Children's Home run by Able Health Care Ltd in Suffolk

Unique reference number SC408714 Inspection date 24/04/2013 Inspector Joanna Heller Type of inspection Full Provision subtype Children's home

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Date of last inspection 17/12/2012 Website: www.ofsted.gov.uk

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

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Brief description of the service

The home is privately owned. It is registered to look after a maximum of six young people with emotional and behavioural difficulties. There are education facilities within the grounds of the home.

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The inspection judgements and what they mean

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

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Overall effectiveness

The overall effectiveness is judged to be inadequate .

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Overall effectiveness

This is a home which has had insufficient management oversight and monitoring over the past year. A solid staff team have ensured that the shortfalls in relation to management and leadership have had limited impact on the care provided to young people. Care provided is of a satisfactory standard and little placement breakdown is experienced. Young people are healthy, enrolled in education and there are no concerns about bullying. Some young people make good progress in the home, are engaging in education and have distanced themselves from previous gang relationships. Young people are given support and advice, but in some instances, continue to engage in risk taking behaviours such as drug use or offending.

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Overall effectiveness

Staff are caring and establish positive relationships with young people. All young people have someone they can talk to about anything which is worrying them. The relationships built between staff and young people make young people feel safe.

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Overall effectiveness

Young people are not fully safeguarded from unsuitable people gaining employment in the home through robust vetting practices. Staff are not well supported in their roles and do not receive adequate levels of supervision. There is inadequate investment in the induction and training of staff. Training in key areas, such as first aid, food hygiene, safeguarding, medication management and restraint has not been provided to most staff.

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Overall effectiveness

There has been insufficient management, monitoring and oversight of the home and the responsible individual is not fully aware of their responsibilities under the Children’s Homes Regulations. The responsible individual has failed to ensure that requirements and recommendations set at previous inspections have been fully addressed and a number of additional requirements and recommendations have been set at this inspection.

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Overall effectiveness

A new manager has been in post since March 2013. This manager is in the process of reviewing the strengths and weaknesses of the service and developing an action plan to take the home forward. Under this new leadership the home has good capacity for improvement.

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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, Children's Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must comply with the given timescales.

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Reg. Requirement Due date

17B (2001) ensure written records of any measure of control, restraint or discipline include all details required by this regulation, with specific reference to the paragraphs noted (Regulation 17B (3) (f) (h) & (i)) 10/06/2013

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Reg. Requirement Due date

(2001) conduct monthly visits to the home in accordance with regulation 33. Prepare a written report on the conduct of the home and supply a copy of this report to Ofsted (Regulation 33 (1) (3) (4)(c ) & (5)(a)) 10/06/2013

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Reg. Requirement Due date

(2001) supply to Ofsted a copy of a report in respect of any review conducted in accordance with regulation 34. Ensure that the system established for monitoring and improving the quality of care provides for consultation with young people accommodated in the home, their parents and placing authorities. (Regulation 34 (2) & (3)) 29/07/2013

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Reg. Requirement Due date

(2001) ensure that the written procedure for considering complaints includes the correct telephone number for Ofsted and that a full record off the outcome of the complaint (Regulation 24 (4)(a) & (5)) 24/06/2013

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Reg. Requirement Due date

(2001) ensure the registered person does not employ a person to work at the children's home unless full and satisfactory information is available in relation to him in respect of each of the matters specified in schedule 2. In particular, ensure that two written references are in place prior to employment (Regulation 26 (3)(d)) 10/06/2013

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Reg. Requirement Due date

(2001) ensure that all persons employed receive appropriate training, supervision and appraisal (Regulation 27 (4) (a)) 22/07/2013

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Reg. Requirement Due date

(2001) ensure that the system established for monitoring and improving the quality of care under regulation 34 provides for the review of the suitability of arrangements for the safe 24/06/2013 administration of medication in accordance with the homes medication policy (Regulation 34 (1) & schedule 6 (14))

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Reg. Requirement Due date

(2001) carry on the home with sufficient care, competence and skill. Ensure the responsible individual undertakes such training as is appropriate to ensure that he has the experience and skills necessary for managing the children's home. In particular; ensure the responsible individual is fully aware of their duties and responsibilities under the Children's Homes Regulations Regulation 9(1) (2) & (3)) 24/06/2013

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Reg. Requirement Due date

(2001) ensure that at all times at least one person on duty at the home has a suitable first aid qualification. (Regulation 20 (2) (e)) 24/06/2013

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Recommendations

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

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Recommendations

 ensure the homes procedures are compatible with and have regard to local Runaway and Missing From Home and Care (RMFHC) protocols and procedures (NMS5.6)  ensure telephone enquires are made to verify written references obtained (NMS 16.1)  ensure the manager regularly monitors, in line with regulations, all records kept by the home to ensure compliance with the home's policies, to identify any concerns about specific incidents and to identify patterns and trends. Immediate action is taken to address any issues raised by this monitoring (NMS 21.2)  demonstrate that the home follows consistently good employment practice in staff recruitment and selection. In particular; conduct a written risk assessment when employing staff using pre-existing Disclosure and Baring Service (DBS) checks (NMS 16.2)  ensure there is an emergency escape plan that all staff and children are familiar with and have practised so they know what to do in an emergency (NMS 10.9)

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Recommendations

 implement a written policy that clarifies the purpose, format and content of information to be kept on file. Ensure staff understand the nature of records maintained and follow the home’s file policy. Ensure a robust system is in place to monitor the quality and adequacy of record keeping and take action when necessary. (NMS 22.1)

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Outcomes for children and young people

Outcomes for young people are adequate .

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Outcomes for children and young people

Young people are making adequate progress in their lives and experience some personal growth while living at the home. This is individually demonstrated through areas such as the reduction in going missing, challenging behaviour, gang membership and a growth in commitment to education. Young people are being actively supported in developing self-care and independence skills.

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Outcomes for children and young people

Young people are healthy and are encouraged to attend all health appointments. Not all young people are, however, engaging with this and staff are experiencing some difficulties in assisting young people accept the purpose of these appointments. Some young people continue to engage in risk taking behaviours such as smoking and using drugs although these are reducing.

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Outcomes for children and young people

Young people are able to maintain contact with family and friends as they wish. However, a recent change to the house rules as the result of a concern over the behaviour of some young people means that friends are not currently allowed into the home.

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Outcomes for children and young people

All young people are regularly attending some form of supervision, education or training. Young people have benefited from the onsite schooling facility, which has successfully helped some young people back into mainstream education.

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Outcomes for children and young people

Young people are being supported to develop positive relationships with staff and people in the community. Young people have good relationships with staff and in particular their keyworkers, who they can talk to openly. Young people say they feel safe and that as a group they get on well together. Young people’s views are sought by staff on all aspects of their daily lives through informal discussions.

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Quality of care

Most young people experience some personal growth while living at the home.. Young people are generally positive about their experiences of living in the home and individually rate it between ‘okay’ and ‘brilliant’. Young people refer to staff who are ‘sound’ and key workers in particular are viewed by young people as positive role models. Placement breakdown is minimal and young people are enjoying stable placements.

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Quality of care

Placing authorities view the placements as positive and identify that some young people have made particular progress settling well. Other placing authorities state they while the child is satisfactorily cared for they are not clear on how the home has helped them to progress.

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Quality of care

Individual care plans are in place, which are sufficiently detailed to guide staff effectively in most of the day-to-day support needs of the young people. However, the recording systems undermine these because it is difficult to access current information in a systematic way. Staff ensure that young people are supported to celebrate their faith and heritage as they wish. Staff consult young people on all aspects of their lives and ensure that the care and support provided is tailored to their needs.

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Quality of care

All of the young people are healthy. Staff nurture young people to develop emotional resilience and increase their maturity and coping mechanisms. Young people are able to benefit from art and psychotherapy to help them understand and come to terms with their personal histories and feelings. Young people are encouraged to enjoy healthy lifestyles and are supported to access medical professionals such as doctors, dentists and opticians as appropriate. Some young people enjoy gym membership and regular dancing classes. Staff discuss with young people the importance of keeping healthy including maintaining sexual health and the impact and risks associated with smoking and taking drugs.

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Quality of care

Most staff have not received current training in key areas, including first aid, medication management, food handling, emotional well-being and other issues which affect young people.

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Quality of care

Medication arrangements for non-prescribed medications have the potential to place young people at risk. For example, one young person was administered medication which was neither prescribed, nor approved as a ‘homely remedy’ in line with the home’s policy. Records are maintained of all prescribed and non-prescribed medication administered.

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Quality of care

Education is positively promoted by staff. All of the young people are engaged in regular training or education. Staff are proactive in assisting young people identify appropriate educational opportunities and ensure that young people have suitable equipment and clothing for the courses they are pursuing. The new teacher at the on-site school is reviewing, in partnership with the responsible individual, the ways in which the school can best support young people through additional tutoring and educational support. Consideration is taking place on the possibility of opening up the school to non-resident pupils and the impact this may have on existing young people.

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Quality of care

A significant proportion of the young people are working towards independence. Young people are supported in managing their own budgets and developing other skills, such as, cooking. Staff highlight the difficulties of supporting this where there are concerns on how young people spend their money if not carefully supervised. The manager is considering developing an outreach service to support these young people as they move on into independent living.

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Quality of care

Behaviour in the home has settled since the last inspection with a significant reduction in aggression. Staff provide consistent rules and boundaries in line with young people’s individual behaviour management plans.

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Quality of care

The arrangements for activities have recently changed which is also an issue of contention for some young people. Individual weekly activity allowances paid directly to the young people have been reduced with an increased commitment to organised group activities, such as a recent trip to Thorpe Park. Young people state they prefer to arrange their own individual activities at a time that suits them. Young people know how to make a complaint and feel able to do so. Staff appropriately support young people in raising any issues of concern. Management ensure that complaints are effectively responded to, investigated and managed. A recent complaint from young people was appropriately investigated by an independent person; however, information on the outcome and resolution of the complaint is not clearly documented. The building provides young people with spacious homely accommodation which meets their needs. There has been some investment into the building since the last

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Quality of care

inspection and damages are now responded to appropriately. Further decorative improvements are planned to enhance the living arrangements for the young people. Some incidents of personal theft have undermined young people’s confidence in the security arrangements. As a result of this new locks have been fitted to each young person’s bedroom. Staff are provided with suitable sleep in accommodation.

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Safeguarding children and young people

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

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Safeguarding children and young people

Young people feel safe and secure, however, a number of shortfalls identified during this inspection have the potential to place young people at risk.

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Safeguarding children and young people

The young people have become more settled as a group in the past four months and the levels of significant incidents has noticeably reduced. Placing authorities comment positively on the ability of staff to effectively introduce structure and boundaries for some young people. Staff ensure that young people know the behavioural expectations and rules, and enforce these rules fairly. Staff focus on restorative measures and rebuilding fragmented relationships through discussions in key work sessions. When sanctions are used these are not always recorded in accordance with the regulations and there is little evaluation of whether these sanctions are effective. While there have been no prohibited sanctions used, there has been little management overview to monitor sanctions are applied appropriately.

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Safeguarding children and young people

Staff use a therapeutic approach to behaviour management, focusing on discussing incidents in key work sessions. This helps young people begin to understand the impact that their behaviours have on others and how they themselves are perceived. No restraints have taken place since the last inspection and young people living in the home are currently settled. However, in the past year staff have had to restrain young people on a number of occasions. This has been to safeguard young people or others and there remains a potential for this to reoccur. A significant number of staff do not have current training in the home’s control, restraint and de-escalation techniques. Any restraint may, therefore, not be carried out in accordance with the guidelines and has the potential to injure either young people or staff. No central record of restraints is maintained in the home, this has the potential to make it

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Safeguarding children and young people

difficult to effectively monitor the number and frequency of restraints, in particular, any emerging patterns and trends. Some young people have made a commitment to severing gang relationships and are keen to ensure that the home stays a place of refuge from such past negative ties. Bullying is currently not an issue of concern. Regular one-to-one discussions evidence how young people are encouraged to learn about keeping themself safe and to take responsibility for their actions.

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Safeguarding children and young people

Staff seek to find young people who go missing and ensure that they are notified to the appropriate agencies. However, the approach staff take to effectively safeguard young people is not in line with the home’s current policy. The home’s policy is not in accordance with current Department for Education guidance or local joint protocols with the police and local authority because it states anyone missing after three hours should be reported. Staff practice makes no clear differentiation between being absent without permission and being missing from care. There are no detailed risk assessments which evaluate for each young person the particular risks or vulnerability that they face and what the agreed individual protocols are. The home does not maintain an accurate central log of the number of incidents of young people going missing this makes it difficult to effectively monitor the number and frequency

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Safeguarding children and young people

of incidents, in particular, any patterns and trends..

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Safeguarding children and young people

Young people are not fully safeguarded from unsuitable people gaining employment in the home through robust vetting practices. The home, while adhering to the spirit of the regulations governing recruitment of staff, has failed to always robustly implement them. For example, not all staff have two written references, nor can it be evidenced that such references are verified through a telephone call to check their validity. Management, however, ensure no member of staff is employed at the home unless checks on their identity and any possible criminal history have been undertaken to ensure their suitability to work with vulnerable young people. However, the home has accepted new staff with Disclosure and Barring Service checks carried out by a previous employer without undertaking a risk assessment.

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Safeguarding children and young people

No child protection issues have arisen; however, training on safeguarding and child protection has not been provided to most staff. The failure to ensure that staff are suitably guided and trained in relation to safeguarding undermines safe care practice and has the potential to place young people at risk. Any investigations of a child protection nature may be undermined if staff are not fully aware of what actions they should take.

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Safeguarding children and young people

Management ensure suitable systems are in place to ensure the safety and security of the building through regular checks. Hazardous chemicals and sharp knives are stored securely. Fire precaution arrangements in the home ensure young people and staff are safeguarded from fire in line with current good practice. Fire practice arrangements are not sufficiently regular to ensure that new staff and young people undertake practical instruction of what to do in the case of an emergency. This means that these individuals may not exit the building safely in the event of fire.

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Leadership and management

The leadership and management of the children's home are inadequate . This home has had poor management oversight and leadership over the past year. The responsible individual has not ensured that requirements and recommendations set at previous inspections are fully addressed and a number of additional requirements and recommendations have been set at this inspection. The previous Registered Manager left the home in February 2013 and a new manager is now in post.

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Leadership and management

The quality of care to the young people remains sound as a result of the solid commitment of staff. Staff demonstrate positive expectations of, and aspirations for, the young people in their care. Staff feel that their key strength is that they work well together as a team and this has minimised the impact of recent, management changes and staffing shortages. Staffing levels are suitable to meet the needs of the young people. A minimum of three staff are on duty at any given time during the day with one waking and one ‘sleep in’ staff on duty at night. Agency and bank staff are frequently used to plug current staffing gaps. Regular bank or agency staff are used in order to ensure continuity of care is not compromised.

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Leadership and management

Regular staff meetings and effective shift handovers ensure that staff are aware of key issues within the home. Staff have established genuine and positive relationships with young people and provide positive role models of both sexes.

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Leadership and management

Staff recruited come with a variety of experience of working with young people; however, there is very little evidence of an effective induction programme to establish staffs basic competence. The organisation has not sufficiently invested in staff training. The vast majority of staff have not received training in key areas such as safeguarding, control and restraint, food handling, first aid and medication. Staff highlight this as an area where they feel the home is not recognising their needs and helping them develop their knowledge and awareness. Individual staff supervision arrangements are not sufficiently robust. The staff supervision contract states that staff can expect individual supervision for a minimum of one and a half hours a month; however, staff have often had gaps of six months. Staff refer to a period where they have felt unsupported and ‘rudderless’ with a lack of clear direction.

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Leadership and management

Shortfalls in staff supervision were raised at the last inspection. The failure to provide staff with suitable induction, supervision and training means that there is little baseline for professional competence, monitoring their practice and support.

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Leadership and management

Recording systems for key events such as sanctions, restraints and missing from care incidents are not maintained accurately and in line with regulatory requirements. The organisation has yet to establish well organised and consistently effective recording and file management systems which aid monitoring of the service and help identify emerging patterns and trends. A requirement set at both the previous full and interim inspections with regards to the recording of sanctions and restraints has not been addressed.

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Leadership and management

The Statement of Purpose and children's guide are useful documents which are kept under review and serve to inform young people and placing authorities about the services available within the home.

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Leadership and management

There are inadequate systems in place for effectively monitoring the standards of care and management within the home. No review of the quality of care in line with Regulation 34 has been forwarded to Ofsted. No monthly visits to monitor the quality of care have been carried out under Regulation 33 since November 2012. As a result the responsible individual has not been sufficiently aware of the shortfalls within the home. The responsible individual states that they are unaware of the requirements of the regulation governing this, which indicates that they do not have sufficient awareness of their roles and responsibilities under the Children’s Homes Regulations.

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Leadership and management

The new manager has identified a number of the shortfalls outlined in the inspection and is developing a plan of action to address these and move the home forward. The manager has had very limited opportunity to put these into place; however, is able to demonstrate some of the plans of action, such as plans in relation to staff recruitment, induction and reviewing of file management. The home has, under the leadership of the new manager, significant capacity to improve.

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About this inspection

The purpose of this inspection is to assure children and young people, parents, the public, local authorities and government of the quality and standard of the service provided. The inspection was carried out under the Care Standards Act 2000 to assess the effectiveness of the service and to consider how well it complies with the relevant regulations and meets the national minimum standards.

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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 and the evaluation schedule for the inspection of children's homes.

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