Children's Home run by Essandore Limited in St Helens

Unique reference number SC066218 Inspector Denise Jolly Type of inspection Full Provision subtype Children's home

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Registered person Essandore Limited Registered person address 21 Walker Suite, Connect Business Village Derby Road Liverpool L5 9PR Responsible individual Robert Chirk Wing Leung Registered manager Richard Gary North Date of last inspection 10/02/2014 2 of 12 Inspection date 31/07/2014

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Previous inspection good progress Enforcement action since last inspection There has been no enforcement action since the last inspection.

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Overall effectiveness good

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

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Overall effectiveness

The children's home is making a measureable difference to the lives of young people with autism and complex needs. Staff use their enthusiasm and knowledge of specialist child care practice to provide personalised, well-planned and effectively reviewed care. The majority of professionals involved in the lives of young people say staff work tirelessly to help young people overcome their difficulties to achieve their individual potential. They help young people to identify and use strategies that enable their lives to improve.

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Overall effectiveness

Young people are safe and mostly content and happy in the home. Staff demonstrate in-depth knowledge and understanding of the risks young people face, and always take positive action to ensure risks are minimised and safely managed. They introduce and reinforce appropriate boundaries with young people, and work creatively to sustain fragile placements when it is in the best interests of the young person. Young people enjoy warm, open and trusting relationships with staff. This means they feel confident in the support available to them, readily ask for help, and respond well to praise and encouragement given for their achievements.

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Overall effectiveness

Staff readily communicate their vision for an exceptional service and work in effective partnership with all stakeholders to achieve this. The qualified and 3 of 12 experienced Registered Manager places a clear emphasis on maximising improved outcomes for young people. Managers have a thorough understanding of the strengths and weaknesses of the home and monitoring takes account of the views of all stakeholders. They are keen to address shortfalls and develop the service they provide in partnership with professionals and young people, to enable them to reach their full potential. One requirement is made, to improve the procedures for medication administration. There are some recommendations to improve minor shortfalls in recruitment and incident records, to have all necessary consents available, and to ensure all relevant incidents are notified to Ofsted, although these shortfalls have not affected the welfare of young people.

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Information about this children’s home

The home offers accommodation for young people who have learning disabilities and who may also have physical disabilities. The home is owned by a private company.

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Inspection date Inspection type Inspection judgement

10/02/2014 Interim good progress 20/06/2013 Full good 22/01/2013 Interim good progress 20/09/2012 Full adequate

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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 there are suitable arrangements for the safe administration of medication to young people by ensuring young people receive medication directly from the pharmacy packaging provided. (Regulation 21 (1)) 19/09/2014

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Recommendations

To improve the quality and standards of care further the service should take account of the following recommendation(s): 5 of 12  ensure that the use of audio monitors to improve the safety of young people is included in the plans agreed with the placing authority (NMS 10.5)  ensure that the home has a record of all the recruitment and vetting checks for agency staff working in the home, including for employment history and qualifications (NMS 16.3)  ensure that information about young people is clearly recorded in a way that contributes to an understanding of their lives, particularly with regard to health matters and incident reports (NMS 22.5)  ensure that the system to notify Ofsted of significant events is consistently used. (NMS 24.1) 6 of 12

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Outcomes for children and young people outstanding

Young people enjoy living in the home. Young people with autism develop an understanding of their starting point and the steps they need to take in order to progress. For some, this means they have worked together with staff to rebuild their relationships with appropriate family members. Parents say, ‘This home ticks all the right boxes for us, they really understand where our child needs support.’ Young people receive consistent and intuitive support from staff to help them overcome any difficulties in relationships. This means they maintain and develop attachments to important adults and experience continuity of knowledge and understanding of their background.

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Outcomes for children and young people outstanding

Young people pursue active and healthy lifestyles. They exercise in ways that they enjoy and acquire new skills along the way. For example, one young person has started to experience horse riding, while another has been introduced to swimming. All young people enjoy going for long walks in the fresh air, to the beach or parks. They develop routines that help them to understand the importance of personal care and, when necessary, taking medicine to improve their health.

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Outcomes for children and young people outstanding

Young people are learning to follow prompts such as word or picture schedules to help them to remember the correct order for some routines such as how to improve their independence in getting ready for school or what is coming next after the activity they are completing. This enables them to complete many daily living tasks with increasing independence and reduced anxiety and stress. In turn, this helps them to progress and build trusting relationships with staff.

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Outcomes for children and young people outstanding

Some young people suffer periods of extreme upset and distress. Staff support them to manage their feelings regarding past trauma or the impact of low mood or anxiety on their behaviour. Because young people trust staff, they respond to them to accept alternative activities and diversions that help them to regain composure. Other professionals such as psychologists and psychiatrists support their mental and emotional health and help them to improve further by ensuring they are prescribed the medication and programmes they need to stay fit and healthy.

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Outcomes for children and young people outstanding

All young people attend school. All enjoy the routine imposed by school attendance and benefit from the range of skills and development opportunities that they experience. They practice their skills when they return to the home, because staff know about their educational goals and targets and encourage them to show them what they have learnt. This helps them to take continual steps towards achieving a greater understanding of the world and their place in it. 7 of 12

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Quality of care good

Staff provide very good care to ensure young people enjoy their time at the home. Relationships appear to be well established. Most young people express confidence and contentment by their settled behaviour and the progress they make. Parents, social workers and other professional visitors are complimentary about the positive impact the service has on the lives of young people. Staff use observation of young people and reflective practice to ensure that the service adapts to support their unique needs. Beautifully decorated and annotated photograph books capture the daily and special experiences of young people. The images reflect that young people and staff enjoy each other’s company and engage in many exciting activities together.

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Quality of care good

Staff see young people in a realistic light, and recognise their strengths and development needs. This means young people progress, supported by encouraging staff who are proud of their achievements. Staff help them to find activities they can enjoy safely. For example, they gradually introduce young people to practise skills in choosing and preparing snacks safely or to participate in simple baking activities. Some young people enjoy being read stories or join in with interactive songs and stories. This gives them a chance to progress their communication skills by anticipating set actions and words and by engaging in shared attention activities. Young people clearly enjoy the adult attention while learning how to accept relationships that are more sociable. This improves their awareness of a range of constructive and developmental activities while becoming more independent.

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Quality of care good

Staff place young people’s well-being at the centre of their practice. Key workers prepare and regularly review care plans to ensure that they receive appropriate support to meet their needs. Parents and social workers agree the plan at regular intervals so that all changes important to the young person are incorporated. For example, staff reduce support to young people in their morning routine as they acquire skills in toileting or dressing, or adapt a tooth brushing routine to enable greater independence in the task. Key workers discuss the plans in staff meetings and daily handovers. This ensures staff continually update their knowledge and understanding of the impact of the plans on the welfare and development of young people. Although general arrangements for the use of audio monitors are known and understood by parents, individual consents are not available in the home. This means that their use is not routinely reviewed in planning meetings to ensure that parents

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Quality of care good

and the placing authority agrees with their continued use.

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Quality of care good

Arrangements for dealing with medication are mostly safe and effective and staff are suitably trained. However, the inspector noted that staff remove some medication from its packaging before taking it to the young person. Although there have been no errors in administration, the manager agreed to review the practice to ensure greater levels of safety. Managers had already moved the location of the medicines cupboard to a quieter area of the home and they monitor staff practice to ensure young people get the medication and health support they need. Young people are familiar with the 8 of 12 routines associated with how they receive their medication and are mostly happy to cooperate with staff. Staff discuss medication requirements with medical practitioners and parents in order to identify how best to support young people’s health needs.

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Quality of care good

Staff set clear and appropriate boundaries for young people, while recognising their individual starting points. Staff carefully match young people’s activities to their interest areas, such as trips to quiet beaches for those who enjoy sand but have difficulties with lots of children. This helps young people to access activity that is appropriate to their ability and helps them to remain calm and enjoy their experience. Parents of young people who live at the home recognise that relationships between staff and their child are strong because staff know the young people very well. Parents say that this fosters a sense of security in their child, which for some leads to a reduction in outburst type behaviour so they cause less harm to themselves or others.

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Quality of care good

Managers and keyworkers promote communication between the local authority, health professionals, school, families and the home to provide an effective team approach. Young people benefit from detailed and regularly reviewed plans of care that identify all actions necessary to promote their welfare and development. This includes, for example, how and when contact with families will take place and how much support staff will give to enable the contact to be successful. Social work professionals offer high praise for the achievements of young people in the home, due to the efforts of staff. For example, one social work manager said, ‘Young people have an improving quality of life, although they are very complex. Staff give them a sense of self awareness, take them out of their inner world and develop their independence.’

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Quality of care good

Young people contribute their views and opinions in a variety of ways, specific to their unique communication style and ability. Some young people talk to staff about their needs and wishes in simple phrases and gestures, while others have their views interpreted and recorded for them by staff. Parents also provide feedback to staff about the quality of care provided. When they raise concerns, staff do their best to rectify the situation. Parents say, ‘Staff are always ready to talk to me, on the telephone, or whenever I visit.’ While it is unusual for young people to complain, staff are alert to any sign of unhappiness and work hard to improve matters. Social workers and parents say staff are good at listening and responding to suggestions for improvement to the service, to provide consistently improving care practice. For example, one behaviour support worker said, ‘The staff are reflective practitioners,

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Quality of care good

they are always willing to ask the question, ‘How can we do this better for the young person?’.’

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Keeping children and young people safe outstanding

9 of 12 Young people appear safe and happy in the home. The environment affords safe access to bedrooms and leisure spaces. Waking night staff ensure the oversight of young people’s health while they sleep. Staff provide sensitive and personalised care for young people with complex needs. Social workers say the staff are very good at providing for the needs of young people and work hard to keep them safe.

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Keeping children and young people safe outstanding

Managers conduct rigorous recruitment procedures that protect young people from unsuitable individuals having access to them in the home. However, the manager does not oversee all records of checks in relation to some agency staff, such as employment histories and qualifications. While this has not affected the safety of young people, due to close working supervision of agency staff, it limits the ability of managers to assess their overall suitability to work in the home.

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Keeping children and young people safe outstanding

Staffing levels are tailored to the individual needs and programmes of young people and are sufficient to maintain their safety and welfare. Staff know and understand procedures to safeguard and protect young people and have attended refresher training from child protection professionals to enhance their knowledge and understanding. Although rare, if any allegation is made about staff conduct, the manager provides transparent and clear communication with all relevant professionals. On one occasion, they overlooked informing Ofsted. This did not have any impact on the progress of the investigation because appropriate independent oversight explored the concerns raised.

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Keeping children and young people safe outstanding

Staff are mostly successful in redirecting young people when their behaviour challenges the safety or welfare of themselves or others. In partnership with health and education staff, they encourage young people to adopt less harmful ways to express themselves. Behaviour support professionals praise the attitude, enthusiasm and skill of staff. They say that staff are fully engaged in the training opportunities they provide to enhance staff knowledge and understanding of a specific behavioural approach. This has meant that some young people have exceeded expectations in their development of important skills and attributes such as waiting and initiating communication. Professionals say this is because staff offer consistency and dedication to agreed programmes that help young people to improve.

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Keeping children and young people safe outstanding

Staff use minimal restraint and other measures of control, such as an approved car safety harness, when young people endanger their welfare or the safety of others. Restraint is very rare and staff mostly use minimal physical prompts to help to redirect young people when they are in crisis. Parents and professionals say they are always told about each incident and have every confidence in the ability of staff to help their child to improve their reactions to stress.

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Keeping children and young people safe outstanding

Managers assess each incident report and discuss any arising changes to care plans with staff and those who support the child. Occasional minor errors in recording mean that the report is not always clear about the reasons why staff physically intervene. However, because staff maintain excellent descriptive records of young people’s daily lives, the information can be found in other documents in the home. 10 of 12 Parents and professionals are confident that staff use the minimum measures necessary to ensure young people are given safe access to daily living experiences, such as going to the park or shops, that they may otherwise be prevented from achieving. Behaviour professionals said that young people’s physical safety and appearance has improved because of reductions in self–injurious behaviour. They say that this is because staff are very good at identifying ways to help young people explore the world without the associated stresses that cause young people with

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Keeping children and young people safe outstanding

Young people live in a home that is physically safe and appropriately secure. Staff use audio monitors to provide additional oversight of specific risks, such as seizure activity. Staff are very well trained in the use of emergency rescue medication and procedures for young people whose health deteriorates rapidly, for example, as a result of epilepsy. They are therefore able to respond quickly to emergencies that may arise. Staff complete risk assessments for all aspects of life at the home to provide young people with safe opportunities for development and independence.

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Leadership and management good

An experienced and qualified Registered Manager provides enabling leadership to a stable, committed and competent staff team. Staff respond enthusiastically to his expectation that they will deliver continually improving care to complex and vulnerable young people. Young people benefit from a placement that fully supports their emotional and learning needs and helps them to progress in leaps and bounds. Staff recognise and celebrate the efforts of young people to improve their knowledge and understanding of the world and their interaction with it.

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Leadership and management good

Parents and professionals say that the home exceeds their expectations for the quality of care provided. Behaviour specialists and most social workers say staff are extremely supportive of their role and always contribute to a holistic approach to meeting need. Placing authorities are equally complimentary about the home and say that staff are highly skilled in offering personalised and developmental care to young people. Most feedback to the home includes recognition of the high levels of motivation and interest shown by staff. Parents and professionals say that young people prosper and gain increased self-awareness because of the willingness of staff to work cooperatively with all adults who support young people.

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Leadership and management good

The Registered Manager and provider conduct thorough and transparently recorded monitoring of the home. Occasionally, minor errors in records, such as lack of detail in some incident reports or incomplete records for appointments attended by young people, are not rectified within timescales that ensure all staff have the most up to date information about young people’s needs. However because of highly effective staff handovers this has not impacted on the welfare of young people. Through reflective discussions and carefully planned approaches, the home continues to develop and deliver services that have proven benefit to young people. Because of 11 of 12 consistent and responsive consultation with all stakeholders, complaints are rare, with most areas of concern resolved at an early stage. Professionals say that the home is always responsive to feedback and works hard to get the best possible outcomes for young people.

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Leadership and management good

The provider, Registered Manager and staff are aspirational about the future of the home and the lives of young people. Together, they assess and discuss the quality of care provided and identify any development need required for the home to continue to progress. Currently, they are exploring better ways to measure the progress young people make, to provide improved data that highlights the success of young people. Through highly detailed and interactive staff meetings, managers identify best practice, and ensure that all staff operate at this consistent level of performance. The benefits to young people are clear in their confidence in staff and the home.

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Leadership and management good

Staff benefit from regular and developmental supervision. They say that this helps them to reflect on their performance, and ensures they continually improve the quality of care they provide. The Registered Manager works with the provider to identify training and development needs for the team and ensures this is reflected in the development plan for the home. Recently, the Registered Manager has secured training for staff to enhance the support they offer for any behavioural and emotional welfare needs of young people with autism. They have embarked upon a joint project with speech and language professionals to refresh and update staff knowledge about how young people communicate. This ensures staff continue to provide care that reflects the immediate and emerging needs of young people and keeps them up to date with legal and professional developments. Website: www.ofsted.gov.uk

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Leadership and management good

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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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