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

Inspection report children‟s home: 1253862 1 Registered provider: Tees, Esk and Wear Valleys 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 children‟s home provides care and accommodation for children and young people who have a learning and/or physical disability for short breaks. The home is operated by a National Health Service Foundation Trust.

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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: This is the first inspection since the home was registered.

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requires improvement to be good

Overall judgement at last inspection: not applicable

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requires improvement to be good

Enforcement action since last inspection: none

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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

 The children‟s guide does not include information, in a format that is suitable to Inspection report children‟s home: 1253862 2 the age and understanding of the children and young people, to inform them about how to complain and how complaints will be dealt with.  The registered person has not revised and updated the statement of purpose in a timely manner to include changes in the home.  There have been no fire drills carried out.  There are no records kept in the home that record the details of any child protection allegations, or the actions taken in response.  The independent visitor‟s report does not set out the visitor‟s opinion regarding the safety of the children and young people, or whether the conduct of the home promotes the children‟s and young people‟s welfare.  The staff do not regularly consult the children and young people to ascertain their views and wishes about how the home operates.

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Key findings from this inspection

 The registered persons have not considered the staff‟s additional training needs to enable the staff to understand the impact of the home moving from being a registered hospital to a social care provision.

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Key findings from this inspection

 The children and young people receive good, individualised care that meets their needs. They thoroughly enjoy their short breaks, and they have very good relationships with the staff and with each other.  The children and young people are progressing as a direct result of attending their short breaks. Their healthcare needs are very well met and they have access to a wide range of activities. Support for parents and families is very good.  The children and young people are safe and the staff manage behaviour positively. Risk management is effective.  The registered manager is a strong leader who is highly respected by his staff team. He has high aspirations for the young people. The staff team is committed to delivering a high quality service, and the staff put the children and young people at the heart of their practice.  Relationships with other professionals are good, and all aspects of inter-agency

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Key findings from this inspection

working are highly effective. The registered manager and the staff team are strong advocates for the children and young people, and positive equality and diversity are intrinsic to the home‟s ethos.

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Recent inspection history

This is the home‟s first inspection. Inspection report children‟s home: 1253862 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 children‟s views, wishes and feelings standard is that children receive care from staff that – Ensures that an explanation is given to each child as soon as reasonably practicable after the child‟s arrival about the children‟s guide, and how to make a complaint or representations in relation to the home or the care the child receives and how any such complaint or representations will be dealt with. (Regulation 7(d)(i)(ii)) 02/03/2018

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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. (Regulation 16(1)) 02/03/2018

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Requirement Due date

The registered person must ensure, by means of fire drills and practices at suitable intervals, that persons working at the home and, so far as reasonably practicable, children are aware of the procedure to be followed in case of fire. (Regulation 25(1)(d)) 28/02/2018

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Requirement Due date

The registered person must prepare and implement a policy which provides for records to be kept of an allegation of abuse or neglect, and the action taken in response. (Regulation 34(2) (d)) 28/02/2018

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Requirement Due date

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 whether the conduct of the home promotes children‟s well-being. (Regulation 44(4) (a) (b)) 28/02/2018

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Recommendations

 Ensure that children are consulted regularly on their views about the home to inform the quality of the care provided, giving due consideration to the child‟s cognitive ability. („Guide to the children‟s homes regulations including the quality standards‟, page 22, paragraph 4.11) Inspection report children‟s home: 1253862 4  Ensure that the home has enough suitably trained staff to meet the needs of the children. („Guide to the children‟s homes regulations including the quality standards‟, page 51, paragraph 10.1)

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Recommendations

In particular, ensure that the staff receive bespoke training to enable them to make an informed, positive transition from working in a hospital environment to working in a registered children‟s home.

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improvement to be good

The children and young people receive good individualised care that meets their needs. The staff are particularly skilled in meeting the needs of the children and young people who have complex behavioural and healthcare needs. There is at least one qualified registered nurse on duty at all times. This ensures that the children and young people with specialised needs have access to skilled and experienced staff. This enhances all aspects of the children‟s and young people‟s care and support.

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improvement to be good

A parent said: „The unit is fantastic, brilliant, and we could not manage without it. [Name] loves coming here and he has learned lots of new skills. His behaviour is so much better, and he is a lot more sociable.‟

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improvement to be good

A visiting professional said: „A lot of the children I work with attend the unit for short breaks. One of the strengths of the unit is that because they have qualified nurses they are able to accurately record and monitor specific health needs. For example, children who have epilepsy who experience regular seizures. The staff often pick up behaviours that are important, that are fundamental to the children‟s treatment, including what medication they need.‟

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improvement to be good

The children and young people have very good relationships with the staff. They are very happy during their short-break stays, and they respond positively to the caring and nurturing environment. The staff know the children and young people very well, and they understand the importance of providing the children and young people with a settled, comfortable „home from home‟. This approach ensures that the children and young people feel happy and secure.

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improvement to be good

A parent said: „My son cannot talk, but I know he is happy to be here and he is happy to go with the staff to enjoy his evening. He always starts to smile as soon as we drive up to the unit. I think the staff are brilliant, and I know my son is looked after and he is safe. I have every confidence in them. They ring me straight away if anything happens or if they are worried about him, and I ring every night that he stays to make sure that he is settled.‟

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improvement to be good

The children and young people have positive day-to-day experiences during their short breaks. They have access to a range of activities that are both enjoyable and Inspection report children‟s home: 1253862 5 meaningful. For example, the children and young people are able to choose what activities they would like to take part in. In addition, for those children and young people who have specific sensory needs, the staff organise bespoke activities to help them self- regulate their anxiety levels. This focus on using activities to support the children‟s and young people‟s choices and their individual needs is good, child-focused practice.

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improvement to be good

The staff support the children and young people to attend school and, where appropriate, they liaise with teachers to promote good communication that provides the children and young people with consistency. Each child and young person has a home/school diary that the staff complete, to share information about how the children and young people have been during their short breaks.

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improvement to be good

A headteacher said: „I have a number of children who attend the unit and the feedback from parents is always very positive. We communicate with the staff, mainly by using the home/school diary. However, if there are any concerns the staff will ring here or we will ring the unit. The staff always attend for the children‟s review meetings, where we all discussed the children‟s care and progress.‟

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improvement to be good

Transitions for new children and young people coming to have short breaks, and for those moving on to adult services, are well managed. The staff ensure that the planning for transitional arrangements meets the needs of the children and young people. This supports the children and young people, and their families, through what can be a difficult time for them.

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improvement to be good

A parent said: „This is a brilliant place. I am so grateful for the support. I am on my own and it can be difficult sometimes. My son loved his tea visits, and he is more than happy to be here. I would never leave my child anyway if I felt they weren‟t safe. I trust the staff here completely and I know he will be well looked after.‟

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improvement to be good

Communicating with, and consulting with, the children and young people about their care was reviewed as part of this inspection. The registered manager explained to the inspector that this is an area that he needs to improve, and he is taking measures to seek advice from an organisation that specialises in consulting with disabled children.

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improvement to be good

However, the children‟s guide, which is fundamental to informing the children and young people about how it is to have their short breaks, does not include all the information that is required by regulation. In particular, it does not advise the children and young people, or their parents, about what to do if they are unhappy about any aspect of the care provided. Nor does it include information about how the registered persons will deal with a complaint. This potentially compromises the children‟s and young people‟s rights to raise any concerns that they may have.

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improvement to be good

Risk management is good. All the children and young people have individual risk assessments that set out potential risks, and how the staff will manage these. The staff Inspection report children‟s home: 1253862 6 have a good awareness of each child‟s and young person‟s risks that are associated with their complex health and behavioural needs. This protects the children‟s and young people‟s safety and welfare.

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improvement to be good

There have been no children or young people who have gone missing, and none are at risk of exploitation, neglect, radicalisation or extremism. There are no reported instances of bullying.

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improvement to be good

The staff manage behaviour in a positive and supportive way. They receive specialised training to manage behaviours that are associated with the children and young people who have specific behavioural difficulties. Their approach has positively impacted on the children and young people. Feedback from parents, during this inspection, includes positive comments about how their children‟s behaviour has improved since they have been attending the unit for short breaks. The staff also work alongside a clinical nurse who specialises in behaviour management. The feedback about how the staff manage behaviours is positive.

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improvement to be good

The specialist nurse commented: „The staff have very strong values and an excellent attitude towards children and young people. They have a very good understanding of the children‟s and young people‟s needs, and they are effective working with children and young people who experience significant behavioural difficulties. They are very child focused and they provide a good service.‟

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improvement to be good

All the staff receive regular child protection training that is provided by a senior manager who is responsible for overseeing this within the Trust. The registered manager has provided the staff with some good information, and guidance, about how to keep the children and young people safe. Where a safeguarding incident has occurred, the staff ensure that they record all the details in the child‟s or young person‟s case file. However, there are no records kept in the home of any allegations made and the actions taken in response. This means that there is no overarching record of all safeguarding concerns that can be referred to should a new enquiry, or investigation, be instigated about a historical safeguarding incident.

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improvement to be good

The registered manager oversees the health and safety and fire safety measures to provide the children and young people with a safe environment. The Trust‟s health and safety team, whose responsibility it is to carry out regular checks and audits, supports the registered manager to ensure that all health and safety inspections and risk assessments are relevant and up to date. However, there has not been a fire drill carried out to ensure that the staff, the children, and the young people know what to do in the event of a real fire emergency situation. This lack of action and foresight potentially compromises the children‟s and young people‟s safety.

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

The registered manager is an experienced practitioner whose nursing qualifications are of a high standard. He became the registered manager in August 2017 when the unit was registered with Ofsted as a children‟s home. Prior to this, the unit was registered as Inspection report children‟s home: 1253862 7 a hospital and was regulated and inspected by the Care Quality Commission.

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

The registered manager is an aspirational leader who prioritises the needs of the children and young people. He advocates high standards, and he has high expectations of the staff team. There are measures in place to ensure that the staff receive the guidance, support and supervision that they need to carry out their roles effectively. The staff are committed and motivated to deliver good services to the children, the young people, and their families. Good equality and diversity for the children and young people is paramount.

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

Since the home was registered, there has been good progress made in a number of areas of practice. A review of how services are provided has resulted in changes that enable more flexibility when planning the children‟s and young people‟s short breaks. This means that more support can be offered to families who are struggling and who need additional support.

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

Another area of progress is securing funding to provide the children and young people with computer tablets so that they can develop a range of skills by using computer technology. The staff have also introduced more child-friendly, visual, communication aids that encourage the children and young people to be involved in making choices about activities and menus.

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

Relationships with other professionals are positive, which results in the children and young people being able to access a wide range of holistic care. Support for parents is also very good. This joint working and positive collaboration promotes positive outcomes for the children and young people.

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

The unit is still in a transition phase, moving from being a hospital to a social care provision. This is because of a significant change in how the unit needs to operate to meet the legislation and statutory guidance that is required to run a children‟s home. Outcomes from this inspection, along with staff testimony, show that there is an overall lack of understanding of the changes needed. In addition, the registered person has not provided the staff with additional training to help them to fully understand the new legislation, guidance, or inspection frameworks that they now have to adhere to.

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

The statement of purpose does not include all of the required information as listed in regulation to fully inform parents, commissioners, and other professionals involved in the care of the children and young people about what the home sets out to provide to the children and young people who attend for short breaks. The statement of purpose could, potentially, misinform those who are responsible for arranging suitable placements.

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

The independent monitoring of the home is not fully compliant with regulation. In particular, the independent visitor has not determined that, in their opinion, the children and young people are effectively safeguarded, or that the home promotes the children‟s and young people‟s well-being. This potentially compromises the children‟s and young people‟s welfare. Inspection report children‟s home: 1253862 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 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: 1253862 9

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Children’s home details

Registered Provider : Tees, Esk and Wear Valleys NHS Foundation Trust.

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Children’s home details

Registered provider 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: 1253862 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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