Children's home run by Tees, Esk and Wear Valleys NHS Foundation Trust

Inspection report children‟s home: 1253865 1 Registered provider: Tees, Esk and Wear Valleys NHS Foundation Trust Full inspection Inspected under the social care common inspection framework

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Information about this children’s home

This children‟s home provides short breaks for children and young people who have learning disabilities and/or physical disabilities, and emotional and/or behavioural difficulties, and for children and young people who have mental disorders, excluding learning disabilities. The home is provided by a National Health Service Foundation Trust.

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Information about this children’s home

Inspection dates: 20 to 21 December 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 requires improvement to be 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: This is the first full inspection since registration.

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good

Overall judgement at last inspection: Not applicable. Inspection report children‟s home: 1253865 2 Enforcement action since last inspection: None.

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Key findings from this inspection

 The children and young people receive highly individualised care that meets their needs. They are all making good progress. The relationships between the staff and the children and young people are very good.  The children‟s and young people‟s healthcare needs are extremely well met and they have access to a wide range of specialist support services. Activities are good. The children and young people are supported to attend school while they are staying at the home.  There are good contact arrangements in place. The registered manager and the staff provide very good support for parents and they fully involve families in the care of their children.  The children and young people are consulted and they are encouraged to make daily choices. Equality and diversity are embedded throughout the home‟s childcare practice and ethos.  The children and young people are actively encouraged to learn independence

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Key findings from this inspection

skills. Transitions to, and from, the home are very well-planned.  The children and young people are safe during their short breaks and their behaviour is positively managed.

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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

 A number of the home‟s policies and procedures are not compliant with regulations.  The statement of purpose does not include all of the required elements that are listed in regulations. Additionally, the registered person has not supplied Ofsted with a copy of the home‟s statement of purpose.  The registered person has not provided Ofsted with an independent person‟s monitoring report for each month that the home has been operational. Additionally, the one report that has been sent is not compliant with regulations.  There is no children‟s guide available for the children and young people.

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Inspection date Inspection type Inspection judgement

N/A N/A N/A Inspection report children‟s home: 1253865 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

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

ensures that the home‟s workforce provides continuity of care to each child (Regulation 13(e)).

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Requirement Due date

In particular, ensure that the continuity of the care provided is guided, and underpinned, by the home‟s required policies and procedures and that these policies and procedures are fully compliant with regulations. 28/02/2018

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Requirement Due date

The registered person must compile in relation to the children‟s home a statement (“the statement of purpose”) which covers the matters listed in Schedule 1, and the registered person must provide a copy of the statement of purpose to HMCI. (Regulation 16(1) and (2)) 31/01/2018

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Requirement Due date

The registered person must ensure that an independent person visits the children‟s home at least once each month and when the independent person is carrying out a visit, the registered person must help the independent person, if they consent, to interview in private such of the children, their parents, relatives and persons working at the home as the independent person requires. The independent person must produce a report about a visit (“the independent person‟s report”) which sets out, in particular, the independent person‟s opinion as to whether children are effectively safeguarded, and the conduct of the home promotes children‟s well-being. (Regulation 44(1) and (2)(a) and (4)(a)(b)) 31/01/2018

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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 make sure they understand it. („Guide to the children‟s homes regulations Inspection report children‟s home: 1253865 4 including the quality standards‟, page 24, paragraph 4.21)

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Overall experiences and progress of children and young people: good

The quality of individualised care is very good. This children‟s home offers short breaks for children and young people who need a range of assessments and interventions to meet their individual needs. All placements are arranged by the mental health trust provider.

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Overall experiences and progress of children and young people: good

All of the children and young people who attend for short breaks have specific aims and objectives that have been agreed by a professional multidisciplinary team prior to admission. A clinical specialist registered nurse case-manages each child‟s and young person‟s care package, and a clinical lead registered nurse based at the home is responsible for all care planning. Each of the children and young people also has an allocated key worker. This level of specialist input contributes greatly to the children and young people successfully achieving very good outcomes.

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Overall experiences and progress of children and young people: good

A professional involved with the home said: „I work with two boys who attend the unit. The staff are able to carry out a lot of the assessment work that may result in a firm diagnosis. I work closely with the staff, especially the boy‟s primary nurse and we meet regularly to inform future treatments. All the staff are very good.‟

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Overall experiences and progress of children and young people: good

The children and young people enjoy their short breaks and they have very positive day- to-day experiences. They take part in a wide range of activities that are both therapeutic and fun. The home provides a spacious, homely environment that enables the children and young people to enjoy indoor play and to take part in energetic games, which help them to unwind and relax before bedtime.

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Overall experiences and progress of children and young people: good

A parent said: „I think the unit is brilliant. The staff are great, and they are so helpful. My child loves it there, the staff support his interests and hobbies and they have really helped us as a family. I really do not know what we would have done without them.‟

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Overall experiences and progress of children and young people: good

The children and young people are regularly consulted, taking into account their ages and their levels of understanding. The staff use a range of communication aids and they are skilled in understanding the children‟s and young people‟s gestures and body language. This way of working encourages the children and young people to make decisions and express their views. It also promotes their equality, as it offers them choices.

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Overall experiences and progress of children and young people: good

A parent said: „I cannot fault the home, it is brilliant. The staff help me out whenever they can. They have an excellent understanding of my son and the environment is perfect. There is absolutely nothing bad that I can say.‟

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Overall experiences and progress of children and young people: good

Transitional arrangements are good. Admissions are carefully planned to reduce any Inspection report children‟s home: 1253865 5 stress or distress that may be linked to a child or young person staying away from home for the first time. Introductory visits gradually increase in duration, with the staff carefully monitoring the children and young people. Parents are fully included in all transitions, which enables them to support their children, and alleviate any concerns they may have. For children and young people who are leaving the home, thorough planning and good introductions to new placements support smooth, positive transitions.

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Overall experiences and progress of children and young people: good

A parent said: „My daughter loves to stay at the home, but she is leaving soon. The staff have taught her new skills such as shopping and cooking. They will help her move to her new place, we will both miss the home and the staff.‟

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

The children and young people are safe and good risk management ensures that the staff know each child‟s and young person‟s vulnerabilities, and how reduce known risks. All of the staff have received child protection training, which is regularly updated, and they know what to do if they are worried or concerned about any potential safeguarding concerns. These measures protect the children‟s and young people‟s welfare and their well-being.

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

A parent said: „I have no concerns whatsoever. I know my child is safe and I fully trust the staff.‟

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

No children or young people have gone missing and none are at risk of exploitation, radicalisation or extremism. There have been no incidents of bullying and none of the children and young people, or their parents, have made a complaint.

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

The skilled staff team manages behaviour positively. Individual behaviour management plans are highly comprehensive, which ensures that the children and young people are gently encouraged, supported and guided towards learning new ways to express their feelings and frustrations. The staff also work alongside parents to show them positive behaviour management strategies that empower and enable them to better cope with difficult behaviours at home and in the community. This innovative way of working reduces stress for the children and young people, and their families.

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

A parent said: „My children have extreme behaviours and they have definitely improved since they started their short breaks. The staff try to identify any triggers that lead to the behaviours, and they are going to show me different strategies that I can use at home.‟

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

Environmental health and fire safety are regularly checked to keep the children, young people, staff and visitors safe when they are in the home. Annual environmental risk assessments are undertaken to ensure that known risks are reduced. Weekly fire drills prepare the children, young people and staff in case of a genuine fire emergency.

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

All visitors to the home are checked and vetted and they sign the visitors‟ book. This allows for the registered manager to be satisfied that the children and young people are Inspection report children‟s home: 1253865 6 not exposed to unsuitable adults.

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The effectiveness of leaders and managers: requires improvement to be good

This unit has been operating as an intervention led care provision since 2013. Prior to being registered with Ofsted as a children‟s home, in August this year, the unit was regulated and inspected by the Care Quality Commission because it focused on providing healthcare for children and young people who have disabilities and complex behavioural needs.

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The effectiveness of leaders and managers: requires improvement to be good

The home is still in a transition period as it moves from being a hospital setting to being a social care provision. This involves the provider having to make complex operational and administration changes. Consequently, this inspection has highlighted a number of shortfalls in leadership and management.

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The effectiveness of leaders and managers: requires improvement to be good

These have not as yet impacted on the care and support delivered to the children and young people. However, continued failures to comply with regulations and statutory guidance could, potentially, compromise the quality of care provided.

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The effectiveness of leaders and managers: requires improvement to be good

The registered manager is an experienced registered nurse who specialises in looking after children and young people who have learning and/or physical disabilities. She also has additional skills, training and experience in looking after children who have complex behavioural and emotional needs that are linked to their disabilities.

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The effectiveness of leaders and managers: requires improvement to be good

The registered manager is supported by a highly skilled staff team that is made up of a clinical lead qualified nurse, qualified staff nurses and experienced healthcare support staff. The team is very well established and, between them, the staff have years of valuable experience in supporting children and young people. They receive extensive training that enables them to meet the needs of the children and young people. All of the healthcare support staff have completed a level 3 qualification in caring for children and young people.

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The effectiveness of leaders and managers: requires improvement to be good

A staff member said: „We are always attending training, and if we want to do anything extra we just have to ask.‟

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The effectiveness of leaders and managers: requires improvement to be good

All of the staff feel valued and appreciated. They receive regular, meaningful supervision and annual appraisals. Team meetings are an open forum where all of the staff can express their views and have a say in how the children and young people are cared for, and how the unit operates. Reflective practice is actively encouraged in order to create an open and transparent ethos where the staff feel they can express their views and opinions. This way of working creates a harmonious team whose members consistently work together to improve the children‟s and young people‟s quality of life and their outcomes.

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The effectiveness of leaders and managers: requires improvement to be good

A staff member said: „We are really supported and we are involved in the care planning. The team is very supportive of each other and all the managers are approachable. I would not want to work anywhere else.‟ Inspection report children‟s home: 1253865 7 The home is still using hospital policies and procedures that are not fully compatible for use in a social care provision. For example, they refer to „patients‟ rather than „children‟ and „young people‟. The hospital procedures are generalised for use in all of the hospital wards/practice areas and they are not, therefore, specific to the social care needs of the children and young people. In addition, the procedures are not fully compliant with social care regulations and statutory guidance. The registered manager has introduced some written protocols that complement the current policies and procedures, but, in the main, they are still lacking what is required for a provision that is operating as a

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The effectiveness of leaders and managers: requires improvement to be good

The statement of purpose is incomplete, in that it does not include all of the required information that is listed in regulations and there is no children‟s guide available. Additionally, the registered persons have not supplied Ofsted with a copy of the statement of purpose, as they are required to do. Failing to provide suitable, accurate information can potentially misinform those who are responsible for placing the children and young people, parents and carers who wish to know about the services offered, and the children and young people who attend the home for their short breaks.

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The effectiveness of leaders and managers: requires improvement to be good

There has only been one independent visitor‟s report submitted to Ofsted since the home was registered. These should be provided monthly. There is no consultation evident in the report and the independent visitor has not clearly set out their opinion regarding the safety of the children and young people, and how the conduct of the home promotes their welfare. Incomplete monitoring of the home and the quality of care provided can, potentially, negatively impact on outcomes for the children and young people.

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The effectiveness of leaders and managers: requires improvement to be good

There are three requirements and one recommendation arising from this inspection.

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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 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: 1253865 8

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Children’s home details

Providers address : West Park Hospital, Edward Pease Way, Darlington DL2 2TS

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Inspector:

Debbie White, social care inspector Inspection report children‟s home: 1253865 9 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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