Children's Home run by Keys Group Progressive Care & Education Limited in Southampton

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’s provision is outstanding because:

 Children and young people require a high degree of medical attention and personal care, because of their medical conditions. The manager and staff ensure that this is provided with an extraordinary level of dedication and affection.

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The children's home’s provision is outstanding because:

 This results in staff giving highly individualised care to each young person, particularly in identifying objectives for improving their independence, however slight, and in providing experiences that will enrich their experience and enjoyment.

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The children's home’s provision is outstanding because:

 One carer described the staff’s understanding of a young person’s needs as ‘they get him’, adding that this is not their experience of all services. As a result, ‘we think it is brilliant and can’t speak highly enough of them’. This praise is richly deserved.

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The children's home’s provision is outstanding because:

 Staff are painstaking in their care of children’s and young people’s health and well-being. They work hand-in-hand with numerous medical professionals to maintain or improve young people’s quality of life. A notable example is that by implementing overnight ventilation and using a chest massage vest, one young person’s breathing has improved significantly so that he does not require long periods in hospital to manage infections.

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The children's home’s provision is outstanding because:

 Staff are particularly vigilant in the safe administration of a substantial number of prescriptions and other remedies. Medication is carefully stored and its administration is properly recorded. The systems employed by the home ensure that the margin for error is very small.

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The children's home’s provision is outstanding because:

 One health professional said that she was ‘delighted’ with the level of care provided at the home. She gave an example of a young person whose health was ‘turned around in weeks because he was being given his medication, and care and love’ by the staff.

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The children's home’s provision is outstanding because:

 The manager has monitoring systems in place to ensure that documentation is relevant, up to date and maintains high professional standards.

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The children's home’s provision is outstanding because:

 The manager leads a dedicated team which takes pride in achieving the best they can for children and young people, provided within an atmosphere of warm affection.

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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

In order to meet the leadership and management standard, the registered person is required to: ensure that staff have the experience, qualifications and skills to meet the needs of each child. (Regulation 13 (2)(c)) In particular, staff who are not qualified nurses have focused training for healthcare tasks which they are required to do, specific to the relevant named child. 31/05/2017

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Requirement Due date

If a home has a website, the registered person must ensure that a copy of the statement of purpose is published on that website unless the registered person considers that such publication would prejudice the welfare of children in the home. (Regulation 16 (4)) The copy must be up to date. 31/03/2017

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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

 The registered person must ensure that staff have the relevant skills and knowledge to be able to: respond to the health needs of children, administer basic first aid and minor illness treatment, help children to manage long-term conditions and where necessary meet specific individual health needs arising from a disability, chronic condition or other complex needs (‘Guide to the children’s homes regulations including the quality standards’, page 34, paragraph 7.12). This is with specific regard to ‘CQC and Ofsted guidance: registration of healthcare at children’s homes’, Annex 4, page 17, which states that: ‘The permitted tasks for non-health qualified staff and focus of training for these tasks must be on the care as it applies to a named child. The individual carer will require specific training and assessment in order to participate in the care of a second or third child.’

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Recommendations

 The health of looked-after children must be assessed at regular intervals and the child’s care plan must include an individual health plan setting out the approach that the placing authority will follow, and the desired outcomes required to meet the child’s health needs. These outcomes, recorded in the health plan, will be the basis on which the registered person will be expected to meet regulation 10 (2)(a)(i) in the health and well-being standard for each looked-after child in their care. (‘Guide to the children’s homes regulations including the quality standards’, page 33, paragraph 7.4)

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Recommendations

 The registered person should have a workforce plan which should detail the process for managing and improving poor performance. (‘Guide to the children’s homes regulations including the quality standards’, page 53, paragraph 10.8)

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Recommendations

 Case records must be kept up to date and signed and dated by the author of each entry. (‘Guide to the children’s homes regulations including the quality standards’, page 62, paragraph 14.3)

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Recommendations

 The registered person to have a system in place which allows them to monitor the matters set out in the regulation at least once every six months. The Regulation 45 report should clearly identify any actions required for the next six months of delivery within the home and how those actions will be addressed (‘Guide to the children’s homes regulations including the quality standards’, page 64, paragraphs 15.2 and 15.4). This entails producing the report within a reasonable time of the period being covered.

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Information about this children’s home

This home is privately owned by a national organisation. It provides care and accommodation for up to six children and young people with complex health needs arising from learning disabilities and physical disabilities.

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Recent inspection history

Inspection date Inspection type Inspection judgement 29/09/2016 Interim Sustained effectiveness 22/03/2016 Full Good 14/09/2015 Interim Sustained effectiveness 23/01/2015 Interim Improved effectiveness

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Outstanding

The home specialises in providing care for children and young people with complex health needs, including physical disabilities and severely limited communication. They require an environment in which wheelchair users have easy access to facilities, and medical and other equipment is close to hand. While the home is geared to meet these needs, the manager and staff maintain a homely environment. One parent described her son’s bedroom as ‘fantastic; he’s got what he wants in there’, adding, ‘The place is nice and tidy and they have got all kinds of rooms for the children to go in.’

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Outstanding

The manager and staff sensitively welcome new arrivals and help them to manage what can be a difficult transition. One parent said her son ‘settled in straight away and loves the place’, commenting on the extent of time and care offered to him. The children’s guide is not accessible by most young people, but staff do give them photographs of the home and staff so they have some prior knowledge before they come to visit.

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Outstanding

Staff pay close attention to children’s and young people’s moods, expressions and vocalisations in relation to activities they engage in. These are recorded and analysed to identify ways of responding to each individual’s needs, wishes and preferences. As a result, for example, staff identified that one young person was showing signs of being unsettled when given personal care, so they introduced changes which mean that he now rarely seems uncomfortable at these times. Another young person is adversely effected by high temperatures, so staff introduced methods to help him keep cool. Such attentive care means that children and young people are much happier than they might otherwise be.

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Outstanding

Staff provide experiences that enhance individual young people’s enjoyment. One young person who likes to play music has DJ decks, attends club nights for young adults with learning disabilities and was being taken to a concert during the inspection. Others are taken to places of worship, as they have expressed a wish to do this.

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Outstanding

Staff will go to extraordinary lengths to provide young people with these opportunities: researching facilities available for disabled people on the journey as well as at a venue, making provision for emergency medication, oxygen, feeds, water and suction equipment, as well as taking account of weather that could affect health and the young people’s health on the day. In doing so, they ensure that young people are disadvantaged as little as possible by their conditions. ‘Activity outcome’ forms, used to evaluate the success of activities, have lapsed, which means that the manager does not have a formal means of gathering information about them and potential learning is missed.

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Outstanding

As children and young people have significant health issues, staff could prevent them from experiencing any degree of risk. However, they are not averse to allowing them to experience activities that carry an element of risk. For example, one young person enjoys putting his head under water while having a bath, which he does while under supervision.

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Outstanding

Goal planning is now an embedded part of the nurture provided by staff. Staff set targets that are carefully attuned to the current abilities of young people. They record outcomes in a way that shows the level of support that has been required to achieve a task and the degree of competency achieved. Charts readily show advances made over time. Progress may be incremental but still significant: one young person now opens his mouth for staff to clean his teeth, which he was previously resistant to. Another has moved from objects of reference to indicate that an activity is going to take place (such as a flannel for washing) to associating key words (in this case, ‘wash’) with the same events.

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Outstanding

Staff liaise with schools and colleges to promote children’s and young people’s attainment, particularly of individual education plans. When young people are unable to attend education provision, due to ill health, staff obtain work and go through it with them to avoid them falling behind.

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Outstanding

Key workers regularly review children’s and young people’s progress and methods of care. Staff produce excellent reports that highlight achievement, what has been learned from observations, changes made to regimes of care and new objectives. The reports reflect the exceptional level of professionalism, coupled with loving care and high aspirations, that staff have for young people.

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Outstanding

Relationships between staff and young people are underpinned by respect for each young person’s dignity, and a desire to ensure that young people’s well-being is at the core of all that is done for them. A striking example is the care given to one young person whose skin is sensitive, requiring the application of different barrier creams depending on its condition. A member of staff described the fine judgements that are made to give the best treatment, how these are reviewed and new decisions made. Doors are closed to bedrooms when personal care is being given to young people in order to preserve dignity, but only when two staff are present. Acknowledgement is therefore made of the increased vulnerability of children with additional needs and measures are taken to ensure that such care is provided safely.

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Outstanding

Staff are aware of the procedures to follow if they believe that a young person may be at risk and the manager promptly deals with these, liaising well with the designated officer of the local authority and others as necessary. Paperwork in the home was inconsistent in who it identified as the ‘designated safeguarding lead’ for the home, but staff were nevertheless clear about who they should report safeguarding issues to and steps were taken during the inspection to address this.

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Outstanding

Professionals and parents commented favourably on the level of supervision staff give to children and young people, to ensure that changes in their physical health are quickly identified and prompt action is taken. One mother, whose son was very unwell is reassured that she knows ‘checks are made and they are right near him at his bedside’.

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Outstanding

Staff involve parents and carers as much as possible, and most take the opportunity to participate and provide feedback. Some children and young people also have advocates who provide additional external support.

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Outstanding

Health professionals also commented on the appropriate decisions made by staff, either to intervene themselves or to call emergency services. There are protocols in place for such eventualities that staff know and follow, including remaining with a young person until they are on a ward. They pass on information, medication and feeds to nursing staff. Protocols and risk assessments are reviewed and updated as required.

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Outstanding

There are systems in place that allow the manager to monitor safety procedures, and actions recommended by external assessors are promptly followed up.

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Outstanding

The home holds regular checks of fire and safety equipment, weekly or monthly as required. However, those for emergency lighting were missing the signature of the person checking and the date he carried them out. There is an endorsed policy of staying put whenever possible in the event of a fire, with reliance on fire doors and a sprinkler system to protect children and young people. This is a proportionate response to the potential danger of a fire and avoids vulnerable children and young people having an adverse reaction to an evacuation.

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Outstanding

The manager has rectified a gap in employment records for a new recruit identified at the last inspection. No further appointments have since been made.

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Outstanding

An impact risk assessment format has been introduced, which records potential risks posed by a young person referred to the service and how they will be addressed. This demonstrates that the manager takes account of the needs of current residents when deciding whether or not to admit a new young person to the home.

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Good

The registered manager leads a team that has continuously improved since she came into post. This is demonstrated in the progress made in the way staff administer medication to children and young people. A health professional, who professed herself to be ‘really worried a few years ago’, said she ‘noticed the difference the change of head and others has made’ and commented that ‘medicines management is on time and reliably given’.

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Good

Children and young people have highly complex and often multiple health needs and staff are highly adept at working with other professionals to meet them. None of the staff are health professionals but competently perform permitted tasks. However, the training provided for them does not comply with guidance issued jointly by the Care Quality Commission and Ofsted. This states that individual carers require specific training and assessment in order to participate in health tasks for each individual child. Despite strenuous efforts, the manager has not been able to obtain the training and ongoing observation from a qualified health professional that this requires. No child has been put at risk as a result.

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Good

The home’s health plans for children and young people draw together the treatment programmes for different conditions. However, local authority health plans have not been used to ensure that the approach and desired outcomes, required by the placing authority to meet the children’s health needs, are being followed. Authors do not always sign and date documents and other stakeholders, including social workers and family members, do not sign to say that they have read and agreed the contents.

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Good

The manager and key workers ensure that they have appropriate documentation from other agencies, with the exception of health plans and pathway plans, which the manager made written requests for during the inspection.

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Good

Policies and procedures are in place for staff to follow; some require updating to reference current regulations and statutory guidance but provide staff with appropriate direction.

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Good

The manager has an aspirational development plan in place – although funds have yet to be released for a new sensory room to be built that would be a welcome facility for children and young people to use. The review of the home’s quality of care under regulation 45 is late in being produced, meaning that actions to improve or maintain the service have not been set for the current six months.

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Good

All professionals spoken to were complimentary about the level of communication and cooperation from the manager and staff; some were effusive in their praise, describing them as ‘very brilliant’. The majority of parents and carers also expressed high levels of satisfaction with the information shared with them and the support offered to them.

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Good

The manager has a workforce development plan in place, but it lacks detail regarding supervision and does not address the process for managing and improving poor performance. The supervision of staff, though, is held at the frequency laid down in the statement of purpose; logs helpfully record when both formal and informal sessions have taken place. Staff say that this, together with training, meets their needs, addressing professional development, the emotional impact of the work and other support needs.

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Good

The home’s training matrix shows that almost all staff have undertaken compulsory training that is required by the provider. Only one member of staff has not completed the level 3 diploma for residential childcare (or equivalent) within regulatory timescales, but a deadline to complete the remaining units has been set.

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Good

These words, written by a mother to the manager, exemplify the culture developed in the home: ‘What a tower of strength you are to the young people in your care, their families and your amazing staff. It was such a comfort to know that you were holding the reins.’

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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 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, work- based learning and skills training, adult and community learning, and education and training in prisons and other secure establishments. It inspects services for children looked after 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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