Children's home run by Oxleas NHS Foundation Trust in Dartford

Inspection report children's home: SC036911 1 SC036911 Registered provider: Oxleas NHS Foundation Trust

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Full inspection Inspected under the social care common inspection framework

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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 and/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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Overall experiences and progress of

children and young people, taking into account

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good

How well children and young people are helped and protected good

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good

The effectiveness of leaders and managers good

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good

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

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good

Date of last inspection: 15 November 2016

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good

Overall judgement at last inspection: Good

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Enforcement action since last inspection

None Inspection report children's home: SC036911 2

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Key findings from this inspection

 Young people receive meticulous care and support from staff who understand their particular needs.  Young people enjoy an extensive range of activities inside and outside of the home.  Young people do not go missing. Sanctions and physical restraint are not used in the home.  All staff are trained to understand how young people communicate. This enables the young people to express their wishes and feelings, and contribute during their short break.  The committed staff team has extensive clinical knowledge. A very broad range of staff training ensures that young people receive specialised medical and social support during their stay.  Parents and professionals are very complimentary about the quality of care provided by the staff at the home.  The innovative manager excels in driving the service forward. Ideas from parents and professionals are routinely considered and acted upon, enhancing the young people’s overall experiences during their short break.

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Key findings from this inspection

The children’s home’s areas for development

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Key findings from this inspection

 All fire escapes must be accessible to the young people.  The young people’s risk assessments fail to include all possible risks and are not signed by managers and staff.  Record-keeping does not always accurately reflect on or review the continual progress of young people.

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Inspection date Inspection type Inspection judgement

15/11/2016 Full Good 22/03/2016 Interim Sustained effectiveness 01/12/2015 Full Good 10/03/2015 Interim Sustained effectiveness Inspection report children's home: SC036911 3

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Statutory requirements

This section sets out the actions that the registered person 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 must comply within the given timescales.

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Fire precautions

After consultation with the fire and rescue authority, the registered person must—

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Fire precautions

provide adequate means of escape from the home in the event of fire

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Fire precautions

This relates specifically to the accessibility of the kitchen fire escape. 31/08/2017

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Recommendations

 Staff need the knowledge and skills to recognise and be alert for any signs that might indicate a child is in any way at risk of harm. In particular, ensure that risks relating to cyber bullying and social media use are understood by staff, and that measures are in place to minimise those risks. (‘Guide to the children’s home regulations including the quality standards’, page 43, paragraph 9.12)  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. In particular, ensure that goals and targets set for the young people are regularly reviewed and revised. (‘Guide to the children’s home regulations including the quality standards’, page 31, paragraph 6.4)  Regulations 35 to39 detail the records that must be kept in children’s homes. All children’s case records (Regulation 36) must be kept up to date and stored

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Recommendations

securely while they remain in the home. 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) Inspection report children's home: SC036911 4

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Overall experiences and progress of children and young people: good

The young people benefit from highly individualised care during their short breaks. Collaborative relationships exist between the staff, parents, carers and professionals. This ensures that young people’s key information is gathered and assessed prior to their first stay at the home. This approach, coupled with staff visits to the young people’s homes and schools, enhances staff’s detailed knowledge of the young people. As a result, in-depth, high-quality pre-admission assessments ensure that the staff team has the specialised skills to meet the young people’s complex needs. A young person writes, ‘I like the staff here because they help me with everything.’

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Overall experiences and progress of children and young people: good

All the young people who access the service have highly complex medical and/or physical needs. While safe medical care is prioritised, the manager and staff team are committed to supporting the young people’s social progress during their short breaks. In consultation with parents and carers, staff actively support the young people’s agreed ‘social outcome’ targets. For example, one young person is encouraged to brush her teeth and another young person is encouraged to engage in play activities. Progress is made in small steps. For many young people and their families, these steps are highly significant. A professional comments that staff provide the young people with, ‘regular opportunities to develop their independence’. However, while the committed staff team facilitates social-outcome activities, there is no consistent recording of incremental progress. This makes it difficult to review the young people’s progress and plan

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Overall experiences and progress of children and young people: good

The manager invites parents, carers and the young people to visit the home before their first overnight stay. This sensitive planning provides reassurance to parents and carers whilst the young people familiarise themselves with new peers, adults and their new environment.

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Overall experiences and progress of children and young people: good

The pre-admission nurse always meets parents and carers at the start of each short break. Staff fastidiously record updates in relation to the young people’s medical prescriptions, diet and physical, social and emotional welfare, which ensures that care plans are up to date and tailored to their individual needs. Controlled medication and other medical equipment is stored appropriately and securely. The records for the administration of medicines in the home is exemplary. Rigorous timekeeping for medicine administration and gastrostomy feeding ensures that young people’s specific medical needs are met.

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Overall experiences and progress of children and young people: good

The staff team provides responsive care which meets the young people’s changing needs during their stay. For example, on a warm summer day staff bathed a young person to help him cool down on his return from school. This ensured that the young person was comfortable. Staff provide additional support to the young people when needed. For instance, staff follow particular physiotherapy exercise plans, which ensures that a young person’s physical needs are met. A parent says, ‘I know my son is loved and cared for by each of you, he loves his time with you and he care and attention you have provided him Inspection report children's home: SC036911 5 has helped him feel that this is his second home.’

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Overall experiences and progress of children and young people: good

Many young people using the service are non-verbal. Staff know the young people very well and are responsive to their individual communication styles. The young people receive high levels of supervision. This enables staff to immediately respond to non- verbal cues such as facial expressions, body language and gestures. For example, a young person expressed unhappiness in their chair. Staff immediately changed the seating arrangement and the young person gestured being happy and settled.

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Overall experiences and progress of children and young people: good

Staff take care to provide the young people with meals that meets their specific dietary requirements. Any food allergies or cultural choices are accurately recorded, which ensures that menu planning is bespoke to each young person needs. Staff successfully combine healthy eating with the young people’s choices of favourite foods, food consistency and cultural preferences such as a halal diet.

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Overall experiences and progress of children and young people: good

The home environment is bright, clean and welcoming. Photographic displays of the young people’s activities add to the homely atmosphere. The young people benefit from access to a large garden with suitably adapted play equipment. Staff help the young people grow flowers and vegetables in the raised garden beds.

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Overall experiences and progress of children and young people: good

Young people have fun during their visits. They enjoy a range of high quality, exciting activities and experiences. Activities include arts and crafts, pampering sessions, toys and musical instruments, complemented with quiet time opportunities in the sensory room. The young people and their families particularly appreciate the home’s annual summer and Christmas parties. A young person describes their short break as, ‘The best fun.’ The staff team is not risk averse and plans numerous activities outside the home. Trips to local landmarks, parks and farms provide the young people with experiences which broaden their social opportunities. One young person writes, ‘Today I went bowling, had a really good time, I loved it.’ Young people who move on to adult services enjoy their leaving parties. Staff buy presents and the young people request their preferred party activity, such as karaoke, which adds to the celebration. A young person

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Overall experiences and progress of children and young people: good

The young people’s large bedrooms are suitably equipped and furnished. During the young people’s short breaks, their photographs are placed on the doors of their bedrooms by staff. This helps young people to identify their bedroom, which increases their sense of ownership. The innovative manager has introduced personalised bedroom communication boards for every young person. The communication boards highlight each young person’s favourite activities and communication preferences. As a result, staff provide considerate and consistent care that meets the needs of the young people.

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Overall experiences and progress of children and young people: good

The manager and staff team work tirelessly to support the parents and carers in the community. A parent says, ‘They make an effort to visit and listen to us.’ The manager is instigating regular parent and carer’s coffee mornings which will further increase the home’s inclusive approach. Managers are also implementing plans to publish a regular newsletter to keep everyone informed of events in the home. The home’s transition nurse actively challenges professionals when young people move on to adult services. A Inspection report children's home: SC036911 6 parent says that staff ‘insisted that the local authority provide X with a transition social worker’, and helped the parent by ‘ringing around the area for information about local adult respite services’. A parent praises the work of the staff saying, ‘I simply cannot thank you enough.’

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How well children and young people are helped and protected: good

The manager and staff team take exceptional care to ensure that staff ratios and skills exactly match the needs of each young person during their short-break stay. The manager provides statutory weekly reports to the health trust in relation to safe staffing levels. Staffing levels always meet the trust’s safe staffing level guidelines. Clear shift handover discussions between staff record any welfare concerns and care plan updates. This excellent level of detail ensures that the young people continue to receive good quality safe care.

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How well children and young people are helped and protected: good

All statutory fire, health and safety checks and certificates are complete. Personal evacuation plans are comprehensive. However, one of the four nominated fire escapes is not suitably adapted for wheelchair users.

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How well children and young people are helped and protected: good

Staff prepare thorough and meticulous assessments which ensure that the young people’s risks and needs are understood. In addition strategies put in place minimise those risks further. Increased staffing levels and specific transport arrangements ensure that young people enjoy their community activities safely. Additional bespoke risk assessments increase the young people’s safety in the home, for instance assessments that address behavioural challenges that young people may display. However, not all risk assessments are signed by the author. This does not negatively impact on the considerable high level of care that the young people receive.

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How well children and young people are helped and protected: good

The staff team has an extensive and detailed knowledge of the medical care and support that young people require. This ensures that the young people remain safe and protected. All staff are clinically trained in National Health competencies to provide care to young people who have complex medical and/or physical needs.

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How well children and young people are helped and protected: good

All staff are trained in restraint techniques. There have been no restraints since the last full inspection. The young people receive high levels of staff supervision, which ensures that young people do not go missing from the home. The need for sanctions does not arise.

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How well children and young people are helped and protected: good

Staff recruitment procedures are robust. Staff receive appropriate safeguarding training. They understand safeguarding procedures and are confident in reporting concerns. However, staff have not received internet safety training. E-safety training will ensure that staff have the skills to protect the young people when they access social media websites or other web-based programs.

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How well children and young people are helped and protected: good

The manager deals with any complaints swiftly. There has been one complaint since the last full inspection. A parent complained that a young person’s physical support equipment was incorrectly fitted. The manager immediately responded to the parent and Inspection report children's home: SC036911 7 the staff team received additional training to ensure no further occurrence.

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The effectiveness of leaders and managers: good

The highly qualified nurse manager is currently awaiting Ofsted registration. She has a clear vision for the service and aims to further improve the effectiveness of the service and the experiences of the young people. Wide-ranging plans include the use of inclusive software applications to facilitate feedback from the young people during their stay. This software application will also enhance staff monitoring of young people’s social outcomes progress. A parent writes, ‘Keep the good changes coming!’ adding, ‘The manager has improved things and listens to us.’

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The effectiveness of leaders and managers: good

Staff report feeling anxious due to some staff turnover in recent weeks. However, leaders and managers have ensured safe staffing levels, and the young people’s care has not been compromised. A recruitment drive is currently underway.

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The effectiveness of leaders and managers: good

To improve the service further, the manager visits other similar services to share ideas and good practice. As a direct result, young people’s activity evaluation feedback and communication boards have been introduced to the home to enhance the young people’s overall experiences during their short breaks, and to inform the service they receive. Staff describe the manager as ‘pro-active and full of good ideas’.

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The effectiveness of leaders and managers: good

A recent clinical commissioning group ‘quality assurance visit’ to the home identified no concerns and singled out ‘the professionalism and helpfulness of all staff’. They also reported that the young person at the home during the visit ‘was very positive about the care they receive’. The National Health service compile six-monthly ‘patient experience surveys’ of the home. Parents and carers compliment the service for the care, dignity and respect that the young people receive during their short-break stays.

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The effectiveness of leaders and managers: good

Staff say training is ‘very good’. All staff hold the NVQ level 3 in health and social care as a minimum. The manager keeps a matrix of training completed by all staff. All training is refreshed regularly in line with guidance. All staff receive National Health clinical training, which includes basic life support, first aid, food safety, infection control, gastrostomy feeding techniques, diabetes care, tracheotomy support and patient handling. The manager actively sources additional staff training to complement their existing skills. Speech and language therapists, physiotherapists and dietician training provided at the monthly team meetings increase staff knowledge. This comprehensive training ensures that young people who have complex needs can access the service. Further staff training in sign language and play therapy is planned for the future.

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The effectiveness of leaders and managers: good

Robust monitoring systems are in place. The external independent visitor visits the home once a month. The visitor scrutinises records and provides detailed reports, highlighting areas of strength, good practice and areas for improvement. The manager actions any recommendations made.

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The effectiveness of leaders and managers: good

Families praise the manager and staff team, describing them as ‘some of the most amazing people we know’. Inspection report children's home: SC036911 8

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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.

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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: SC036911 9

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Children’s home details

Registered provider address: Oxleas NHS Trust, Bexley Hospital, Pinewood Place, DARTFORD DA2 7WG

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Inspector

Victoria Jones, social care inspector Inspection report children's home: SC036911 10 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 children looked after, safeguarding and child protection.

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Inspector

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Inspector

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Inspector

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