18 February 2019
During a routine inspection
This announced inspection took place on the 18 and 19 February 2019.
The service had two registered managers, both registered paediatric nurses with an extensive background in providing care and support to children and young people living with complex care needs and the effects of brain injury. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.
Staff had been highly trained in recognising any potential harm and they were exceptionally knowledgeable about how to help protect children and young people from any actual, or potential, incident of harm. A sufficient number of skilled, safely recruited and competent staff were in post day and night.
Children and young people’s medicines, including medicines prescribed to be given ‘when required’ were safely administered by those staff who had been trained and deemed competent. Children and young people’s medicines were managed and disposed of safely. The recording of medicine administration was accurate and easy to understand using documentation adapted to be safe and practicable to use.
Staff were supported in their role with an effective induction, training and on-going clinical supervision, safeguarding supervision in some circumstances over-and-above recommendations and associated mentoring.
Appropriate risk management strategies were in place to help ensure people were kept as safe as reasonably practicable. Systems were also in place to support people in the event of an emergency such as need to evacuate the premises.
The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The registered managers, nursing, senior and care staff were knowledgeable about if and when a decision needed to be made in any person’s best interests.
People were supported by, and they had to access to, a wide range of health care services. Children and young people’s nutritional support needs were met and they were effectively supported to maintain a safe level of hydration and nutrition. Children and young people who were at risk of malnutrition were supported in a safe way.
Children and young people’s care came first and foremost and this care was provided by staff with compassion and respect.
Staff undertook this role with full consideration of children and young people’s needs and personal dignity. Children, young people and their relatives, were involved in the planning and delivery of the care that was provided. Advocacy arrangements were in place should any child or young person require this support.
Children and young people’s care plans contained detailed and sufficient up to date guidance. This was to help ensure that their care was as individualised as it could possibly be. Reviews of care plans were effective in identifying in a timely manner if and when changes were required. 'All About Me' plans and personal scrapbooks helped staff and visitors relate to each child and understand their individual likes and preferences. Children and young people were supported to be given the best opportunities to be involved in and living as meaningful lives as potentially possible as did their peers in the community. They were supported with a wide range of hobbies, interests, social awareness, interaction and stimulation. There were no boundaries as to the provision of equipment that could practicably be used to support children and young people lead positive and fruitful lives.
A complaints, suggestions and compliments process was in place and actions were taken to implement changes or sustain good practice although no complaints had been made during the 12 months prior to this inspection. Children, young people, staff and visitors were encouraged to provide their feedback and views on the quality of care provided in a variety of ways and service provision was seen to be altered according to those views.
Parents, carers and external multi-disciplinary professionals were extremely complimentary about the way the home was run by the two registered managers and also how staff dedicated themselves to the support of children and young people in their care, positively promoting those children as individuals who could, where possible, lead effective and happy lives alongside their peers in the community.
A range of effective audit and quality assurance procedures were in place. This was to help identify what worked well and any area that did not work as well as planned and where necessary service provision was be adjusted accordingly.
The registered managers fostered an open and honest culture within the staff team. Best practice was seen as being part of the day-to-day care people received. Innovation was considered and acted upon with a tangible benefit so that children and young people could live ordinary lives in extraordinary circumstances. The registered managers enabled those children and young people in their care to access the local community in range of ways to suit their wishes and capabilities.