Children's home run by Oxleas NHS Foundation Trust in Dartford

Good

The children's home provides effective services that meet the requirements for good.

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The children's home provision is good because:

 The service is warm, welcoming and fully equipped to meet the health and care needs of young people.  Young people stay in a safe, well-resourced service.  Detailed care plans are in place to meet the highly complex needs of young people.  Young people receive highly personalised and sensitive care that meets their needs during the short break.  An experienced and skilled staff teamwork effectively as a team with young people who have profound and multiple disabilities, complex medical needs and learning disabilities.  Young people engage in activities in the home and local community.  Parents are appreciative of the service and have confidence in the care provided.  There are strong links between the home and health professionals.  Appropriate risk assessments and strategies are in place to ensure young people’s safety; this includes efficient systems to ensure health and safety.  Management of the home is child focused, with strong leadership ensuring

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The children's home provision is good because:

good quality management.  External monitoring of the home is robust and helps to support continued development.  Managers have revised policies and procedures to reflect new legislation.

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Recommendations

To improve the quality and standards of care further the service should take account of the following recommendations:

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Recommendations

Assess in conjunction with parents should what would be safe, achievable and reasonable for each child, in line with their relevant plans and ensure activities are available to enable participation in leisure and cultural activities in the community. This is particularly relevant for young people who access the short breaks service at the weekend. (The Guide to the Quality Standards, page 32, paragraph 6.10)

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Recommendations

Ensure the policy for the protection of children from abuse and neglect includes arrangement in relation to dealing with allegations involving managers in the home. (The Guide to the Quality Standards, page 44, paragraph 9.19)

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Recommendations

Ensure that staff can access joint and appropriate training to support their needs. With specific reference to paediatric and learning disability nurses engaging in joint training to enhance their understanding of the impact disability may have on young people’s behavioural patterns. (The Guide to the Quality Standards, page 53, paragraph 10.11)

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Information about this children's home

A national health service foundation trust runs this home. It provides short breaks for up to four young people with learning disabilities and/or physical disabilities. The home provides nursing care; it is registered with the Care Quality Commission . Young people usually stay either from Monday to Thursday morning or during weekends. The home does not offer overnight stays on Thursdays.

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Recent inspection history

Inspection date Inspection type Inspection judgement

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Recent inspection history

10/03/2015 Interim Sustained effectiveness

p.5

Good

Young people who access this service have exceptionally high levels of multiple complex medical needs, requiring 24 hour continuing care and supervision. The quality of care young people receive from staff is of a good standard. Positive relationships between the service, parents and health professionals ensure that care plans are individualised and detailed. Consequently young people receive care that is responsive and appropriate to meet their level of health needs.

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Good

Staff provide highly personalised care to young people and demonstrate sensitivity, humour and appropriate affection to them. They know and understand them well and are skilful in interpreting sounds, gestures and individual words, taking appropriate action to meet a required need. A parent comments, ‘My son loves it. He recognises the staff and will often decline to do an activity at home, preferring to wait until he comes here.’

p.6

Good

The home provides a safe and stimulating experience for young people. To facilitate the focus on young people, staff make individual time during the day the short break commences to meet with parents. When parents bring in medication, equipment and clothing their child will need during their stay, they have the opportunity to discuss any changes in their child’s care or medical needs. Parents and staff both sign these off; this enables parents to know that staff fully understand any changes in their child’s medical or care needs, making them feel safe and secure in leaving them. Staff use this time to discuss and agree any goal or experience parents would like the young person to achieve during their stay.

p.6

Good

Staff plan well to ensure that as soon as young people arrive the person responsible for their care greets them. Well-decorated bedrooms are personalised for young people with favourite duvets and stimulating toys. Good knowledge of young people ensures that rooms are hazard free and contain specialist equipment to meet individual needs.

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Good

Staff provide activities in the home appropriate for individual needs and abilities. For example, young people have experienced trips in the local community, the circus and days out at the seaside. A well-equipped garden provides a range of activities. Parents have expressed a wish for more planned activities, particularly for those young people who receive weekend short breaks. Managers say activities in the wider community can be difficult to plan due to the complexity of care needs of some young people together with the home’s limited access to adapted transport. Young people’s health and medical needs receive a high priority, provided by qualified and experienced nurses. The highly effective assessment process ensures that the staff team can fully meet the health care needs of individuals, including providing additional training and guidance when required. A parent says, ‘The assessment and induction process for my daughter took some time. This was due

p.6

Good

to the manager putting in training to ensure they could meet her very specialist and specific health care needs. The fantastic understanding they now have of X means that as a family we are learning and gaining better understanding from them.’

p.7

Good

Systems for the control, storage, administration, recording and monitoring of medication are good. Effective arrangements ensure staff agree any changes in writing with parents and doctors. Specialist equipment is in place to monitor specific medical conditions, with good quality and consistent recording in place. A parent comments, ‘I am sleeping at night now, due to the trust l have in the staff.’ Staff understand and are respectful of meeting the individual cultural and religious needs of young people. Personal care needs are carried out in line with care plans and as requested by parents.

p.7

Good

Young people make progress according to their individual health and social abilities. The service is placing better emphasis on the progress and experiences of young people during their short break stay. Parents and staff agree goals and targets personal to the individual young person at the start of each short break period. Staff monitor goals and record achievements. Due to the highly complex medical and dependency needs of the young people, significant progress is often small. For example, for one young person it is drawing a picture for his parents and for another it is to achieve a bedtime routine and sleep throughout the night.

p.7

Good

Young people are encouraged to have a say in their care, for example in the choice of meals and activities. Due to complexity of need, young people are often not able to comment on their care or make choices; the service makes effective use of observational information together with feedback from parents to make changes in personal care. Young people who are able to make verbal and written comments use the ‘what we like and what we would like to change’ book to communicate their views. Annual surveys are carried out with parents and young people; these are used to review practice and for improvement and development of the service.

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Good

Young people are cared for in a safe and well-resourced service. Parents comment on the high priority staff give to safeguarding young people. For example, doors are secure to keep those who are mobile safe and to ensure and only vetted individuals gain access to the service.

p.8

Good

Risk assessments are in place to inform staff on the care for young people. Only those young people with challenging behaviour have behaviour management plans in place. Staff devise detailed plans in conjunction with parents and educational professionals to ensure practice is effective and consistent. These inform staff of triggers to behaviour and effective strategies to manage these. There is understanding of health and disability and the impact it has on behavioural patterns. However, the team would benefit from more coordinated internal training to ensure consistent understanding and approaches to behaviour.

p.8

Good

Staff effectively protect young people from harm and neglect due to their comprehensive knowledge and understanding of the health authority’s policies and procedures. However, in the event of an allegation about the managers of the home, local strategies are not in place to inform staff of what procedures to follow. Young people do not go missing from this home; however, comprehensive procedures are in place to promote safety.

p.8

Good

Safeguarding training for staff is effective and current. Staff comment positively on the wide range of quality training available to them. There is rare use of sanctions in this home with physical intervention only used as a last resort to ensure the safety of young people. The service receives few complaints; when complaints are received these are satisfactorily resolved.

p.8

Good

The foundation’s safer recruitment practices ensure that only qualified and carefully vetted staff work with young people. Staff are vigilant about identifying visitors to the service, thus ensuring they know who is having contact with young people.

p.8

Good

The building premises is a purpose built centre, designed to meet the needs of young people with complex health and physical disabilities. There is safe maintenance of specialist equipment and effective fire precautions in place. For example, each young person has an individual fire risk assessment and evacuation plan in place. The building is clean, well maintained and physically safe.

p.8

Good

The Registered Manager is a registered general nurse, registered sick children’s nurse and holds a master’s degree in leadership. She has extensive experience of caring for children with complex health needs and has been in post since 2012.

p.8

Good

Young people benefit from a stable, suitably qualified staff team. Qualified paediatric and disability nurses make up the senior staff team. Health care assistants hold the level 3 qualification. This ensures that suitably trained and experienced staff provide appropriate care to young people with significant needs.

p.9

Good

Since the last inspection managers have made significant progress in focusing more intently on establishing individual goals and targets for each young person. Staff know and understand these targets and work well with young people to achieve their goals. As a result, young people experience a more fun and developmental short break experience.

p.9

Good

The Registered Manager has developed excellent working partnerships with relevant professionals to ensure best possible outcomes for young people. This is particularly the case with community children’s nurses and local authority social workers. A social worker comments, ‘The home visit the manager made with me went a long way in helping me to understand complex medical needs and the reassurance many parents need from social workers.’ Staff are good at recognising the anxieties of parents. They will undertake home visits to help with developing routines, discuss any changes in care and give positive reassurance. A social worker comments, ‘The staff are flexible and creative to ensure that young people and parents are fully supported.’

p.9

Good

There is well planned matching of young people ensuring a good mix of young people who, where possible, get on with each other. Staff rotas ensure sufficient staff to meet the holistic needs of young people. There is good representation of equality and diversity, with staff representing a range of cultures. Staff are respectful in ensuring they promote privacy, dignity and choice for all.

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Good

Regular supervision supports staff to do their job confidently and ensures they have good understanding of their roles and responsibilities. There is an excellent induction process, with clear competencies to achieve prior to completing the probation period. On-going training is excellent, with a strong focus on providing staff with the skills to work with young people who have complex health needs. All staff receive an annual appraisal which the manager uses to identify training priorities. Staff comment positively on the wide range of training opportunities available to them.

p.9

Good

Robust internal and external quality of care monitoring systems provide rigorous scrutiny of the service. Staff seek the views of young people, together with those of parents and relevant professionals. The Registered Manager uses feedback to inform practice and service development.

p.9

Good

The statement of purpose is a clear document which accurately describes the ethos of and the service provided by the home. It reflects new legislation and Quality Standards. The children’s guide provides a simple and effective summary provided in different formats. Managers provide a comprehensive and informative induction manual for parents prior to using the service.

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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

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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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