Behind the Inspection Rating: Small steps to the top target

If Sunrise Children's Centre's move from a "good" to "outstanding" rating after its latest Ofsted inspection can be attributed to one particular change it would be its overhaul of care plans and targets.

"At the time of the last inspection we had numerous targets for all the children," says registered manager Lisa Kavanagh. "Now we've not only improved the care plans to make them much more focused upon the needs of the children, but also improved the consistency of targets."

Today, every disabled child and young person using the short breaks service has three targets that, crucially, are broken down into small steps that build to a bigger goal.

"For some of our young people a big target would be cleaning their teeth," explains Kavanagh. "The first step might be the recognition of their toothbrush or being able to apply the toothpaste onto the brush and it might take several weeks to get onto that stage.

"If we just said brushing your teeth is the target we'd all approach it in a different way. By doing it step by step there's a consistent approach for the child every time they come to us."

This incremental approach to achieving goals has worked well in all kinds of situations. One example was an autistic child who struggled with open spaces.

"Over the summer we took the child to Camber Sands which we chose because it's not too crowded," says Kavanagh. "At first he wouldn't leave the minibus. On the second trip we managed to encourage him off the bus for about five minutes. On the third trip we managed to encourage him to stand on one of the sand dunes.

"By the end of the summer the parents were delighted because it was the first time they were able to go, as a family, to the beach with him and enjoy the seaside, which the rest of us take for granted but for some of our young people is a real challenge."

Sunrise also helps children recognise their progress through the use of achievement charts that are displayed on their bedroom doors.

"When we were looking at the targets we felt it's all very well having targets in care plans but most of our children aren't going to be able to read their care plans," says Kavanagh. "So we got these big plastic sleeves that you can hang on the doors that can hold 15 or 20 photographs and pictures in them."

The pictures the centre puts in the charts reflect both the progress children make and their targets. There might be photos of them making pizza to remind them of an achievement, artwork they made during an activity or a picture that acts as a visual reminder of their current target, such as a toothbrush with the words 'my target is to clean my teeth' beneath it.

The children love the charts, says Kavanagh. "With some we have to keep setting up new picture charts because they keep trying to take them home or to school," she laughs. "The children will do artwork and ask to put it into their wall chart. For our young people, who obviously have limited reading and writing skills, this is a great way to start conversations."

The pictures and images on the wall chart are kept too. Eventually being put together into a scrapbook that the young people are given as a memento of the time they spent and the progress they made at Sunrise.

Fact File

• Name: Sunrise Children's Centre
• Location: Southborough, Kent
• Description: Despite the name, Sunrise Children's Centre is not a children's centre but a short breaks service catering to children and young people with disabilities and complex health needs in West Kent. The centre is run by Kent County Council and located in a purpose-built facility that includes a soft play area, six bedrooms, a spa and a sensory room. The centre's non-residential areas are also used by other services including holiday schemes run by Barnardo's.
• Number of children: 56 children aged five to 18.
• Ofsted reference number: SC068511

Helpful Hints

Think groups. "Sunrise is a group centre," says Kavanagh. "You can work with these children in isolation because their needs are so complex, but we try to get them to understand that it is about turn- taking and being tolerant of others. We plan the groups every six months and look at children's needs, so if we've got children that are noise sensitive and children that are very noisy we don't put them together."

Hire a nurse practice educator. Sunrise's practice educator nurse helps the centre offer its services to more children, says Kavanagh. The nurse oversees medication practices, trains staff and - when children have more complex needs - establishes necessary links with other health services.

Balanced hours mean better care. Sunrise changed staff hours to provide more consistency for children. "We had some shift leaders that were only contracted for 16 hours a week," says Kavanagh. "It was difficult because we'd see them for 24 hours and then they might not be in for another week while they found it difficult to keep on top of things. Now they do 30 hours and it works really well."