Children's Home run by Birtenshaw in Bolton

Unique reference number SC397344 Inspector Jacqueline Malcolm Type of inspection Full Provision subtype Children's home

p.1

Registered person Birtenshaw Registered person address Birtenshaw, Darwen Road Bromley Cross BOLTON BL7 9AB Responsible individual David Gerald Reid Registered manager Marie Frances Smith Date of last inspection 21/11/2013 2 of 11 Inspection date 22/08/2014

p.1

Previous inspection good Enforcement action since last inspection none

p.2

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

p.2

Overall effectiveness

Young people receive a good quality of care and achieve progressive outcomes. Young people have developed improved communication and self-care skills. They self-regulate their behaviours and enjoy a range of stimulating activities. A professional stakeholder said, ‘the young person I am responsible for is happy and well cared for. Her family are involved in any decisions about her care and they are very flexible in supporting contact with her family. She is also able to make lots of choices about the food she eats, the décor of her room and leisure activities’. A conscientious staff team make every effort to ensure that young people are cared for in accordance with their individual placement plans. Well integrated anti- discriminatory practices ensure that young people participate in community life. This is irrespective of their disability. Under these conditions, young people develop in confidence and their social inclusion is promoted.

p.2

Overall effectiveness

Positive and trusting relationships forged between young people and staff nurture strong attachments and keeps young people safe. Although safeguarding is highly prioritised, some practice shortfalls have impacted on this area. These are in relation to less than robust recruitment practices, some out of date and inappropriate risk assessments, the recording of physical interventions and awareness about the role of the local authority designated officer (LADO). Of significance is a restrictive behaviour management strategy that was implemented at least three years ago and 3 of 11 has not been reviewed since. This has resulted in limited opportunities for some young people’s to make choices and prepare them for their transition into adulthood.

p.2

Overall effectiveness

The home is suitably managed by a experiences and qualified Registered Manager. Staff express satisfaction with the quality of their support, training and supervision. Shortfalls in relation to the aforementioned safeguarding issues and leadership and management oversight are acknowledged by the manager. Their firm undertaking to improve practice shows a positive attitude towards improving outcomes and shows capacity to improve. 4 of 11

p.3

Information about this children’s home

The home is part of a charitable organisation. It provides care and accommodation for up to four young people with physical and learning disabilities.

p.4

Inspection date Inspection type Inspection judgement

21/11/2013 Full good 05/02/2013 Interim good progress 08/06/2012 Full good 21/10/2011 Interim good progress

p.4

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.

p.4

Reg. Requirement Due date

(2001) promote and make proper provision for the safeguarding and welfare of children accommodated there; and make proper provision for the care, education, supervision and, where appropriate, treatment, of children accommodated there. This specifically relates to restrictive behaviour management practices in the home (Regulation 11 (1) (a) (b)) 30/09/2014

p.4

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 the purpose which shall include all information set out in that regulation (Regulation 30/09/2014 5 of 11 17B (3)(a-i)(4)(a-b))

p.4

Reg. Requirement Due date

(2001) ensure that where a person has previously worked in a position whose duties involved work with children or vulnerable adults, so far as reasonably practicable verification of the reason why the employment or position ended (Schedule 2 (4)) 30/09/2014

p.5

Reg. Requirement Due date

(2001) ensure that the registered person establishes and maintain a system for improving the quality of care provided in the children's home. Specifically that weaknesses are promptly identified and acted upon. (Regulation 34 (1) (b)) 30/09/2014

p.5

Recommendations

To improve the quality and standards of care further the service should take account of the following recommendation(s):

p.5

Recommendations

 ensure that visits under Regulation 33 inspect compliance with regulations, systems and processes and the person making the visits will wish to be satisfied that the home has an effective approach to behaviour management (Volume 5, statutory guidance, paragraph 3.12)  ensure that all staff are equipped with the skills required to meet the individual needs of all children; specifically in relation to their understanding of the Local Authority Designated Officer (LADO) role (NMS 18.1)  ensure that children's records are clear, up to date, stored securely, and contribute to an understanding of the child's life. Specifically ensure up to date health needs assessments and risk assessments for all eligible young people. (NMS 22) 6 of 11

p.5

Outcomes for children and young people good

Young people enjoy stable and contented lives at this home. They develop a strong sense of belonging, their confidence has grown and some risky behaviours have progressively reduced. Young people's individual personalities and traits are known by the adults who care for them, which meets their needs. Genuinely warm, nurturing, respectful and fun relationships between staff and young people sustain positive attachments and young people’s good progress.

p.6

Outcomes for children and young people good

Young people enjoy exceptionally good health irrespective of their complex needs. Their registration with a range of health professionals ensures prompt access to the services they need. Young people are supported to attend health appointments to ensure their optimum health. For example, young people’s dental checks indicate that no young people need dental treatment. This is testament to the good attention paid to young people’s dental health. Young people who show a keen awareness about healthy eating are learning to eat less and exercise more. This helps them to achieve their weight loss goals and shows a good awareness about healthy lifestyles. Young people who have endured years of pain and discomfort due to their health conditions are thriving post-surgery. This has significantly improved their quality of life.

p.6

Outcomes for children and young people good

Young people of school age experience excellent attendance at the organisations school and external provision. Young people’s engagement in educational activities is reinforced in their home activities. For example, learning to use technology at school helps aid communication and recreational activities in the home. Positive communication from school indicates young people’s educational stimulation and enjoyment. Their education is valued, they are helped to aim high, which supports young people studying towards examinations.

p.6

Outcomes for children and young people good

Young people enjoy a range of activities that they choose to do individually or as a group. This promotes their social, emotional and developmental needs. Young people’s activities include, helping out around the home and garden area, baking and joining in at the local youth club. Photos of young people’s activities provide a permanent account of fun memories during their time at the home.

p.6

Outcomes for children and young people good

Young people benefit from the consistency of regular contact with their families. This promotes their identity and stability needs. Some young people have overnight stays with relatives, which sustains family life, maintains important relationships and enriches their life in other communities. Families are welcomed when they visit the home. This gives a positive message to young people about how their families are valued. A relative said that the staff team, ‘are all lovely’ and ‘yes, everything is okay. I can talk to staff at any time’.

p.6

Outcomes for children and young people good

Young people show promising independence skills in line with their abilities. Most 7 of 11 young people are supported to perform basic life skills, such as making own drinks, cooking, baking, helping to clean the house and following personal care routines. This enables young people to become less dependent on adults and challenge themselves. Careful and tenacious planning ensures that eligible young people make a positive, well planned transition into suitable adult placements.

p.6

Quality of care good

Overall, young people receive a good quality of care. This is summarised by an independent reviewing officer who says, 'from my perspective as (young person's name) IRO, I can only speak positively about all of those elements of (name of young person) care. She is safe, well looked after, has her health needs met and is making good progress in her education with support from the home. Communication is very good- no complaints and (name of young person) appears a lot happier in herself since being placed at (name of the home) whose staff are also very good at involving (name of young person) father and grandmother as well'.

p.7

Quality of care good

No new placements have been made since the last inspection, which promotes good placement stability. The impact of good matching has resulted in a compatible group of young people who live relatively harmoniously together. High quality placement plans support young people’s diverse needs and celebrates their personal identity and individuality.

p.7

Quality of care good

All young people, without exception, benefit from care by staff who are committed, child centred and place them at the centre of their work. Positive, affectionate and patient approaches helps staff maintain trusting relationships with young people. This good level of supports improves young people’s outcomes and quality of life and has exceeded expectations. Relatives report that young people tell them that they like living at the home as reported by a relative who was told by a young person, ‘I love it at (name of the home)'.

p.7

Quality of care good

Young people are regularly consulted and their views are listened to and respected. Young people’s communication needs are familiar to staff. Some young people have no verbal skills and some are able to respond verbally. Young people are adept at using technology, such as the IPad to project their needs and the views of families are also incorporated into their care. This helps young people to express themselves and make well informed basic choices on daily matters. For example, choosing activities and meals. A major strength is the significant progress that some young people have made to develop clarity of speech and form coherent sentences. This has gone some way to make young people feel understood and minimises frustrations that may lead to disruptive behaviours. Although the complaints policy is known to young people, families and professionals, none have been made.

p.7

Quality of care good

Good partnerships with health professionals ensure that young people receive prompt health attention and their health can be monitored. Young people's health plans 8 of 11 provide sufficient details to meet their health needs, but not all young people have an up to date health needs assessment. This does ensure that any changes needed to health plans are in place. Medication procedures provide safe and effective protection against poor practice and errors. This keeps young people safe.

p.7

Quality of care good

Staff value young people's education. This ensures that young people have the best opportunities to thrive and they are transported to and from school. Young people's achievements are recognised and praised. However, not all young people's most up to date personal education plans are readily available at the home. This does not provide staff with an accessible reference that informs and updates them about young people's progress.

p.8

Quality of care good

Young people live in a pleasant home environment. The home provides communal space, decorated and designed in neutral colours to meet young people's needs arising from Autism. Young people have personalised their bedrooms, which reflects their individual personalities and interests. Plans are in place to redecorate the whole house in the next few weeks to improve the overall worn appearance of the home. Young people have access to an enclosed outdoor area should they wish to play outside.

p.8

Keeping children and young people safe adequate

Young people’s safety and welfare is highly prioritised. Families and professional stakeholders are satisfied that young people are cared for safely at this home. Good staffing ratios, observations and monitoring young people safeguard them against harm associated with abuse, child sexual exploitation, bullying and missing from care events. Staff confirm that they feel confident about dealing with safeguarding and child protection concerns and have received safeguarding training. However, although staff understand their responses to dealing with safeguarding issues, not all staff understand the role of the Local Authority Designated Officer (LADO). This may limit their understanding of how allegations against staff are investigated to their outcomes.

p.8

Keeping children and young people safe adequate

Most young people’s behaviour is generally well managed by trained staff who understand their personalities, moods and related behaviours very well. Consistent behaviour management practice, supported by behaviour management plans has positively reduced risky habitual behaviours presented by some young people. For example self-injurious behaviours. This is positive. It demonstrates that young people have learnt to self-regulate their behaviours with more frequency. There have been occasions when staff have used physical intervention to prevent young people from harming themselves or others. Records of these events are made in the incident book, but this document is not created for the purpose of recording restraint and physical interventions. This record does not provide sufficient detail to ensure transparency or enable the manager to robustly monitor staff practice. The lack of clarity contained in the current recording system leave staff vulnerable to future

p.8

Keeping children and young people safe adequate

9 of 11 challenge because the information would not withstand scrutiny.

p.9

Keeping children and young people safe adequate

Furthermore, it is of concern that some behaviour management strategies promote restrictive practice. This is in the form of locking bedroom furniture in a young person's room, which prevents them from accessing their personal belongings. The rationale behind this practice was made to address challenging and risky behaviour that staff found to be too unsafe to manage. This practice has not been reviewed since it was implemented at least three years ago. Young people's independence and opportunities to develop other coping mechanisms are hindered by this practice. The manager has agreed to cease this practice and review this area of concern.

p.9

Keeping children and young people safe adequate

Staff understand the impact of young people's disabilities which helps them to protect their vulnerabilities. This enables staff to effectively manage known risks and minimise harm to them. However, not all risk assessments have been prioritised and reviewed to ensure they remain current and appropriate. For example, a risk assessment that promotes a restrictive behaviour management practice.

p.9

Keeping children and young people safe adequate

A small number of new staff have been recruited to the home since the last inspection. Recruitment procedures are generally good. This minimises the risk of unsuitable adults having access to vulnerable young people. However, in one example, an application form does not include information making clear the reason why an applicants employment in childcare positions ended. This does not fully promote robust recruitment practices.

p.9

Keeping children and young people safe adequate

Young people's health and safety is protected. For example, environmental risk assessments, maintenance of electrical and gas equipment ensure their continued safe use. Fire evacuation checks, including individual evacuation plans allow young people and adults to safety evacuate the building in the event of a fire. These practices keep everyone safe.

p.9

Leadership and management adequate

The well qualified and experienced manager has held Registered Manager status since 2010. She holds level 4 qualifications relevant to caring for children and young people and in leadership and management. The manager is currently studying towards Diploma level 5 in leadership and management. This demonstrates her commitment to further learning and development. The manager knows the young people very well and invests in the best quality of care and outcomes for them. A consistent, child focussed core staff team provides good support to the manager. They show a firm commitment to improving young people’s life chances, which is reflected in young people's good progress. An ambitious development plan support improvements in the home.

p.9

Leadership and management adequate

No previous requirements or recommendations were raised at the last inspection. However, there are shortfalls in aspects of management oversight and prompt 10 of 11 monitoring of some care practices. This relates to how some young people's challenging behaviour has been managed and how some records of incidents are maintained. For example, the locking of bedroom furniture in a young person’s room has not been challenged with sufficient rigour or timeliness. Physical interventions are not recorded in the restraint book, which does not ensure clear and transparent information that complies with the regulations. The manager has failed to recognise and review the identified shortfalls. This does not identify weakness and inspect capacity for poor and unsafe practice. The manager has not identified and addressed the recruitment shortfall or has promptly chased up to date personal education plans and health needs assessments as required. Not all of the risk assessments are

p.9

Leadership and management adequate

current and some records, such as the incident book lack clarity, which undermines some good recording practices.

p.10

Leadership and management adequate

Although Regulation 33 visits are regularly conducted by an independent visitor, the restrictive behaviour management issue has gone by undetected. This means that opportunities to quickly drive improvement have been missed. These shortfalls are significant because they show a lack of systematic and good scrutiny of practice.

p.10

Leadership and management adequate

Good staffing levels ensure that young people consistently receive individual care and attention. Staff speak highly of the support and guidance provided by the manager. Staff confirm good supported through regular supervision, training and appraisal. Typical comments include, ‘I have regular supervision’ and ‘I have had my 2014 – 2015 appraisal meeting’ and ‘my knowledge and training is refreshed regularly. I have recently completed Team Teach, health and safety, supervision for supervisors, Diploma 5, accident reporting and risk assessment’. Members of the staff team have also attended specialist training course. This updates their knowledge base and helps them to support young people’s needs arising from their disabilities.

p.10

Leadership and management adequate

One external complaint received by the home has been dealt with. This related to a neighbour complaining about a car parked close to their home that in reality, did not present an obstruction.

p.10

Leadership and management adequate

The home has a comprehensive statement of purpose. This is regularly reviewed and informs stakeholders of the services that young people can expect to receive. Social stories help young people to gain some insight into the home, which helps to reduce any anxieties. Social workers and families confirm a positive relationship with the home. A professional stakeholder said, ‘I am regularly provided with reports (key worker/incidents) about the young person who is placed with this provider and I receive emails and phone calls regarding any serious issues’. Website: www.ofsted.gov.uk

p.10

Leadership and management adequate

This document may be reproduced in whole or in part for non-commercial educational purposes, provided that the information quoted is reproduced without adaptation and the source and date of publication are stated.

p.11

Judgement Description

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

p.11

Judgement Description

Good A service of high quality that exceeds minimum requirements.

p.11

Judgement Description

Adequate A service that only meets minimum requirements.

p.11

Judgement Description

Inadequate A service that does not meet minimum requirements.

p.11

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.

p.11

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.

p.11