Children's Home, Residential special school run by Rowden House School Limited in Herefordshire

SC035625 Unique reference number 11 August 2010 Inspection date Julian Mason / Martha Nethaway Inspector Key Type of Inspection

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10 February 2010 Date of last inspection .

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This document may be reproduced in whole or in part for non-commercial educational purposes, provided that the information quoted is reproduced without adaptation and the source and date of publication are stated.

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You can obtain copies of The Children Act 2004, Every Child Matters and The National Minimum Standards for Children's Services from: The Stationery Office (TSO) PO Box 29, St Cripins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop

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About this inspection

The purpose of this inspection is to assure children and young people, parents, the public, local authorities and government of the quality and standard of the service provided. The inspection was carried out under the Care Standards Act 2000. This report details the main strengths and any areas for improvement identified during the inspection. The judgements included in the report are made in relation to the outcome for children set out in the Children Act 2004 and relevant National Minimum Standards for the establishment.

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The inspection judgements and what they mean

this aspect of the provision is of exceptionally high quality Outstanding: this aspect of the provision is strong Good: this aspect of the provision is sound Satisfactory: this aspect of the provision is not good enough Inadequate: 3 of 12 Inspection Report: SC035625

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Brief description of the service

This service is a registered children's home that also provides education on site to 44 young people of either gender with special educational needs. The home is registered to accommodate young people between the ages of 11 to 17 years. However, the home can accommodate some young people up to the age of 19. The service comprises of seven separate residential homes with a school, offices and leisure facilities. Living units are self contained, with six homes accommodating up to seven young people and one home accommodating up to two older teenagers. The home is located in a very rural area but reasonably close to several local towns.

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Summary

This was a full unannounced inspection that focused on key national minimum standards. Thirty-seven young people were living at the home and many were present during the visit. One young person participated in some of the inspection process and many more were observed interacting with staff and participating in their daily routines.

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Summary

Overall, young people are receiving an inadequate service. Staying safe and organisation are assessed as inadequate and many of the actions and recommendations that have been made are around these important outcome areas. In particular, the management of young people's behaviour and staffing arrangements are very poor. As a result of this inspection, 17 actions and 18 recommendations have been made which highlights significant shortfalls in the home's operation. The overall quality rating is inadequate. This is an overview of what the inspector found during the inspection.

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Improvements since the last inspection

At the last inspection in February 2010 managers were required to: implement a written behaviour management policy that sets out all the measures of control which may be used in the home; maintain an accurate record of measures of control used; and ensure fire drills and practises are carried out at suitable intervals. Also, a good practice recommendation was made to ensure staff meetings occurred at least monthly.

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Improvements since the last inspection

The home's behaviour management policy is still under review and being rewritten. Little progress has been made in the other areas highlighted. Consequently, the three actions and one recommendation have been repeated at this inspection.

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Helping children to be healthy

The provision is satisfactory. Generally, young people’s health needs are being met because they are supported to access the services they need. In most cases, health information is readily accessible to carers with some staff demonstrating a clear understanding of individual needs. However, some young people do not have health care plans or health information that is kept up to date. Consequently, it is not clear if carers are fully informed about some individual needs or current circumstances.

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Helping children to be healthy

Young people and their carers have regular access to the home’s nurses who play a key role in monitoring each individual’s health and well-being. The nursing team also provide timely, 4 of 12 Inspection Report: SC035625 practical advice and guidance about a range of health related matters. In addition, the administration of all medication is monitored and audited by trained care staff and nurses. Medication errors are being reported through these systems, resulting in poor practice and administration routines being tackled and addressed. However, some young people’s medical needs are not being met because they are frequently refusing to take their medication. These circumstances are well known by managers and staff but plans to address shortfalls in meeting these individual health needs are unclear. In addition, staff practice for administering prescribed antipsychotic drugs as and when needed is muddled and not supported by clear or robust

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Helping children to be healthy

protocols. Although administration records are being completed, decisions about when to administer or resulting outcomes are not monitored or fully evaluated for the impact on young people's health. Some young people’s health and safety is not being fully protected in these circumstances.

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Helping children to be healthy

Young people are provided with a range of different foods that sometimes reflects their choices and preferences. The catering team provide some choice for each mealtime that reflects the planned menus advertised around the homes. Some specific dietary needs are catered for including those relating to culture, religion, food intolerance and allergies. However, where medical concerns have been raised about young people’s body weight, little is being achieved currently to improve an individual's health in this area. Although some care plans provide helpful guidance, outcomes for young people in terms of their weight remain the same.

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Protecting children from harm or neglect and helping them stay safe

The provision is inadequate. Overall, arrangements for keeping young people safe are inadequate. In particular, some of the home’s behaviour management practices are very poor. In addition, some recent formal notifications to the regulator and local authority safeguarding teams indicate some poor staff practices that have exposed young people to additional risks and harm. In one case, the failure of staff to provide basic care resulted in a young person suffering from severe sunburn. In response to this event, managers have reinforced the roles and responsibilities of carers by issuing new and updated practice guidance to staff.

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Protecting children from harm or neglect and helping them stay safe

Managers use well-established reporting systems and routines to disclose notifiable events to the regulator and the local adult and children’s safeguarding teams. In some cases, staff practice has been brought into question and managers have been asked to carry out investigations into these events. Some investigations have not been robust, failing to clearly highlight staff practice issues or organisational shortfalls. Young people’s welfare and safety have not always been robustly promoted through these investigations. Managers have responded to this feedback by strengthening the arrangements for investigating alleged poor staff practice.

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Protecting children from harm or neglect and helping them stay safe

In addition, other notifications highlight that the safety of young people and staff is not always promoted. Some staff behaviour and conduct has been questioned in terms of the contact they have with young people outside of the service. The home’s written guidance and child protection training is not clearly presented in a way that helps define safeguarding practice or professional boundaries in this area. Managers are currently addressing these shortfalls and are in the process of taking remedial action to improve practice.

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Protecting children from harm or neglect and helping them stay safe

For a number of staff, child and adult protection training is not ongoing. This brings into question the ability of the whole staff team to fully implement and understand the home’s 5 of 12 Inspection Report: SC035625 safeguarding policies. However, some carers are clear about their responsibilities and the home’s reporting systems in terms of keeping young people safe.

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Protecting children from harm or neglect and helping them stay safe

Arrangements and practices for the management of some young people’s behaviour are poor and unsafe. Some measures of control used by staff which are sanctioned by managers fall outside of the home’s agreed behaviour management policy. In addition, the bound books that the home is required to keep regarding the use of sanctions and physical interventions are very poorly kept. For example, information headings do not consistently follow what is required and entries are very brief. Staff handwriting is sometimes difficult to read and unprofessional language is used to describe some young people’s challenging behaviours. There is no indication that the views and opinions of young people are sought after an intervention has taken place. Loose-leaf records are also completed to describe the actions staff take to manage risk and promote safety. These records are also variable in quality and content and do not always match

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Protecting children from harm or neglect and helping them stay safe

entries made in the bound books. The storage and access to some of these records is chaotic and fragmented. It is difficult to confirm that all physical interventions are being recorded.

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Protecting children from harm or neglect and helping them stay safe

Some young people are physically restrained on a regular basis. However, available records do not provide enough information for managers to evaluate whether these interventions are proportionate or appropriate. Managers are signing records, but there is no indication that individual events are being assessed. Young people’s safety is not being promoted because oversight and scrutiny of staff practice in relation to physical intervention is poor. Also, it is not clear how measures of control, discipline and restraint currently being used in the home are made clear to placing authorities, social workers, young people, parents or carers.

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Protecting children from harm or neglect and helping them stay safe

Furthermore, the restriction of some young people’s liberty in isolation is being used as a routine method of physical restraint. This measure is not included in the home’s behaviour management policy but is sometimes included in intervention plans agreed through multi-disciplinary meetings. Staff are holding young people’s bedroom doors closed while they are alone inside. Intervention plans highlight strict criteria for its use along with a robust monitoring system when these events occur. However, records are variable in quality and do not always provide enough information to determine whether the use of this measure is in proportion to the behaviours or risks presented. No discernable evaluation is taking place with this measure of control to ensure young people are protected from its inappropriate use. The routine and frequent use of this intervention for some young people is completely inappropriate

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Protecting children from harm or neglect and helping them stay safe

Some staff who are working with young people are not trained in the home’s behaviour management techniques or methods of control. Young people are not being served well by these circumstances because they present real challenges in terms of staff deployment and effectiveness. When needed, staff have to call for support from other homes on the site to ensure that only trained staff assist with physical interventions. When this happens, staff to young people ratios are affected, sometimes disabling the normal operation of a shift and the one-to-one support that each young person has been assessed as needing.

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Protecting children from harm or neglect and helping them stay safe

Where intervention plans look to support staff in the supervision of young people and their behaviour, in practice they fail to do so. For example, one plan identifies that staff should rotate every couple of hours to ease the load and intensity of one-to-one support, currently, this does not happen. Some staff expressed feeling worn out and concerned that the supervision of some young people is not shared. Very few formal opportunities are afforded to staff to talk 6 of 12 Inspection Report: SC035625 about behaviour management practice or routines. Some staff who take on a good deal of this work expressed feeling isolated and sometimes unsafe, with a lack of concern or interest from managers about how they are feeling.

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Protecting children from harm or neglect and helping them stay safe

Young people’s health and safety is not fully protected when prescribed antipsychotic drugs are used as and when needed to help manage behaviour. The use of this restraint is not clearly defined within policy, guidance, training or the home’s behaviour management framework. Where antipsychotic medication is being used in this way, practice across the home is not consistent or robust enough to safeguard young people. Although prescription instructions are being followed, decisions about when to use the medication are variable and do not follow any clear assessments, permissions or reporting procedures. Current practice places young people at risk of the inappropriate use of this type of restraint because it is not robustly monitored or supervised. Managers are aware of the need to develop stronger protocols and monitoring arrangements to ensure young people only receive this intervention when absolutely

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Protecting children from harm or neglect and helping them stay safe

Further areas of the home’s operation fail to fully promote young people’s safety or protection. For instance, some complaints made about the service do not detail information about resolutions or if complainants are satisfied with the achieved outcomes. The use of closed circuit television in bedrooms is not transparent or approved in a way that clearly demonstrates the promotion of young people’s privacy, welfare or safety. Some health and safety routines in relation to fire prevention are not robust enough to ensure staff can respond in an emergency and keep young people safe.

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Protecting children from harm or neglect and helping them stay safe

Young people’s protection is not fully supported by the recruitment, selection and vetting processes for new staff. Generally, systems for determining the suitability of staff to work with young people are in place. However, some records show that information is missing for some agency staff and for newly recruited employees from overseas.

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Helping children achieve well and enjoy what they do

The provision is satisfactory. Overall, young people are receiving a satisfactory level of support. Most young people are on a one-to-one staff ratio which sometimes affords personalised quality support. However, this is dependant on the availability of suitability experienced, skilled and competent staff who know young people well. In some homes, the use of cover and agency staff is high; bringing into question the service’s ability to deliver consistent care and support that matches individual needs. Sometimes the one-to-one support is diluted because of the increased needs of others. This can take the form of staff being asked to support other homes or young people in difficulty while still having one-to-one responsibilities. Consequently, as staffing ratios reduce, the impact becomes greater on those young people whose behaviour is less risky or demanding. As a consequence, some young people do not always consistently receive the one-to-one support

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Helping children achieve well and enjoy what they do

and attention outlined in their plans of care.

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Helping children achieve well and enjoy what they do

Much of young people’s free time is filled with basic and familiar routines that are repeated on a daily basis. In addition, during the school holidays little difference in the day-to-day routines are experienced by many young people. The new Registered Manager has recognised the need to provide better guidance that promotes more individualised support and activity. However, the implementation of weekly planners for each young person is patchy and inconsistent. Where staff are motivated to promote personal interests, hobbies and a greater 7 of 12 Inspection Report: SC035625 range of supportive routines these are sometimes cancelled or delayed because of staffing difficulties.

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Helping children make a positive contribution

The provision is satisfactory. Generally, permanent staff are well informed about young people’s needs because they have access to a range of information that helps them know how to care for each individual. However, not all young people have placement plans or up-to-date information that describes their current needs. In addition, some care routines are being carried out which are not in any individual plans of care. Young people’s placements are being formally reviewed. Staff produce reports that help inform families and social workers about the progress and development each young person makes.

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Helping children make a positive contribution

Young people are supported to maintain constructive contact with their families and others who play a significant role in their lives. Agreed contact plans are well known including necessary supervision arrangements to ensure young people are safe. Staff work in a way that ensures arrangements are positive and meaningful. Young people are asked for their views about their daily lives and they are involved in some decision making that relates to the care and support they receive. Young people's daily support is sometimes effectively delivered in partnership with carers because of the skill, dedication and experience of some individual staff team members. Their knowledge about how young people communicate their wishes and feelings is significant in delivering personalised, high quality care.

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Helping children make a positive contribution

Some very positive and professional relationships exist between some care staff and young people. However, some staff are meeting with young people outside of any agreed contact or moving-on plans. In some cases, boundaries have become blurred and expected standards of professional behaviour and conduct have lapsed. In response to these circumstances, managers have issued new guidance and reminders about staff roles and responsibilities.

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Achieving economic wellbeing

The provision is satisfactory. Young people are living in accommodation that is barely satisfactory because individual homes are variable in quality, standards of cleanliness and décor. Nearly all of the homes contain some unpleasant odours and smells which vary across the site. Some homes are cleaner and tidier than others. Many fixtures, fittings and furnishings are worn and old, adding to the generally scruffy presentation of some living areas. A renewal and replacement programme has started, but it is unclear how long improvements will take before young people benefit from these measures.

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Achieving economic wellbeing

Young people are being supported to develop skills, knowledge and experience in their preparation for moving into adult services. However, it is not clear if what staff are doing is matched to individual needs as written transition plans are not in place. Although this is an area that staff provide a strong focus to, assessed needs may be missed because information is lacking.

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Organisation

The organisation is inadequate. 8 of 12 Inspection Report: SC035625 Overall, staffing and management arrangements in the home are inadequate. Young people are not being supported by a sufficient number of experienced, trained or qualified staff who have successfully completed their induction and probationary periods. Some arrangements for helping young people manage their behaviours and associated risks are unacceptable. Some young people’s welfare and protection is not being supported by safe staff practices.

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Organisation

Furthermore, not all staff feel supported in their work, although some staff are very positive about some managers and how they help them in their day-to-day roles. However, managers and supervisors are failing to provide regular work based supervision for many staff. There are very few staff meetings where teams can discuss the home's practices or the work involved in meeting young people's needs. Staff do not have their performance formally appraised nor do they have current personal development plans.

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Organisation

The numbers of different staff working in some of the houses is high and unacceptable. Very few of the shift teams have a full a compliment of permanent staff despite occupancy levels being high. For some shift teams on some days, high numbers of agency and cover staff mean that young people do not always have staff who really know them or their needs. In these circumstances, some permanent members of staff feel unsupported, while others lack direction and close supervision of their work.

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Organisation

The home has a written Statement of Purpose and young people's guide which are made available to people who need to know about the service. However, it omits important information about who works in the home or their skills, experience and qualifications.

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Organisation

The promotion of equality and diversity is satisfactory. Many permanent staff know about young people's needs in relation to their identity and backgrounds. Many staff are aware of how to help and support young people in a fair and non-judgemental way.

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Organisation

Services being delivered to young people are being monitored by senior managers within the organisation. A recently conducted monitoring visit has resulted in managers becoming fully aware of the home’s strengths, weaknesses and outcomes for young people. As a result of this information, many areas of the home's operation have been identified as needing development and improvement. Also, new management and staffing arrangements are in the process of being introduced and implemented. A senior manager of the home has produced an updated written response however, progress has been identified as slow in some areas.

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Organisation

The service has recruited a new manager who is very experienced. The new Registered Manager has a clear insight and understanding into the residential task and the complexity of managing a large service for young people with special educational needs. A new quality assurance framework has just been introduced which some managers have already begun to use to assist with improving services for young people.

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Statutory requirements

This section sets out the actions, which must be taken so that the registered person meets the Care Standards Act 2000, The Childrens Homes Regulations 2001 and the National Minimum Standards. The Registered Provider must comply with the given timescales.

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Due date Action Standard

9 of 12 Inspection Report: SC035625 30 September 2010 keep under review and where appropriate, revise the home's Statement of Purpose (Regulation 5) 30 September 2010 prepare a written placement plan for all children about how on, a day to day basis the child will be cared for, and their welfare safeguarded and promoted by the home (Regulation 12(1)(a)) 31 August 2010 ensure that electronic or mechanical monitoring devices for the surveillance of children are not used in a children’s home, except for the purpose of safeguarding and promoting the welfare of the child concerned, and follows all the requirements outlined in regulation(Regulation 22(a)(b)(c)(d)) 30 September 2010 ensure that any special dietary needs of a child accommodated in the home which is due to a health diagnoses is met (Regulation 13(2)) 31 August 2010 ensure that the health of all children is promoted and protected (Regulation 20(1))

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Due date Action Standard

31 August 2010 ensure any medicine which is prescribed for a child is administered as prescribed (Regulation 21(2)(b)) 31 August 2010 ensure that a written record is made of any complaint, the action taken in response, and the outcome of the investigation (Regulation 24(5)) 31 August 2010 ensure that within 24-hours of the use of any measure of control, restraint or discipline in a children’s home, a written record is made in a volume kept for the purpose which shall include all the information set out in children’s homes regulations (Regulation 17(4)) 30 September 2010 prepare and implement a written policy which clearly sets out the measures of control, restraint and discipline which may be used in the home and the means whereby appropriate behaviour is to be promoted (Regulation 17(2)(a)(b)) 31 August 2010 ensure that the children’s home is conducted so as to promote and make proper provision for the welfare of children

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Due date Action Standard

accommodated there (Regulation 11(1)(a)) 30 November 2010 ensure that all parts of the children’s home used by children are kept clean and reasonably decorated, maintained and suitably furnished and equipped (Regulation 31(2)(c)(d)(e)(f)) 31 October 2010 ensure that the children’s home is kept free from offensive odours (Regulation 31(3)) 31 August 2010 ensure by means of fire drills and practises at suitable intervals, that the persons working at the home and so far as practicable, young people accommodated there are aware of the procedure to be followed in the case of a fire (Regulation 32(e)) 10 of 12 Inspection Report: SC035625 31 August 2010 obtain for all staff (including agency staff), before they start work at the home, all information set out in schedule 2 of the children’s homes regulations which can be verified from recruitment records (Regulation 26) 30 September 2010 ensure that all staff employed at the home receive appropriate

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Due date Action Standard

training, supervision, appraisal and are enabled to obtain further qualifications appropriate to the work they perform (Regulation 27) 31 December 2010 ensure a sufficient number of suitably qualified, competent and experienced persons working at the home (Regulation 25(b)) 31 December 2010 ensure that the employment of any persons on a temporary basis at the children’s home will not prevent children from receiving such continuity of care as is reasonable to meet their needs. (Regulation 25(2))

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Recommendations

To improve the quality and standards of care further the registered person should take account of the following recommendation(s): • ensure the provision of training for all staff, including ancillary staff and agency staff in the prevention of abuse, recognition of abuse (including its recognition in non-verbal children), dealing with disclosures or suspicions of abuse, and the home’s child protection procedures. This training is ongoing for the staff group in keeping with the aims and objectives of the home (NMS 17.8) • ensure there is a clear written policy, procedures and guidance for staff based on a code of conduct setting out the control, disciplinary and restraint measures permitted and emphasising the need to reinforce positive messages to children for the achievement of acceptable behaviour (NMS 22.2) • ensure any measures taken to respond to unacceptable behaviour are appropriate to the age, understanding and individual needs of the child, for example taking into account that

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Recommendations

unacceptable or challenging behaviour may be the result of illness, bullying, certain disabilities such as autism, or communication difficulties (NMS 22.5) • ensure all staff of the home are aware of, trained in, and follow in practice the registered person’s policy. Training covers reducing or avoiding the need to use physical restraint. All staff have signed a copy of the policy and evidence of this is retained on their personnel file. (NMS 22.8) • ensure measures of control, discipline and restraint used by the home are made clear to the placing authority, child, parent/s or carers before or, in an emergency placement, at the time the child is to move into the home (NMS 22.12) • ensure all children are given an opportunity to discuss incidents and express their views either individually or together where unsafe behaviour can be discussed by children and adults. When disciplinary measures or restraint are used, children are encouraged to write

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Recommendations

or have their views recorded and sign their names against them if possible in the records kept by the home (NMS 22.14) 11 of 12 Inspection Report: SC035625 • ensure staff meetings address issues of control and agree practicable and acceptable means of responding to behaviour and control problems of both the current group of children and of individual children in the light of their histories, any current problems and placement plans (NMS 22.16) • ensure there is regular testing of emergency lighting, fire alarms and fire fighting equipment (NMS 28.7) • ensure relationships between staff and children are based on mutual respect and understanding and clear professional and personal boundaries which are effective for both the individuals and the group (NMS 21.1) • ensure all children are given individualised support in line with their needs and wishes, and children identified as having particular needs receive help, guidance and support when

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Recommendations

needed or requested (NMS 7.1) • ensure staff implement the leaving care plan and any aspects of the transition plan which are the responsibility of the home. These plans clearly outline the arrangements for areas listed in national minimum standards (NMS 6.2) • ensure staff meetings occur at least monthly, and include discussion of both the home’s work in caring for individual children and the management of the current child group, together with review of the home’s practices. Meetings have an agenda and are minuted. (NMS 28.10) • ensure that 80% of the workforce are qualified to at least National Vocational Qualification at Level 3 in Working with Children and Young People (NMS 29.5) • ensure all staff and others working in the home (including temporary, contacted, seconded and ancillary staff) receive at least one and half hours of one-to-one supervision from a senior member of staff each month (NMS 28.2)

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Recommendations

• ensure new staff receive one-to-one supervision at least during the first six months of their employment (NMS 28.2) • ensure agency staff and those employed infrequently to cover staff absences receive one-to-one supervision no less frequently than after eight shifts worked in the home (NMS 28.2) • ensure supervision of staff working with children addresses the areas outlined in national minimum standards (NMS 28.4) • ensure all staff have their performance individually and formally appraised at least annually by their line manager. The employee’s personal file contains a record of the appraisal showing the level of performance achieved, targets for the coming year and the agreed training needs to be met within the following year as part of the individual’s personal development plan. (NMS 28.7) 12 of 12 Inspection Report: SC035625

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