Setting

DS0000047194.V299304.R01.S.doc Version 5.2 Page 1 RESIDENTIAL FAMILY CENTRE

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SE24 9QP

Lead Inspector Caroline Wilson Announced Inspection 20th July 2006 10:00 DS0000047194.V299304.R01.S.doc Version 5.2 Page 2 The Commission for Social Care Inspection aims to:

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SE24 9QP

• 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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SE24 9QP

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 DS0000047194.V299304.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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SE24 9QP

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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SE24 9QP

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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SE24 9QP

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. DS0000047194.V299304.R01.S.doc Version 5.2 Page 4

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manager (if applicable)

Type of registration Residential Family Centre

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of places

DS0000047194.V299304.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 six. 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:

'46', a residential family Centre run by St Michaels, is an establishment that provides accommodation, assessment and support for children and their parents. The service user’s capacity to respond to the children's needs and to safeguard their welfare is assessed and the service users are given such advice and guidance as is considered necessary to enable them to do so. Service users are therefore 'looking after' their own children whilst their 'parenting skills' are assessed by the staff team. The stated aims include ' providing fair, objective and comprehensive assessments of families to assist local authorities and the courts in making decisions for the welfare of the child'. Centre staff seek to make formal counselling available for service users who may benefit from it, but do not provide counselling themselves. The centre manager and staff team undertake formal twelve-week assessments. Final reports aim to

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Brief Description of the Service:

identify both risk and protective factors and make recommendations for after- care. An 'eclectic' approach based on the individual needs of families has been adopted, using a variety of theoretical models, concepts and ideas for 'interventions with families' that 'place the child first'.

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Brief Description of the Service:

Fees for one parent and one child are £2310 per week, (includes £73 rent). Each additional family member costs £500 per week. The cost for waking night staff is £25 per hour. Extra staffing between 8pm and 9am is £25 per hour and £20 per hour between 9am and 8pm. Placements last for a minimum of 12 weeks. Fees include, interim and final placement reports, all placement meetings and court attendance. Additional support needs such as 1:1 support, specialist consultancy, waking nights and childcare will involve extra costs to be negotiated with the manager. Court attendance, following the end of the placement, is £80 per hour, half a day minimum. DS0000047194.V299304.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 20 July 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:

Service users have access to local health care services. Health and safety systems are inspected within relevant timescales. Service users are aware of what information is written about them and sent out to relevant professionals. Staff have good knowledge of the child protection process. Where English is not a service users’ first language written agreements are provided in their first language. Evaluation forms have been introduced to improve the quality of the service. Staff are well qualified to do their jobs.

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What has improved since the last inspection?

Placing authorities are now made aware of their responsibility to provide educational placements for young people placed. Service users have been informed that they are responsible for the administration of their children’s medication. The key system has been simplified.

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What they could do better:

Service users are not always aware that they can continue with their employment whilst being assessed. Timescales for complaints are not clear. Dates and signatures are not always inputted on forms. Clarity is needed on forms in which child protection concerns and significant events are recorded. Single beds that are pushed together to make a double bed do not always match up. A risk assessment on water temperatures is required. DS0000047194.V299304.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. DS0000047194.V299304.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 DS0000047194.V299304.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):

Service users have access to local health services. This ensures that they receive good medical care in an emergency. Relevant information is held about them on file. Service users are encouraged to remain in their employment to ensure that the assessment is as realistic as possible. Service users need to be made aware of this to prevent possible financial hardship for the family once the assessment is complete. Responsibility for engaging is leisure activities rest with service users although staff make them aware of local amenities and events.

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EVIDENCE:

Two service user’s files were looked at. Relevant information is available on file relating to adults and young people, including hospital discharge notes and information from relevant health professionals. One service user spoken with said that their family have temporarily registered with a GP in the area and that they have access to the health services when needed. The manager told the inspector that service users are responsible for their children’s medication, therefore the medicine cabinet that was in the office at the previous inspection has now been replaced by a key cabinet.

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EVIDENCE:

One service user spoken to said that they had to leave their employment in order to take part in the assessment. A recommendation has been made about this. Another said that they did not want to participate in external activities as they are at this placement, “for a reason” and that they “did not want to do too much outside due to the assessment.” They added that they felt that the centre should provide activities for families. The manager said that they encouraged service users to stay in their day-time activity as this would make the assessment more accurate. The manager said that service users must make their own arrangements for activities, as it is not the centre’s role. Instead they will put them in touch with organisations such as Sure Start if DS0000047194.V299304.R01.S.doc Version 5.2 Page 10 they are interested in going to parents’ groups, or if they are activities going on at the local park, they will make service users aware of them.

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EVIDENCE:

DS0000047194.V299304.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):

Staff have good knowledge of child protection procedures. This ensures that referrals are passed to social services without delay. Child protection and incident forms are recorded on the same format and are not easily distinguishable. This may lead to delay in accessing information in an emergency. Timescales relating to complaints are not recorded. Procedures relating to service users receiving visitors are clear. They are aware of the need for safety.

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EVIDENCE:

DS0000047194.V299304.R01.S.doc Version 5.2 Page 12 Five complaints have been made since the last inspection. Two made by service users and three made by members of their families. The complaints related to service users feeling that they were, “bullied and treated like a child (ren)” by members of staff. Three complaints were made by service users’ family members. One of the complainants advised that this was because the service user feared that to complain themselves might affect the outcome of their assessment. One service user complained that a member of staff had treated them unfairly. No further action was taken on this matter. The manager told the inspector that she had witnessed the incident and that was why the complaint was not upheld. This information had not been recorded on file. Another service user retracted their complaint. One service user did not pursue their complaint. They were advised by staff to put their concerns in

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EVIDENCE:

writing. Timescales of the complaints were unclear. Only the date that the complaint was received had been entered in the complaints book. A requirement has been made about this.

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EVIDENCE:

The gas safety inspection took place on 6 October 2005. Routine maintenance of the security systems was undertaken on 20 July 2006. The fire inspection, emergency lighting and fire alarm testing took place in April 2006.

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EVIDENCE:

The inspector looked at two family service users’ files. Included was information on data protection, which informed them of what information is kept about them, where their files would be kept and stored and what staff at St Michaels would have access to this information. In most instances, staff would ask permission before sharing other information with other relevant professionals. The exception to this would be if staff believed that a child would be put at risk. The agreement on the file was not signed or dated. The inspector spoke to two service users. They said that they were aware that information gets shared with the local authority, especially in relation to child protection issues, and that they will get sent a copy of the information that is sent out.

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EVIDENCE:

The centre has a standard form where significant events are written down. Child protection concerns are not easily distinguishable from significant events. When the inspector requested further information relating to a child protection incident on a case that closed within the past year it took the worker some time to find it on the file. A recommendation has been made about this. Workers do not always identify what category the incident relates to, for example, whether the concern is of a physical, sexual or emotional nature on this form. The centre dealt with a child protection concern using the appropriate policies and procedures. An account of the incident was taken from the service user by staff. This information was discussed with a manager at the centre. The information was faxed soon after to the placing authority who instigated a child protection investigation. Staff supported service users

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EVIDENCE:

through this process. Staff spoken to said that they had attended a twelve day DS0000047194.V299304.R01.S.doc Version 5.2 Page 13 advanced child protection course in the past year. The manager said that they are in the process of obtaining a copy of the Pan London Child Protection procedures.

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EVIDENCE:

The manager told the inspector that where service users are aggressive towards staff or other residents the matter is taken very seriously. Where this happened an emergency meeting was called and the service users’ placement suspended until further information was gathered. The manager added that this situation is rare and it is more common for children to be aggressive towards others. Staff will remove themselves from the situation after making sure everything is safe. The matter is addressed with service users when things have calmed down.

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EVIDENCE:

Two service users were spoken to about the arrangements for having visitors at the centre. They both said that visitors were welcome, bit that they needed to give notice to staff as they needed to be “police checked” before they came. Information relating to staff vetting procedures will be undertaken at the time of the inspection of a sister unit of St Michaels. DS0000047194.V299304.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 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):

House meetings are held on average twice a month. They mainly focus on issues that arise from communal living, for example undertaking chores. Service users are reluctant to speak up on certain issues for fear that it may lead to a negative assessment. Staff state that they are aware of the power imbalance and that this matter is discussed regularly within the staff team. In order to improve the quality of service that is offered, the centre has introduced evaluation forms for service users, professionals and staff.

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EVIDENCE:

The inspector looked at the placement plans on two service user’s family files. Both had a pre-placement questionnaire. Both were not signed and one not dated. A recommendation has been made about this. This gave service users the opportunity to say what they were hoping to achieve, what they are worried about and any questions that they may have prior to entering the placement. Once they are in the home, a written agreement is set out following a meeting between the service users, the centre and placing authority where with the expectations of all parties are outlined explicitly. Also included are the following: background information, the placement objectives, contact arrangements with professionals and how the assessment will be undertaken. The placement plan is updated on a weekly basis and any changes in risks identified. Risks are measured on a low, medium or high DS0000047194.V299304.R01.S.doc Version 5.2 Page 15

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EVIDENCE:

basis. Service users are regularly monitored their key-worker. Assessments are informed by direct observations of care, including service users’ interaction with their child(ren). Staff record this information in daily logs. Service users are encouraged to view the information written in the daily logs and sign and make comments where appropriate. Two service user’s spoken to said that they were not sure what would happen if they disagreed with what had been written as this had never happened. The key-worker also provides service users with key-working sessions on a weekly basis.

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EVIDENCE:

There have been 28 house meetings held since 22 April 2005. Most discussions relate to house rules, for example any washing to be finished by 9pm, smokers to make sure that cigarettes are extinguished under the tap and that chores should not be done at night. One service user spoken to said that they did not find the meetings useful as they are, “mostly to do with chores” as they felt that they, “could not win.” The service user continued that they were unhappy that staff only did chores when people came around. They added that they, “felt like little kids in the house” that they felt, “constantly criticised” by staff. Although there was systems put in place, like the complaints procedure, for putting their views forward, that they were reluctant to use them. This was because they were worried that it would affect the outcome of their assessment and alternative arrangements made for the care of their children.

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EVIDENCE:

The service users said that they were unhappy that staff seem to relate to them only when they needed to do an observation. In addition, staff spent most of their time in the office.

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EVIDENCE:

The manager in response to this being raised with her said, that she was aware of the power dynamic within the service user/staff relationship. The manager added that the power differential is especially noticeable in the early days of an assessment and/or if the service user has previously been through the care system. This is constantly being reflected upon within the staff team. The manager said that she has asked staff to ask questions rather than make suggestions to service users. There has been a recent crisis, which has meant that staff are not as accessible as usual. The manager told the inspector that they try hard to get the balance between being child protection professionals and making relationships with service users right. The centre have introduced feedback forms for service users to provide them with their views on assessment planning and feedback following their first and subsequent

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EVIDENCE:

reviews. There are also placement evaluation forms for service users, staff and professionals.

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EVIDENCE:

English was the second language of two former relatives of the home. Staff spoken to said that both of them had an understanding of the English language but that they would ensure that written agreements were set out in their first language. There was no evidence of this on the service user’s file. DS0000047194.V299304.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):

19, 20 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):

The centre is decorated and furnished to a high standard. A health and safety risk assessment is needed to address possible risks from hot water outlets. Service users in relationships find the arrangements beds have a negative impact on their sleeping arrangements. Improvements are planned in the kitchen area to generate more space. Current systems for living room space allow service users privacy within their family units.

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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. Two service users said that they were unhappy with their bed as instead of having a double bed there were two single beds that were different heights that were pushed together. A recommendation has been made about this. The service users were also unhappy that there was not air conditioning. They said that the fans given to cool the room down were not effective in the recent hot weather. This was discussed with the manager. She replied that single beds were more practical for storage purposes.

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EVIDENCE:

Service users share kitchen space but have separate cupboards and areas within the fridges. There are plans to extend the kitchen area to make more space. Service users also share a sitting area and a playroom, which are situated on the ground floor. Each family have separate bathrooms. DS0000047194.V299304.R01.S.doc Version 5.2 Page 17 The hot water temperature has not been amended. The manager said that this is due to the risk of legionnaires disease. In addition it makes the placement more realistic for service users as they do not have temperature gauges at home. A requirement has been made about this. DS0000047194.V299304.R01.S.doc Version 5.2 Page 18

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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):

1, 14, 24 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):

Placing authorities are now made aware of their responsibilities to organise educational placements, which means young people do not miss out on formal learning whilst their parents are being assessed. Staff are well qualified to do their jobs. Staff have access to courses that are relevant to the service that they provide.

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EVIDENCE:

DS0000047194.V299304.R01.S.doc Version 5.2 Page 19 Staff and the manager spoken said that placing authorities are now provided with information packs informing them of their responsibility for making arrangements for the education for children and young people. The inspector was given a copy of the letter containing this information.

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EVIDENCE:

A manager from another unit has undertaken an audit of qualifications. In the past year staff have undertaken courses, which include, advanced child protection, parental mental health and the impact on children, violence de- escalation and breakaway techniques and the assessment of competence strengths and difficulties in families. Three members of staff have a Diploma in Social Work, the other five have degrees with an element of psychology. DS0000047194.V299304.R01.S.doc Version 5.2 Page 20

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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 3 5 X MAKING A POSITIVE 14 3 CONTRIBUTION 16 X Standard No Score 17 X 2 X 18 X 3 3 23 X 6 3 24 3 7 X 25 X DS0000047194.V299304.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? No

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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(1)

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STATUTORY REQUIREMENTS

11(4)(a) The registered person must ensure that a risk assessment is undertaken to ensure that it is at a level to ensure there is no risk to service users and their children as well as preventing the spread of legionnaires disease. 08/03/07

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STATUTORY REQUIREMENTS

2. RFC10 20 (5) The registered person must ensure that the dates that complaints are received, investigated and the complainant informed of the outcome is recorded in the complaints book. 01/10/06

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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.

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RECOMMENDATIONS

No. Refer to Standard Good Practice Recommendations

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RECOMMENDATIONS

1. RFC13 The registered provider to consider changing the format of child protection/significant incidents forms to make child protection concerns more easily identifiable. 2. RFC4 The registered provider to consider making it more apparent in information provided to prospective service DS0000047194.V299304.R01.S.doc Version 5.2 Page 22 users that they could continue with their employment whilst they are assessed. 3. RFC3 The registered provider to ensure that staff and service include dates and signatures on written agreements, placement plans and similar documentation. 4. RFC20 The registered provider to consider making sure that single beds are a similar height to ensure that they match up if they need to be pushed together to make a double bed. DS0000047194.V299304.R01.S.doc Version 5.2 Page 23

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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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