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

Requires improvement

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

p.2

The children’s home provision requires improvement because:

 Safeguarding issues, while highlighted by staff, are not robustly pursued to conclusion with other professionals to ensure change for young people. The manager has not sufficiently challenged the local authority when social workers have not visited young people in the home, in line with agreed care plan actions.  When staff use body maps to record unusual marks, the organisation‟s safeguarding procedure is not followed, which potentially places vulnerable young people at risk.  Monitoring of key documents by managers requires improvement. Specifically, this impacts on the accuracy of written medication procedures, the implementation of certain procedures and storage of documents and reviews of young people‟s stay in the home.  Not all young people enjoy the same extent and frequency of activities as others.  The bath in the home has been broken for nine months and the replacement was not ordered until 28 June 2016. This is a pleasurable and

p.3

The children’s home provision requires improvement because:

healing activity for many of the young people and is a requirement resulting from the previous inspection.  While bedrooms are personalised and the garden colourful and well equipped, parts of the home are in need of refurbishment.

p.3

The children’s home strengths

 The registered manager and staff team are committed and caring. They support the children and young people well and have excellent relationships with them.  Staff receive regular and bespoke training and a newly appointed, dedicated clinical lead nurse focuses on ensuring that the nursing staff meet all professional competencies.  Professionals report that they have positive relationships with staff and that communication is good.  Nearly all parents speak highly of the home. They have every confidence in the staff and state that their children and young people really enjoy their short breaks.  Some children and young people have experienced increased activities since the previous inspection, which they have really enjoyed. Staff take pleasure in children and young people‟s enjoyment of such activities.  The home has thorough records of incidents, which are regularly analysed to identify themes and corresponding strategies are put in place when

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

p.5

Requirement Due date

5: Engaging with the wider system to ensure children‟s needs are met In order to meet the engaging with the wider system standard, the registered person must, and must ensure that staff— a) seek to involve each child‟s placing authority effectively in the child‟s care, in accordance with the child‟s relevant plans; b) seek to secure the input and services required to meet each child‟s needs; c) if the registered person considers, or staff consider, a placing authority‟s or a relevant person‟s performance or response to be inadequate in relation to their role, challenge the placing authority or the relevant person to seek to ensure that each child‟s needs are met in accordance with the child‟s relevant plans. 1 August 2016

p.5

Requirement Due date

9: The enjoyment and achievement standard In order to meet the enjoyment and achievement standard, the registered manager must ensure that— (1) children take part in and benefit from a variety of activities that meet their needs and develop and reflect their creative, cultural, intellectual, physical and social interests and skills. (2) In particular, the standard in paragraph (1) requires the registered person to ensure— (a) that staff help each child to— (i) develop the child‟s interests and hobbies; (ii) participate in activities that the child enjoys and which meet and expand the child‟s interests and preferences; and (b) that each child has access to a range of activities that enable the child to pursue the child‟s interests and hobbies. Ensure that all children and young people take part in a variety of 29 August activities that they enjoy and expand their preferences, and can share regularly mealtimes with staff with similar food, where

p.5

Requirement Due date

12: The protection of children standard In order to meet the protection of children standard, the registered manager must ensure that children are protected from harm and enabled to keep themselves safe. In particular, the registered person must ensure that staff— (iii) have the skills to identify and act upon signs that a child is at risk of harm; (vii) are familiar with, and act in accordance with, the home‟s child protection policies. Ensure that procedures regarding body maps are adhered to. 18 July 2016

p.6

Requirement Due date

13: The leadership and management standard In order to meet the leadership and management standard, the registered person should enable, inspire and lead a culture in relation to the children‟s home that— (a) helps children aspire to fulfil their potential; and (b) promotes their welfare. (2) In particular, the standard in paragraph (1) requires the registered person to— (a) lead and manage the home in a way that is consistent with the approach and ethos, and delivers the outcomes, set out in the home‟s statement of purpose; (d) ensure that the home has sufficient staff to provide care for each child; (f) understand the impact that the quality of care provided in the home is having on the progress and experiences of each child and use this understanding to inform the development of the quality of care provided in the home; (h) use monitoring and review systems to make continuous improvements in the quality of care provided in the home.

p.6

Requirement Due date

 Ensure that the bath is available to young people with no further delay  audit and monitor procedures in safeguarding, medication and reviews of young people‟s experiences  Consider having a named supervisor for each supervisee. 29 August

p.6

Information about this children’s home

This service is provided by the NHS Foundation Trust and offers respite care for up to four children and young people at any one time. Children and young people with significant health needs and learning disabilities can be provided for by a team of nursing staff and care support staff. 

p.7

Recent inspection history

Inspection date Inspection type Inspection judgement

p.7

Recent inspection history

29 February 2016 Interim Sustained effectiveness

p.7

Recent inspection history

6 March 2015 Interim Sustained effectiveness

p.7

Requires improvement

The home is judged on providing activities and experiences to all young people that may not otherwise be available to them. Some young people do not have the same range of activity experiences as others, despite the manager stating that they would enjoy and benefit from such experiences. The manager and staff have not overcome presenting difficulties by reviewing behaviour management plans and strategies or planning ahead with staffing and practical arrangements. Staff report that activities are generally decided on the shift handover of the same afternoon that young people arrive, despite one member of staff entering activity suggestions in the staff diary well in advance. The specially designed bath has now been broken for nine months, with still an estimation of a further six to eight weeks for the new bath to be installed. The manager and staff have made efforts to expedite the replacement, but blocks have

p.8

Requires improvement

occurred during negotiations at more senior levels. Many young people do not have the facility to enjoy a bath at home and used to take great pleasure in this activity. The use of the bath is referred to in the children and young people‟s placement plans for the home. Additionally, staff report that young people who have significant physical disabilities are not able to achieve the same level of cleanliness with a shower. The bath also relieves the physical discomfort arising from spending long periods in a wheelchair. Young people have not been taken swimming or offered alternative hydrotherapy experiences. The home‟s organisation will only provide food for the children and young people in this home, so staff have to cook and prepare their own food separately. This leads to a disjointed mealtime experience, despite staff‟s best efforts, and leads to missed opportunities for social gatherings. Staff try to make up for this by

p.8

Requires improvement

financially contributing for a Sunday meal so that children and young people and staff can share the same meal together once a week. Since the previous inspection, staff have made considerable progress in increasing the opportunities for some young people. In addition, an increased entertainment budget, which staff are now aware of, has assisted with this progress. These young people now go out regularly and experience trips and activities such as films, bowling, animal parks, garden centres and the local fire station. In the home, all children and young people enjoy Lego, craft, the sensory room, planting and colourful outdoor equipment. Parents and staff have commented positively on the increased activities that the children and young people enjoy. Staff evaluate individual experiences for children and young people in writing, as well as taking photographs and making scrapbooks for them. Staff say that children and young

p.8

Requires improvement

people have benefited from these activities. The manager and staff continue to look after children and young people in the home with a high degree of sensitivity and care. Staff are proud of the children and young people, know them well and they have good relationships. Staff support children and young people to exercise choice and use visual aids, for example, to choose meals. Nearly all parents praise the home highly, „I can‟t speak highly enough of them and we have good communication‟, „when I told my son he was going tonight he said “yippee!”‟ and „she is pampered and has nice meals‟. A school teacher said that they have no concerns, „I have good relationships with staff and excellent communication.‟

p.9

Requires improvement

Concerns about children and young people are identified by staff and reported to the relevant professionals or parents, but not to a level which has an impact for the child. Staff do not robustly follow up and seek assurance that such concerns have been addressed, so that outcomes for children and young people improve as a result. Minutes of important external meetings are not stored in a consistent location by staff. In some instances, they cannot be located and as a result, staff cannot robustly ensure multi-agency action plans for children and young people are followed. Specified social work visits do not take place in accordance with the child‟s plan, but the manager has not escalated this matter with the local authority to resolve this. As a result, some vulnerable children and young people are not receiving the level of advocacy and safeguarding that has been identified that they need. The recording and follow up of suspicious or unusual marks to children and young

p.9

Requires improvement

people is not followed in line with the home‟s procedures. Given that some children and young people move between a variety of care situations and are not able to articulate their views because of highly complex needs, the potential exists for young people to not be adequately safeguarded. The manager does not evidence regular audit of medication records. Although minor errors in recording of medication are evident, no medication errors have occurred since the previous inspection. However, vigilant monitoring in this area is important due to the high levels of medication that children and young people receive. The previous inspection highlighted a need for medication procedures to be updated following past medication errors. Written procedures do not reflect the added safeguards that staff now implement when administering medication. Therefore, potential for confusion exists, particularly for new staff.

p.9

Requires improvement

Young people in this home have not gone missing and care is of a high standard, which negates the need for physical intervention. Young people are clear about what staff expect of them and consistent boundaries help them to feel safe. Staff are able to prevent incidents from happening because of their understanding of young people‟s needs.

p.9

Requires improvement

The three requirements from the last inspection have not been met, although progress has been made in some areas. The manager and staff recognise that parts of the home need to be updated and resourced to meet the young people‟s changing needs. The lounge and corridors are showing signs of wear and tear. The manager has had discussions with staff and the children and young people about refurbishment and funding is agreed, but no firm plans are in place as yet. However, a trampoline has been purchased with donated monies and the manager is arranging for this to be set into the ground. Other new resources have also been purchased, including two new iPads and toys. One young person, who stays in the home for 11 nights a month, does not benefit from the recommended „sleep system‟ equipment, unless it is not in use by anybody else. They are supported by rolled up blankets and pillows instead. The plan surrounding the sleep system has consistently failed and not been dealt with,

p.10

Requires improvement

despite a referral made to request a second sleep system over two months ago. The caring staff group is taking part in a charity activity to raise money for a second sleep system. However, the reason for the sleep system not being provided has not been escalated and pursued robustly by the manager. The manager‟s service plan is in place, but not yet implemented. The manager, as of two weeks ago, no longer manages two homes and believes this will assist in quicker implementation of the service plan. The youngest person to use this service is five years old and then the next oldest is 13 years old. Therefore, the manager is looking at different ways to promote the service and encourage new referrals. An open day was held recently, but was poorly attended. Due to vacancies in the home, young people, who normally stay in a short-breaks home of the same organisation, have recently been staying in this home. The

p.10

Requires improvement

manager has considered compatibility of young people, but these arrangements are ad hoc and not a permanent arrangement. Two young people in the home stay more than 75 days per year, which conflicts with the home‟s current short-break registration conditions. Senior managers are in the process of requesting a minor variation to ensure that the children‟s homes regulations 2015 are met. Every three months, staff hold a meeting to review young people‟s progress and experience in the home. The reviews tend to have a health and education focus, but records often do not include an overview of how young people experience the home socially and in terms of hobbies. Evaluation of young people‟s responses to activities, others‟ views and future plans are not recorded in discussion. This omission has not been highlighted through a management audit. The manager is caring, committed and has a „hands on‟ approach. Staff, children

p.10

Requires improvement

young people and parents value her support. The independent visitor assists the manager with monthly objective monitoring of the home. Incidents are well recorded and the manager has a robust system in place to review incidents and put strategies in place where necessary. The members of the long-standing staff team work together well and attend regular team meetings, which are comprehensively recorded. Staff receive regular monthly supervision. Staff are not always supervised by the same supervisor and while this has not been problematical, it does not allow for supervisors to have a consistent overview on particular themes or concerns. Other professionals, such as school and social workers, say that they have good relationships with the home, communicate regularly and reinforce that young people like coming to the home.

p.11

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 and young people's homes: framework for inspection‟.

p.12

What the inspection judgements mean

An outstanding children and young people'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 and young people'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 and young people's home that requires improvement , there are no widespread or serious failures that create or leave children and young people being harmed or at risk of harm. The welfare of looked after children and young people is safeguarded and promoted. Minimum requirements are in place. However, the children and young people's home is not yet delivering good protection, help and care for children and young people. A children and young people's home that is inadequate is providing services where

p.12

What the inspection judgements mean

there are widespread or serious failures that create or leave children and young people being harmed or at risk of harm or that result in children and young people looked after not having their welfare safeguarded and promoted.

p.12

Information about this inspection

Inspectors have looked closely at the experiences and progress of children and young people living in the children and young people'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 and young people, 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 and young people, young people and their families. In addition, the inspectors have tried to understand what the children and young people'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

p.13

Information about this inspection

and young people's Homes (England) Regulations 2015 and the „Guide to the children and young people'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 .

p.13

Information about this inspection

regulates and inspects to 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 and young people's social care, and inspects the Children and young people 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 young people 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

p.14

Information about this inspection

www.nationalarchives.gov.uk/doc/open-government-licence , write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: psi@nationalarchives.gsi.gov.uk .

p.14

Information about this inspection

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

p.14

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

p.14