Children's Home run by 3 Dimensions Care Limited in Somerset

Unique reference number SC060758 Inspector Janice Hawtin Type of inspection Full Provision subtype Children's home

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Registered manager POST VACANT / Shirley Cowell Date of last inspection 21/08/2014 2 of 12 Inspection date 16/10/2014

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Previous inspection inadequate Enforcement action since last inspection none

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Overall effectiveness adequate

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

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Overall effectiveness

The home provides a service which focuses on and achieves sustained improvements for young people. The quality of care is centred on the needs of young people and a parent commented ‘this is just like one big family, the staff take as much delight in the achievements of the boys as any parent would’.

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Overall effectiveness

A development plan is in place and many improvements have been made since the last inspection. Significantly, anomalies around management of the home have been acted on. The previous manager resigned, allowing for the person undertaking the manager’s role to apply for registration with Ofsted. This in turn has evoked a revived enthusiasm amongst staff who feel they now have a sense of direction and appropriate leadership.

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Overall effectiveness

Within the wider organisation, the appointment of a person with significant care experience to undertake quality assurance visits has increased the effectiveness of independent monitoring. Monitoring demonstrates effective scrutiny of behaviour management, physical restraint, and other records. Recommendations from these visits are being acted on to benefit and protect young people.

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Overall effectiveness

Attention to records is ongoing, improvements made have yet to be consistently applied and embedded in practice. Medication records are not accurate, particularly 3 of 12 those relating to dietary supplements such as vitamins and minerals. While very few sanctions are used in the home these records are insufficient making it difficult to evidence effectiveness of this disciplinary measures. A full audit and review of records has recently been commissioned within the wider organisation to ensure records are fit for purpose.

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Overall effectiveness

Staff understand the complex needs of young people. Careful planning is in line with placing authority expectations and contributes to the success of placements. Regardless of their starting point all young people make sustained improvements and progress in many areas of their lives. Ongoing improvements are evident in a short space of time.

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Overall effectiveness

Young people continue to have exceptionally good attendance at school and sustained growth in attainment levels. Clear expectations and firm boundaries contribute to young people acquiring life changing social and practical skills, for example, being able to play with other young people, sharing things and being able to get dressed for school. A social worker commented ‘the young person is happy here, they have very complex needs and the staff are able to find an effective balance between making sure they are safe but allowing them to live a full life and get involved in things their peers would’.

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Overall effectiveness

Young people are engaged in a wide and varied range of activities which support their learning and development. They are involved in both community projects and community activities alongside pursuing individual hobbies and interests. Activities have recently been extended to include Coasteering, power boating and other exhilarating and exciting opportunities. 4 of 12

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Information about this children’s home

This privately owned home provides care and accommodation for up to five young people, who may have emotional and behavioural problems. Some young people may also have specific learning disabilities.

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Information about this children’s home

The provision is registered with the Department for Education to provide education on site for young people who live in one of the three homes run by the provider.

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Inspection date Inspection type Inspection judgement

21/08/2014 Full inadequate 19/11/2013 Interim satisfactory progress 31/07/2013 Full good 19/02/2013 Interim satisfactory progress

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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 suitable arrangements are in place for the recording, handling and safe administration and disposal of medicines received into the home (Regulation 21) 21/11/2014

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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 in a children's home, a written record is made in a volume kept for that purpose of which shall include information listed as items 3 (a)-(i) and 4 (a) and 21/11/2014 5 of 12 (b) of this regulation. (Regulation 17B (3)and (4))

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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 staff support and encourage young people to make and keep a record of their time in the placement (NMS 22.6)  ensure the home implements a written policy which clarifies the purpose, content and format of information to be kept in the home. Staff understand the nature of records and how to maintain them and that there is a system in place to monitor the quality and adequacy of records keeping and take action when needed.(NMS 22.1) 6 of 12

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Outcomes for children and young people good

Young people continue to make significant progress in developing emotional well- being and confidence. Often from a very difficult starting point they develop socially acceptable behaviour, communication skills and begin to benefit from the opportunities that these improvements bring. It is possible to discern significant improvements in a very short space of time and many of these are life changing, such as being able to play and communicate with other young people.

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Outcomes for children and young people good

Contact with families supports young people’s knowledge and understanding of their background and promotes their sense of identity. Attachments with relatives are sustained and reinforced where appropriate. This includes the provision of joint activities arranged by the home for young people, their siblings and other family members.

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Outcomes for children and young people good

Some extremes of debilitating behaviour exhibited by young people have reduced significantly. Those young people who were not able to leave their bedroom or keep clothes on are now dressing appropriately and able to take part in activities out in the community. In addition, young people develop and improve their communication skills, in particular for one young person they rely less on the use of echolalia to process listening, or on the use of toy characters to communicate.

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Outcomes for children and young people good

Young people benefit from full time, exceedingly good attendance at school and they continue to progress towards expected target levels. Bespoke packages of education are provided and enable young people to develop important life and social skills alongside academic and practical skills.

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Outcomes for children and young people good

Young people are encouraged to make choices whenever the opportunity arises. They commonly make decisions about clothing, food and activities, but also make known their views about more complex issues, for example, future placements to inform planning meetings. One young person recently helped to organise the food and organised games for an eighteenth birthday party.

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Outcomes for children and young people good

Young people are involved in a wide range of activities that support their learning including membership of specialist community group and clubs. They enjoy holidays which broaden their experiences, and support the development of friendships. Young people commonly enjoy trips to theme parks, adventure parks, sea fishing and involvement in local carnival committees. Within the wider organisation working in partnership with activity providers has seen additional opportunities to take part in additional activities. Young people have recently enjoyed canoeing, coasteering and power boating.

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Outcomes for children and young people good

Independence skills are maximised. Dependent on their ability, young people have 7 of 12 varying knowledge and skills in understanding and acting on the importance of staying healthy. They eat a healthy diet and take part in regular exercise. Young people are not engaged in risk taking behaviours such as smoking, drinking alcohol or use of illicit drugs.

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Quality of care good

Since the previous inspection there have been many improvements to the home, young people continue to appear happy and at ease in this environment and around the staff caring for them.

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Quality of care good

Each young person has an individualised behaviour management plan which has led to a reduction in both difficult and dangerous behaviour. For the most part, behaviour management is focused on changing behaviour through positive interventions and rewards. The positive relationships between staff and young people are instrumental in helping you people to feel valued and understood. This in turn influences behaviour, and behaviour management planning to avoid difficulties and conflict.

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Quality of care good

Staffing numbers are high with at least a one-to-one, but also a two-to-one ratio for some young people, depending on the complexity of their needs. Each young person has a dedicated, limited number of care workers who provide consistency and familiarity. This provision encourages positive attachments and generally fosters a good understanding of young people's needs.

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Quality of care good

Care planning is thorough and meets the expectations of the placing authority. Staff will advocate and challenge decisions on behalf of young people. Recent interventions undertaken on young people’s behalf have seen the stability of placements improve and secured additional care services.

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Quality of care good

Young people know how to make a complaint. Staff are also skilled in interpreting behaviour linked to emotional problems or discomfort and respond to reduce young people's anxiety and distress. This is particularly evident when they are dealing with young people who have high needs autism and complex communication needs.

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Quality of care good

Young people interact well with one another, the home is spacious and divided into two distinct areas, each with its own lounge, dining area, kitchen and access to bedrooms. Consequently, it is possible to separate young people and avoid conflict. This also reduces the impact on other young people when an individual is having some difficulties, but allows for social interaction and developing communication skills at other times.

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Quality of care good

Staff take account of the feelings and wishes of young people. Bedrooms are personalised by young people and meet their individual taste and needs. It is possible to determine which bedroom belongs to each young person by the décor, fittings and 8 of 12 belongings. This gives young people a real sense of ownership and belonging.

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Quality of care good

Communal areas of the home are personalised with pictures of young people. The lounges have been updated and one has been re-decorated with the help of a young person. Notices which gave something of an institutionalised feel to the home have been removed and replaced with pictures and art chosen by the young people. On the same site, the school now has a new dedicated kitchen and dining room avoiding the need to use the home during school lunch times and avoiding complication with health and safety requirements and notices.

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Quality of care good

Young people have access to the services they require to develop and promote their health and emotional well-being. Alongside routine health checks and preventative health care, young people have access to a range of specialists including speech and language therapists, psychological, and occupational therapists and nutritionist.

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Quality of care good

With the guidance of medical professionals and support of the staff young people have been able to stop taking prescription medication which is designed to control behaviour. This is a major step in allowing young people to become more independent and self-regulating. Although medication is safely locked away, records are not accurate and it is not always recorded when or why young people stop taking or refuse dietary supplements such as vitamins. Unused medication has not been returned to the pharmacy for disposal, and stock balances are not clear. Some permission slips to allow young people to take dietary supplements prescribed by a nutritionist have not been sort from the placing authority. This practice complicates the safe administration of medication to young people.

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Quality of care good

The home is located in a rural area, close to several small villages, community facilities, and within reach of a large city when using the home’s own transport. The home is spacious and well-equipped, it has a large fenced garden with enough space to play ball games. Young people are enthusiastic and keen to demonstrate their gymnastic ability on the homes trampoline. The garden also has fruit trees and a large fish pond which young people have some responsibility for looking after.

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Quality of care good

A previous recommendation to support young people to keep appropriate memorabilia of their time in the placement has been repeated. All now have a memory box but the contents are currently sparse and there is a risk of young people not having sufficient information when they move on. One young person has a positive comments book which staff write in. There are plans to extend this facility to all young people so that these can be kept for the future.

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Keeping children and young people safe adequate

9 of 12 Records of restraint have been reviewed and amended to enable capture of the information required. Each incident is now recorded separately making it clearer what happened and who was involved. The practice of reviewing these records to ensure they contain the correct information is not yet consistently embedded in practice. Two out of nine recent records did not fully meet regulatory requirements. The missing information was recorded elsewhere in incident reports and there is no evidence to suggest any inappropriate use of these interventions, which have prevented serious injury. Physical restraint has not been used to force compliance and additional staff training and discussion has been provided to ensure staff are clear about the criteria for such interventions.

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Keeping children and young people safe adequate

Discussions with individuals in supervision sessions, and groups discussion in the team meetings have been held to look at staff's understanding of safeguarding. Staff are now clear about what to do should they receive an allegation or suspect a young person is being abused. Recently appointed staff demonstrate a good understanding of the procedures to follow. This protects young people and avoids compromising investigations should any incidents occur.

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Keeping children and young people safe adequate

The organisation has recently produced additional guidance and checks for agency staff who may be employed in the home. This provides for robust vetting checks and essential induction information which includes checking safeguarding knowledge and clarity around roles and responsibilities. Vetting and recruitment checks for permanent employees are robust. The home is not currently using any agency staff.

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Keeping children and young people safe adequate

All visitors to the home are checked to ensure they have a right to enter. Staff are aware of the particular vulnerabilities of young people and what makes them feel safe. Staff have built an enclosed den above the bed of a young person who sometimes feels safer in small places. Another young person has a tent in their bedroom which they can use when they are feeling anxious. This attention to individual need continues to help young people to feel safe and secure. Young people have dedicated workers allocated to them and are able to express any discontent.

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Keeping children and young people safe adequate

Incidents of young people going missing from this home are rare. The policies in place are compliant with the local safeguarding board joint police protocols which contribute to keeping young people safe and returning them quickly, should any incidents occur.

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Keeping children and young people safe adequate

The environment is physically safe and secure. The front door is kept locked as some young people have no understanding of danger and have tried to leave using this exit. However, young people who do not need this restriction can leave through one of several other doors. Doors throughout the building have fire safety devices and will close automatically should alarms go off. Fire detection systems are in place so that staff and young people can get out of the building quickly in the event of a fire. 10 of 12

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Leadership and management adequate

The Registered Manager resigned from this home following the last inspection. The manager who has been undertaking this role has now applied to Ofsted to be registered as required. She has experience of work in similar settings and understands the complexities of managing children’s home and a large number of staff. The strengths and weaknesses of the home are understood by her and she demonstrates a continuing determination and commitment to improve the home. In addition a director of the organisation has now taken on the role of Responsible Individual and has also been involved in driving improvements.

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Leadership and management adequate

The development plan has been updated to address the shortfalls identified at the last inspection. Many improvements have been made in recent weeks to benefit the home and services to young people. Developments are on-going, some changes have yet to be constantly applied and embedded in practice. It is evident that management arrangements have been inadequate for some time and as such this has left significant gaps in records. In recognition of this an external audit and review of all records have been externally commissioned.

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Leadership and management adequate

The Statement of Purpose has been fully reviewed and now meets current requirements. The written information provided to parents, commissioning bodies and regulators is up to date and comprehensive.

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Leadership and management adequate

The home employs a sufficient number of staff to look after the young people in its care. The supervision policy has been updated and since the last inspection supervision has been provide on a monthly basis. Records are kept on the premises and supervision is taking place between managers, directors and the responsible individual. This ensures that all those who have access to young people and are involved in their care are accountable for their work practice. Staff report that they are ‘confident in the ability of the manager’, ‘enjoy their work’ and feel they ‘get the support and guidance they need’.

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Leadership and management adequate

The programme of induction, mandatory and specialist training available to staff is comprehensive and contributes to them meeting the needs of young people, who without exception make measurable progress in this home. The effectiveness of training and knowledge is being tested at staff meetings and in supervision sessions. The deputy manager is also working less office hours to allow him to shadow staff on duty and analyse their ability and development needs as part of appraisals to ensure on going personal development.

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Leadership and management adequate

Leaders and managers are in regular communication with parents, staff, and commissioners. This communication underpins clarity about the aims and objectives of placements. Staff work in close partnership with other agencies to deliver effective services, and support to meet young people’s needs. Partnership includes consultation with social workers, specialist therapists, and education providers and provides for continuing evaluation, and evidencing of the progress made by young 11 of 12 people.

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Leadership and management adequate

Following the last inspection the home commissioned a different person to undertake Regulation 33 visits and provide reports. These now demonstrates effective monitoring and identification of development needs.

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Leadership and management adequate

Young people’s individual records are clear and up to date, they contribute to understanding the life and history of young people. Planning documents, risk assessments and school information are readily available so that staff are clear about the needs of the young people they care for.

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Leadership and management adequate

Monitoring by the Registered Manager has improved and findings from this monitoring have led to identifying some development needs. A report detailing this monitoring has been forwarded to Ofsted for quality assurance purposes. While the use of sanctions is very rare, current recording formats do not capture the information required to ensure they are effective and reviewed. Thee shortfalls identified do not appear to impact on the quality of care provided or impact on the continuing improved outcomes for young people. 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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