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:

 An experienced and skilled staff team provides care to young people, many of whom have profound and multiple disabilities, complex medical needs and learning difficulties.

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The children's home provision is good because:

 Young people receive highly personalised and sensitive care from a staff team that knows them well. Relationships are warm, nurturing and affectionate.

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The children's home provision is good because:

 Planning for short-break stays is good. Staff enable young people to settle in the home without stress.

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The children's home provision is good because:

 Care plans focus on young people’s medical needs and ensuring safe care.

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The children's home provision is good because:

 Active partnership relationships between the home and a range of health professionals are a positive aspect of the home. They work together to support young people and solve any problems as they arise.

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The children's home provision is good because:

 The incoming manager has a passion to raise standards and provide a service that is individual to each young person. She is beginning to make an assessment of the strengths and weaknesses of the home and is developing clear plans for improvements to the service.

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The children's home provision is good because:

 Some shortfalls were identified during this inspection. Management records are not in place, and those that are have not been reviewed in a timely manner.

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The children's home provision is good because:

 Risk assessments lack strategies for safeguarding.

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The children's home provision is good because:

 Appropriate support is not in place to enable young people to contribute to their care plans. Consequently, their views and opinions are not actioned in a timely manner.

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The children's home provision is good because:

 Staff do not clearly fully follow young people’s progress in relation to their starting points, showing what actions the service is taking to maintain or improve goals and targets.

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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

(1)The registered person must compile in relation to the children’s home a statement of purpose which covers the items listed in Schedule 1; (2) The registered person must provide a copy of the statement of purpose to HMCI. (Regulation 16 (1)(2)) 30 January

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Requirement Due date

The registered person must review the appropriateness and suitability of the location of the premises used for the purposes of the children's home at least once in each calendar year taking into account the requirement in regulation 12 (2)(c) (the protection of children standard). (Regulation 46 (1)) 30 January

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Requirement Due date

The registered must give notice in writing to HMCI, as soon as it is reasonably practicable to do so, if any of the following events take place or are expected by the registered person to take place–

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Requirement Due date

(a) a person other than the registered person carries on or manages the home. (Regulation 49 (a)) 30 January

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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

 Ensure that the children’s guide helps children to understand: how to make a complaint in line with the home’s complaints procedure; and how to contact the Office of the Children’s Commissioner. (‘Guide to the children’s homes regulations including the quality standards’, page 24, paragraph 4.22)  The children's home’s staff should seek to identify and provide appropriate opportunities for children to develop themselves as part of the home’s plan for their care. This is with particular reference to ensuring that goals and targets set for young people record achievements, progress and evidence of continual revision. (‘Guide to the children's homes regulations including the quality standards’, page 31, paragraph 6.4)  Ensure that staff continually and actively assess risk. This specifically relates to reviewing young people’s individual risk assessments. (‘Guide to the children’s homes regulations including the quality standards’, page 42, paragraph 9.5)

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Recommendations

 The registered person must have a workforce plan which can fulfil the workforce related requirements of regulation 16, schedule 1 (paragraphs 19 and 20). (‘Guide to the children’s homes regulations including the quality standards’, page 53, paragraph 10.8)  Children should be encouraged by staff to see their support plans as ‘living documents’ supporting them to view and contribute to the plans in a way that reflects their voice for each short-break stay. (‘Guide to the children’s homes regulations including the quality standards’, page 58, paragraph 11.19)

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Information about this children's home

A National Health Service foundation trust runs this home. The home provides short breaks for up to four young people who have learning or physical disabilities, complex medical needs and who may have life-limiting conditions. The home is also registered with the Care Quality Commission.

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Recent inspection history

Inspection date Inspection type Inspection judgement 22/03/2016 Interim Sustained effectiveness 01/12/2015 Full Good 10/03/2015 Interim Sustained effectiveness 02/12/2014 Full Adequate

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Good

Young people benefit from highly individualised and personal care. Care plans are detailed and focus on medical needs, safe routines and care. However, young people’s social experiences during their short-break stay receive less attention. Young people do not benefit from good enough access to new experiences and activities. Parents, when asked how the service could be improved, overwhelmingly asked for more involvement for their children in activities outside the home. Individual planning is developed in conjunction with parents and professionals to enable young people to have positive health outcomes. Staff continue to make individual time for parents at the commencement of the short break. This gives parents the opportunity to discuss any changes in medication or routine. Staff use this time to discuss with parents any specific developmental goals or experiences that they would like the young person to achieve or take part in during their stay.

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Good

However, while these are recorded, the actions needed to progress them are not clearly understood or evidenced. Consequently, it is not possible to track young people’s progress in relation to their starting points, showing what actions the service is taking to maintain or improve progress. For example, a parent had requested support in establishing a hygiene routine. However, there is little evidence on how the staff are supporting this request. This is a missed opportunity to assess development, which in turn could be fed back to parents to reassure and motivate them to continue with the process. Support for young people’s health needs during their stay is safe and effective. Qualified nursing staff promote and ensure good understanding of safe administration of medication. Many young people have alternative feeding methods. For others, nutritious home-cooked food, which meets individual dietary needs, is available. Staff are currently working on developing a vegetable garden to

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Good

enable young people to have greater access to homegrown produce and increased healthy eating. Staff have a good understanding of the individual communication methods that young people use, and this enables them to communicate at the young person’s level of understanding. However, this understanding is not consistently used to involve and enable young people to make choices during their stay in the home. Consequently, it is not possible to evidence how the wishes and views of young people contribute to the further development of the care provided by the home. The staff strive to ensure that young people have an enjoyable short break. Young people have recently experienced a good range of activities. These include going to the cinema, fun fairs, activity centres and walks in the local community. However, there is a need for better planning and a better variety of activities based on young people’s capabilities and age.

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Good

The home is compact, warm and well furnished to meet young people’s needs. Young people have access to a sensory room and living area, as well as their own bedrooms, during their stay. To help young people feel comfortable and relaxed, the bedrooms are personalised with duvet covers of their choice, and they are able to bring in other items to help them feel settled. Externally, there is a secure play area with a range of equipment for them to enjoy. A sensory garden is identified as an area for development in the home’s action plan. Lack of a minibus places some restrictions on young people’s access to activities in the wider community. The manager and staff promote positive and supportive relationships with parents. They understand the pressures on families who care for young people with complex health needs; they work hard to ensure that both young people and parents benefit from the service. The manager is seeking to develop a support

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Good

group for families to prevent isolation, raise awareness and share learning.

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Good

High levels of staff supervision and an appropriately secure environment keep young people safe and protect them from going missing. For example, the comprehensive internal and external security system ensures that mobile young people are safe and that only vetted individuals gain access to the service.

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Good

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

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Good

Risk assessments in place are of variable quality. They do not fully identify the support needed to keep young people safe or the strategies required to reduce risks, particularly in accessing the local community. Behaviour management systems ensure that young people are safely managed. A calm and measured approach is adopted to defuse incidents. On occasions when a young person’s behaviour has impacted on others in the home, managers and staff have been quick to take appropriate action to ensure that young people feel safe while they deal with the situation.

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Good

Staff receive appropriate safeguarding training and demonstrate good understanding of the whistleblowing and safeguarding procedures. The manager oversees all safeguarding matters. Two members of staff are due to receive training from the local safeguarding children’s board to prepare them to undertake designated safeguarding roles in the home. Effective multi-agency working and sharing of information helps ensure that young people are safe.

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Good

Parents consulted confirm that they understand how to make a complaint. In the event of a complaint from parents or other professionals, there is rigorous follow up. The manager is reflective in her management of complaints and can demonstrate when lessons have been learned and areas for improvements identified. A parent commented: ‘I was unhappy with the approach taken by staff following an incident with my child. However, the manager quickly followed this up, apologised and has put strategies in place to prevent reoccurrence.’

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Good

Recruitment procedures are sound, and appropriate checks are in place prior to staff commencing work. Visitors to the home are verified and appropriately chaperoned. This helps to safeguard young people.

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Good

Regular health and safety checks are in place and maintained in the home. Young people have emergency evacuation plans, which identify the individual support that they may require. Servicing of equipment and all safety checks to maintain a safe environment are undertaken within timescales

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Requires improvement

The registered manager has been seconded to a new post within the healthcare trust. The provider has appointed an interim manager with appropriate experience to meet the medical needs of young people. The acting manager is a registered sick children’s nurse. She is suitably qualified with a level 4 management certificate. The service failed to inform HMCI in a timely manner of the change in the day-to-day management of the home. The newly appointed manager is in the process of making an application for registration with Ofsted.

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Requires improvement

Despite the changes to the management team, the young people’s needs have continued to be prioritised and the commitment of the individual team members to the home has resulted in young people having a positive short-break stay.

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Requires improvement

Staff report high levels of satisfaction at the management support that they receive. They describe the interim manager as being visible, empowering and maintaining a hands-on approach to learning. A member of staff commented: ‘We now feel listened to and our individual skills are respected. She has had an amazing effect in boosting team morale.’ There is well-planned matching for short-break stays ensuring a good mix of young people. Staff rotas ensure sufficient staff to meet their holistic needs. There is good representation of equality and diversity, with staff representing a range of cultures. Staff are respectful in ensuring that they promote privacy, respect and dignity for all.

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Requires improvement

Record-keeping requires improvement. The interim manager acknowledges this. She wishes to review and rewrite some documents, for example the children’s guide; this lacks information on the routines in the home and the procedures should young people wish to make a complaint. In addition, the review of premises assessment fails to identify how young people will be safeguarded in the community. These documents do not support staff in understanding how to keep young people safe in crucial areas.

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Requires improvement

The interim manager has a vision for the home’s development and the quality of care that she wishes to provide. She is aware of the shortfalls within the home and communicated these in an open way during the inspection. The manager has an interim action plan for the home to commence improvements on care planning for young people. This demonstrates that new management aims to be transparent, reflective, and wishes to lead a service that is not static but is seeking ways to improve young people’s experiences during their short break.

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Requires improvement

Robust monitoring occurs through the monthly visits of a challenging independent visitor. The visitor scrutinises records and the overall standards of care provided to young people. He highlights areas for improvement together with timescales for actions, while recognising what is working well in 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 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 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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