Children's home SC393048

Requires improvement

The children's home is not yet delivering good help and care for children and young people. However, there are no serious or widespread failures that result in their welfare not being safeguarded or promoted.

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because:

 The home has suitable systems in place for the administration of medication and staff take immediate action to ensure children‟s wellbeing is safeguarded. However, despite these arrangements medication errors continue to undermine the robustness of medication administration.  Staff are not always provided with core training updates sufficiently frequently.  Qualified nurses are not provided with appropriate clinical supervision.  The quality of care review does not provide for consultation with young people, parents and partner agencies.  The children's guide is available in symbols and pictures, however, is not available in other formats which are accessible to young people with visual impairments.  The home provides accommodation to a small number of young adults, however, there is no documented assessment of any potential risks that any such individual may present.

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The children's home strengths

 Young people benefit from a very well-equipped, well maintained and spacious building which meets their needs.

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The children's home strengths

 The on-site availability of specialist therapeutic services means that these are easily accessible and staff are effectively guided to meet young people's complex individual needs.

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The children's home strengths

 The stimulating environment transcends both the school and home providing young people with opportunities to learn and develop throughout the day.

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The children's home strengths

 Equality and diversity is firmly embedded into all aspects of care.

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The children's home strengths

 Young people receive highly personalised child focussed care which meets their complex individual needs. As a result young people remain healthy and safe.

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The children's home strengths

 The strong commitment to young people's involvement in the home means that young people feel fully included in all decisions about their lives

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The children's home strengths

 Young people feel safe and like living at the home. They enjoy positive relationships with staff and all have someone who they can raise issues of concern with. One young person was able to say they think the home is excellent and will miss it when they leave.

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The children's home strengths

 Staff work well in partnership with families and other professionals ensuring young people‟s needs are consistently well met.

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The children's home strengths

 This setting is held in high very regard by all parents and professionals. This demonstrates young people's well-being is at the centre of the care delivered. Their comments include „Staff are very caring and committed‟ and „Its amazing, total professionalism comes with total care‟.

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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 (England) Regulations 2015 and the Guide to the children's homes regulations including the quality standards. The registered person(s) must comply with the given timescales.

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Requirement Due date

The registered person must make arrangements for the handling, recording, safekeeping, safe administration and disposal of medicines received into the children‟s home. Furthermore, ensure medicine which is prescribed for a child is administered as prescribed to the child for whom it is prescribed and to no other child. (Regulation 23(1)(2)(b)) 31/08/2015

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Requirement Due date

The registered person must ensure that all employees undertake appropriate continuing professional development and receive practice-related supervision by a person with appropriate experience. (Regulation 33(4)(a)(b)) 30/10/2015

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Requirement Due date

The registered person must complete a review of the quality of care provided for children (“a quality of care review”) at least once every 6 months. In order to complete a quality of care review the registered person must establish and maintain a system for monitoring, reviewing and evaluating the quality of care provided for children. The system must provide for ascertaining and considering the opinions of children, their parents, placing authorities and staff. (Regulation 45 (1)(5)) 31/10/2015

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Recommendations

To improve the quality and standards of care further the service should take account of the following recommendation(s):  Produce a children's guide which is age appropriate, provided in an accessible formats and explained to each child to make sure they understand it. (The Guide to the Quality Standards, page 24 paragraph 4.21)  Ensure staff are alert to the possibility that children may be at risk from relationships including with other children in the home, staff, family members, friends and others outside the home. In particular; undertake an assessment of the potential safeguarding impact on children of any person over the age of 18 living in the home. (The Guide to the Quality Standards, page 43 paragraph 9.13)

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Information about this children's home

A large registered charity runs this multidisciplinary home. The majority of placements are up to 52 weeks and are long term. The home provides some short breaks. The other services shared within the grounds of the home are, a school and accommodation for young people over 18. Currently registered to provide accommodation for up to 33, the home cares for children and young people with complex support and health needs. This includes profound learning difficulties, sensory and physical impairments. A range of facilities are available on site, including education, outdoor and multi-sensory equipment and physiotherapy services.

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Recent inspection history

Inspection date Inspection type Inspection judgement

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Recent inspection history

18/02/2015 CH - Interim Declined in effectiveness

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Requires improvement

Many of the young people have complex health needs which require medication, therefore a large amount of medication is administered on a daily basis. Suitable systems are in place for the receipt, administration, recording and monitoring of medication. Where medication has not been administered correctly staff have immediately sought the guidance of medical professionals. The manager has taken action to enhance individual staff competence. However, the systems are not sufficiently robust, as despite this, human error continues to undermine the safety of medication administration. For example, in the three months prior to this inspection there were three incidents where a young people failed to receive their prescribed medication of either laxative or anticonvulsant and two incidents where a double dose of such medication was given. The manager and the provider are well aware of the potential risks to young people where medication is not

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Requires improvement

appropriately managed. As a result, further safeguarding training in relation to medication management is planned and a nurse consultant has been employed to review and improve medication arrangements.

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Requires improvement

The young people flourish in the care of staff who know them well. Good-quality assessments and care planning systems ensure staff are able to meet their complex needs. Young people receive person centred care which helps them feel safe and secure. One young person described how staff helped them manage their anxieties through a visual diary and daily plan. As a result they feel calmer and more in control of their life.

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Requires improvement

Staff and young people develop positive relationships which help young people develop a strong sense of permanence and belonging. One young person thought the support they received was excellent and said: „All the staff are nice kind people with a sense of humour.‟ They summed up their feelings about the home saying „It‟s just home to me.‟

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Requires improvement

The well-being of individual young people is at the centre care delivery. Staff develop strong partnership working relationships with parents and professionals ensuring that young people‟s needs are met. Parents and professionals have absolute confidence in the staff to provide high-quality individualised care. One placing social worker commented: „Staff have a very good understanding of the children and provide very child focused care.‟

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Requires improvement

Equality and diversity is threaded through the service and, however, profound the young person‟s disability, staff ensure that their specific cultural and spiritual needs are catered for. For example, one young person's end of life plan includes specific details of their faith and how staff should ensure appropriate rituals, such as, sprinkling holy water and wearing specific clothing, are followed. Other young people have religious memorabilia in their rooms, and are supported to say their prayers and grace.

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Requires improvement

A variety of on-site specialist professionals guide staff ensure young people maintain optimum health despite complex health conditions. For one young person this means that they have remained healthy and lived well beyond what was expected. When young people require hospitalisation staff stay with them throughout continuing to ensure their needs are met.

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Requires improvement

The young people benefit from an environment which is suitably adapted and equipped to meet their needs and any specialist equipment which would benefit them is provided. Staff undertaking complex care tasks are trained and their competence periodically reassessed. Where competence reassessment has not occurred within the timeframes detailed in the home's policies there is a schedule for this to be completed.

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Requires improvement

Staff provide a learning environment variety of activities provided enabling young people to have a better understanding of the world around them ensuring they remain consistently appropriately stimulated. Young people enjoy on site parties and experience fun activities, such as, trips to the zoo, museum and beach which without the high staffing levels may not have been open to them. Photographs in personalised events books help them share and remember these memorable moments.

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Requires improvement

Good communication between staff both in the home and school ensures a consistent approach which is particularly important due to the highly complex needs of the young people. Parents say that the home „has been transformative in understanding my child and has been able to give them the proper wraparound care they need and deserve.‟

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Requires improvement

Young people are encouraged to develop appropriate new skills which help them progress. One young person spoke excitedly of their planned move to their own supported living flat. The good quality planning and full involvement of the young person means they are well prepared and feel more secure and confident for their future. Inclusion is central to the philosophy of care and staff constantly seek young people‟s thoughts wishes and feelings through direct discussion and observation of their non-verbal communication. Staff are committed to helping young people make decisions and choices around their lives at levels which are appropriate to them. The development of pictorial communication regimes provide key information, such as, how to tell someone if they are not happy promote young people‟s ability to express themselves and any worries they may have. Independent advocates are available to assist young people to complain should

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Requires improvement

they wish. There have not been any complaints, however, families have confidence that any concerns would be thoroughly reviewed.

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Requires improvement

Parents say they have total confidence in the staff. One parent commented: „This is her world and everything is catered for her here. Everybody lives according to her world and her needs.‟

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Good

The young people are helped to feel safe and secure through the consistent support and routines which reflect their individual needs and help reduce any anxieties. One parent said: „„X‟ doesn‟t trust people but she trusts the staff at the home.‟

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Good

Families and partner professionals have absolute confidence in the ability of staff to keep the vulnerable young people safe. One parent said: „We feel that our son is in safe and caring hands when we have to leave him.‟ Another said: „They care for my child better than I can as a parent.‟

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Good

Staff receive appropriate safeguarding training and guidance and are conversant with the home‟s safeguarding and whistleblowing procedures. Staff are vigilant ensuring any concerns or potential safeguarding issues are well managed with partner agencies in an open and transparent manner.

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Good

Young people are able to talk to staff about any concerns they have and are confident that these will be addressed. They also are able to raise any concerns with the independent advocate who regularly visits.

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Good

Good preadmission risk assessment and management plans which are regularly updated, guide staff effectively in how to manage challenges and risk. However, no assessment has been undertaken in relation to potential risks posed by young adults with disabilities living in the home. This means that staff may not give full consideration to any particular area of potential concern. However, the individual needs of these young adults‟ means that there has been no impact for young people in this regard.

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Good

Thresholds for physical or environmental restraint are clear and no inappropriate interventions are used. However, a significant number of staff have not received suitable updates in training within the specified timeframes. The impact of this is minimal as physical intervention is very rarely used within the home.

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Good

Robust staff vetting procedures ensure young people are effectively safeguarded from unsuitable people gaining employment within the home. No staff are employed until checks on their identity and suitability are verified.

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Good

The building is suitable to meet the needs of the young people. Health and safety arrangements are well managed with regular servicing of equipment and suitable fire prevention measures in place.

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Good

The suitably qualified and experienced Registered Manager has been in post for three years and provides consistent good-quality leadership. An effective senior team support the manager. Staff feel they are well supported by a committed manager who is passionate about the young people and has high expectations of staff. Staff enjoy working at the home and say: „It's like an extended family with both the staff and young people as members.‟

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Good

The home is well resourced and all young people are able to access a wealth of specialist support services and facilities, such as, physiotherapy, hydrotherapy and speech and language therapy. Staffing levels are high and meet the individually assessed needs of each child. Agency staff are frequently used, however, these are usually regular staff and there are clear boundaries on the activities they are able to undertake.

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Good

The organisation demonstrates a strong commitment to enhance staff professional development through the good quality training program. The majority of staff are well trained and operate at an enhanced level, however, some staff have yet to undertake core update training or have their competence reassessed in areas such as, food hygiene, physical intervention and enteral feeding. Managers are aware of this and arrangements are in place to address this. Parents and social workers say that staff are caring and competent. Comments include „their expertise in caring for children with such severe and complex needs is outstanding.‟

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Good

Staff feel well supported and the vast majority receive appropriate supervision. Qualified nurses, however, appropriate clinical supervision is not provided which undermines their ability to reflect on their clinical practice enhancing their personal and professional development.

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Good

Staff build positive relationships with families and partner professionals which ensure the best possible all-round support is provided to young people. The availability of specialist professionals and the enhanced skills of staff means they are able advocate effectively challenge partner agencies ensuring that young people receive any specialist equipment and services.

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Good

Staff demonstrate a strong commitment to individual young people and their welfare with placing authorities comment that „the staff go above and beyond‟. Parents comments include „those staff are hand-picked, you can tell‟ and „staff are lovely, superb kind. They are very lovely people.‟

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Good

The manager is reviewing how to provide the young person‟s guide in a suitable format for the visually impaired young people who use the service.

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Good

The majority of requirements and recommendations set at the previous inspection have been met. Suitable monitoring systems are in place to review the quality of care provided, however, these need further development to provide for feedback from young people, and their families or placing authorities. However, there is no impact on young people in practice as they and their families are very positive about the home.

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What the inspection judgements mean

The experiences and progress of children and young people are at the centre of the inspection. Inspectors will use their professional judgement to determine the weight and significance of their findings in this respect. The judgements included in the report are made against Inspection of children's homes: framework for inspection.

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What the inspection judgements mean

An outstanding children's home provides highly effective services that contribute to significantly improved outcomes for children and young people who need help and protection and care. Their progress exceeds expectations and is sustained over time. A good children's home provides effective services that help, protect and care for children and young people and have their welfare safeguarded and promoted. In a children's home that requires improvement , there are no widespread or serious failures that create or leave children being harmed or at risk of harm. The welfare of looked after children is safeguarded and promoted. Minimum requirements are in place, however, the children's home is not yet delivering good protection, help and care for children and young people. A children's home that is inadequate is providing services where there are widespread or serious failures that create or leave children and young people being

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What the inspection judgements mean

harmed or at risk of harm or result in children looked after not having their welfare safeguarded and promoted.

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Information about this inspection

Inspectors have looked closely at the experiences and progress of children and young people living in the children's home. Inspectors considered the quality of work and the difference adults make to the lives of children and young people. They read case files, watched how professional staff work with children, young people and each other and discussed the effectiveness of help and care given to children and young people. Wherever possible, they talked to children, young people and their families. In addition the inspectors have tried to understand what the children's home knows about how well it is performing, how well it is doing and what difference it is making for the children and young people who it is trying to help, protect and look after. This 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 Children's

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Information about this inspection

Homes (England) Regulations 2015 and the Guide to the children's homes regulations including the quality standards. the guidance raising concerns and making complaints about Ofsted, which is available from Ofsted's website: www.gov.uk/government/organisations/ofsted . If you would like Ofsted to send you a copy of the guidance, please telephone 0300123 4234, or email enquiries@ofsted.gov.uk .

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Information about this inspection

achieve excellence in the care of children and young people, and in education and skills for learners of all ages. It regulates and inspects childcare and children's social care, and inspects the Children and Family Court Advisory and Support Service (Cafcass), schools, colleges, initial teacher training, workbased learning and skills training, adult and community learning, and education and training in prisons and other secure establishments. It inspects services for looked after children and child protection. If you would like a copy of this document in a different format, such as large print or Braille, please telephone 0300 123 4234, or email enquiries@ofsted.gov.uk . You may reuse this information (not including logos) free of charge in any format or medium, under the terms of the Open Government Licence. To view this licence, visit www.nationalarchives.gov.uk/doc/open-government-licence , write to the Information Policy Team,

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Information about this inspection

The National Archives, Kew, London TW9 4DU, or email: psi@nationalarchives.gsi.gov.uk .

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Information about this inspection

Interested in our work? You can subscribe to our monthly newsletter for more information and updates: http://eepurl.com/iTrDn .

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Information about this inspection

Store Street Manchester M1 2WD T: 0300 123 1231 Textphone: 0161 618 8524 E: enquiries@ofsted.gov.uk W: www.gov.uk/government/organisations/ofsted

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