Children's Home run by Cornwall Partnership NHS Foundation Trust in Cornwall

Unique reference number SC432404 Inspector Paula Lahey Type of inspection Full Provision subtype Children's home

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Registered person Cornwall Partnership NHS Foundation Trust Registered person address Fairview House Corporation Road BODMIN Cornwall PL31 1FB Responsible individual Alison Helen Cook Registered manager Donna Maria Parker Date of last inspection 13/12/2013 2 of 10 Inspection date 09/12/2014

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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

The children who visit this home for short breaks benefit from good quality care and the support of knowledgeable and caring staff. Families and social workers are very complimentary about the service provided. Families say ‘the staff’s knowledge of complex needs is phenomenal and I am totally happy with my child coming to this home’, ‘we see this home as vital support for the whole family in coping with a child with very complex needs’ and ‘the care is first rate with a child who is very complex medically’. In addition a social worker said ‘my experience of this home is really good; it is of benefit to young people and their families and provides valuable support’. Children were observed to enjoy their visit and be comfortable with staff.

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Overall effectiveness

Children have profound disabilities and multiple health needs. The care provided is child-focused, meets children’s complex needs and promotes their well-being. Consequently, children are safe and enabled to enjoy a range of opportunities and positive experiences. Nurturing relationships are fostered and this supports children to feel happy and cared for during their stay. Staff have an excellent understanding of children’s diversity and provide professional, well-informed and personalised support to them. Suitable training and good quality care planning underpins this practice.

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Overall effectiveness

Staffing arrangements and the management of the home are strong and effective. 3 of 10 Team members have a good understanding of their individual and shared responsibilities and have continued to work hard this year to develop further the service provided to children. This is particularly evident in the improvements made to the environment and the range of purposeful and stimulating activities available for children. There are some minor shortfalls in respect of the recording of complaints and effective planning of supervision for support workers. These shortfalls do not detract from the positive experiences of the children or the quality care provided. 4 of 10

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Information about this children’s home

This children’s home is part of a local authority short breaks service for up to two children with disabilities, complex individual needs and fragile health.

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Inspection date Inspection type Inspection judgement

13/12/2013 Interim satisfactory progress 30/07/2013 Full good 28/02/2013 Interim good progress 17/07/2012 Full adequate

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Recommendations

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

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Recommendations

 ensure that staff have access to support and advice, and are provided with regular supervision by appropriately qualified and experienced staff. In particular, ensure that supervision is planned in advance and provides routine opportunities to reflect on practice (NMS 19.4)  ensure that the registered manager has provided the home with a written procedure for considering complaints and responding to representations and complaints. In particular, ensure that the records maintained in the home provide a clear and consist audit trail of the response to and outcome of complaints. (NMS 21.10) 5 of 10

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Outcomes for children and young people good

Children enjoy their short break visits. Activities are purposeful, varied and rewarding and positively benefit children. This year children have accessed the community more regularly. This includes trips to the local library, woodland walks and visits to the beach and leisure areas. These activities enable children to become valued members of their local community.

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Outcomes for children and young people good

In addition to community-based activities, children are also able to enjoy a wide range of sensory activities in the home. These include numerous craft activities as well as cooking, pamper sessions, massage, water play, interactive toys, sporting activities and music. All of the activities provide sensory stimulation and help the children to explore and experience their immediate and wider environment.

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Outcomes for children and young people good

Children enjoy the sensory story activities they engage in. Staff creatively engage children in imaginary journeys to other places and changing seasons. Some children really liked the ‘Gruffalo’ walk and treasure hunt. Photographs of the children’s experiences adorn the communal areas of the home and are copied into the newsletters sent home to families and placed in individual scrapbooks which children can keep. As such, children’s experiences and successes are celebrated effectively.

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Outcomes for children and young people good

Children’s contributions to the home are valued. Children have helped to make beautiful pictures for each of the bedrooms. They have also helped to choose the colours for and paint the garden fence, decorate birdhouses and plant flowers. These contributions have helped to make the home more inviting and child-friendly.

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Outcomes for children and young people good

Children’s diverse needs and individual preferences are recognised and accommodated. Some children like to have a lie in-at the weekends and spend the time watching rugby or Formula 1 and listening to music videos. Some children like to spend time out of their wheelchairs and stretch out on the floor while watching the sensory lights. Some children like to have their favourite toy placed on their bed when they visit. Some children prefer to have a quick shower rather a long bubble bath. Staff know children’s likes and dislikes and work hard to incorporate them into all aspects of the children’s stay.

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Outcomes for children and young people good

Families who have provided feedback, either to Ofsted or directly to the home, agree that children achieve positive outcomes during their stay. One family says that short breaks give their child an opportunity for independence and to experience things they may not have done otherwise.

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Quality of care good

6 of 10 The staff have worked at the home for many years and provide children with stable relationships and continuity of care. Relationships between children and staff are very positive; children enjoy and benefit from the time they spend with the staff. One family told the inspector that ‘staff are friendly, warm and affectionate with my child’. Other families also said they value the fact that the staff genuinely care for the children; they felt this was one of the key strengths of the home. Staff work hard to establish and maintain positive relationships with families. Newsletters are sent home regularly, coffee mornings are held, home visits take place and routine contact and communication are sustained.

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Quality of care good

The quality of the care provided is good and is underpinned by detailed care planning. Families and professionals are involved in helping to devise care plans which ensures that these documents are individualised and personal to each child. A parent of a child who has recently started to visit the home was impressed with how well written her child’s care plan was and how it had captured the key information about the child. Staff understand children’s individual needs and ensure care plans are implemented.

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Quality of care good

Staff support children’s complex health needs well. Qualified nurses and trained carers on each shift ensure that children’s medical needs are met. The competency of staff to administer medication, deliver medical interventions and manage emergency situations is regularly assessed. Clinical practitioners and the children’s pharmacist oversee this.

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Quality of care good

Staff understand the children well; they are familiar with the way children communicate and express their wishes and feelings well and can promptly identify any changes in children's health or personal care needs. Appropriate action is taken to care for them. A parent confirmed this; ‘my child has managed to stay out of hospital because of such a high standard of respite care. Because staff are trained and know my child so well, any problems in their health can be picked up very quickly’.

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Quality of care good

During the summer the home was closed for a period of two months in response to a health and safety issue that had been identified. Alternative breaks were offered at another of the provider’s homes and the majority of families accepted this. Staff from this home went with children to ensure they received continuity of care. Staff try hard to respond to parents’ requests for short break requests and accommodate any changes to planned stays, although this is not always possible. In one case this led to a complaint about the effect it had had on the family leading to changes in the way in which visits are planned. Before visits are confirmed staff try make sure that they are aware of other services the family is receiving in order avoid potential conflicts. It is too soon to judge the effectiveness of this approach because it has only recently been implemented. 7 of 10

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Keeping children and young people safe good

The staff work hard to keep children safe. Families who provided feedback confirmed this. One family said that this home is ‘the only other place apart from with family that we feel happy to leave our child; he is immensely well cared for’. Another parent concurred with this view and provided positive feedback directly to the providers ‘the overnight stay is invaluable, feeling your child is safe and you are able to relax and be as free as you can’.

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Keeping children and young people safe good

From their responses, it is evident that children feel safe and assured in the home and in their interactions with the staff who care for them. Staff understand the importance of developing and maintaining good relationships with the children and their families. This approach contributes to the confidence and sense of security that children display while they are staying at the home.

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Keeping children and young people safe good

Staff receive regular safeguarding supervision and have routine access to child protection specialists The Registered Manager meets formally with the lead health professional responsible for child protection at regular intervals. Supervision sessions provide staff with the opportunity to refresh their knowledge, remind them of their responsibility to implement safeguarding procedures and discuss individual concerns. As a result, staff spoken with during the inspection demonstrated a good understanding of how to protect children and promote their well-being.

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Keeping children and young people safe good

Staff understand children’s diverse and complex needs well. The fact that children’s welfare is of paramount importance is evident in the approach and practice of the staff. Children’s health, development and presentation is routinely monitored and well documented. Case records are detailed and comprehensive. While children do not go missing from this home, and while bullying and/or challenging behaviour which requires the use of physical restraint are not an issue for these children or the home, there are appropriate policies in place and staff have had the relevant training.

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Keeping children and young people safe good

Key records such as body mapping charts and incident reports are reviewed on a monthly basis. Senior managers and staff evaluate the information to identify any changes in children's presentation, patterns or concerns. During the inspection staff demonstrated an appropriate understanding of how to respond to concerns identified in this way and were clear about their child protection responsibilities, including what to do and who to refer their concerns to.

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Keeping children and young people safe good

Attention to detail ensures that the home is safe, clean and well maintained. Risks are assessed and action taken to minimise potential hazards to children and others. Utilities and specialist equipment are routinely checked. The prompt identification of a problem with water pipes during the summer is evidence of the effectiveness of those checks. Appropriate action was taken to protect children and provide them with an alternative short break while essential remedial work was carried out. The housekeeping is excellent; the home is constantly maintained to a high standard. A recent bi-annual inspection of the health, safety and housekeeping of the home 8 of 10 recognised this as an area of real strength.

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Leadership and management good

The leadership of the home is robust. A suitably qualified and experienced Registered Manager and deputy directly lead and manage the home. The Registered Manager is also responsible for the leadership of another home. Consequently, the deputy carries out many of the day-to-day management tasks. These tasks are completed efficiently and effectively resulting in a well organised and well run home. The working roster ensures that either the Registered Manager or the deputy is available to provide management oversight of the home at all times.

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Leadership and management good

The Statement of Purpose has been revised within the last 12 months and contains all the required information. The staff have produced alternative versions of the Statement of Purpose to make it easily accessible to children and families. The documents are available on the provider’s website. As a result, those who use the service are well informed about what to expect from the home and the services it provides. This year the staff have been consulted about, and have been involved in helping to re-shape, the provider’s shared values. Staff speak positively about the exercise and are pleased to see their views have been incorporated.

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Leadership and management good

There is informed engagement with families and other professionals. Good relationships have been established and maintained over time. The staff team regularly consult with others about the quality of the care and services they provide. Families, staff and external professionals regular attend coffee mornings organised and facilitated by the home. These sessions are welcomed by the families and provide them with routine opportunities to meet with professionals and other families and speak to staff about their children. Feedback received following these sessions is incredibly positive; it was ‘great to catch up with parents and staff’ and ‘lovely to have time to chat about the children and share information and knowledge’.

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Leadership and management good

The professionalism of the staff team and their understanding of their regulatory responsibilities has continued to develop since the last full inspection. The whole staff team has been involved in reviewing the service and evaluating its strengths and weaknesses. Areas identified for improvement have been incorporated into the annual development plan. The vast majority of the actions have been completed ahead of schedule. Requirements from the previous Ofsted inspection and recommendations from internal audits are taken seriously and promptly attended to. Involving the staff team in the review and development process has ensured greater ownership of and accountability for the running of the home. Staff who took part in the inspection demonstrated a shared understanding of the purpose of the home and a commitment to continuous improvement. 9 of 10 Regular supervision, performance appraisal, training, competency assessments and

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Leadership and management good

team meetings provide support for the staff and promote their development. Staff spoken with say they feel well supported and directed by their line managers and each other. The nurses’ supervision is well planned and is of a good quality. However, supervision sessions for support workers are not currently booked in advance and often take place at very short notice. This practice limits the opportunity for the supervisor and worker to prepare for the session in advance in order to ensure that it is as purposeful and reflective as it could be. A plan is in place to deal with this situation; however, at the time of inspection it had not been implemented.

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Leadership and management good

The way in which records are organised and maintained, particularly children’s records, is excellent. However, the recording of complaints, and the action taken in response to them, lacks consistency which means that there is not an effective audit trail in every case. It is evident that in the majority of cases appropriate action is taken and that lessons learnt are used to improve practice. However, in a small number of cases there is no record of the date the complaint was received or by whom and whether the complainant was satisfied with the outcome. This is a recording shortfall and does not have an adverse impact on the quality of care provided to children and their families. 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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