Children's home run by Pathway Care Solutions Ltd in Nottingham

Outstanding

The children’s home provides highly effective services that consistently exceed the standards of good. The actions of the home contribute to significantly improved outcomes for children and young people who need help, protection and care.

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The children’s home provision is outstanding because:

 Staff are exceptionally attentive to the care needs of each child and young person.  Transitions to and from the home are extremely well planned. Staff ensure that children and young people experience very little anxiety or distress as a result of changing care arrangements.  The planning for, and response to, emergency medical situations are excellent.  Staff ensure that children and young people are fully involved in their community and that their disabilities do not prevent them from enjoying a wide range of stimulating and enjoyable activities.  Managers act as highly effective advocates for children and young people. They provide very effective challenge to partner agencies when appropriate.  Very strong support is provided to families. This enables children and young people who have complex needs to participate fully in family activities such as holidays.  Strong safeguarding systems are in place. Staff set high expectations of

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The children’s home provision is outstanding because:

each other’s conduct and report concerns to managers. This provides assurance that children and young people are protected at all times.  The registered manager is highly effective. She has driven significant improvement in recent years. With her management team, she ensures that staff are very well supported to provide high-quality care.  Children and young people often make educational progress beyond the expectations of their families and social workers.  One area for improvement has been identified at this inspection. This is for staff to have better knowledge and understanding of each child’s education targets and their next steps for learning.

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Recommendations

To improve the quality and standards of care further, the service should take account of the following recommendation:  Staff need to have the knowledge and skills to understand each child’s education and training targets and their next steps for learning. (‘Guide to the children’s homes regulations including the quality standards’, page 28, paragraph 5.11)

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Information about this children’s home

This privately owned home is registered to provide care and accommodation for up to five children and young people who have learning disabilities and physical disabilities.

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Recent inspection history

Inspection date Inspection type Inspection judgement

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Recent inspection history

25/02/2016 Interim Improved effectiveness

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Recent inspection history

22/01/2015 Interim Improved effectiveness

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Outstanding

Staff are highly attentive to children and young people who are not able to communicate verbally. They are good at providing stimulation through play and quick to recognise which activities children and young people enjoy. Staff take considerable pride in their ability to recognise when children and young people are unhappy, and go to great lengths to ensure that they are contented and comfortable. They know each resident’s preferences and how they like to be comforted and cared for. One young person is visually impaired and non-verbal. Staff use appropriate touch to provide reassurance and comfort. Staff are creative in finding new experiences for him and are not afraid to try new things. For instance, they quickly recognised that he did not enjoy his time at a theme park, but have returned to the cinema a number of times, having noted his positive response to surround sound systems. Building on this, staff have purchased tickets to a musical theatre show and a

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Outstanding

musical pantomime for this young person. His quality of life is significantly enhanced by the enthusiasm of staff. Children’s and young people’s ability to access the community is enhanced by the recent purchase of an additional, larger, wheel chair accessible minibus. This enables young people to enjoy group activities away from the home. The home’s commitment to community involvement for the children and young people is underpinned by research. Staff are able to talk confidently about why they try to empower young people to feel part of their community. The home is a very welcoming environment. It is well decorated and furnished throughout. The addition of personalised murals has significantly improved the appearance of bedrooms. However, the main reason why the home is such a nurturing environment is the energy and enthusiasm of staff and managers. This is exemplified in the way that they interact with children and young people. At the

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Outstanding

beginning of shifts or at the end of the school day, staff present as genuinely excited and pleased to see the children and young people. They take pleasure in the fun that children and young people have in such things as making their favourite sounds or blowing bubbles. This means that the home is often full of laughter. The flexibility and adaptability of staff enabled a young person to go on holiday to Florida with his family. In order to safely facilitate the holiday, the home assessed that two members of staff would be required to accompany the young person. Managers were able to secure significant additional funding and identify staff willing to support. As a result, the holiday was a very positive experience for both the young person and his family. The views of parents and social workers are unanimously positive. Comments made by parents include, ‘My son is cared for excellently. … His quality of life has

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Outstanding

improved since his placement’, and ‘Our child is now a very busy and happy little boy, always engaged in some indoor and outdoor activities, which helps him to be physically and mentally motivated and stimulated, along with guaranteeing a certain level of progress.’ A social worker who has spent time at the home observing young people said, ‘It is a really good place.’ Transitions are very well organised to ensure that young people are not distressed by moving to or leaving the home. Placement matching systems are very strong. For example, a recent referral for a young person who has physical disabilities, but no learning disability, was declined because managers assessed that she would be at risk of social isolation if placed with current residents. This very child-centred approach reduces the risk of placement breakdown. Two young people have recently reached adulthood and moved from the home into a separate annex that

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Outstanding

is registered as an adult care provision. The registered manager also manages this provision. Both young people had a seamless transition into the annex. Exceptional continuity of care was ensured because they continue to be cared for by the same staff group and maintain the same routines. Education progress is strong. Each young person attends a specialist education placement either full time or as often as his or her health conditions allow. Some young people have made progress beyond expectations. When there are delays in reviewing or updating education plans, the managers follow this up and provide appropriate challenge. This means that each child and young person has an up-to- date education plan. Although all educational targets are being met, they are not being actively worked towards in the home environment and do not feed into wider care plan objectives. This has the potential to hinder the attainment of young

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Good

Children’s and young people’s health conditions mean that they have very complex medication regimes. Despite this challenge, staff have a comprehensive understanding of when and how to administer each medication. This promotes the safety of children and young people because they receive their medication as prescribed. The risk of medication errors is further reduced by a recent change to shift management systems, to ensure that shift leaders take responsibility for all medication. Health plans are detailed and fully reflect the complex health needs of each child or young person. They provide staff with comprehensive information about medical conditions, treatments, medications and dietary needs. They also provide guidance to staff on how to respond to any emergency medical situations, such as seizures. Since the last inspection, staff have very skilfully responded to several situations in which emergency medical treatment was required. Because they are experienced,

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Good

confident and well trained, they respond calmly to ensure that children and young people are provided with the best possible care. A key strength of the staff team is the way that, as well as responding to the immediate medical need, they ensure that family members are informed and involved in decisions, and that all relevant information is shared with health professionals. Intimate care routines are carried out very sensitively to ensure that the dignity of children and young people is respected. Staff are good at recognising any potential health issues through close monitoring and observation. For example, having noticed a mole on the skin of one young person, they sought immediate medical assessment. An early diagnosis enabled effective treatment. A range of health professionals are involved in the care of each child and young person. The home works very well to report any issues and fully adheres to all advice given. Staff

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Good

demonstrate a very clear understanding of advice provided by dieticians, particularly for residents who have complex feeding regimes. This ensures that children and young people have a healthy and balanced diet. The particular vulnerabilities of children and young people in the home ensure that food hygiene is a very high priority. A recent local authority environmental health inspection resulted in a 5* rating. This reduces the risk of infection or illness. High-quality risk assessment means that potential hazards to young people are identified and removed. Careful supervision eliminates the possibility of young people going missing. Staff are trained in moving and handling. This results in young people being hoisted correctly and not experiencing unnecessary discomfort during the process. On occasions when staff intervene physically to prevent harm to a young person, they use only approved techniques in which they are trained.

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Good

Each incident of physical intervention is well recorded and evaluated thoroughly by the manager and independent visitor. This reduces the risk of abusive practice developing in the home. There is a very open and transparent safeguarding culture. Parents are welcome to visit at any reasonable time and can arrive unannounced if they wish. Managers understand that this approach provides reassurance to parents. Staff fully understand their safeguarding responsibilities. All are trained in safeguarding and speak knowledgably about the particular vulnerabilities of children who have disabilities. A member of staff who has recently completed her induction commented on how thorough the safeguarding training is. She said, ‘I have realised how important recording is for the safety and welfare of the children. Staff here take protecting the children very seriously.’ New staff are carefully vetted to ensure that they are not likely to present a risk to children or young people.

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Good

Recruitment checks include careful verification of references and enhanced criminal record checks.

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Outstanding

The experienced and qualified registered manager is highly effective in her role. She is well supported by senior managers. Alongside her enthusiastic and capable deputy, she creates a culture of high aspiration. High expectations are set of staff conduct and performance. Over time, the registered manager has reduced staff turnover and significantly increased the proportion of staff who are qualified. She has also improved the way that she uses performance management systems to ensure that staff conduct themselves in a consistently professional manner. The registered manager now takes a lead role in the recruitment of new staff so that she is able to take full responsibility for her staff team. High expectations are also placed on other agencies that provide services to young people. Staff and managers act as strong advocates for disability rights and disability access. For example, the deputy manager has recently received assurances from the local

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Outstanding

authority transport department that a local bus stop will be considered for refurbishment to make it fully wheelchair accessible. This will make it easier for children and young people to use public transport. Managers make great efforts to improve the experiences of children and young people. For example, although current residents are unable to provide detailed feedback on their care, the manager has taken the opportunity to seek advice from a person who has disability who visited the home. This visitor, who uses the same feeding system as a young person who lives at the home, was able to describe the experience of being tube fed. As a result, staff have modified their practice. The manager undertakes regular reviews of the home to identify areas of potential improvement. Her current development plan is excellent. Some objectives, such as the creation of a play room, improved consultation with staff and better access to

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Outstanding

specialist staff training, have already been achieved. Other objectives, such as the creation of a new footpath outside the home to improve the experience of wheelchair users, the development of a large sensory room and the refurbishment of a bathroom, have been funded and scheduled. An independent visitor carries out a monthly audit of the home. These visits promote improvement because they are challenging and set high expectations of the staff and managers. Staff receive regular supervision that they find helpful and supportive. Their developmental needs are well understood by the managers who make good use of annual appraisals to identify strengths and address weaknesses. In addition, managers have issued a questionnaire to staff in order to gain a better understanding of their knowledge base, so that training plans can be tailored to individual need. As well as core training in areas such as moving and handling,

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Outstanding

safeguarding, food hygiene, first aid and medication administration, staff are provided with specialist training to meet the specific needs of particular children and young people. This means that they are all currently trained in autism, epilepsy and seizure management. Managers have become increasingly creative in identifying new training opportunities. For example, some children and young people have life-limiting conditions and are provided with services by a local hospice. The manager has established strong links with the hospice and has arranged for staff to access the specialist training that they provide to their staff. Training in cooperation with agencies such as the hospice enables staff to learn from the expertise of others. Complaints are rare, but managed very well. A parent reflected on their experience by saying that, ‘We experienced some problems in the first few months of care, as [the home] was struggling to understand [care] needs and meet them. However,

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Outstanding

after discussing the issue with staff and managers, … I am happy to say that [our child] receives an excellent quality of care.’ Staff work very well with parents, respecting their wish to play as full a part as possible in the care of their children, while ensuring that the best interests of the young people are prioritised. For example, managers ensure that the provision of independent advocates to children and young people is prioritised even when their social workers or families have not requested the service. This demonstrates that managers do all they can to ensure that the voice of the child is heard in all decision-making.

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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 children looked after 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 that 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 that 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 whom 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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