Children's Home run by Northamptonshire Healthcare NHS Foundation Trust in North Northamptonshire

Inspection report children’s home: SC465287 1 SC465287 Registered provider: Northamptonshire Healthcare NHS Foundation Trust

p.1

Full inspection Inspected under the social care common inspection framework

p.1

Information about this children’s home

This service, provided by a healthcare foundation trust, is a six bedded short breaks service, for children with learning disabilities and associated health care needs.

p.1

Overall experiences and progress of

children and young people, taking into account

p.1

good

How well children and young people are helped and protected requires improvement to be good

p.1

good

The effectiveness of leaders and managers good

p.1

good

The children’s home provides effective services that meet the requirements for good.

p.1

good

Overall judgement at last inspection: Sustained effectiveness

p.1

Key findings from this inspection

 Children benefit from positive experiences and build trusting relationships during their stays. Inspection report children’s home: SC465287 2  The manager and staff give careful consideration to matching the needs and preferences of children who stay together for their breaks. Staff continue to assess peer interaction and friendships.

p.1

Key findings from this inspection

 Staff work well with all partners in the child’s network, they share information in a timely way and are proactive in problem solving to ensure that children benefit from their stays.

p.2

Key findings from this inspection

The children’s home’s areas for development

p.2

Key findings from this inspection

 The responsible individual will ensure that training is delivered to refresh staff skills regarding child protection procedures about allegations of harm. The manager will ensure that child protection procedures are followed when any concerns are reported about what a child has said about their stay.

p.2

Key findings from this inspection

 The manager and staff will ensure that risk reduction plans are updated when new behaviours emerge that result in additional vulnerabilities for children.

p.2

Inspection date Inspection type Inspection judgement

05/01/2017 Interim Sustained effectiveness 28/09/2016 Full Good 26/01/2016 Interim Sustained effectiveness 26/08/2015 Full Good Inspection report children’s home: SC465287 3

p.2

Statutory requirements

This section sets out the actions that the registered person(s) must take to meet the Care Standards Act 2000, Children’s Homes (England) Regulations 2015 and the ‘Guide to the children’s homes regulations including the quality standards’. The registered person(s) must comply within the given timescales.

p.3

Requirement Due date

The protection of children standard is that children are protected from harm and enabled to keep themselves safe.

p.3

Requirement Due date

In particular the standard in paragraph (1) requires the registered person to ensure—

p.3

Requirement Due date

that staff have the skills to identify and act upon signs that a child is at risk of harm. (Regulation 12 (1) and (2)(a)(i)) 31/08/2017

p.3

Requirement Due date

A manager may only manage a children’s home if—

p.3

Requirement Due date

the person has by the relevant date (1st April 2017) attained level 5 diploma in leadership and management for residential childcare. (Regulation 28 (1) and (2)(c)(i)) 29/09/2017 Inspection report children’s home: SC465287 4

p.3

Overall experiences and progress of children and young people: good

This home provides short-breaks care for children who have learning disabilities, some may also have associated complex behaviours and/or physical disabilities. The home provides a structured, safe environment, which is adapted to meet children’s needs. Since the last inspection, one of the bathrooms has been improved and bedrooms and communal areas have been refurbished. It is a child-friendly environment, with photographs and art work, a garden with accessible play equipment and a sensory room.

p.4

Overall experiences and progress of children and young people: good

Children referred for a service have the opportunity to visit with family, before an overnight stay. Staff visit the family home to share information about the service and to learn about each child’s needs, routines, likes and dislikes. In this way, staff have detailed records prepared before a child stays and children are supported to settle. A parent reported that she had confidence in the service because before her child stayed, all relevant information had been shared and they had enjoyed a visit to the home.

p.4

Overall experiences and progress of children and young people: good

The manager and staff give careful consideration to matching the needs and preferences of children who stay together for their breaks. Staff continue to assess peer interaction and friendships. One child used to have every stay with another child that he knew from school. Staff assessed that they were not benefiting from the opportunity to develop other friendships, so this was changed. School and family reports and observations by staff confirm that they have developed more friendship groups.

p.4

Overall experiences and progress of children and young people: good

The registered manager is the lead for the home in supporting transitions for children moving on to adult services. He is developing practice with staff to improve this process for children and families. He used to work in adult services and is familiar with services available. He liaises with managers of adult services, case responsible social workers and with the transitions team. Families are often anxious about this significant change for their child, sometimes children move into full-time care at this stage and families need advice and support. Transitions plans are agreed with the social worker and parent. Staff support children to visit residential resources, information is shared and routines are observed. In this way, children are supported to have planned transitions.

p.4

Overall experiences and progress of children and young people: good

There are detailed records about each child’s health needs including information about the impact on behaviours of some health needs. Parents send information about any changes including medication, so that there are up-to-date records for each stay. Sometimes, parents will directly contact staff to update any changes to needs in between stays. Children’s moods and psychological well-being are also assessed at every visit. Staff have been proactive in checking out and reporting concerns if children present as low. Staff know that good information sharing for each child is essential to a safe stay, particularly for children who are non-verbal. As a result, children’s health and well-being needs are met.

p.4

Overall experiences and progress of children and young people: good

Children’s plans show liaison with family and incorporate new information based on observations, assessments and children’s views at home and at school. For example, Inspection report children’s home: SC465287 5 staff observed one child being more independent at mealtimes in school than in the short-breaks home. Staff changed his care plan and were able to encourage and support more independence in the home. Home staff have also implemented structured routines that have resulted in improved sleep patterns for some children.

p.4

Overall experiences and progress of children and young people: good

Children use a range of communication methods. Staff are experienced and trained in using a range of methods. They also visit and observe children communicating in school. Staff will use each child’s preferred method of communication and encourage development in other methods.

p.5

Overall experiences and progress of children and young people: good

Staff liaise with family and other services to problem solve, where children are experiencing difficulties or parents are worried. One child has experienced difficulties in transitions from school to the home, associated with transport arrangements. The manager and key worker liaised with transport, family and the social worker. All have agreed a plan that is reducing some of the difficulties.

p.5

Overall experiences and progress of children and young people: good

Parents expressed a concern about the level of overnight monitoring of a child with particular health problems. A professionals’ meeting was held and arrangements were robustly reviewed. This has been resolved and all concerned are satisfied that the child’s needs are carefully monitored throughout the night.

p.5

Overall experiences and progress of children and young people: good

Staff and the manager achieve an appropriate balance between being child-focused and supporting parents by providing clear information.

p.5

Overall experiences and progress of children and young people: good

Care plans include goals that are informed by children’s needs, their education plans and liaison with involved professionals and family. Goals are regularly reviewed. One child has made progress in making choices at mealtimes. Another child has made progress in developing independent personal care skills. Staff ensure that goals are aspirational and they celebrate and reinforce achievements.

p.5

Overall experiences and progress of children and young people: good

Consultation with children and capturing the child’s voice are embedded in practice within the home. The Health Trust regularly consults with parents using ‘I want great care’ questionnaires that are sent to a selection of families on a monthly basis. Managers and staff review and act on responses. The child-friendly version is used by staff and advocates in individual sessions with children. On a daily basis staff report children’s views based on comments and observations in the consultation book. Staff report using ‘you said, we did’. For example, one child has been taken bowling and a group have visited a farm park. Children’s activities in the home and outside of the home are based on children’s preferences.

p.5

Overall experiences and progress of children and young people: good

Staff are continuously collating information for each child in a ‘my journey at the Squirrels’ book, that they take with them when they move on. These capture all progress and favourite experiences and are an important contribution to a positive leaving process. Staff liaise with social workers if they believe that individual children will benefit from independent advocates.

p.5

Overall experiences and progress of children and young people: good

Staff carefully prepare for each child’s stay. Following a handover of information between Inspection report children’s home: SC465287 6 staff, they have rooms and routines ready. They welcome children returning from school, ask about the day and establish views and wishes about meals and activities for the evening. The inspector observed positive interaction between staff and children, based on trusted relationships, and the skills and knowledge of staff. Staff know children’s personalities and their likes and dislikes. Good relationships and communication resulted in a calm, comfortable experience for children.

p.5

improvement to be good

This inspection identified safeguarding practice that requires improvement.

p.6

improvement to be good

There are effective risk assessments and risk reduction plans for children. These are regularly reviewed and updated, this is essential given that there are often changes to information in between stays. One child had assessed behaviours that increased her vulnerability. This was identified in individual care plans. However, there was not a corresponding risk reduction plan. This was immediately addressed by the key worker and manager.

p.6

improvement to be good

The inspector reviewed one incident, dated just before the inspection, involving a child’s parent reporting to a social worker, a comment that the child had made. The comment raised concerns about access to inappropriate material on digital technology in the short- breaks home. The social worker contacted the manager to report this and query safe arrangements for accessing online material in the home. The manager was able to reassure the social worker that safe arrangements were in place. However, child protection procedures were not followed, a professional had not discussed with the child directly and a discussion with the designated officer had not been undertaken. This is a concern given the additional vulnerability of children who have disabilities. The registered manager and social worker accepted the concerns raised by the inspector and responded by following relevant procedures immediately. The subsequent child protection enquiry

p.6

improvement to be good

has not raised concerns about the safeguards in place in the home in respect of the use of digital technology. A requirement is made that staff and managers adhere to child protection procedures and a refresher training session is delivered to strengthen safeguarding practice.

p.6

improvement to be good

Every child has a range of detailed care plans that identify all needs including identity needs. There are risks associated with managing complex health conditions such as epilepsy and managing behaviours, such as self-injurious behaviours. Children who are non-mobile and/or non-verbal have additional vulnerabilities. Plans identify individual vulnerabilities and safeguarding needs.

p.6

improvement to be good

Staff have made appropriate safeguarding referrals to social workers. They carefully monitor any changes to presentation and mood when children come to stay. Detailed records are kept and staff liaise with family, school and health professionals, as well as social workers if there are any concerns.

p.6

improvement to be good

Consideration is given to the combination of vulnerabilities of peers in groups when the Inspection report children’s home: SC465287 7 manager is planning stays.

p.6

improvement to be good

Staff develop behaviour management plans linked to the assessment of individual needs and risks. There are good behaviour management plans that are underpinned by procedures, they refer to triggers and provide guidance to staff about what works to change behaviours.

p.7

improvement to be good

Personal evacuation plans give consideration to children’s mobility and sensory needs and their level of understanding.

p.7

improvement to be good

There are appropriate staffing levels to meet supervision and monitoring needs. As a result, children do not go missing. However, police are aware of the location of the home. Each child has essential information prepared, to be shared in the event of an emergency. This includes information about health, medication and communication needs and an up-to-date photograph.

p.7

improvement to be good

Staff are trained in the use of physical interventions. All interventions are low level and are only used as a last resort to prevent children harming themselves, another child or a member of staff. There are a very low number of interventions, which are recorded in incident reports.

p.7

improvement to be good

Detailed incident reports are maintained, reviewed and evaluated by the manager. They are also reviewed by the independent visitors on a monthly basis and by the Health Trust (the provider) quality assurance team. This is to identify and plan responses to any emerging themes, to learn from incidents and identify good practice. In some cases, this has led to the manager requesting multi-agency strategy meetings and planning meetings to review children’s needs and have resulted in changed health plans, care plans or a reassessment of needs. As a result, children are kept safe.

p.7

improvement to be good

Transitions between school, the family home and the short-breaks home can be a challenging time for some children. Staff have a range of strategies prepared for children if there are difficulties. They have good liaison with families and transport providers so that information is shared about any difficulties.

p.7

improvement to be good

A safe environment is maintained for children and any damage is reported and repaired within safe timescales.

p.7

improvement to be good

There are detailed procedures for administering medication and maintaining accurate records. There have been a small number of medication errors, none have had an impact on the health and welfare of a child. The children’s services clinical lead has reviewed all errors. There have been changes to procedures and refresher training to enhance practice. In a small number of cases, individual performance management plans have been implemented. A review of practice has not identified any themes. There is a development day planned, focusing on medication administration, for all nursing staff initially. The manager and the clinical lead respond seriously to this practice responsibility. Inspection report children’s home: SC465287 8

p.7

The effectiveness of leaders and managers: good

The manager is an experienced manager and qualified nurse. He is currently undertaking the relevant leadership and management qualification, unfortunately completion has been delayed due to competing demands. This has been addressed. However, he was not qualified at the relevant date of April 2017. A requirement is made and he expects to be qualified by July 2017.

p.8

The effectiveness of leaders and managers: good

He is part of a management team covering children’s services within the Health Trust that include two other short-breaks services. Managers share resources, knowledge and skills and provide out of hours management cover.

p.8

The effectiveness of leaders and managers: good

There is a stable staff group, made up of staff who have worked in the service for some time and recently qualified nursing staff who have had placements in this service (or similar) and have chosen to work in short-breaks services.

p.8

The effectiveness of leaders and managers: good

There have been improvements since the last inspection. The manager has developed the key worker system, which has had an impact on supervision arrangements resulting in improved regularity and quality of supervision. Supervision always covers safeguarding practice. Care staff now have key working responsibility that is overseen by registered nurses. This has provided development opportunities for care staff. This also frees up capacity for registered nurses to increase and enhance supervision arrangements. The manager is carefully reviewing the arrangements. Staff report that they are positive about the new key working arrangements.

p.8

The effectiveness of leaders and managers: good

The manager has also developed the quality assurance processes within the home. A small quality assurance group, with representatives from across the staff group, has reviewed and developed the case file audit checklist. This is to ensure that there is consistently good information held in each child’s records.

p.8

The effectiveness of leaders and managers: good

The manager is aware of the strengths and areas for further development for the home. He is proactive in responding to recommendations from the independent visitor reports. The visits are thorough and reports provide detailed feedback on meeting regulations and quality standards.

p.8

The effectiveness of leaders and managers: good

Processes are in place to ensure that up-to-date plans are provided by the local authority. There are links with the relevant team and staff escalate concerns if plans are not received in a timely way. Staff attending meetings make their own records, particularly capturing any changes to information and actions for the home.

p.8

The effectiveness of leaders and managers: good

Staff are qualified. A small number of recently appointed staff are in the process of undertaking care qualifications. Staff also receive in-service training that recently included safeguarding children who have disabilities.

p.8

The effectiveness of leaders and managers: good

There are robust recruitment, induction and monitoring processes in place to ensure safe staffing. The manager works closely with the Health Trust’s human resources service and seeks advice from senior managers and colleagues appropriately. Inspection report children’s home: SC465287 9 The home has a good track record in caring for children with complex health, medical, behaviour and learning needs. Families and professionals report that staff share information about the needs of children and their experiences in the home in a timely way. There is good partnership working with all of those involved in the child’s network. This is essential given the number of agencies involved in meeting children’s complex needs.

p.8

The effectiveness of leaders and managers: good

The manager strikes the right balance between critical challenge when following up concerns and proactive partnership working. He understands that up-to-date information from partners is essential to inform care plans and practice to meet children’s needs.

p.9

The effectiveness of leaders and managers: good

Families report that staff advocate on behalf of children, particularly regarding plans for transitions to adult services. One parent said, ‘The manager and staff have been invaluable in supporting me to work through the transitions process for my child. I am anxious about changes in services and I know that my child struggles with change. But his key worker has been very helpful and supportive by working with the adults’ short- breaks home and having a clear plan in place. This has reduced the challenges for him.’

p.9

The effectiveness of leaders and managers: good

The manager accepts that he should have challenged the social worker regarding referring on a concern about the use of digital technology within the home. He is very aware of the vulnerabilities of children who have disabilities. In response to this incident, the responsible individual is commissioning training to revisit, for all staff, their understanding of child protection procedures about allegations of harm.

p.9

Information about this inspection

Inspectors have looked closely at the experiences and progress of children and young people. Inspectors considered the quality of work and the difference made to the lives of children and young people. They watched how professional staff work with children and young people and each other and discussed the effectiveness of help and care provided. Wherever possible, they talked to children and 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.

p.9

Information about this inspection

Using the ‘Social care common inspection framework’, this inspection was carried out under the Care Standards Act 2000 to assess the effectiveness of the service, how it meets the core functions of the service as set out in legislation, and to consider how well it complies with the Children’s Homes (England) Regulations 2015 and the ‘Guide to the children’s homes regulations including the quality standards’. Inspection report children’s home: SC465287 10

p.9

Children’s home details

Registered provider address: Sudborough House, St Mary’s Hospital, 77 London Road, Kettering, Northamptonshire NN15 7PW

p.10

Inspector(s)

Cathey Moriarty: social care inspector Inspection report children’s home: SC465287 11 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, further education and skills, adult and community learning, and education and training in prisons and other secure establishments. It assesses council children’s services, and inspects services for looked after children, safeguarding and child protection.

p.10

Inspector(s)

If you would like a copy of this document in a different format, such as large print or Braille, please telephone 0300 123 1231, 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 http://www.nationalarchives.gov.uk/doc/open-government-licence , write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: psi@nationalarchives.gsi.gov.uk .

p.11

Inspector(s)

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

p.11

Inspector(s)

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

p.11