’s health is a consistently prioritised and that young people are able to receive timely intervention

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Quality of care good

when required. Staff are trained and experienced in the safe handling and administration of medication. Good arrangements exist for managing young people’s medication needs, ensuring that young people’s safety is not compromised. This includes clear arrangements for the recording and auditing of all medication brought into the home and used and suitable arrangements for its safe disposal when it is no longer required.

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Keeping children and young people safe good

Young people say that they feel safe and feel well protected by staff. They do not identify bullying as an issue of concern at this time. However, they are able to identify a number of adults that they can speak to should they have a concern and feel reassured that they will be appropriately supported.

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Keeping children and young people safe good

All young people have highly personalised risk assessments that are reviewed regularly and updated as required. This ensures that staff have a clear understanding of any risks that exist and how these should be managed. Although the overall quality of risk assessments is good, there was one specific issue identified during this inspection concerning a recent incident with a young person’s internet use where the initial level of risk had been judged higher than the circumstances of the incident suggested. Consequently the response was not proportionate and resulted in the young person having additional supervision and support for a short period of time before this was amended. This did not impact negatively on the young person’s safety but did mean that the young person received closer supervision than was necessary.

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Keeping children and young people safe good

Restraint is seldom used in this home, there has been one incident since the last inspection. Staff are trained and experienced in behaviour management and use a range of de-escalation and distraction techniques, ensuring that restraint is a last resort to protect young people and those around them. The home appropriately documents any physical interventions that take place, including detail of the incident and de-briefs that occur with staff and the young people following the event. As such the home ensures that there is an accurate record of any such events.

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Keeping children and young people safe good

Positive behaviour is promoted by the use of a range of incentives that can include additional pocket money and trips out. These are specific to the young person’s interests and desires, ensuring that they are well motivated to achieve them. Young people are familiar with their targets and the expectations surrounding their behaviour. They have a clear understanding about the use of sanctions to address less desirable behaviour and generally view these to be fair. Sanctions are generally 9 of 12 well documented, enabling a clear understanding of the issue and the sanction imposed. However, a shortfall in recording was noted in relation to the duration of the sanction for some entries. This means that the record lacked clear guidance for staff in relation to when the sanction was complete.

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Keeping children and young people safe good

There have been no incidents of young people going missing from this home since the last inspection. Young people are currently very settled, well supervised and understand the dangers of leaving the home without permission. The home has in response to new legislation updated its policy and procedure to ensure that all staff have clear guidance and instruction on both the measures they can take to prevent young people absenting themselves from the home and the action to be taken if they do go missing.

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Keeping children and young people safe good

A range of comprehensive risk assessments exist to address young people’s safety within the home, out in the community and when enjoying activities. These are successful in informing staff of potential risks and how they may be minimised or eliminated. An assessment of the location of the home has been completed, taking into account the views of local police, probation, the local authority, neighbours and local services such as rail and transport services. As a result the home is able to demonstrate the safety of its location and the measures in place to address any risks that have been identified.

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Leadership and management adequate

The home has a suitably qualified manager who has worked in the home since 2009 and been the home’s Registered Manager since 2012. She continues to develop her management skills with the guidance and support of the organisation’s Senior Care Manager. She has recently completed the organisation’s in-house diploma course to further develop her knowledge and skills in working with young people that have suffered significant trauma in their lives.

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Leadership and management adequate

At the last interim inspection on the 25 September 2013 the home was judged to be making inadequate progress. This inspection resulted in nine requirements and four recommendations being made to improve the quality of care and safeguarding within the home. Four compliance notices were issued By Ofsted in relation to care and safeguarding practice. These notices were monitored and found to have been met during an unannounced Ofsted visit on 04 November 2013. The home acted to review and update its safeguarding procedures, including the procedures and protocols to be observed when a child goes missing. The home improved communication with the Local Authority Designated Officer (LADO) and strengthened its links with community policing ensuring that children’s safety and well-being were appropriately prioritised and promoted.

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Leadership and management adequate

Since the last inspection the home has successfully acted on all remaining requirements and recommendations. Young people’s care and risk management 10 of 12 plans are current and comprehensive, providing staff with sufficient information and guidance to promote both safety and welfare. Further measures have been put in place to encourage young people to make their views known and have their voice heard. Staff have received additional guidance and support to enable young people to raise issues if they have concerns and a grumbles book has been introduced for young people to record more minor issues that they wish resolution on. Appropriate records are successfully maintained. They demonstrate how matters have been dealt with, the outcomes and response to young people.

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Leadership and management adequate

The home has successfully recruited and now has sufficient staffing, no longer relying on the use of agency staff. This means that young people benefit from the consistency of care provided by a familiar staff team. Young people speak positively about the improvements in the home’s general appearance and identify it as a comfortable and homely place to live.

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Leadership and management adequate

Staff benefit from regular supervision and regular meetings with a visiting psychologist and play and art therapists. These arrangements provided staff with good opportunities to receive advice and professional support, ensuring that consistent guidance is shared in relation to the emotional needs and behaviour management of individual young people. In response to the last inspection staff have benefited from a wide range of training opportunities to develop their knowledge, skill and expertise in working with young people. The Registered Manager has introduced revised arrangements for monitoring staff personal development that enables her to swiftly address any practice issues as they arise and share learning within the team as appropriate. This provides staff with consistent guidance and support to maintain good practice standards and identifies areas for further staff training and support. The home has a well-developed training

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Leadership and management adequate

programme that ensures staff have sufficient opportunity to increase their knowledge and develop their skills in working with young people.

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Leadership and management adequate

Appropriate quality assurance arrangements exist to monitor the quality of care provided within the home and to determine how it functions to safeguard young people. External monitoring conducted by an independent person takes place with the appropriate frequency and full reports are received by Ofsted within the required timescale. The Registered Manager also regularly monitors activity and standards within the home to sustain and improve the quality of care provided. However, the reports produced and sent to Ofsted in relation to three-monthly periods of monitoring activity lack clear evaluation of matters monitored. For example, the incidence of young people missing from home is identified as having significantly declined but no corresponding explanation provided as to the reasons. Without this level of evaluation, the Registered Manager is not effectively demonstrating her understanding of the results of her monitoring and how she can use this to improve

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Leadership and management adequate

The home has a current development plan in place that identifies priorities for young people, staff and the home and progress to date. The Registered Manager 11 of 12 demonstrates an understanding of the strengths and weaknesses of the home, identifying particularly her own personal development as a manager as a key priority. The organisation has reflected on the recent challenges that the home has faced and identified a change to the home’s admission criteria as being a positive way forward for the home. The home will now only admit those young people they know that have resided in one of the two other homes operated by the provider. This is to promote and ensure positive matching of young people takes place.

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Leadership and management adequate

Young people’s individual records are well maintained and organised. They provide easy access to essential documentation concerning their placement, progress and achievements. However, an absence of documentation providing the outcomes of some young people's statutory reviews was noted. For those young people, their records were incomplete and important information was not available to staff. All records are stored securely within the home maintaining young people’s rights to privacy and confidentiality. Website: www.ofsted.gov.uk

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Leadership and management adequate

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Judgement Description

Outstanding A service of exceptional quality that significantly exceeds minimum requirements.

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Judgement Description

Good A service of high quality that exceeds minimum requirements.

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Judgement Description

Adequate A service that only meets minimum requirements.

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Judgement Description

Inadequate A service that does not meet minimum requirements.

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Information 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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Information 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 framework of inspection for children's homes.

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