Children's Home run by Lancashire County Council in Lancashire

Inspection report children’s home: 1231405 1 Registered provider: Lancashire County Council Full inspection Inspected under the social care common inspection framework

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Information about this children’s home

This home provides residential short-stay care for up to six young people with learning disabilities and/or physical disabilities. The home is run by a local authority.

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Information about this children’s home

Inspection dates: 12 to 13 September 2017

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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

Overall judgement at last inspection: sustained effectiveness

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Key findings from this inspection

 Young people receive good-quality care which meets their individual needs and promotes their positive development.  Young people who use the service enjoy positive relationships with staff and Inspection report children’s home: 1231405 2 each other.  Young people who are new to the service and those moving on from it are well supported.  Young people have good quality day-to-day experiences and are encouraged to engage in positive activities.  Staff provide safe and effective care which promotes young people’s safety and well-being.  Staff have a clear understanding of their safeguarding responsibilities and clear knowledge of reporting procedures.  Consistent, positive behaviour support helps young people to develop positive behaviours.  Young people are provided with safe accommodation and supported by carefully recruited staff.  Young people, their carers and external professionals express high levels of

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Key findings from this inspection

satisfaction with the service, and speak highly of managers and staff.  Young people receive their care from staff who are well trained and well supported.  Well-established quality assurance processes enable the registered manager to monitor quality and safety.

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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

 The current arrangements in place for the care of young people with complex healthcare needs require some improvement so that young people receive a consistent and reliable service.  Current quality monitoring processes should be reviewed to incorporate the provision of health care for those young people with complex healthcare needs.  Risk assessments should be regularly reviewed to ensure that the information within them is up to date and current.  Arrangements for the routine supervision of staff and the provision of debriefings following an incident of physical intervention should be reviewed.  The development of personal emergency evacuation plans and clear fire drill records would further safeguard the safety and well-being of young people.  Some young people would benefit from a more accessible children’s guide.

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Inspection date Inspection type Inspection judgement

16/03/2017 Interim Sustained effectiveness 22/08/2016 Full Good Inspection report children’s home: 1231405 3

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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.

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Requirement Due date

(1) The health and well-being standard is that— (a) the health and well-being needs of children are met; (2) In particular, the standard in paragraph (1) requires the registered person to ensure— (c) that each child has access to such dental, medical, nursing, psychiatric and psychological advice, treatment and other services as the child may require. (Regulation 10(1)(a)(2)(c)) 20/10/2017

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Requirement Due date

(1) The protection of children standard is that children are protected from harm and enabled to keep themselves safe. (2) In particular, the standard in paragraph (1) requires the registered person to ensure— (a) that staff— (i) assess whether each child is at risk of harm, taking into account information in the child’s relevant plans, and, if necessary, make arrangements to reduce the risk of any harm to the child. (Regulation 12(1)(2)(a)(i)) 20/10/2017

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Recommendations

 Ensure that the children’s home complies with relevant health and safety legislation. Specifically, by means of the development of personal emergency evacuation plans, which take into account the individual needs of the young person and detail the support they may require to evacuate the home in an emergency, and through effective fire drill arrangements. (‘Guide to the children’s homes regulations including the quality standards’, page 15, paragraph 3.9)

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Recommendations

 The children’s home must produce a children’s guide. The children’s guide must be made available to all children when their placement in the home is agreed (or on arrival at the home if the placement is made in an emergency) and must be age appropriate, provided in an accessible format and explained to each child to Inspection report children’s home: 1231405 4 make sure they understand it. (‘Guide to the children’s homes regulations including the quality standards’, page 24, paragraph 4.21)

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Recommendations

 Specifically relating to staff debriefing; The registered person should ensure that all incidents of control, discipline and restraint are subject to systems of regular scrutiny to ensure that their use is fair and the principles as set out in 9.35 are respected. (‘Guide to the children’s homes regulations including the quality standards’, page 46, paragraph 9.36)

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Recommendations

 A record of supervision should be kept for staff, including the manager. The record should provide evidence that supervision is being delivered in line with regulation 33(4)(b). (‘Guide to the children’s homes regulations including the quality standards’, page 61, paragraph 13.3)

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Recommendations

Specifically relating to monitoring of agency healthcare staff training, 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)

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Overall experiences and progress of children and young people: good

Young people receive good-quality care and support which are tailored to their individual needs. As a result, they make good progress in many areas. Examples include growing in social confidence, engaging well with each other and making friends. Some young people are increasingly confident in making and expressing choices on a day-to-day basis. One young person is now comfortable to take part in activities in the community, following a long period when this caused her a great deal of anxiety. There are many examples of young people developing skills such as independent personal care and managing meals with less support.

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Overall experiences and progress of children and young people: good

Feedback from the parents or main carers of the young people who use the service is extremely positive. One parent commented: ‘It is just great. I couldn’t think of one thing they could do better.’ External professionals, such as social workers involved in young people’s care, are also highly complimentary about the service. Their comments include: ‘They really take time to understand young people and get to know them. I have always been extremely happy with the home.’

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Overall experiences and progress of children and young people: good

There is a stable and consistent staff team, which means that young people benefit from consistency and receive their care from staff who know them well and understand their needs. This helps young people to develop secure and trusting relationships with staff. Staff support young people in a warm and caring manner, and interactions between them are very positive. Inspection report children’s home: 1231405 5 Careful planning is in place to ensure that each new young person is introduced to the home in a sensitive way. The registered manager ensures that she and the staff have a clear understanding of the young person’s needs so that their care can be effectively planned. New young people are introduced to the service gradually, often starting with short mealtime visits and gradually building up to overnight stays. A parent said: ‘The way they introduced him was brilliant. They definitely got to know him. They did a home

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Overall experiences and progress of children and young people: good

visit and learned all about his needs. They asked a lot about his communication and the things he likes. He went for teatime visits for a few weeks and then for a few hours over the weekend. They built him up slowly and it really worked. He has settled so well.’

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Overall experiences and progress of children and young people: good

Young people who are moving on from the service are also well supported. Managers and staff work positively with adult services to ensure that their knowledge of young people is passed on. A social worker was particularly complimentary about this area of the service. They described how staff from the home worked with one young person’s new staff team to ensure that the young person continued to receive the care and support that he needed following his transition to adult services.

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Overall experiences and progress of children and young people: good

Staff have a clear understanding of young people’s needs and are able to speak confidently about how they support them on a day-to-day basis. There are examples of innovative care planning. For example, the care plan of one young person, who sometimes refuses personal care, contains some highly personalised and innovative strategies aimed at positively encouraging him to engage in this aspect of care.

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Overall experiences and progress of children and young people: good

A small number of young people who use the service have some complex healthcare needs. Agency workers are arranged by healthcare commissioners to provide care for the young people during their stays. There have been some recent issues in relation to reliability, as a result of the agency failing to provide the healthcare staff as agreed. On some occasions, this has meant that the registered manager has had no option but to cancel the young people’s stays at short notice. One parent described the situation as worsening over recent months, but was very clear that she felt that the registered manager had done all within her power to resolve it.

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Overall experiences and progress of children and young people: good

The quality of care planning carried out by healthcare workers is variable. The healthcare plan of one young person contained some conflicting information in relation to his enteral feeding regime. This meant that he was at risk of not receiving the correct nutrition. Shortfalls in healthcare planning are of particular concern, on the basis that there has been a lack of consistency in the healthcare workers provided to care for some young people.

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Overall experiences and progress of children and young people: good

The registered manager has identified the issues, and is working closely with those responsible for commissioning the healthcare services to try to resolve them. However, there are no clear formal arrangements in place to monitor the safety and quality of healthcare provided to young people. A requirement is raised in relation to this matter.

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Overall experiences and progress of children and young people: good

Staff know young people well and take time to understand their individual methods of communication, such as non-verbal gestures. Staff were observed interacting meaningfully with young people, assisting them to make and express their choices and Inspection report children’s home: 1231405 6 preferences using a variety of communication methods. Staff were observed responding to young people’s non-verbal gestures in a positive manner. This good practice helps to ensure that young people have a voice and are listened to. It also promotes young people’s communication skills and confidence to express their views.

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Overall experiences and progress of children and young people: good

Young people are provided with various information in accessible formats that they can understand. Some examples include pictorial rotas and photo menus, which are in place and regularly used by the young people. However, it is recommended that the children’s guide is reviewed and improved so that the information within it is accessible to more young people.

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Overall experiences and progress of children and young people: good

All the young people who use the service benefit from full-time education placements. Staff support the young people’s education through positive joint working and regular communication with school staff. This helps to ensure that young people continue to receive effective support.

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Overall experiences and progress of children and young people: good

Young people enjoy good-quality experiences when staying at the home. A range of fun and fulfilling activities are provided, including trips to shows and pantomimes and activities such as swimming and woodland walks. At the home, young people can enjoy trampolining, baking and sensory relaxation. One young person recently met at the home a TV cooking celebrity who he is a big fan of. Encouraging young people to engage in fulfilling activities increases their confidence and provides opportunities for them to learn new skills.

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

Young people enjoy staying at the home and present as relaxed and content in their surroundings. This demonstrates that they feel safe. Parents and main carers express high levels of confidence in the registered manager and staff to promote young people’s safety and well-being. Their comments included: ‘I don’t have the slightest worry when (x)is there. I know he is in completely safe hands.’

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

The registered manager works positively with external agencies to ensure that young people receive the support required to maintain their safety and well-being. Safeguarding practice is strong. All staff are provided with safeguarding training at the start of their employment. This is regularly updated to help to ensure that they retain their knowledge and are updated about any changes in procedures or good practice. Staff are able to confidently discuss safeguarding procedures and describe the action that they would take in the event that a concern is identified about a young person’s safety or well-being.

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

Managers and staff have an understanding of young people’s individual needs and the risks to their safety or well-being. Each young person has a range of risk assessments in place which identify risks and the support required by staff to maintain their safety. However, the quality of young people’s risk assessments is variable. One young person’s moving and handling risk assessment was found to be out of date and another young person’s risk assessment failed to address a daily risk in relation to equipment used in Inspection report children’s home: 1231405 7 his care. Gaps in risk assessment and management information could result in staff not having sufficient information to maintain young people’s safety. As such, a requirement is raised.

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

Some young people present complex behaviours. Individualised behaviour support plans provide staff with guidance about young people’s behaviours and how to support them in a consistent manner. This consistent support helps young people to develop safe and appropriate behaviours. There are several examples of positive outcomes for young people who have been supported to reduce negative behaviours over time.

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

Incidents of physical intervention or restraint are rare. On the small number of occasions when they do occur, they are recorded and carefully reviewed by the registered manager. However, some records do not include evidence that staff involved in the incidents have had the benefit of a debriefing and the opportunity to review and discuss the incident in detail. It is recommended that arrangements are improved to ensure that all staff involved in an incident are provided with a debriefing. This supports a consistent, professional and reflective approach, and helps to safeguard young people from inappropriate or excessive restraint.

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

The young people who use this service require constant care and support due to their level of needs. Young people do not leave the home unsupported and, as such, incidents of young people being missing do not occur. There is a safe area risk assessment in place which identifies local hazards. This document is regularly updated to ensure that the information within it remains current.

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

Young people are cared for in safe, secure surroundings, and this helps to protect them from harm. A range of health and safety checks are regularly carried out to enable the registered manager to identify and address any safety issues. A fire risk assessment is carried out by a suitably qualified professional, and this is reviewed on an annual basis. To further support the safety of young people, it is recommended that personal emergency evacuation plans are developed to ensure that any potential difficulties in evacuating a young person, for example due to limited mobility, are identified and planned for. In addition, it is recommended that records of fire drills are improved to include which staff and young people have taken part. This will help to ensure that everyone experiences a fire drill within the recommended timeframes.

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

Arrangements are in place to ensure that staff are carefully recruited. Managers follow well-established recruitment procedures, which include carrying out a number of background checks of prospective employees. This reduces the risk of young people being cared for by people of an unsuitable character and therefore helps to protect them from harm.

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The effectiveness of leaders and managers: good

The home is managed by a suitably qualified and highly experienced registered manager. Staff, parents and main carers of young people and external professionals speak highly of the registered manager and express confidence in her to run a safe and Inspection report children’s home: 1231405 8 effective service.

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The effectiveness of leaders and managers: good

Stakeholders express high levels of satisfaction with the home and the service provided. A parent commented: ‘I could not be happier. It is an excellent place. You can see their dedication. The home has a lovely feel. Staff always seem happy to be there.’ A social worker said: ‘It is an excellent environment with excellent facilities. Above all, the care is excellent.’

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The effectiveness of leaders and managers: good

The home benefits from a stable and consistent team of staff who are well motivated and show pride in the service. Staff describe a positive and open culture within which they feel able to express their views. They describe a good level of support and express satisfaction with the training provided.

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The effectiveness of leaders and managers: good

The staff team receives a range of training that helps them to provide safe, effective care. The registered manager also arranges specific training which is in line with young people’s individual needs. For example, the staff have recently completed a course on diabetes to assist them in caring for a young person diagnosed with this condition. Staff are encouraged to complete nationally recognised qualifications in caring for young people. Currently, 25 of 29 staff members hold these qualifications and the remainder are in the process of obtaining them.

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The effectiveness of leaders and managers: good

The registered manager monitors the staff team’s training to ensure that each team member completes mandatory learning within the appropriate timescales. However, the processes to monitor the skills and training of agency staff working at the home providing healthcare could be improved. Some examples of outdated information were noted. A recommendation is raised to improve the process so that the registered manager can ascertain that the agency staff provided have the appropriate skills to provide safe care.

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The effectiveness of leaders and managers: good

Staff express pride in the service and demonstrate good understanding of their role and the needs of the young people that they care for. Staff report a good level of support and confirm that managers are always available to provide advice and guidance. There are processes in place to provide all staff with formal supervision on a regular basis. However, records demonstrated some shortfalls in this area, with some staff not having supervision within the appropriate timescales. It is recommended that this matter be addressed so that all staff have a regular opportunity to engage in formal supervision. This helps to promote professional practice and positive team working.

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The effectiveness of leaders and managers: good

There are well-established quality assurance procedures in place. These assist the registered manager to monitor safety and quality across the service on an ongoing basis. Adverse incidents or complaints are carefully analysed to ensure that any potential learning is identified and passed on to the staff team. This promotes continuous improvement. It is recommended that consideration be given to how the safety and quality of the externally commissioned healthcare service can be incorporated into the home’s own internal quality monitoring processes. This would further promote the safety and well-being of the small number of young people in receipt of this service. Inspection report children’s home: 1231405 9

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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 whom 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: 1231405 10

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Children’s home details

Registered provider address: Lancashire County Council, PO Box 78, Preston PR1 8XJ

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Inspector

Marie Cordingley, social care inspector Inspection report children’s home: 1231405 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.

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Inspector

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Inspector

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Inspector

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