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

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:

 Young people continue to enjoy positive experiences during their short breaks in this home.  Staff enjoy caring for young people and supporting families. They recognise young people’s high level of need, and do their best to ensure that they are comfortable, safe and have fun.  Young people have opportunities to experience interests that they enjoy and go out on trips.  Managers and staff are proud of the young people whom they care for. Staff are clear about what young people’s achievable goals are and support them to make as much progress as possible.  The environment is welcoming, clean and well resourced. Parents and social workers report that they have every confidence in the staff to care for the young people.  Safeguarding policies and procedures are in place and implemented by managers and staff. Managers and staff know what to do if they have a child protection or safeguarding concern.  The requirement and recommendation made at the last inspection are now

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The children’s home provision is good because:

met.  Medication administration records do not reflect the home’s procedures and show some omissions of dates and signatures.  Management oversight and monitoring are weak. Systems are not securely in place to ensure the smooth running of the home.  Not all complaints and concerns are collectively and transparently recorded to enable the manager to identify themes and improve the home.

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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 within the given timescales.

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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; (b) ensure that staff work as a team where appropriate; (c) ensure that staff have the experience, qualifications and skills to meet the needs of each child; (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

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Requirement Due date

of care provided in the home; (g) demonstrate that practice in the home is informed and improved by taking into account and acting on— (i) research and developments in relation to the ways in which the needs of children are best met; and (ii) feedback on the experiences of children, including complaints received; and (h) use monitoring and review systems to make continuous improvements in the quality of care provided in the home. In particular, the registered person is required to:  Ensure that management arrangements are robust. 20 December  Audit and monitor supervision, medication and care plan reviews of young people’s experiences.  Ensure that medicine administration records are completed fully and in line with procedures.  Ensure that clinical nursing staff have regular access to clinical consultation in addition to regular and formal supervision.  Hold supervision and appraisal records on site to ensure

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Requirement Due date

that supervisors have access to documentation to review performance objectives.  Record centrally a list of complaints and concerns raised.  Ensure that communication takes place with social workers prior to care plan reviews, in line with the statement of purpose.  Hold a register of young people who use the service and those who no longer use the service.  Ensure that other employees do not use the home for other purposes while young people are enjoying their short breaks.  Follow up the application to vary the registration criteria, in line with regulation 52 requirements, as some young people’s short breaks exceed 75 days in total.

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Recommendations

To improve the quality and standards of care further, the service should take account of the following recommendation(s):  Where appropriate, children should be involved in choosing and preparing meals and opportunities to sit together and eat shared meals should be promoted. (‘Guide to the children’s homes regulations including the quality standards’, page 15, paragraph 3.8)  For children’s homes to be homely, domestic environments, young people’s belongings should be stored accordingly and rooms personalised with photographs and pictures, when appropriate. ‘Guide to the children’s homes regulations including the quality standards’, page 25, paragraph 3.9)

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Information about this children’s home

The children’s home provides a short breaks service for up to two children with disabilities, complex individual needs and fragile health. This service is managed by an NHS foundation trust.

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Recent inspection history

Inspection date Inspection type Inspection judgement 22/02/2016 Interim Sustained effectiveness 16/11/2015 Full Good 10/03/2015 Interim Sustained effectiveness 09/12/2014 Full Good

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Good

Young people continue to receive sensitive and well thought out care from a committed and caring team of staff. Many of the staff are long-standing and know the young people well.

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Good

Parents of the children who visit the home report that children enjoy coming to the home and have positive experiences. One parent said: ‘Staff are caring and are brilliant. For families like mine, getting the right people who can think on their feet and act quickly is essential. The unit is a hidden gem.’ A social work team manager confirmed that they have no concerns about the care that staff provide and describe staff as ‘always flexible, responsive, kind and helpful’. The social work team manager commented that staff know the children, know the families and are confident of the quality of care for children who have significant health needs.

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Good

Staff are fully aware of young people’s achievable goals and actively support young people to achieve these goals. For example, one young person’s goal is to increase the use of their hand. Staff use play resources such as sensory light strands and musical instruments to help the young person to achieve this goal. Staff are proud of one young person, who can demonstrate their views and choices by eye contact through the use of a newly designed communication board.

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Good

Staff ensure that young people enjoy experiences and activities in this short-breaks home that are not always possible for them to have at home. Although the young people have significant health needs, they have opportunities to enjoy a variety of activities and trips that staff plan in advance. Two staff members have unofficially taken the lead for this, printing out pictures and plans in advance for young people to choose and enjoy. Trips include going to the fair, walks in the park or the woods, cinema, ice cream, a garden party and to local attractions. Staff have prepared colourful scrapbooks for the children and young people that are kept up to date to celebrate their craft and activities. The young people enjoy reading time; therefore staff have purchased age-appropriate books that young people enjoy.

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Good

The building is meticulously maintained and cleaned. The housekeeper plays an important role in achieving these high standards. The young people use a variety of stimulating toys and resources. When young people use the bath, they have sensory lights and underwater bath toys. These resources help young people to relax and enjoy the experience. Each bath toy is carefully cleaned and stored away afterwards.

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Good

One nurse has informally taken a lead to ensure that young people who are approaching adulthood have effective transition plans in place. The nurse had recognised a delay in receiving services for one young person who turns 18 early next year, so has ensured that the young person receives advocacy.

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Good

The home is a welcoming, colourful and homely environment. Staff have furnished the conservatory to provide a sensory space for young people. This location is not ideal; because of the difficulty in controlling the room temperature The home’s development plan includes a plan to create a bespoke sensory room for the young people.

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Good

The garden is well maintained, and staff have planted herbs and flowers with the young people. There is limited play equipment in the garden, which the manager has identified as an area for improvement.

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Good

Young people have favourite toys and belongings that are kept at the home to help them to feel comfortable and welcome. These belongings are kept in NHS plastic bags. The manager plans to introduce personal boxes and also some noticeboards with more photographs and favourite pictures to personalise the rooms further.

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Good

Currently, one young person eats food in the home. This young person has started helping to prepare meals. The manager has identified that this young person has not been sharing the same meal with staff, although the staff do sit at the table together with the young person. Staff want to eat the same meal as the young person and recognise the social benefits. However, this has not been happening.

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Requires improvement

The home has a specific safeguarding policy and procedures which staff have read and digested, and adhere to. Staff are clear about what to do in a safeguarding situation, and understand when and how to use body mapping to record concerning marks or bruises. Consequently, the requirement from the previous inspection is now met.

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Requires improvement

The local area designated officer has had no contact with the home since the last inspection, but managers know what to do, should an allegation be made.

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Requires improvement

On rare occasions, minor medication errors have occurred, but managers or staff have put them right and young people’s health has not been compromised. However, in some incidences, staff have not signed or dated the necessary paperwork. The manager has not audited medication records. Young people who stay at this home often need high levels of medication and it is essential that medication records are kept in accordance with procedures and monitored carefully. For this reason, safeguarding is judged as requires improvement rather than good. Judgement grade

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Inadequate

The management arrangements are not sufficient to ensure that children and young people will continue to receive good experiences and make progress, as they have been doing.

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Inadequate

Changes in the management of the home in recent months have affected the running of the home. The new manager has been in post for just under two months, and is responsible for the management and running of this home and another. The home does not have a deputy manager and systems are not in place to ensure the effective monitoring of the functions of the home. For example, the home’s policy is for the manager to sign off incidents within five days. The manager was unclear as to who should deal with a recent medication incident, and five days lapsed in the meantime.

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Inadequate

Management oversight is poor and uncoordinated. The dedicated clinical nurse lead, who is not based at the home, supervises the nurses and covers additional tasks to support the running of the home. These tasks include improving medication cards and care planning with other professionals. The manager and the clinical lead have not formally met to discuss roles, responsibilities or a communication structure. The manager has not fully appraised herself on how the clinical lead’s role works within the home, and consequently, cannot review the objectives for the home.

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Inadequate

Some of the staff are not receiving the correct level of supervision and the manager was unable to explain why as she has not audited supervision records or schedules. Some staff do not feel that they have enough access to clinical supervision on a day-to-day basis. The manager, who does not have a nursing qualification, has recognised this problem and is in the process of arranging peer supervision on a monthly basis, to be led by the clinical lead nurse.

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Inadequate

Support workers are supervised by a recently appointed team coordinator, who has not had direct experience of care work. Support workers’ supervision and appraisals are organised, supportive and occur within timescales, but they do not include discussion about young people’s progress and experience, in line with their care plan objectives.

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Inadequate

The home has nursing vacancies, although the manager is unclear on how many. However, there is evidence of significant efforts to recruit to vacancies. As a result of the home being understaffed, short breaks have been cancelled at short notice, on occasion, due to sickness or shortages of staff. The clinical lead has covered shifts in the home on an ad hoc basis. This has assisted in the lead becoming familiar with the young people and staff, but it has impacted on other duties that she is responsible for at this home.

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Inadequate

There is no register at the home, so the manager could not easily establish which young people had stopped using the service in the past 12 months, why or when. The manager’s six-monthly monitoring document has not analysed why these young people have left and how the service can improve in future to meet the needs of young people who are admitted. The care plans and reviews completed by staff are not audited by the manager. There continues to be confusion regarding young people’s looked after status.

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Inadequate

The manager is clear that several young people receive more than 75 days of short breaks per year and that an application has been made to remove the short breaks criterion from the home’s registration. However, a new registration certificate has not been sent out and this matter has not been followed up.

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Inadequate

The statement of purpose indicates that there is communication between social workers before care plan reviews take place, but this is not happening. This does not ensure that services provide a coordinated response for young people. Managers and staff identify that communication in the home needs to improve, both internally and externally. A manager from the local authority identified that communication needs to improve on both sides, as reviews are held that home staff are not invited to and vice versa.

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Inadequate

Complaints and concerns are not transparently recorded in a central file any longer, and the manager could not easily establish where complaints are recorded. Concerns that have been raised by parents are dealt with by staff as and when they arise. However, they are not collated or analysed collectively so that the manager can identify themes to improve the running of the home. Complaints which are escalated to senior managers are dealt with thoroughly and recommendations made.

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Inadequate

Employees of the same organisation who do not work at the home use the office located in the garden, which is accessed through the home. An agreement is in place that the employees do not use the home when children are using the short- breaks service The manager has not enforced this agreement and, during the week of the inspection, at least seven workers came in and out of the home while children and young people were having their short break.

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Inadequate

The manager has prioritised the need to improve communication and morale within the team. Team meetings have taken place since the last inspection and this recommendation is now met. The manager has since recognised that gaps in attendance impact upon communication and has now reorganised the rotas to ensure that the maximum possible number of people attend in future.

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Inadequate

The lead nurse consultant line manages the manager and provides supervision for some staff, on occasions. The quality of this supervision is robust and detailed.

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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’. 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

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What the inspection judgements mean

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 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 0300 123 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, work- based 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

T: 0300 123 1231 Textphone: 0161 618 8524 E: enquiries@ofsted.gov.uk W: www.gov.uk/government/organisations/ofsted

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