Children's Home run by Northamptonshire Healthcare NHS Foundation Trust in North Northamptonshire

Unique reference number SC465287 Inspector Mary Timms Type of inspection Full Provision subtype Children's home

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Registered person

Northamptonshire Healthcare NHS Foundation Trust Registered person address Sudborough House, St Mary's Hosptial 77 London Road Kettering Northamptonshire NN15 7PW Responsible individual Sharon Toyer Registered manager Nathan James Ward Date of last inspection 05/06/2014 2 of 11 Inspection date 06/01/2015

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Registered person

Previous inspection sustained effectiveness Enforcement action since last inspection There has been no enforcement action since the time of the last inspection.

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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 well managed service provides positive and enjoyable experiences for the children during short break stays at this home. The staff and management team are held in high regard by parents, staff and involved professionals. Managers demonstrate a good understanding of the strengths and weaknesses of the service and show a commitment to ongoing service development.

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Overall effectiveness

Children make good progress, which parents and professionals link to the service provided. Care is delivered in-line with individually assessed needs and placement planning developed in collaboration with parents and involved professionals. There are good safeguarding arrangements and children feel confident and secure while staying away from home at this setting. Children's safety and general wellbeing is prioritised and supported by well-planned risk management strategies which are effectively implemented in practice.

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Overall effectiveness

A high standard of personalised care is provided by a consistent and committed staff team. Parents and involved professionals have a positive view of the quality of service provided and are confident that the service ensures children's safety. Comments include 'It is a caring environment and the staff are great with my child.’ 3 of 11 Five recommendations are set within this inspection report in order to further improve the quality of care provided. The shortfalls identified are not found to have impacted negatively on the children directly or on the progress that they make. Recommendations relate to strengthening areas of recording including the documentation to support the use of video/audio monitoring used for some children. To improve access to the garden for children using wheelchairs. Also, to ensure that all staff have undertaken recent training in relation to communicating with children with a learning disability and to strengthen one area of staff recruitment checks.

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Information about this children’s home

This home is a six-bedded residential short break service operated by a healthcare foundation trust for children with learning disabilities.

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Inspection date Inspection type Inspection judgement

05/06/2014 Interim sustained effectiveness 04/02/2014 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 the management of the home ensures staff practice is consistent with the home's policies and procedures. In particular this relates to the need to implement into practice the full detail of policies and procedures relating to the use of video/audio monitoring within the home (NMS 21.3)  ensure that there is a system in place to monitor the quality and adequacy of record keeping and take action when needed (NMS 22.1)  ensure that the home's design promotes children's well-being. In particular this relates to the need to improve the accessibility of the rear garden for those children who rely on wheelchairs (NMS 10.2)  ensure that telephone enquires are made as well as obtaining written references for all people working in the home (NMS 16.1)  ensure that a good quality learning and development programme is provided which ensures that staff are equipped with the skills required to meet the needs of the children and purpose of the setting, and training

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Recommendations

keeps them up-to-date with professional practice developments. In particular this relates to the need to ensure that all staff have undertaken 5 of 11 recent training in communicating effectively with children with a learning disability including those children who are non verbal. (NMS 18.1) 6 of 11

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Outcomes for children and young people good

There are good outcomes for children during their short break stays at this home. Parents speak positively about their child's progress and confirm that children very much enjoy the time they spend at this service. Comments include 'our child always seems happy and contented', 'my child has a wonderful time' and 'my child has made excellent progress.’

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Outcomes for children and young people good

Children engage in a broad range of stimulating and relaxing activities, both within the home and during trips into the community. As a result, children's skills and self- confidence improve. Activities include trips to the cinema and to country parks, swimming and meals out. Within the setting children take part in craft activities and enjoy using the broad range of toys and play equipment provided. Children also benefit from use of the facilities provided within a well-equipped sensory room.

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Outcomes for children and young people good

Children achieve excellent school attendance during their short break stays. Staff are proactive in engaging with schools and communication is described by involved professionals as 'very good'. This promotes a consistency in approach from both school and care and ensures that emerging or changing needs are identified and acted upon promptly. Educational professionals confirm a view that the high standard of care and the good partnership working impacts only positively on the progress children make within their education.

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Outcomes for children and young people good

Children's views are seen as important. Staff understand the differing communication needs of each child and work hard to promote opportunities for engagement. As a result children are able to make personal choices. For example, they choose the activities they wish to engage in and select preferred snacks, drinks and make choices about the daily menus. Practice is underpinned by patient staff who work creatively to support each child to communicate their wishes. As a result children feel that their views are valued.

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Outcomes for children and young people good

Children enjoy good health. This is because of the very good standard of care provided and the close oversight of the qualified nursing team. Good health is further promoted by the manner in which both nursing and care staff utilise their knowledge and understanding of individual needs to ensure that each child's assessed and planned health needs are fully met.

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Outcomes for children and young people good

The progress children make benefits from the setting of individual goals. As a result of targeting identified areas or opportunities children develop new skills and abilities. For some children this will be just small steps such as reducing the staff support when washing hands. For others this could be a social skill such as for the first time visiting the cinema and watching a film through to the end. 7 of 11

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Quality of care good

The service provides a well maintained healthy living environment. The home is described as being 'warm and welcoming' by an involved professional. Required adaptations are provided. For example, necessary hoisting arrangements are in place to support the care and dignity of children with physical disabilities. Also, specialist bathroom facilities support individual needs and preferences. Adaptations and equipment are subject to regular monitoring and maintenance if required. As a result children are able to take full advantage of the facilities provided within the home. A large garden provides children with outside space for relaxation and play. Appropriate play equipment is provided which is shortly to be upgraded. This inspection finds that while staff support is always readily available wheelchair users have restricted independent access to some areas of the garden. This raises the potential that

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Quality of care good

children will feel their independence is curtailed.

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Quality of care good

Children receive a good quality of service delivered by a consistent staff team who are both caring and competent. Staff are imaginative and enthusiastic in supporting all children regardless of their disability to achieve their full potential. Genuine warmth underpins the well-structured and yet very nurturing care provided. As a result children and their parents have developed positive relationships with staff and are confident in the service they can expect to receive. As a short break service staff work very closely with parents who present a very positive view of the standard of care provided. Comments confirm the view that 'The care and support my child get from staff at the children’s home is excellent.’ Also, the service is completely A 1 in all areas.’

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Quality of care good

Individual short breaks are well organised. As a result personal preferences and needs are accounted for within each short stay peer group. This also means that friendships between children are promoted and sustained. Children are cared for in- line with their individual placement plan. The care provided is good and underpinned by detailed individual placement plans, which clearly reflect assessed individual needs, identify health and medication needs, clarify risks, and risk management strategies. However, planning and recording linked to the use of video and/or audio monitoring is found to lack information. Additionally some inconsistencies in detail were identified when records were reviewed against the home's policies and procedures. While there is no evidence of a negative impact on children to date this shortfall in recording raises the potential that policies and procedures may not be adhered to in practice.

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Quality of care good

Staff work in a focused manner to ensure that children enjoy each short break stay. Children are supported to engage in their preferred and chosen relaxing, creative and stimulating activities. Children enjoy viewing the numerous photographs displayed around the home showing recent activities both in the community and also within the home. This enables children to reflect positively on the enjoyable activities they take 8 of 11 part in during a short break stay. Staff also facilitate occasional group functions which promote a sense of belonging. For example, a recent Christmas party held at the service for all the children and their families.

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Quality of care good

The monitoring and management of children's complex and diverse health needs is prioritised. Parents have a positive view about the manner in which staff maintain children's health and follow agreed healthcare plans. Staff liaise with parents and health professionals to ensure that the latest information about changing health and also medication needs are always available to inform practice. The safe administration of medication is underpinned by staff training and through the close oversight of qualified nursing staff.

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Keeping children and young people safe good

Staff have a good understanding of the individual vulnerabilities of the children using the service. Children are confident in the staff caring for them, which add to their sense of wellbeing and safety. Staff practice is underpinned by training specifically relating to safe care practice. As a result children's safety is prioritised within all areas of care. Individual risk assessments are comprehensive and clarify detailed risk reduction strategies which are reviewed regularly. Consequently, staff are confident and understand how best to safeguard children. There have been no incidents of children going missing since the last inspection. This is because children are highly supervised both within the home and when on trips within the community.

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Keeping children and young people safe good

Due to children's complex disabilities this inspection has not relied on views collated directly from children about their feelings of safety at this home. Parents consistently report a view that their child is kept safe by care arrangements and say that they a confident that their child feels safe. This is explained as identified by children showing pleasure in attending the service, resistance to leaving in some cases and their obvious pleasure in seeing the staff working there. Parents recognise that staff respond quickly to potential safeguarding situations and are confident in their response.

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Keeping children and young people safe good

Recruitment procedures are well established. Background checks required by regulation are completed before new staff commence work in the home. However, this inspection notes that the recommended guidelines to ensure written references are verified verbally has not been followed in all cases. Visitors’ identities are checked and a record of visits is maintained. Alongside the effective security of the premises this means that children are protected from unsuitable persons gaining access to the home.

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Keeping children and young people safe good

Children's behaviour is well managed. Behaviour is assessed and understood by staff in the context of individual disabilities. Staff work effectively with parents and involved professionals to establish consistent behaviour management strategies. Staff understand each child's potential for heightened anxiety and endeavour to calm 9 of 11 situations before anxiety leads to behavioural incidents. Physical holds are used only as a last resort and in response to potentially harmful situations.

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Keeping children and young people safe good

The home environment is safe and well maintained. A broad range of environmental risk assessments and safe practice monitoring checks are operated effectively. For example, the use of adaptations and support equipment is subject to annual service monitoring by external agencies and staff training. This means that children using adaptations and additional equipment are kept safe. Fire safety is prioritised within care arrangements. Fire safety training is facilitated for staff who also undertake regular fire evacuation drills. As a result staff understand their roles and responsibilities should a real fire occur in the home.

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Leadership and management good

The Registered Manager was endorsed by Ofsted as the manager of this home in June 2014. He has extensive previous experience working within residential nursing provisions caring for individuals with diagnosed learning disabilities and associated health conditions. The manager is a qualified nurse who provides clinical supervision for the nurse practitioners working within this service. The manager has recently commenced further training and development by commencing level five residential management training. The manager is closely supported by a service manager who visits the home on a regular basis providing support and guidance when required.

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Leadership and management good

The quality of care provided is monitored directly by the Registered Manager and also during monthly visits to the home made by an independent person. Reports produced subsequent to monthly visits are found to be extremely detailed and to capture a real sense of the quality of care provided and the current issues at the time. The Registered Manager acts when areas for improvement are identified. For example by taking action recently to broaden each child's opportunities to access community activities and resources.

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Leadership and management good

The management team are well regarded by the staff, involved professionals and parents. There is an evident commitment to the continuous improvement of the quality of care provided and the outcomes for young people using this service. The management team responded promptly to emerging areas for service development during this inspection, making immediate changes to practice in some areas. This demonstrates there is a management capacity to be able to make changes to practice and to develop the service when necessary.

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Leadership and management good

The Registered Manager has addressed the regulatory requirement and the practice recommendation set during the previous inspection of this home. A more detailed record is now maintained of the low level concerns received about the service alongside more formal complaints. This supports improved monitoring of the service provided as there is now a clear picture of all concerns and complaints. Full details of escalating behaviours leading to the use of physical holds are now clearly reflected 10 of 11 within behaviour management records. However, a recommendation has now been set to further improve records following the identification of some inconsistent details within some behaviour management records.

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Leadership and management good

Children's needs are effectively met through the provision of appropriate numbers of suitably experienced and competent staff. There is always a qualified nurse on duty which demonstrates that health care needs are well supported. Staff training is prioritised within the management of this home. Each year staff undertake a block programme of core training, including, fire safety, food hygiene and behaviour management. Nurses undertake additional specific training as and when emerging needs arise and refresher training as required. This inspection finds that while staff understand children's differing communication styles they have not attended recent specific training to promote ongoing development of their skills to communicate with children who have restricted or no verbal ability. This raises the potential that staff may not respond appropriately to children wishing to communicate a message. 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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