Setting

DS0000047199.V300451.R01.S.doc Version 5.2 Page 1 RESIDENTIAL FAMILY CENTRE

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Lead Inspector Caroline Wilson Announced Inspection 29th August 2006 10:00 DS0000047199.V300451.R01.S.doc Version 5.2 Page 2 The Commission for Social Care Inspection aims to:

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• Put the people who use social care first • Improve services and stamp out bad practice • Be an expert voice on social care • Practise what we preach in our own organisation

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Reader Information Document Purpose Inspection Report Author CSCI Audience General Public Further copies from 0870 240 7535 (telephone order line) Copyright This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Internet address www.csci.org.uk DS0000047199.V300451.R01.S.doc Version 5.2 Page 3 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Residential Family Centres. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop

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Every Child Matters, outlined the government’s vision for children’s services and formed the basis of the Children Act 2004. It provides a framework for inspection so that children’s services should be judged on their contribution to the outcomes considered essential to wellbeing in childhood and later life. Those outcomes are: • Being healthy • Staying safe • Enjoying and achieving • Making a contribution; and • Achieving economic wellbeing.

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In response, the Commission for Social Care Inspection has re-ordered the national minimum standards for children’s services under the five outcomes, for reporting purposes. A further section has been created under ‘Management’ to cover those issues that will potentially impact on all the outcomes above.

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Copies of Every Child Matters and The Children Act 2004 are available from The Stationery Office as above. This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000047199.V300451.R01.S.doc Version 5.2 Page 4

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Name of service

St Michael`s Fellowship, 84 Herne Hill Road

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manager (if applicable)

Type of registration Residential Family Centre

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of places

DS0000047199.V300451.R01.S.doc Version 5.2 Page 5

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Conditions of registration:

1. The maximum number of adult members of families residing at any one time shall not exceed five. 2. Before a fifth family is admitted, the registered person shall notify the registration authority of the additional staffing arrangements to be put in place.

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Brief Description of the Service:

'84', is a residential family centre run by St Michael's. It is an establishment that provides accommodation, assessment and support for children and their parents. Emphasis has been placed on offering a service to families where there is parental mental ill health. The parent's capacity to respond to the children's needs and to safeguard their welfare is assessed and the parents are given such advice and guidance as is considered necessary to enable them to do so. Parents are therefore 'looking after' their own children whilst their 'parenting skills' are assessed by the staff team. The centre also seeks to make external counselling available for some of the parents, if considered necessary. The stated aims include: ' informing the professional network around a family of the needs of the children; the capacities of the family to meet those needs; and identify factors, which either promote or isolate children

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Brief Description of the Service:

from experiences, which will give them the opportunity to grow and develop as any other healthy child". The home manager and staff team undertake formal twelve-week assessments. Final reports aim to identify both risk and protective factors and make recommendations for after-care. A variety of models for 'interventions with families' are used in the centre, the staff aiming to "understand the childhood experiences of parents of being parented, in order to understand their values, beliefs and practices". DS0000047199.V300451.R01.S.doc Version 5.2 Page 6

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SUMMARY

This is an overview of what the inspector found during the inspection.

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SUMMARY

The inspection took place on 29 August 2006. Staff and service users were spoken with. The inspector also looked at various policies and procedures, service user’s files and had a tour of the premises.

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What the service does well:

There is a good staff mix of race, gender and experience. Training offered to staff is good. A cross team working policy is to be implemented to ensure all staff have access to support and supervision. The home is clean and well decorated. A service user described it as feeling, “like home.” Contracts, key- working sessions and house meetings ensure that service users are aware of the purpose of the placement and that they are kept updated of their progress. Health and safety inspections are undertaken within timescales. Complaints are dealt with, within timescales. Staff have good knowledge of child protection procedures. Service users have good access to health services.

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What has improved since the last inspection?

Staff have to get clearance before any information is removed from the premises.

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What they could do better:

Information about how to complain needs to be consistent in all the information given to service users. Key-working sessions are to be recorded in accordance with relevant timescales. Dates of house meetings need to be recorded. DS0000047199.V300451.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. DS0000047199.V300451.R01.S.doc Version 5.2 Page 8

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CONTENTS

Enjoying and Achieving - There are no NMS that map to this outcome

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CONTENTS

Statutory Requirements Identified During the Inspection DS0000047199.V300451.R01.S.doc Version 5.2 Page 9

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The intended outcomes for these standards are:

• Families have access to health care, education, employment and leisure activities which promote their good health and well being, including their mental health, in a safe environment.(NMS 4)

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JUDGEMENT – we looked at outcomes for the following standard(s):

Outcome in this area is good. This judgement has been made using available evidence including a visit to this service.

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JUDGEMENT – we looked at outcomes for the following standard(s):

Temporary registration with medical services within the vicinity ensures that service users and young people health needs are safeguarded. Staff are able to get an accurate assessment of family life by ensuring that service users and their families maintain the lifestyles that they had prior to being placed.

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EVIDENCE:

Two service user’s files were looked at. Relevant and detailed information is available on file relating to adults and young people, including immunisation records, health visitor notes and consent to medical treatment. The service user spoken to said that they have temporarily registered with a GP in the area. They added that they make their own appointments with medical professional and that the health visitor comes to the unit frequently.

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EVIDENCE:

The manager told the inspector that service users are responsible for their children’s medication. Service users’ ability to administer medication for themselves and their children is part of their assessment.

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EVIDENCE:

The manager told the inspector that service users were encouraged to stay in their employment whilst placed at the unit. This gave them the opportunity to make an assessment of the dynamics of family life more accurately. The manager said that they undertook an assessment of this nature recently. CSCI have been informed by the Director of the unit that continuing employment is considered on a case-by-case basis. It would not always be appropriate for a parent to continue in employment.

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EVIDENCE:

Service users are encouraged to attend play therapy sessions with their child. The member of staff that runs this group told the inspector that, “ a child’s emotional development is very significant.” A young person’s experience of neglect, witnessing domestic violence may affect their ability to bond and form DS0000047199.V300451.R01.S.doc Version 5.2 Page 10 secure attachments with their primary carer. One service user spoken to said that these sessions, “teach you a lot of stuff…you basically get to understand how babies feel.” DS0000047199.V300451.R01.S.doc Version 5.2 Page 11

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The intended outcomes for these standards are:

• Parents and children enjoy a level of comfort and security within the centre based on mutual respect and an understanding of what may have an adverse effect on other residents.(NMS 8) • The privacy of parents and children is respected and information about them is handled with appropriate confidentiality.(NMS 9) • Parents and children are able to complain if they are unhappy with any aspect of the centre. They are confident that any complaint will be taken seriously, investigated and addressed without delay and they will be kept informed of the progress.(NMS 10) • The welfare of children is promoted, children are protected from abuse, and an appropriate response is made to any allegation or suspicion of abuse.(NMS 11) • Families are protected from abuse, neglect and self-harm.(NMS 12) • All significant events relating to the protection of children or vulnerable adults within the centre are notified by the registered person to the

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The intended outcomes for these standards are:

appropriate authorities.(NMS 13) • There is careful selection and vetting of all staff and anyone else resident on the premises.(NMS 15) • Parents and children stay in accommodation that provides physical safety and security.(NMS 22) • Parents and children enjoy a level of comfort and security within the centre based on mutual respect and an understanding of what may have an adverse effect on other residents.(NMS 8)

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JUDGEMENT – we looked at outcomes for the following standard(s):

9, 10, 11, 12, 22 Outcome in this area is good. This judgement has been made using available evidence including a visit to this service.

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JUDGEMENT – we looked at outcomes for the following standard(s):

Complaints are dealt with speedily, effectively and in accordance with relevant policies and procedures. Staff have extensive knowledge of child protection procedures this ensures good outcomes for young people as any concerns are passed to relevant organisations within timescales. Robust vetting procedures for visitors ensure vulnerable people are kept safe.

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EVIDENCE:

DS0000047199.V300451.R01.S.doc Version 5.2 Page 12 Two complaints have been recorded since the last inspection. These relate to equipment in the unit not working. Engineers were called to fix the problems within ten days. Residents were informed of the outcome of their complaints during this time. This is within relevant timescales. The service user spoken to said that they were aware of the complaints procedure. They added that they had, “received a copy of the complaints form.” The complaints procedure written in the resident’s contract differs from that written in the complaints book. The contract advices service users to, ‘talk to their social worker, advocate, solicitor or the manager in the first instance. The complaints book advises staff, ‘ it is important that all types of complaints from residents, including minor, day-to-day matters.’ Service users are to put complex matters in writing. Staff to support service users with recording where

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EVIDENCE:

necessary. A requirement has been made about this.

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EVIDENCE:

The gas safety inspection took place on 16 March 2006. Environmental and food inspection took place on 1 December 2005. The water samples, ‘meet the suggested standards for the tests performed.’ Portable Appliance Testing (electrical) took place in September 2005. A Health and Safety Inspection of the premises was conducted in January 2005. Fire drills are undertaken regularly. This is in accordance with relevant legislation. A routine fire inspection took place on 9 August 2006. The Director of the unit informed CSCI that fire drills are done more frequently if a new family moves in between monthly drills.

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EVIDENCE:

The inspector looked at two family service users’ files. The contract gave service users information on data protection. This specified details of professionals who may have access to their case notes. Service users’ permission is requested before the unit tell anybody else, with the exception of the police in an emergency. Service users are also told where information will be stored. For example whether written or on computer. They are also advised what would happen to this information once their placement had ended. This included the timescales for destruction. Staff now have to obtain permission from managers before being given permission to take files from the unit. This information is logged.

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EVIDENCE:

Four significant incidents involving a service user and their child occurred since the last inspection. Three of these were of a child protection nature. Relevant professionals were notified within relevant timescales. The contract advises service users of procedures put in place where there are immediate concerns for the young person’s welfare. Where a service user wishes to leave prior to the end of the placement, staff will call the police and service users will not be able to leave with their child, unless this is agreed in a prior meeting.

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EVIDENCE:

The unit expects service users to behave in a respectful way towards others. The contract states that racist, sexist or homophobic abuse, whether verbal or DS0000047199.V300451.R01.S.doc Version 5.2 Page 13 physical is not tolerated. An emergency meeting may be called to determine the viability of the placement. Service users may use the complaints procedures if they believe that they are being discriminated against by staff. The service user spoken to told the inspector that up until a week ago, theirs was the only family resident at the unit.

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EVIDENCE:

Restrictions on contact are clearly written on file. A risk assessment is completed to assess whether the risk is low, medium or high. Protective measures are written should the person turn up at the unit. This may involve staff refusing to open the door or the police being called. The risk is reviewed weekly during staff meetings. Service users’ contract advises them that they are responsible for any visitors to the unit. Otherwise visitors need to be agreed by social services and police checked prior their visit. Visitors can stay for a maximum of two hours. The Director of the unit informed CSCI that the length of time visitors can stay is more flexible. It is dependant on what is going on in the building, how many families are resident and the particular needs of the family. DS0000047199.V300451.R01.S.doc Version 5.2 Page 14

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The intended outcomes for these standards are:

• Parents and children are admitted to and leave the centre in a planned and sensitive manner.(NMS 2) • Children and their parents have their needs assessed and written plans outline how the assessment will be undertaken.(NMS 3) • Parents and children using the centre feel well-informed and party to decisions made.(NMS 6) • Parents and children enjoy sound relationships with staff based on honesty and mutual respect(NMS 7)

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JUDGEMENT – we looked at outcomes for the following standard(s):

3, 6, 7 Outcome in this area is good. This judgement has been made using available evidence including a visit to this service.

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JUDGEMENT – we looked at outcomes for the following standard(s):

Service users enjoy relationships with staff based on mutual trust and respect. Service users are given the opportunity to improve the services that they receive. The induction process gives service users an understanding of the expectations of the placement.

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EVIDENCE:

The service user told the inspector that they had come to visit the unit 3- weeks before they were placed. They were shown around the unit and given a copy of the Statement of Purpose. They added that they, “ have an understanding of what the placement is about,” due to the information provided in the contract. The inspector looked at the placement plans on two service user’s files. Both had signed contracts on them outlining the scope of work that would be undertaken. This includes any financial aspects of the case. For example if the placing authority needed to provide equipment or financial support for service users. The contract is set out following a meeting between the service users, the unit and placing authority. Expectations of all parties are outlined explicitly. Also included are background information, the placement objectives, contact arrangements with professionals and how the assessment will be undertaken. The placement plan is updated on a weekly

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EVIDENCE:

basis and any changes in risks identified. Risks are measured on a low, medium or high basis. DS0000047199.V300451.R01.S.doc Version 5.2 Page 15 Service users have weekly key-work sessions with their key-worker. Information, which forms part of the assessment, is recorded in daily logs. Each sheet is signed by the service user to confirm that they have read it. They can make factual amendments where necessary. The service user spoken to said that they have not had to make any changes to the daily log, as, “so far, everything written is correct.” In addition they told the inspector that these logs helps them get an understanding of their progress. The manager told the inspector that she, “felt better that residents are knowledgeable about observations. We try to work in an open and honest way. There are no secret recordings. Everything is very open and above board.” Only one page in the daily log was not signed by a service user.

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EVIDENCE:

Key-working sessions are used for information sharing, emotional issues and to induct service users on the policies and procedures of the unit. The service user spoken to said that they had, had two sessions since placed two weeks prior. They found them “useful” and they discuss how the placement is progressing. In one service users’ file, three weeks of key-working sessions had not been written up. A file note stated that this would be completed once the key-worker had returned from annual leave. A requirement has been made about this.

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EVIDENCE:

The service user spoken to said that they find input from staff, “constructive.” Staff make observations of service users’ care of their children. The service user told the inspector that when staff make suggestions, staff’s tone of voice and affect, means that they are not offended when suggestion are made about feeding or changing their child. One member of staff spoken to said that they are conscious of the power imbalance between staff and service users. Staff try to balance this by ensuring that no one member of staff makes a decision during assessments. It was their belief that all staff in the unit ensures that all service users are treated equally by staff.

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EVIDENCE:

Nine house meetings have been held since the last inspection. Two of these are undated. General feelings, updates in changes within the unit, cleaning arrangements and any repairs pointed out by service users were discussed. The service user spoken to said that during their stay they have not had a house meeting, as until a few days ago, as no other service users were placed. Service users are able to give feedback on their placement via first review feedback forms. Service users are asked to give their feedback on how useful the previous two-weeks had been, their opinions on key-work and play sessions and what improvements, what they would like to stay the same for the next phase of the placement. DS0000047199.V300451.R01.S.doc Version 5.2 Page 16

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The intended outcomes for these standards are:

• Parents and children live in pleasant, well designed and maintained surroundings providing sufficient space and adequate facilities to meet their needs.(NMS 19) • Parents and children enjoy homely accommodation, decorated, furnished and maintained to a high standard, providing adequate facilities for their use.(NMS 20) • Shared spaces complement and supplement residents’ private rooms.(NMS 21)

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JUDGEMENT – we looked at outcomes for the following standard(s):

Outcome in this area is good. This judgement is made using available evidence including a visit to this service.

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JUDGEMENT – we looked at outcomes for the following standard(s):

Service users enjoy the comfort of a clean, well-furnished environment, which make them feel at home.

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EVIDENCE:

Each family have their own bedroom, which is furnished with beds, cot, wardrobes, a chest of drawers and bedding and furnishing. The service user spoken to said that they found the unit, “clean…. it makes you feel at home.” At present, they did not have to share their bathroom, but this might change if another service unit moves into the unit. The service user said that there is a communal room that service users can sit in. They found the kitchen area, “nice and clean.”

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EVIDENCE:

Hot water temperatures are not maintained for between 41 and 46 degrees centigrade. The manager stated that she understands that this is an issue being dealt with by senior management. DS0000047199.V300451.R01.S.doc Version 5.2 Page 17

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The intended outcomes for these standards are:

• Parents and children who use the centre know what they can expect, how they will be treated, how the centre operates, and have had this information in written form prior to admission.(NMS 1) • Parents’ progress is recorded to reflect their ability to care for the children in a safe manner, promoting their welfare.(NMS 5) • Parents and children receive the care and services they need from competent staff.(NMS 14) • Staff are sufficient in number, experience and qualification to understand the needs of parents and children and who are able to respond appropriately when required.(NMS 16) • Parents and children receive a service from staff who are themselves supported and guided in safeguarding and promoting the children’s welfare.(NMS 17) • Staff are trained and enabled to carry out the role to which they are appointed.(NMS 18) • Parents and children enjoy the stability of an efficiently run service and purchasers have confidence that they are getting value for money.(NMS

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The intended outcomes for these standards are:

23) • The service’s work with parents and children is continually adapted in the light of information about how it is operating.(NMS 24) • There are adequate records of both the staff and families using the service.(NMS 25)

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JUDGEMENT – we looked at outcomes for the following standard(s):

Outcome is this area is good. This judgement has been made using available evidence including a visit to this service.

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JUDGEMENT – we looked at outcomes for the following standard(s):

Staff are aware of updates in child and adult protection matters, which they receive through regular training. Staff’s practice and values are constantly challenged via varied methods of supervision. The unit should consider the implementation of a policy where bank staff or staff who work across a number of units feel equally valued.

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EVIDENCE:

DS0000047199.V300451.R01.S.doc Version 5.2 Page 18 Staff are varied in race, gender and experience. They have a mixture of therapeutic and social work qualifications. The manager told the inspector that she believed that her team were, “very good at monitoring risks.” The team have access to an external consultant. One member of staff said that this helped keep, “staff dynamics in check.” Another member of staff told the inspector that they received clinical supervision in the role that they had and this helped in their work with service users with mental health problems.

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EVIDENCE:

The scope of work that this unit undertakes does not fit easily into the modules covered in NVQ training. The manager told the inspector that they were in negotiations with CSCI to provide training for workers that is specific to the work that they do. Supporting documentary evidence was given to the inspector about this. Staff spoken to said that they have had access to recent training in child and adult protection.

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EVIDENCE:

In the absence of a manager on the unit, staff have access to an on call manager from other units should the need arise.

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EVIDENCE:

Sessional workers are not always supervised or involved in the team meetings of the unit that they are working in. They may have access to information that others may not have or being able to observe changes in service users that they have not seen for a number of days. The inspector spoke to the manager about this. The manager replied that St Michaels are working on a cross team working policy that would incorporate all the concerns raised. Where sessional workers are placed at this unit, the manager told the inspector that they would be supervised and invited to meetings, as would be the expectation for a permanent member of staff. The Director of the unit advised that, “sessional workers who work four or more shifts in a row are given supervision and they are invited to team meetings where they have regular input into the daily work of the unit. Any changes they observe, or information they may glean should

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EVIDENCE:

all be recorded in the daily recording sheets.” DS0000047199.V300451.R01.S.doc Version 5.2 Page 19

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SCORING OF OUTCOMES

This page summarises the assessment of the extent to which the National Minimum Standards for Residential Family Centres have been met and uses the following scale.

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SCORING OF OUTCOMES

4 Standard Exceeded (Commendable) 3 Standard Met (No Shortfalls) 2 Standard Almost Met (Minor Shortfalls) 1 Standard Not Met (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable

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SCORING OF OUTCOMES

STAYING SAFE ACHIEVING ECONOMIC WELLBEING Standard No Score Standard No Score 8 X 19 3 9 3 20 2 10 2 21 X 11 3 12 3 13 X 15 X 22 3

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SCORING OF OUTCOMES

ENJOYING & ACHIEVING MANAGEMENT Standard No Score Standard No Score No NMS are mapped to this outcome 1 X 5 X MAKING A POSITIVE 14 X CONTRIBUTION 16 4 Standard No Score 17 3 2 X 18 3 3 3 23 X 6 2 24 X 7 X 25 X DS0000047199.V300451.R01.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? Yes

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STATUTORY REQUIREMENTS

This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Residential Family Centres Regulations 2002 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales.

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STATUTORY REQUIREMENTS

No. Standard Regulation Requirement Timescale for action 1. RFC20 21 10(1a) 11(4a) The registered manager must ensure that hot water accessible to very young children, or people with disabilities which place them at risk from excessively hot water, is maintained at between 41 and 45 degrees centigrade at tap and other outlets accessible to them. Previous unmet requirement. 01/09/07

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STATUTORY REQUIREMENTS

2. RFC10 hh The registered manager must ensure that information given regarding the complaints procedure is correct in all documentation given to service users. 01/09/07

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STATUTORY REQUIREMENTS

3. RFC6 hh The registered person must ensure that records relating to key-working sessions and house meetings are signed and dated where appropriate. 01/09/07

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RECOMMENDATIONS

These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. DS0000047199.V300451.R01.S.doc Version 5.2 Page 21 No. Refer to Standard Good Practice Recommendations

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RECOMMENDATIONS

1. RFC8 Centre staff should receive training breakaway techniques. 2. RFC2 Responsibility for the moving of the possessions of families whose placement ends abruptly should be considered during pre-admission planning with the placing authorities. 3. RFC20 Wall decorations/pictures and lampshades removed during recent redecoration should be replaced. 4. RFC16 Staffing levels should be reviewed and if necessary increased to provide adequate time to complete administration tasks and other duties. DS0000047199.V300451.R01.S.doc Version 5.2 Page 22

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Commission for Social Care Inspection

SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH

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Commission for Social Care Inspection

National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI

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