Children's home run by Cornwall Partnership NHS Foundation Trust in Cornwall

Inspection report children’s home: SC429523 1 SC429523 Registered provider: Cornwall Partnership 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

This service is provided by the NHS Foundation Trust and offers respite care for up to four children at any one time. Children who have significant health needs and learning disabilities are cared for by a team of nursing and support staff.

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Overall experiences and progress of

children and young people, taking into account

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requires improvement to be good

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

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requires improvement to be good

The effectiveness of leaders and managers requires improvement to be good

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requires improvement to be good

The children’s home is not yet delivering good help and care for children and young people. However, there are no serious or widespread failures that result in their welfare not being safeguarded or promoted.

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requires improvement to be good

Date of last inspection: 7 February 2017

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requires improvement to be good

Overall judgement at last inspection: sustained effectiveness

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Enforcement action since last inspection:

none Inspection report children’s home: SC429523 2

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Key findings from this inspection

This children’s home requires improvement to be good because:

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Key findings from this inspection

 Children’s goals and experiences are not normally discussed at care plan reviews. This means that issues such as how often children go out or favourite activities are not reviewed, and this is an important part of the short break experience.  The home does not provide wi-fi for children to use on their own devices. Children have asked for this but the manager has not looked into whether this is possible. Children are waiting for an iPad that has been ordered, which they will be able to use in the home.  Children do not have independent advocacy and, when this is needed, staff have not pursued this need.  Staff do not have clear guidance as to what action to take if a child tries to harm themselves or others. Although staff have not restrained a child, instruction in the care plan as to how to do this safely is unclear.  Children’s bedrooms do contain some of their belongings and familiar items but, for

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Key findings from this inspection

some young people, they are not personalised enough.  The gardens and outside space are well looked after but the children do not use very much of the equipment and this issue has not been reviewed by the manager. The manager has identified the need for a trampoline but it has taken a long time to decide if this is a viable option.  Management oversight and monitoring, while improved, are not strong enough yet to thoroughly evaluate how well young people’s needs are met.  A requirement in relation to safe recruitment is repeated and relates to verification of references.  The manager does not gather together informal concerns and issues raised and therefore cannot identify areas for improvement easily.

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Key findings from this inspection

 The manager and staff are a very committed and caring team with high levels of expertise in caring for children who have complex health needs. The team enjoys caring for the children and celebrates their achievements. Staff have good relationships with the children.  The manager regularly seeks out children’s views and feelings so that she can use this feedback to improve children’s stays.  Parents praise the care and commitment from staff and find staff very helpful.  The manager and staff communicate effectively with parents. They attend all meetings in respect of the children whom they care for. Staff have developed good Inspection report children’s home: SC429523 3 working relationships with social workers and have regular contact with them.  The manager and staff take pride in the home, which is clean and well looked after.

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Inspection date Inspection type Inspection judgement

07/02/2017 Interim Sustained effectiveness 04/07/2016 Full Requires improvement 29/02/2016 Interim Sustained effectiveness 13/07/2015 Full Good Inspection report children’s home: SC429523 4

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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, the 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

The children’s views, wishes and feelings standard is that children receive care from staff who—

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Requirement Due date

ensure that each child has access to the home’s children’s guide, and the home’s complaints procedure, when the child’s placement in the home is agreed and throughout the child’s stay in the home; and is given appropriate advocacy support. (Regulation 7(1)(b)(ii)(iii)) 22/11/2017

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Requirement Due date

The enjoyment and achievement standard is that children take part in and benefit from a variety of activities that meet their needs and develop and reflect their creative, cultural, intellectual, physical and social activities and interests and skills.

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Requirement Due date

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

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Requirement Due date

that each child has access to a range of activities that enable the child to pursue the child’s interests and hobbies. (Regulation 9(1)(2)(b))

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Requirement Due date

 Review the outside play equipment and decide if the trampoline is a viable option. If so, progress this with speed.  Ensure children can access appropriate technology via wi-fi in line with their age. 22/11/2017

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Requirement Due date

The protection of children standard is that children are protected from harm and enabled to keep themselves safe. In particular the standard in paragraph (1) requires the registered person to ensure that staff—

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Requirement Due date

help each child to understand how to keep safe; have the skills to identify and act upon signs that a child is at risk of harm; take effective action whenever there is a serious concern about a child’s welfare. (Regulation 12(1)(2)(a)(ii)(iii)(vi)) 22/11/2017 Inspection report children’s home: SC429523 5 In particular:

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Requirement Due date

 Ensure staff have appropriate training in relation to helping children to have healthy relationships and sexual boundaries.  Explicitly detail in care plans how staff should respond to a child if they try to harm themselves and clarify what type of physical intervention should be used. Ensure behaviour support plans are in place for all children where appropriate.  Ensure care plans specifically detail what levels of supervision and monitoring are required for each child. The leadership and management standard is that the registered person enables, inspires and leads a culture in relation to the children’s home that—

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Requirement Due date

helps children aspire to fulfil their potential; and promotes their welfare.

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Requirement Due date

In particular, the standard in paragraph (1) requires the registered person to— ensure that staff have the experience, qualifications and skill to meet the needs of each child understand the impact that the quality of care provided in the home is having on the progress and experiences of each child, and use this understanding to inform the development of the quality of care provided in the home; and use monitoring and review systems to make continuous improvements in the quality of care provided in the home. (Regulation 13(1)(a)(b)(2)(f)(h))

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Requirement Due date

 Audit, and review recommendations from incidents to ensure these have been carried out.  Audit and evaluate children’s experiences and activities; children’s plans and risk assessments and reviews of children’s experiences to identify and address any gaps.  Ensure that reviews of children’s progress, experience and care identify achievable goals for children and these are tracked regularly.  Review supervision arrangements for health care assistants to ensure that supervision is consistent and planned in advance.  Record all concerns and issues raised about the home and how these 22/11/2017 Inspection report children’s home: SC429523 6 have been dealt with to improve the running of the home.  Ensure that each child has a personalised bedroom. The registered person must recruit staff using recruitment procedures that are designed to ensure children’s safety.

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Requirement Due date

ensure that the individual has the appropriate experience, qualification and skills for the work that the individual is to perform; and full and satisfactory information is available in relation to the individual in respect of each of the matters in Schedule 2. (Regulation 32(1)(3)(b)(d)) 23/11/2017

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requires improvement to be good

Children enjoy a variety of different trips and activities. These include cinema, trips to the park, a festival and the zoo, as well as outings to nearby shops. Children do enjoy more activities than they used to, although there are times when they could have more experiences outside of the home. Staff appraise the success of these experiences for the children regularly, which includes observations and feedback from the children. This useful information is not generally used at care plan meetings to review what has worked well and to plan future activities. Not using this information is a missed opportunity to examine how children benefit from experiences that they may not otherwise have at home. Some children have asked for wi-fi to use with their iPads that they bring from home but the manager has not been able to facilitate this. Children are waiting for an iPad with wi-fi for use in the home, which has not

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requires improvement to be good

All young people have goals which staff know. Two children have a goal relating to methods of communication and making choice rather than this being an intrinsic part of their communication plan. These goals are not considered systematically at the care plan reviews, where the focus continues to be mainly medical.

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requires improvement to be good

Children who are moving into adulthood do not have advocates or independent visitors and a system is not in place to promote this. The manager and staff have not recognised enough the importance of Inspection report children’s home: SC429523 7 advocacy in supporting children to have their views heard and acted on. When staff have felt that a child may benefit from advocacy, they have been dissuaded by others who have said that the child can speak for themselves. However, the manager has invited a staff member from another home to come to a team meeting to discuss advocacy for children in general and support for those who will be leaving the home in the near future.

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requires improvement to be good

Staff do prepare bedrooms for children with some of their belongings but not all photographs are ready for displaying in bedrooms. One young child who had their first stay had very little in their bedroom to understand it to be their own or to feel familiar. The manager is in the process of updating bedding and curtains, having had difficulty in meeting organisational fire rules. She wants children to have input into choosing the designs.

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requires improvement to be good

The home has a well-kept outside space. The garden has outside equipment but the manager said children use very little of the apparatus. The manager has had plans for a trampoline for a year and has been liaising with people regarding the installation.

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requires improvement to be good

No formal complaints have been made about the home. However, informal concerns or issues raised by parents, children or outside agencies are not recorded and collated centrally, such as a parent’s concern about lack of flexibility regarding the arrangements of stays. This lack of overview does not help the manager to identify themes and solutions to include in the home’s development plan.

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requires improvement to be good

The manager and staff are very committed, caring and reliable and have good relationships with the children. Many of the staff have worked in the home for a long time and know the children well. They have good communication with the different professionals involved and attend reviews regularly. A schoolteacher spoke positively about the home and said, ‘We have verbal and written handovers.’ Nearly all parents are very positive about the home and do not have any concerns. They say, ‘My child is always happy when we drop them off and pick them up’, ‘My child loves going there. They go out to the woods and the beach, do baking and crafts’ and ‘They are always helpful, we talk often.’

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requires improvement to be good

Children have journals with photographs of the experiences that they have and take these with them when they move on to other services. The manager uses different ways to ascertain children’s views as to how they experience the home and is building upon this further with a new system for feedback. Inspection report children’s home: SC429523 8

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requires improvement to be good

Staff have not restrained children but one child’s care plan refers to staff using a ‘therapeutic hold’ to stop the child from causing harm to themselves. This term is not an accredited method of restraint. The plan is not explicit about how or when this form of restraint needs to be used. Additionally, the absence of a behaviour management plan makes it difficult for staff to support this young person safely.

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requires improvement to be good

The manager and staff are confident that overnight supervision and monitoring arrangements keep children safe and no incidents have occurred. However, supervision and monitoring arrangements detailed in care plans are not clear. This could potentially cause confusion.

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requires improvement to be good

Some children display inappropriate sexualised behaviours but staff have not had the training to deal with this effectively. Not all children have a behaviour support plan to help them manage their behaviour. Children are not receiving enough help as they become older in relation to their sexual and emotional needs. The manager has not facilitated consultation with children and adolescent mental health services (CAMHS) or expert professionals regarding these issues.

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requires improvement to be good

In other aspects of safeguarding young people’s care, the manager and staff are good advocates for children. Staff monitor children’s health and care both in and out of the home. They have developed strong relationships with social workers over the last year and are confident in raising safeguarding issues to ensure that they are dealt with. A social work team manager said, ‘We have all worked hard to improve working relationships. We are contacted regularly for advice regarding safeguarding concerns and the staff do challenge social workers.’

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requires improvement to be good

Children in the home receive high levels of medication and staff ensure that this is administered in accordance with guidelines. When errors have occurred, these have not caused any harm to children. Staff are asked to write an account to explain why this has happened so any learning can be used to help prevent this from happening again.

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improvement to be good

The manager was successfully registered for this home in July 2017.

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improvement to be good

The registered manager has worked hard with the staff team to make improvements but some systems to understand how well children’s needs are met are yet to be put in place, or are not organised enough. Auditing Inspection report children’s home: SC429523 9 of care plans, care plan reviews, risk assessments and supervision is not systematic. This means that the manager is less likely to identify issues and make improvements. For example, the manager does not have a system to know which staff have read new or updated care plans. The manager signs off incidents with recommendations for action. However, the outcome of these actions and the effectiveness of the recommendations are not analysed thoroughly.

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improvement to be good

The manager has received a number of new referrals for children to start having short breaks but a children’s guide is not available. The manager has a strong ethos for the home and would like to improve the home’s statement of purpose to reflect this. The independent visitor provides helpful monthly reports which scrutinise the running of the home and assist the manager to improve it. The manager is keen to take advice from other registered managers and share practice.

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improvement to be good

The manager values and prioritises supervision. It takes place monthly and all necessary issues are discussed. However, the health care assistants do not have supervision sessions that are with the same supervisor or planned in advance. This has an impact on what support is provided and how performance is monitored to ensure that the needs of children are met.

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improvement to be good

A requirement relating to safe recruitment is repeated as the manager has not verified references for all staff and volunteers that work in the home. Therefore, she is not personally assured as to whether all staff have the skills and experience required for caring for very vulnerable children.

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improvement to be good

Some aspects of management monitoring and oversight have improved. The manager has a clear system for auditing medication to ensure that young people are administered their medication safely.

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improvement to be good

Team meetings take place on a regular basis, cover all relevant issues comprehensively and are well recorded. The equipment in the home is regularly serviced and maintained and the manager has a system in place to monitor this with other staff. The home is clean and well looked after.

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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 differences 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 Inspection report children’s home: SC429523 10 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: SC429523 11

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Children’s home details

Registered provider address: Trust Head Office, Carew House, Beacon Technology Park, Dunmere Road, Bodmin PL31 2QN

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Inspector

Sarah Canto, social care inspector Inspection report children’s home: SC429523 12 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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