RNIB Pears Centre Children’s Home Inspection Report 11/08/2015
RNIB Pears Centre Children's homes inspection - Full
Inspection date / 11/08/2015Unique reference number / SC485607
Type of inspection / Full
Provision subtype / Children’s home
Registered person / RNIB Charity
Registered person address / c/o RNIB, 105 Judd Street, Camden, London, WC1H 9NE
Responsible individual / Virginia Tyler
Registered manager / Linda Cope
Inspector / Anne Daly
Inspection date / 11/08/2015
Previous inspection judgement / N/A
Enforcement action since last inspection / None
This inspection
The overall experiences and progress of children and children and young people living in the home are / GoodThe children's home provides effective services that meet the requirements for good.
How well children and children and young people are helped and protected / GoodThe impact and effectiveness of leaders and managers / Requires improvement
Summary of findings
The children's home provision is good because:
- This home impacts positively on children and young people’s lives. They are making good progress underpinned by high quality personalised care and support from staff. Parents are consistently impressed by the ‘dedication and kindness’ shown by staff.
- Children and young people benefit from a strong, caring relationship with staff. Interactions between children and young people and staff are warm and inclusive. There are lots of smiles evident. There is a calm nurturing environment in which children and young people thrive.
- Children and young people are positive about their experience living at the home and value the support they receive. Scoring the staff ten out of ten.
- This home continues to be managed by an experienced and dedicated manager. She is passionate and committed to ensuring children and young people fulfil their potential in life.
- Staff are imaginative and aspirational in supporting children and young people.
- Detailed and effective behaviour management plans support staff in managing behaviour. Incidents of physical intervention have reduced but are not consistently recorded which reduces opportunities for learning.
- There are a few shortfalls in practice. Children and young people do not always gain access to advocacy services. Safe recruitment procedures are not always rigorous. There are few occasions where appropriately qualified staff are not on site to lead on health care and medication administration guidance is not clearly evident in all care plans. Scrutiny from the independent visitor is not robust and there is no comprehensive workforce plan.
What does the children's home need to do to improve?
Statutory Requirements
This section sets out the actions, which must be taken so that the registered person/s meets 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 with the given timescales.
Requirement / Due date13. In order to meet the leadership and management standard with particular reference to nursing staff. The registered provider must ensure:
2(d) that the home has sufficient staff to provide care for each child. / 25/09/15
The registered person must recruit staff using recruitment procedures that are designed to ensure children’s safety. They must ensure full and satisfactory information is available in relation to the individual in respect of each of the matters in Schedule 2 (Regulation 32 (3(b)) / 25/09/15
The registered person must ensure that within 24 hours of the use of a measure of control, discipline or restraint in relation to a child in the home, a record is made which includes :-
(v) details of any methods used or steps taken to avoid the need to use the measure.
(vii)the effectiveness and any consequences of the use of the measure
(b)within 48 hours of use of the measure, the registered person
(i)has spoken to the user about the measure and
(ii)signed the record to confirm it is accurate and
(c)within 5 days of the use of the measure record confirmation that they have spoken to the child about the measure. (Regulation 35 (3(a(v)(vii))(b(i)(ii))(c)) / 25/09/15
The registered person must ensure that when the independent person is carrying out a visit they inspect the premises of the home and the home’s records.(Regulation 44(2(b)) / 25/09/15
Full report
Information about this children's home.This is a large children’s home that provides care and accommodation for up to 30 children and young people in five purpose built bungalows. The children and young people have a visual impairment, learning and physical disabilities, or sensory impairment. One of the bungalows is also registered by the Care Quality Commission (CQC) and provides a specialist service to children and young people with high health and medical needs who require long-term ventilation or who have life-threatening or life limiting conditions. This establishment is owned by a large national charity.
Recent inspection history
Inspection date / Inspection type / Inspection judgementNo previous inspections - new registration.
Inspection Judgements
The overall experiences and progress of children and children and young people living in the home are / Judgement gradeGood
This is the first inspection of this service since its re-registration in February 2015. Children and young people make good progress in this home. They are respected as individuals with their own personalities and unique characteristics. Therefore, they are happy, settled and blossoming as individuals. In the words of one young person, living in the home is ‘fantastic’.
Staff develop warm positive nurturing relationships with children and young people. They are happy and relaxed in their company. One young person described them as ‘amazing’ and would not know what she would do without them in her life.
Parents have confidence in the care provided and praise relationships between staff and their children and young people. As one parent observed ‘when he comes home at weekends and we take him back , he runs in ,which says it all ,he’s happy there’. They are enthusiastic about the progress children and young people make and that they are involved in all aspects of their care. As one parent reflected, ‘He has achieved a great deal since he has been at the Centre. He has gained lots of confidence and this has been achieved by the full dedication of both management and staff’.
Most children and young people attend the on-site school whilst a few are supported to attend local schools. Their attendance is excellent and they are achieving good educational progress, supported by effective partnership working between care, health and education staff. Those children and young people who have previously not attended school due to complex health care needs are now accessing education. They are offered flexible timetables that take into consideration health and medical interventions.
Care, education and health staff work consistently together to enable children and young people fulfil their potential. For example, one young person has recently been supported to walk safely to and from the on-site school by himself. This is a considerable achievement and has involved detailed planning and preparation of the young person, their family and effective communication with all on-site staff.
Children and young people’s health needs are detailed within individualised plans, which take into consideration their views of how they wish their health care needs to be met. Their needs are assessed and reviewed by a multi-disciplinary team including physiotherapists, nurses, speech and language therapists and mobility specialists. Staff demonstrate good awareness of children and young people’s health needs and receive a comprehensive training programme. This includes autism awareness, epilepsy and infection control. Staff in the high dependency service complete core competency training in complex healthcare which ensures they have the appropriate knowledge and skills to meet the health care needs of children and young people in they care. Medication is appropriately administered, however not all care plans effectively detail administration guidance.
Children and young people with complex health and medical needs are supported in their own bungalow by a team of nursing and health and social care workers who are specifically trained to meet each young person’s needs over a twenty four hour period. This nurse led provision has been compromised on a few occasions when nursing staff have been unavailable on site and instead only providing telephone advice. Although this shortfall is not widespread across the provision, it is significant given the instability of children and young people’s health in this bungalow. The provider has responded to this shortfall and taken immediate steps to address this.
There is good decision making and planning for admissions and transitions. Staff are aware of the impact of change on children and young people and take considerable time to prepare them. For example, staff supporting one young person moving in to adult provision ensured his friend from the home accompanied to help him settle in. This gives him reassurance at a time of change.
Children and young people are supported to contribute their views and opinions in a variety of ways. All have access to a speech and language therapist, who develop communication passports. These are shared with family members and across the provision to ensure consistency of approach. Talking books have been developed to enable children and young people to effectively express their views about the quality of care they are receiving. Regular group meetings and daily interactions encourage and support children and young people influence all aspects of their care. For example, choice of activities and clothing. However, staff recording of their interaction does not always reflect the outcome for children and young people. Independent advocacy is accessed by some children and young people but is not consistently promoted in a timely way. Therefore opportunities children and young people have to positively influence their care or the home’s operation is limited.
Staff are passionate about supporting children and young people to experience a wide range of activities and events. As one parent observed, ‘they are caring, fun, take them out regularly to activities and places which the children can access’. This is safely facilitated through robust risk management planning and high staffing ratios. These have included attending pop concerts, football matches and canoeing. One social worker commented ‘it is good to hear about x doing so many different and exciting activities’.
Children and young people are supported to maintain contact and positive attachments to their family. Family photographs are displayed and celebrations supported. For example, staff accompanied one young person to his sibling’s christening. Staff demonstrate a good understanding of children and young people’s emotional response to seeing their family and support them perceptively. Equally, they are sensitive to parental feelings of loss when children and young people initially move. Family members are encouraged to support children and young people decorate their bedrooms when they first arrive to ensure they have familiar comforts around them.
How well children and children and young people are helped and protected / Judgement gradeGood
There is a strong and effective approach to risk management which helps keep children and young people safe. All have individualised risk assessment’s that identify areas of potential risk and how staff should manage children and young people’s behaviour in order to minimize these risks. Staff have a strong understanding of how to keep children and young people safe and implement strategies consistently, which reduce risk.
Children and young people’s behaviour improves significantly as a consequence of the effective behaviour management strategies. They take account children and young people’s triggers and clearly highlight strategies to manage behaviours. These strategies are actively reviewed and evaluated by the lead nurse specialist and shared in team meetings. This ensures that any new incidents are considered and staff are aware of presenting concerns. Staff are consistent in their approach and firm boundaries are in place. This means children and young people understand what is expected and as a result challenging behaviour has reduced. Staff also work effectively with parents to share behaviour management strategies. They ensure that the significant people in the children and young people’s lives are using consistent approaches. Parents report positive changes in children and young people’s behaviour.
Staff are appropriately trained in physical intervention, which is only used to manage immediate risks or dangerous situations. Incidents of physical intervention are reducing. Records however do not clearly reflect practice and do not consistently record de-escalation strategies or reflect children and young people’s responses. This significantly reduces the effectiveness of the registered manager’s evaluation and monitoring of incidents.
Children and young people who display self-injurious behaviour have been successfully supported through effective multi-disciplinary work. Staff have developed strategies alongside mental health, social work and health professionals, which have led to the significant reduction in the frequency and intensity of incidents for some children and young people. Staff are skilled and experienced at working with children and young people who self-harm. They are highly reflective and robustly evaluate their approach. However, safeguarding policies do not reflect this approach.
Children and young people do not gone missing from the home. They are continually under staff supervision and generally do not go out alone. There is a high vigilance about their contact with adults in the community and visitors to the home.
Children and young people benefit from living in a safe and well-maintained home. Each bungalow design meets the specific needs of children and young people living there. There are robust systems in place to keep children and young people safe from the risk of fire and other potential hazards. Health and safety risk assessments and individual evacuation plans are in place and regularly reviewed to ensure children and young people’s safety.
The impact and effectiveness of leaders and managers / Judgement gradeRequires improvement
The registered manager brings a wealth of knowledge and experience to the role. She is a qualified social worker, and holds the national vocational qualification level 4 registered manager certificate in social service.
She has a keen insight into the progress and development of each young person. She is protective of children and young people already in her care and carefully considers the impact of any new placement. This ensures greater stability for children and young people in the home.
Children and young people’s care is compromised because the employment histories of some newly recruited staff are not consistently verified.
Children and young people living in the bungalow registered to provide nursing care have on occasions not been able to access a nurse on site to lead on their healthcare. This has reduced the safeguards that come with having a nurse led service.
Children and young people’s progress is tracked through multi-disciplinary assessment, target setting and review processes that effectively inform care planning. Staff provide regular summaries to social workers, enabling them to measure progress against placement aims.
The registered manager welcomes external scrutiny and challenge and she uses these to improve the quality of care provided in the home. She has an established and effective quality assurance monitoring process that is informed by the views of children and young people, parents, social workers and other service providers. The leadership team has recognised some of the limitations with the current independent visiting arrangements that do not include a whole site scrutiny on each visit.
The registered manager has endeavoured to ensure that any staff vacancies has not impacted adversely on children and young people and has managed the shortfall with existing and sessional staff who are familiar with their needs. Where agency staff have been employed, it has been for a minimum three-month period to ensure they receive the same induction programme as permanent staff. This has ensured that children and young people are cared for by a staff team who are stable and familiar with their needs.
Staff benefit from regular supervision and appraisals, which enable them to reflect upon practice and recognise strengths and areas for development. There is a strong learning culture in place. Staff benefit from a thorough induction and comprehensive training programme that supports them to develop the necessary skills and knowledge to meet the complex needs of the children and young people in their care. There is no workforce plan which means strategy planning around staffing requirements is not formally captured.