Children's Home run by Keys Group Progressive Care & Education Limited in Southampton

Unique reference number SC389180 Inspector Keith Riley Type of inspection Full Provision subtype Children's home

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Registered person New Horizon Centre Limited Registered person address European Care Group 2 Parklands, Rednal BIRMINGHAM B45 9PZ Responsible individual Amanda Elizabeth Morgan-Taylor Registered manager Christine Joanne Towers Date of last inspection 15/01/2014 2 of 11 Inspection date 30/09/2014

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Previous inspection satisfactory 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 good

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Overall effectiveness

This is a home that provides good personalised care to children with complex needs. A core staff team is guided by comprehensive placement plans. There are positive outcomes such as improvements in health and reductions in self-injurious behaviour.

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Overall effectiveness

Children are safe and happy in the home. Staff understand the unique needs of each child they care for. This means that children with severe communication difficulties have a voice in the home. They enjoy positive and constructive relationships with staff.

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Overall effectiveness

The home is recovering from a number of staff shortages and this is being successfully addressed by the new manager. One improvement is to consider when further checks are required for overseas applicants to comprehensively assess that there are no historical concerns about their suitability to work with children.

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Overall effectiveness

The manager has registered with Ofsted. She is showing strong leadership and effecting positive change. The development plan addresses the shortfalls found at inspection. Work is underway to evaluate and improve training for staff and to amend the floor plan to aid the fire service in the event of an emergency. She is aware of her statutory reporting responsibilities. However there is one report that has not been sent to Ofsted within the timeframes specified in regulation. 3 of 11 Further recommendations for improvement are related to ensuring records of emergency health interventions are always signed by a health professional and that staff training is assessed for each child by name.

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Overall effectiveness

There were no requirements or recommendations from the last inspection. 4 of 11

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Information about this children’s home

This privately run children's home is registered to accommodate up to six young people with multiple disabilities which may include a learning disability, a physical disability and complex health needs.

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Inspection date Inspection type Inspection judgement

15/01/2014 Interim satisfactory progress 06/08/2013 Full good 14/02/2013 Interim good progress 22/10/2012 Full outstanding

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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) supply to HMCI the monitoring report conducted under Regulation 34 (Regulation 34 (2)) 30/11/2014

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Reg. Requirement Due date

(2001) take adequate precautions against the risk of fire in consultation with the fire service. This particularly applies to the provision of a floor plan showing the location of oxygen cylinders. (Regulation 32 (1)(a)) 30/11/2014

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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 11  obtain written consent from health professionals for medical treatment; this particularly applies to emergency protocols (NMS 6.5)  provide staff with guidance and training in caring for children with complex health needs, in accordance with Care Quality Commission/Ofsted guidance on delegated health tasks (NMS 6.8)  consider what further checks are appropriate, to establish suitability to work with children, where the person has lived outside the UK (NMS 16.3 9f))  ensure continuity of staffing so that children's attachments are not overly disrupted (NMS 17.8)  evaluate, at least annually, the learning and development programme for effectiveness; this particularly applies to e-learning. (NMS 18.2) 6 of 11

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Outcomes for children and young people good

Children with complex health needs are cared for well in consultation with health professionals. Close working relationships, such as with the community nursing team, consultant paediatrician and occupational therapist, ensure children who live in this home receive the best health care possible. Staff ensure they follow placement plans carefully with agreed strategies and goals. Children make good progress in this home. For example, children with nutritional difficulties gain weight and children who self- harm show significant reductions in the level and frequency of self-harming behaviour. A professional said that there have been improved outcomes for a child's health due to the interventions that staff are using, such as suctioning.

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Outcomes for children and young people good

Children benefit from being able to make trusting relationships with key members of staff. They are offered close support, and this enables them to feel safe and secure. Children with severe communication difficulties indicate they are happy in the home. A parent said: 'My child is happy and feels safe in the home'. A placing social worker said: '[Name of child] is definitely happy in the home, there are a lot of smiles and giggles'.

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Outcomes for children and young people good

Children with severe physical and learning disabilities are not isolated. They are able to participate in a range of activities within the local community, such as going on a train journey or watching professional football. Children are able to extend their social horizons and enjoy stimulating opportunities. A range of toys helps provide further stimulation for children while in the home. The outside play area contains specially designed equipment that can facilitate individuals with mobility difficulties. A hydrotherapy pool is also accessible at certain times and provides children the opportunity to play in a water environment.

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Outcomes for children and young people good

Children benefit from living in an environment where their education is valued and promoted. Staff work closely with health and education professionals to ensure there is good attendance at school while also meeting young people’s immediate and ongoing health needs.

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Outcomes for children and young people good

Children have good contact with their parents and staff are available to discuss the current and future needs of the children. Staff are committed to working to support parents to have regular and positive contact with their children. As a result, children have a sense of identity and belonging.

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Quality of care good

7 of 11 Quality of care is a strength of the home. A comprehensive assessment process and good liaison with parents and health professionals ensure that the needs of each child are clearly identified before admission into the home. Placement plans are accessible and provide staff with comprehensive guidance on how each individual's care needs should be met.

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Quality of care good

Staff demonstrate a professional approach to meeting the complex health needs of the children in their care which is also very nurturing and caring. For example, a staff member was heard telling a child how lovely their hair is, while another staff member apologised to a child with severe communication difficulties for an interruption. Children enjoy positive and constructive relationships with staff, who put them at the centre of practice.

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Quality of care good

Risk assessments are used to identify any areas of potential concern, with clear strategies to reduce risk. Emergency protocols, such as administering oxygen or epilepsy medication, are agreed with relevant health professionals. However, written consent is not always clearly evident.

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Quality of care good

There have been significant improvements in the environment. The provision of specialist equipment, such as overhead hoists, and the reconfiguring of some rooms to provide a shower facility and medication room have greatly improved the quality of care. Specialist advice has been sought, such as from occupational therapists, to ensure there are individual sleep posturing arrangements in place. Children benefit from reduced discomfort and less fragmented sleeping patterns.

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Quality of care good

There is a comprehensive and thorough system to ensure safe receipt, administration and disposal of all medicines. Systems are in place that check and monitor the administration of medication so that errors can be identified and addressed. These enhanced procedures have resulted in a decrease in errors.

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Quality of care good

There is considerable engagement with other health professionals to ensure that the immediate and ongoing health needs of children are met, for example, through nutrition plans and sleeping posture arrangements. Children have their use of specialist equipment, such as their individually contoured wheelchairs, regularly reviewed to ensure it continues to meet their needs.

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Quality of care good

The views, wishes and feelings of children living in this home are of great importance. Staff understand the individual communication styles of each child with severe communication difficulties. Their views are sought regularly, such as when they want to go to their room or which activity they want to do, such as bowling, ice- skating or going shopping. Children are able to select the colour of their wheelchair or the furniture in their room according to their own taste. This gives them a sense of identity and belonging.

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Quality of care good

Children benefit from staff who show a good understanding of their religious and cultural needs. They are able to celebrate special festivals that are important to them 8 of 11 and their families, dressing in ceremonial clothes. Children are able to celebrate their unique identity and background.

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Quality of care good

Staff support children with their education. They ensure children are ready and prepared for learning, providing support with transport if necessary. A home-school book is used to communicate important messages. This means there is a consistent approach and any issues are addressed quickly.

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Keeping children and young people safe good

Staff understand children's individual needs and vulnerabilities and do all they can to protect them from abuse and harm. The service works closely and effectively with the local child protection agency.

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Keeping children and young people safe good

Staff are confident with the processes, such as whistleblowing, to follow should they be concerned for a child's safety or welfare. They are diligent in keeping comprehensive logs, such as body maps, where appropriate. Any issues that arise are dealt with robustly and investigated to ensure the safety of the children. This means there are improvements to the service, such as detailed nail care plans which help reduce the number of scratches a child might inadvertently inflict on themselves.

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Keeping children and young people safe good

Children are safe in the home. A parent said: '[Child] loves her bedroom and feels safe in the home.' The home is physically safe and appropriately secure. Health and safety certificates verify the safety of the environment. Risk assessments comprehensively identify different areas of risk. These include assessments of the premises and the activities in which the children participate. Risk assessments are regularly reviewed and updated to ensure they continue to promote the well-being of children. This ensures that all risks are managed and that children are assisted to take part in activities with acceptable levels of risk.

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Keeping children and young people safe good

Comprehensive health care plans are in place. These are written in consultation with other professionals, such as a consultant paediatrician. Medical appointment records are kept with clear outcomes written down. Children have their immediate and ongoing health needs safeguarded.

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Keeping children and young people safe good

There are good precautions against the risk of fire, with robust procedures in place to keep children safe in the event of an evacuation. This includes personal emergency evacuation plans. These clearly guide staff on how to support a child with severe mobility difficulties in an emergency. There are clear procedures to advise the fire service of the presence of oxygen in the home. However, the current floor plan does not indicate the precise location of individual cylinders, in particular those that are in children's bedrooms.

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Keeping children and young people safe good

The Registered Manager adopts safer recruitment practices to ensure only adults suitable to work with children are employed. Further checks for applicants who have 9 of 11 worked overseas are considered, such as obtaining a certificate of good conduct. However, the policy does not apply once the applicant has lived in the United Kingdom for longer than six months. This means there is the possibility that further relevant historical information may not be obtained.

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Keeping children and young people safe good

Bullying and going missing are not identified issues in this home. Likewise, there is no need for the use of any physical intervention. Due to the cognitive ability of the children placed sanctions are not a common strategy. There has been one sanction since the last inspection that was reviewed for effectiveness by the manager. The environment is well decorated, with children able to personalise their rooms. There is a warm, homely feel. A room has been reconfigured into a medical room. This means there is a more suitable place for the storage and drawing up of medicines.

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Leadership and management good

The manager was registered in this role in August this year. She is qualified to NVQ level 4 and has a post-graduate management certificate.

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Leadership and management good

Staff are subject to a comprehensive induction programme and must satisfy the management of their competence during a probation period. There is a wide range of training including e-learning. However, this is not evaluated for its effectiveness and some staff speak negatively of it. The professional development of staff is enhanced by participation in other training opportunities. They are guided and supported by relevant health professionals. A member of staff said this is 'brilliant training'. Senior staff undertake observations of staff while they engage in practice such as medication administration or gastrostomy feeding. Although staff demonstrate they understand the individual needs of the children they care for, training is not in strict accordance with published guidance. In particular, staff are not signed off as fully trained for a specific health care task for a named child.

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Leadership and management good

The home has implemented an action plan drawn up in response to concerns expressed by the placing authorities. Since the last inspection a new manager has been appointed who has registered with Ofsted. She is clearly aware of the strengths and weaknesses of the home; for example, staff training has already been identified and is included in the development plan. She was previously registered as a nurse and is using her extensive knowledge and organisational skills to bring effective change, such as changes to medication procedures to minimise the chance for error. Significant changes have been implemented which are benefitting the children. Staff morale is good and they speak positively of the new management arrangements.

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Leadership and management good

The home has suffered from the loss of some staff since the last inspection. However, there is a stable core staff team in place. They are highly motivated to meet the needs of the children in their care to the highest possible standard. They have the experience and skills to guide other staff, such as agency staff. The 10 of 11 Registered Manager has made considerable progress in utilising regular agency staff with the necessary skills while additional permanent members of staff are recruited. Although a parent commented that the situation is improved, a placing social worker said there could be more continuity of staff to ensure more secure attachments are formed by the children placed in the home. A recommendation is made to continue the recruitment processes that are in place to ensure continuity of staff.

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Leadership and management good

The manager uses her own internal monitoring as well as visits by an independent visitor to challenge and inform practice. However, one statutory report has not been sent to Ofsted within the required timescale specified by regulation. There is no negative impact on the children. The Registered Manager is aware of her other statutory responsibilities. For example, she ensures the relevant authority is notified of significant events and she has completed a service location risk assessment in line with recent changes to the regulations.

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Leadership and management good

There is an up to date Statement of Purpose to inform placing social workers of the aims and objectives of the home. A report from a statutory review stated that the home is the right placement and other homes could not meet the complex health needs of the child placed in this setting.

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Leadership and management good

There are systems in place to seek the views of children, their parents and professionals. Consequently, the Registered Manager has clear plans for further improvement, such as establishing a sensory garden. 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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