Children's Home run by Keys Care Limited in Sandwell

Unique reference number SC374268 Inspection date 11/06/2012 Inspector Sharon Treadwell Type of inspection Full Provision subtype Children's home

p.1

Date of last inspection 15/02/2012 Website: www.ofsted.gov.uk

p.1

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.

p.2

Brief description of the service

This home offers medium- to long-term care for a maximum of three young people who have emotional and behavioural difficulties. The home is operated by a large national provider of children's residential care.

p.3

Brief description of the service

Specific direct work and individual therapy programmes are provided to young people by a qualified and experienced psychotherapist, employed by the provider organisation, who makes weekly visits to the home. Staff employed at the home are trained in creating a therapeutic environment to support the work of the psychotherapist.

p.3

The inspection judgements and what they mean

Outstanding : a service that significantly exceeds minimum requirements Good : a service that exceeds minimum requirements Adequate : a service that only meets minimum requirements Inadequate : a service that does not meet minimum requirements

p.3

Overall effectiveness

The overall effectiveness is judged to be adequate .

p.3

Overall effectiveness

The home has provided some young people with long-term, stable placements and has supported them to make significant progress from their starting points at admission. Several senior members of staff have left the home since the beginning of this year and young people have lost adults who have become significant and important to them. This, combined with the failure of the home, in a recent instance, to fully follow its stated admission process, has temporarily destabilised some young people's placements. There was an escalation of challenging and potentially unsafe behaviours and this has reduced the home's recent capacity to consistently promote positive outcomes for all the young people accommodated. Where physical interventions have taken place staff and young people are not always provided with appropriate opportunities to discuss these afterwards. The home is not always ensuring that all staff receive timely and appropriate training in the techniques used

p.3

Overall effectiveness

Two managers have moved on from the home since December 2011. There is currently no Registered Manager at the home. Interim, temporary management arrangements are in place and recruitment of a permanent manager is in progress. The recent period of management instability combined with the requirement for the staff team to manage some very challenging, aggressive and destructive behaviours has had a negative impact on the provision of staff training and supervision and on some record keeping practices. The Statement of Purpose is not fully reflective of the current position.

p.3

Overall effectiveness

There is recognition, at operational management level, that outcomes for young people have been compromised throughout this challenging period and a determination to ensure that young people are able to regain their feelings of security and stability within this home. Young people say that they remain happy in placement and have maintained positive relationships with the staff. Young people have expressed their wish to remain in placement here.

p.4

Statutory Requirements

This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Children's Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must comply with the given timescales.

p.4

Reg. Requirement Due date

(2001) update the Statement of Purpose to provide correct information regarding current management arrangements at the home and to fully clarify the home's admissions policy including the position regarding emergency admissions (Regulation 5(a)) 30/06/2012

p.4

Reg. Requirement Due date

(2001) ensure that decision making in the home, particularly with regard to admissions and placement suitability, promotes and makes proper provision for the welfare of all young people accommodated (Regulation 11(1(a))) 30/06/2012

p.4

Reg. Requirement Due date

(2001) ensure that there is a Registered Manager in post (Regulation 7 (1(a))) 31/07/2012

p.4

Reg. Requirement Due date

(2001) ensure that the records specified under Schedule 4, specifically in relation to the receipt, administration and disposal of medication, are always retained for at least 15 years from the date of the last entry (Regulation 29(2)) 16/07/2012

p.4

Reg. Requirement Due date

(2001) ensure that, at all times, a suitable number of experienced and appropriately trained staff are on duty. (Regulation 25(1)) 30/06/2012

p.4

Recommendations

To improve the quality and standards of care further the service should take account of the following recommendation(s):

p.4

Recommendations

 demonstrate that young people always communicate their views on aspects of their care and support, particularly with regard to areas covered in key work sessions, by reflecting their views in records (NMS 1.3; 22.5)  ensure that staff have the skills, confidence and support to enable them to implement the behaviour management strategies identified in young people's care plans (NMS 3.3)  ensure that all staff, including agency staff when utilised, are trained in the home's agreed techniques for physical restraint (NMS 3.15)  provide young people and staff with opportunities to discuss incidents of restraint they have been involved in, witnessed or been affected by (NMS 3.17; 3.9)  comply fully with the admissions procedure as stated in the home's policy document and Statement of Purpose and ensure that young people are not admitted in an emergency unless this is explicitly included as a function of the

p.4

Recommendations

home (NMS 11.1; 11.6)  ensure that all existing staff have attained a Young People's Workforce Diploma (previously National Vocational Qualification level 3) and that new staff hold an equivalent qualification or begin working towards it within 6 months of confirmation of employment (NMS 18.5)  provide all staff with formal supervision at the required frequency (NMS 19.4)  ensure that all staff fully understand the nature of records maintained and follow the home's recording policy, specifically in relation to the updating of individual placement plans and to retention of records of key working sessions. (NMS 22.1)

p.5

Outcomes for children and young people

Outcomes for children and young people are adequate .

p.5

Outcomes for children and young people

Some young people have experienced lengthy periods of placement stability within this home, which has supported them to make considerable progress in terms of their starting points at admission. Young people have weekly sessions with a qualified psychotherapist to address mental and emotional health and attachment issues. Records demonstrate that the therapeutic focus of the work undertaken has helped some young people to better come to terms with difficult elements of their past history, such as rejection and abuse, and to move towards a more positive self- view. In some cases, young people have developed strong bonds with members of the staff team and have developed the confidence and trust to talk about their feelings and to openly display warmth and affection.

p.5

Outcomes for children and young people

Young people are in good physical health and the home has established sound relationships with the local doctor, dentist and optician to help in supporting young people to access these services quickly, confidently and appropriately. Young people eat well and are happy with the food provided. Staff are ambitious for the young people they look after and have provided encouragement to understand the value of working hard at school as well as providing them with good access to leisure activities. This has supported young people to achieve educational success, of which they are proud. Some young people have been helped to return to full-time schooling after lengthy periods of erratic attendance and staff have worked closely, with schools, to combat the adverse impact that young people's presenting behaviours can have on their capacity to learn. Some young people have received awards recognising their excellent progress in particular subjects. Young people are strongly

p.5

Outcomes for children and young people

supported to get involved in extracurricular activities at school, some regularly attend local youth clubs and all are well supported to use local sports facilities and are regularly taken out on activities, which they say they thoroughly enjoy. The young people currently accommodated are not approaching independence but they are being well supported to develop good self-care and personal hygiene practices and to become more confident and capable about looking after themselves generally.

p.6

Outcomes for children and young people

In more recent months, the departure of a number of senior staff has impacted hard on young people's feelings of stability at the home. This period has additionally featured admissions to the home, which have further disrupted young people's feelings of safety, security and well-being. Some young people have, as a result, reverted to displays of challenging, destructive and sometimes aggressive behaviour and their engagement with education and cooperation with staff has deteriorated. During this unsettled period, young people have been more susceptible to the influence of their peers than to that of staff. Outcomes for all young people have been seriously compromised during this time.

p.6

Outcomes for children and young people

Young people say they remain happy in their placements and say things are 'settling down again now' and still say the home is 'the best'.

p.6

Quality of care

The home experienced a short period of extremely challenging and destructive behaviour earlier this year when a significant amount of damage was inflicted within the home. Repairs and refurbishment were undertaken quickly and the home now presents, once more, as a homely and welcoming environment. Young people's single bedrooms are personalised to reflect their individual tastes.

p.6

Quality of care

While the staff visibly demonstrate a good capacity for communicating with young people and for encouraging their participation in decision making around the home, they are not always good at ensuring that young people's views are recorded in all written records relating to decision making about their care. Records of key-working sessions, for example, often do not incorporate either a record of the young people's views or their signatures. In general, however, record keeping is of a good standard. Individual placement plans are strongly individualised and very robust. Plans are written in the first person to reflect young people's involvement in compiling them. There is clear identification of very specific individual needs in relation to culture and religious belief and clear identification of how staff will ensure that these needs are met. The poorer standard of the recording of key-work sessions makes it difficult to

p.6

Quality of care

link these sessions to identified placement objectives. Comprehensive daily records demonstrate that staff are very focused on helping young people to develop an awareness of the potential impact of their attitudes and behaviours on their capacity to succeed and to enjoy life and there is good dedication to helping young people acquire social skills. The Regulation 33 visitor to the home recently commented: 'The home is very focused on encouraging and supporting the young people to think about how their actions can be viewed by others and how the skills they acquire now will take them forward into adult life.’ Daily records are written as if the staff member is writing to the child about their activities and behaviours that day. This makes these records very easy to share with young people. The home's policy is to update placement plans subsequent to young people's annual reviews and in one recent instance this has been overlooked. Young people are very aware of how to make a

p.6

Quality of care

complaint and records show that complaints are managed in a timely and appropriate way. Some young people have independent advocates to support them in making their views heard.

p.7

Quality of care

The staff team comprises a good mix of appropriate role models of varying ages and from a range of cultural backgrounds, though female staff are in the majority. Staff encourage young people to be aware of and to value difference, and to be proud of their own achievements and of each other’s. Young people thoroughly enjoy celebrating a range of festivals within the community and recently visited Birmingham to take part in the celebrations of the Queen's Diamond Jubilee there. Young people are very proud to show photographs around the home recording these events.

p.7

Quality of care

For many young people, family relationships are complex and are often the subject of sessions with the psychotherapist. Staff have a monthly meeting with the psychotherapist, to guide their work in helping young people to come to terms with their family relationships and to help them to empathise with young people's potential feelings of rejection or distress at being separated from family. Some placing social workers feel that the staff are insufficiently robust in promoting young people's contact with their families and in encouraging them to maintain contact frequency as identified in the care plan. Other social workers are confident that staff are fully committed to supporting young people to retain positive contact with family. Records indicate that the staff convey young people's wishes regarding contact to placing authorities. Sometimes young people's wishes are in conflict with the requests of their families with regard to contact arrangements.

p.7

Quality of care

Young people's behaviour management plans clearly detail the strategies that staff will employ for managing a range of potentially challenging behaviours. Staff struggled to implement some of these strategies, in relation to the challenging and disruptive behaviours demonstrated earlier this year, when their capacity to communicate with some of the young people or to influence their behaviour was significantly reduced. During this period, some of the young people became involved in criminal activities and there was a very significant increase in the use of physical intervention.

p.7

Quality of care

The home's admissions policy is clearly stated in procedural documents and in the Statement of Purpose. In one instance, this procedure has not been fully and appropriately followed and this resulted in a period of turmoil, for both young people and staff, within the home. The home's admission procedure does not include emergency admissions as a function of the home. In this instance, the information available and the timescale involved did not allow for the impact on other young people in placement to be properly predicted. The result was a period during which outcomes for all young people at the home were significantly compromised by the inability of staff to successfully manage the challenging behaviours, which resulted from an inappropriate mix of young people.

p.7

Safeguarding children and young people

The service is adequate at keeping children and young people safe and feeling safe.

p.8

Safeguarding children and young people

Staff recruitment processes are thorough and ensure that young people are safeguarded from contact with unsuitable adults within the home. The provider organisation is a member of Ofsted's National Provider Scheme. An audit of the head office, conducted in February 2012, concluded 'There are very good systems in place to make suitability decisions about staff and records are maintained to a very high standard'.

p.8

Safeguarding children and young people

Young people currently say that they feel safe, although staff say that, during the period when challenging and disruptive behaviours were at their peak, some young people felt insecure and sometimes unsafe. During this period, some young people's sleep patterns were disrupted because disruptive behaviours were continuing very late into the night. At this time, management focused on helping these young people to feel safer by increasing staffing levels to one-to-one. Generally young people are protected because the home has a robust safeguarding policy and all staff know the safeguarding procedures and are fully aware of their responsibilities in reporting and recording any concerns. Where young people have made disclosures relating to historical abuse, the staff have responded quickly and appropriately in notifying all relevant professionals and have ensured that good support has been provided to the young people concerned. The home is not always diligent in ensuring

p.8

Safeguarding children and young people

that new starters receive crucial training, such as safeguarding and restraint, before they become an operational member of the staff team and, therefore, one of only two staff on duty.

p.8

Safeguarding children and young people

Generally, instances of physical intervention are appropriately recorded and demonstrate that they are undertaken to promote young people's safety. Records demonstrate that, for many young people, levels of physical intervention have been very high early in their placement but have reduced significantly as they have engaged with staff. However, for some young people, levels of physical intervention rose significantly during the recent period of challenging and aggressive behaviour. Many of these records detail that no debrief was possible because of 'the level of incidents occurring at this time'. It is not appropriate for young people and staff not to be provided with opportunities to discuss incidents of restraint they have been involved in, witnessed or by which they have been affected. Staff receive regular refresher training in the use of restraint to ensure that safety is prioritised. The provision of this training for new starters is not always early enough in their

p.8

Safeguarding children and young people

employment and managers are not always ascertaining that agency staff, utilised by the home, are trained in the home's agreed techniques. The young people rarely leave the home without permission and clear individual protocols are in place to clarify who staff need to inform and what action they should take, should this happen. Again, there was an increase in instances of absence without authority earlier this year when some young people were not engaging well with staff.

p.8

Safeguarding children and young people

Appropriate systems promote the safety of young people, staff and visitors within the home. There is regular servicing of electrical and fire safety equipment and young people are involved in regular fire drills and discussions about fire safety. This ensures that they understand the importance of evacuating the building quickly to be safe. There is good promotion of appropriate risk assessment, both in relation to the home itself and to young people's presenting behaviours.

p.9

Leadership and management

The leadership and management of the children's home are adequate .

p.9

Leadership and management

During the last six months, the home has experienced significant disruption to management arrangements. The last Registered Manager left the home in December 2011. His replacement, who did not complete the process of registration with Ofsted, has also since left. Interim management arrangements are currently in place, while recruitment is being undertaken. The Statement of Purpose has been recently updated to reflect interim management arrangements and describes the acting manager as the Registered Manager of the service. This is inaccurate.

p.9

Leadership and management

There are, currently, seven residential child-care staff members employed at the home. None have completed National Vocational Qualification level 3 or its equivalent, though several are in process of undertaking this qualification. Recently employed staff are completing appropriate induction training. The departure of a number of senior staff from the home, within a relatively short period, has seriously disrupted young people's attachments and interrupted the stability of some of their placements as well as leaving the home with a shortfall of appropriately qualified staff. The home's Statement of Purpose provides full information about the aims, objectives and care practices. However, it does not currently explicitly include emergency admission as a function of the home and a recent admission appears to have been made on this basis. The failure of the home to follow its stated admission process, combined with management changes, has impacted significantly on the

p.9

Leadership and management

home's recent capacity to promote positive outcomes for the young people accommodated. Records demonstrate that, prior to this period of instability, young people have enjoyed stable placements and have made significant progress.

p.9

Leadership and management

The staff team has a wide range of relevant experience and demonstrates a commitment to providing a high standard of care to young people. Staff receive regular training, from the attached psychologist, to specifically equip them in creating and maintaining a supportive environment for the young people for whom they care, such as child development and attachment and loss. Staff have development plans in place to identify specific training needs relevant to the individual needs of the young people accommodated and to ensure that they receive regular updated training in areas such as child protection and health and safety. There has been some slippage in the provision of refresher training because of the disruption to management arrangements and because the recent instability of young people's behaviours has restricted the capacity to release staff from the rota. These elements have additionally impacted adversely on the frequency of staff supervision, which, prior to

p.9

Leadership and management

April was wholly appropriate. Action is currently being taken to identify and meet refresher training needs and to ensure that staff receive supervision at the required frequency. The staff feel that there are strong systems of mutual support within the team which support them well in recognising and meeting young people's individual needs and in engaging in reflective practice.

p.10

Leadership and management

Placing social workers say that the staff are good at sharing relevant information with them about the young people's placements and that they provide good support to young people in expressing their views at meetings and reviews. Placing social workers also say that young people have built up some very positive relationships with staff which have supported them to make positive progress in this placement. Social workers say that staff provide comprehensive weekly reports to reflect the work undertaken with young people within the home. Placement plans and daily records are completed to a good standard. The home generally retains all the records required by the Children's Homes Regulations but has overlooked the fact that Schedule 4 requires them to retain a record of the receipt, administration and disposal of medication for all young people for 15 years. Currently records relating to medication administration are individual and move with the young person when they

p.10

Leadership and management

Monthly, unannounced visits to the home, on behalf of the provider organisation, provide an independent oversight of care practice, incorporate regular discussions with staff and young people and identify any issues of concern. The reports of these visits are comprehensive and thorough, and help to improve service delivery to young people.

p.10

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 to assess the effectiveness of the service and to consider how well it complies with the relevant regulations and meets the national minimum standards.

p.11

About this inspection

The report details the main strengths, any areas for improvement, including any breaches of regulation, and any failure to meet national minimum standards. The judgements included in the report are made against the Inspections of children’s homes – framework for inspection (March 2011) and the evaluation schedule for children's homes.

p.11