Children's Home, Residential special school run by SES Turnstone Limited in Norfolk

Unique reference number SC452461 Inspection date 21/08/2013 Inspector Stephen Halliley Type of inspection Full Provision subtype Residential special school (>295 days/year)

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Date of last inspection 06/06/2013 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 managed and run by a private company. It provides residential care for up to eight young people with emotional and behavioural difficulties. Education may be provided on the same site.

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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 inspection was brought forward as a direct result of a number of notifications being received by Ofsted. These gave cause for concern regarding the homes ability to meet young people's needs with regard to behaviour management and ensuring they are adequately safeguarded.

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Overall effectiveness

Serious shortfalls were noted in respect of fire checks and the involvement of young people in fire drills and evacuations. There are omissions noted in the recording of the use of physical interventions including the signatures of staff who are making the records. There are serious concerns about the current staffing levels and how these shortfalls have been addressed. This has impacted on manager's ability to monitor the home appropriately and to send copies of these monitoring reports to Ofsted. Additionally several notifications of significant events within the home have not been sent to Ofsted without delay, impacting on Ofsted's ability to maintain an overview of issues in the home at this difficult time. Minor shortfalls were also noted in respect of the frequency of staff supervision, the initial training of new staff and areas of recording which should have been picked up through active monitoring by managers.

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Overall effectiveness

For these reasons the overall effectiveness of this home is judged as inadequate.

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Overall effectiveness

Young people have made notable progress in many areas since moving to this home. The impact of this progress is significantly different across the group of young people though staff have high aspirations to support all young people to make significant progress from their starting points.

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Overall effectiveness

This laudable approach is evident throughout the work undertaken by staff but is only effective during one to one or small group sessions. At these times it is clear young people are developing good relationships with staff and are developing a trust in the staff which has been absent from many of their previous relationships with adults. However, the approach is hampered by the difficult relationships that exist between staff and the group when they respond as a whole. Staff remain consistent in their approach to young people, consistently role model appropriate behaviour and place meeting young people's needs and ensuring they are safe at the heart of their practice. However behaviour management and ensuring young people are adequately safeguarded have been areas of significant difficulty recently.

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Overall effectiveness

Each young person has an individualised care and placement plan to which they have had significant input. This ensures individual needs are clearly identified and individual differences accepted and celebrated. These plans have helped promote positive outcomes in some areas though progress in others has been less evident. Family relationships have been repaired and strengthened, and young people enjoy appropriate levels of family contact. Supporting this is a clear area of strength in this home. Attendance in educational provision is variable though for many young people attendance levels are increasing. Young people have much less interest in their own health needs than was previously noted. Risk taking behaviour such as smoking and drinking alcohol is an area the staff team are actively addressing as it is seen as a significant issue at this time.

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Overall effectiveness

Views of young people about the home are mixed. They are aware why they are living here and what the home offers in terms of helping them move towards an adult placement and independence. Some social workers continue to comment positively on the home, it's aims and objectives and the level of care it provides. However, there are some concerns from other social workers and staff within the home about their ability to keep all young people safe at this time. This has come about due to an increase in inappropriate behaviours being seen, including young people self-harming, and the fact that there are a number of staff vacancies. New appointments to the staff team have bedded in well but managerial appointments have been unable to mentor and coach staff as they would have liked due to working alongside staff to manage young people.

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Overall effectiveness

Young people report they do not feel safe at the moment. They are aware that staff work hard to keep them safe but the impact of the group dynamic and the staff shortages has left a number of young people clearly feeling vulnerable.

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Overall effectiveness

The Registered Manager is aware of the strengths and weaknesses of this team. He feels they are all good quality appointments and fully believes they will develop into a highly competent and effective team. This may take some time and will require some major decisions to be taken about the way the home is currently operating; decisions about which the Registered Manager and senior managers are fully aware. Meetings were being held to discuss some of these changes during the inspection and other plans are at an advanced stage. While this home is currently judged to be inadequate I am confident that if the plans being discussed are fully and robustly implemented this home will once again become a quality provision.

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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 following the use of any measure of control, restraint or discipline in a children's home a record is made in a volume kept for the purpose which shall include the signature of the person authorised by the registered provider to make the record (Regulation 17 (B) (3) (i)) 30/09/2013

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Reg. Requirement Due date

(2001) Ensure that the children's home is conducted so as to promote and make proper provision for the welfare of children accommodated there (Regulation 11 (1) (a)) 30/09/2013

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Reg. Requirement Due date

(2001) ensure that if any of the events listed in column 1 of the table of schedule 5 takes place in a children's home, the registered person shall without delay notify the persons indicated in respect of the event in column 2 of the table (Regulation 30 (1)) 31/08/2013

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Reg. Requirement Due date

(2001) ensure the registered person shall supply to Ofsted a report of any review conducted by him for the purpose of reviewing the quality of care at appropriate intervals (Regulation 34 (2)) 30/09/2013

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Reg. Requirement Due date

(2001) ensure that all persons employed by the registered person receive appropriate training, supervision and appraisal (Regulation 27 (4) (a)) 30/09/2013

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Reg. Requirement Due date

(2001) ensure that, where the Regulatory Reform (Fire Safety) Order 2005 applies to the children's home the requirements of that Order and any regulations made under it, except for article 23 (duties of employees), are complied with in respect of the home. (Regulation 32 (1A) (b)) 13/09/2013

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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 new staff undertake the Children's Workforce Development Council's Induction standards, commencing within 7 working days of starting their employment and being completed within 6 months (NMS 18.3)  ensure the manager regularly monitors in line with regulation all records kept by the home to ensure compliance with the homes policies, to identify any concerns about specific incidents and to identify patterns and trends; this specifically relates to completing the final pages of restraint recording in line with the home's policy (NMS 21.2)  ensure management of the home ensures all staff work is consistent with regulations, national minimum standards and the homes policies and procedures; this is with specific regard to ensuring the full name of young people are entered on incident records and also the name of the member of staff recording the incident is clearly recorded where required. (NMS 21.3)

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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 make measurable progress in all areas of their lives while living in this home. However, the progress made by individuals varies greatly. All young people have been supported to have a clear understanding of their backgrounds and the circumstances which have led to them living in this home. Some young people have developed a high level of emotional maturity and resilience. These young people have also developed skills such as improved reading or the ability to travel independently. They are becoming increasingly self-assured and are developing positive self-esteem. One social worker commented on her young person being, 'Much more settled and making better decisions than in previous placements. He is happy here and they are supporting his independence. He is attending and learning in school and achieving well.' This is very positive progress and represents a positive step from which to progress further. Other young people continue to have low self-

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Outcomes for children and young people

esteem though this area is clearly identified in their placement plans as a priority focus area.

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Outcomes for children and young people

Young people's health is given a high priority and there is regular access to health professionals as appropriate. There are good medical procedures in place and staff respond well to young people when they are unwell. This includes measured responses to the increasing levels of self-harm which have become more prevalent in recent weeks. Young people do not appear overly concerned with taking responsibility for their own health and well-being. Risk taking activities include smoking and using alcohol and there are concerns that some young people are also using illegal substances if they have the opportunity. Access to therapists employed by the organisation supports emotional and psychological health and there are good links to local child and adolescent mental health services.

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Outcomes for children and young people

Young people benefit from the learning centre being on site though attending and achieving in education is again an area where outcomes vary considerably. Notable successes include young people making significant strides in their reading and general literacy. Those who do not flourish in a classroom environment are encouraged to do more vocationally based tasks such as building barbecues and a pond. This ensures they develop their skills in core areas such as mathematics, reading and budgetary management which will be beneficial to them in the future. Some young people are reluctant to engage in education but the staff work consistently hard to try and encourage this.

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Outcomes for children and young people

Young people have lots of involvement in improving the environment of the home and grounds. This has included building the barbecue, growing flowers to decorate the home and running a successful vegetable garden. Young people have also been involved in making good damage they may have done to the fabric of the building. This restorative approach is helping young people realise the impact their behaviours have on other people. Young people are actively involved in a number of community based activities including using leisure centres, attending festivals and boating trips on The Broads. Individual involvement in clubs has been limited though boxing clubs and army cadets have been looked at. The home are aware there is a need to further help young people to develop their coping skills in a variety of social settings so that this aspect of their social development can be enhanced.

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Outcomes for children and young people

Young people benefit from family contact as appropriate to their needs and any restrictions which may be in place. Family contact plans are clear and well managed by the staff. This is an area of strength for this home and ensures young people are able to maintain the relationships which are important to them.

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Outcomes for children and young people

Independence plans are clear and some young people are making significant progress in areas such as travelling independently and spending time in the city on their own or with friends. Others are not yet at this stage though life skills such as household chores are being developed by all young people. Plans are clearly in place for older young people who are starting to consider the transition to adult placements. These should ensure young people are well equipped to move on from this home at the appropriate time.

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Quality of care

Young people generally enjoy good relationships with staff on a one to one basis. At these times young people interact well, enjoy the activities and time with staff and show a degree of valuing and buying in to their placements. For some young people this is the first time they have developed trusting and lasting relationships with adults. However, when the group come together relationships with staff are very different and the management of this group dynamic by staff is very reactive and often ineffective. Young people do not appear to value their relationships with staff at these times. Staff make appropriate, clear challenges to behaviour and requests of young people based on the relationships they know they have with them as individuals. Staff are very clear when young people cannot do as they wish and explain this well in a reasoned manner. However young people feel they can manipulate the staff into changing decisions by threats of, or actual, violence or self-

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Quality of care

harming behaviour. Staff continue to work in a manner designed to reinforce acceptable behaviour but this is a major challenge at this time. Throughout all these interactions and the management of situations there is a clear ethos of staff being there for young people and having their best interests at the centre of their work. One social worker commented, 'The staff are very willing to continue working with her despite the problems that have been evident recently. I feel the home understand her and meet her needs and are able to work with her.'

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Quality of care

Young people do feel staff listen to what they say; this is clearly evidenced in staff's responses to requests to change plans or activities, their actions following issues being raised in house meetings and by the colour schemes and decoration of individual rooms. This shows young people their thoughts and views are valued by staff and important to how the home is run. Young people are clear on the complaints processes but they have not made any complaints. Low key grumbles have been addressed quickly and to everyone's satisfaction. Staff are clear they offer young people the opportunity to complain should they indicate a wish to do so. This was observed during the inspection visit but the young person declined to take this further. This open approach ensures young people know they can raise legitimate concerns they have about their care or the running of the home and that they will be responded to.

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Quality of care

Young people all have detailed daily living plans which are informed by the care and placement plans in place. Young people are actively involved with staff in reviewing these plans and setting new targets. They also attend their reviews and are encouraged to put their views across to those in attendance. This ensures young people are actively involved in the decisions being made about their lives.

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Quality of care

Young people's health and well-being are given a high priority within this home. A well-balanced diet is always available which young people are involved in planning. All young people are registered with, and have good access to, a range of health professionals and staff support appointments to ensure attendance. Staff work hard to liaise with parents and carers to try and minimise the potential for substance misuse but their work is not actively supported in all cases. While the standpoint and work of staff in this area should be commended this leads to young people sometimes returning to the home under the influence of substances and this has a negative impact on the remainder of the group. Emotional and psychological health is supported by a team of therapists employed by the organisation. Access to child and adolescent mental health services is also readily available if required. Staff take great care to ensure the correct therapeutic approach is used for each young person

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Quality of care

to ensure their individual psychological needs can be fully addressed. This approach ensures young people's health needs are well met in all areas.

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Quality of care

Young people are actively encouraged to attend education and the links between the educational and pastoral teams are very strong. Each young person has a 24-hour learning plan on file which ensures that all learning opportunities are taken up and recorded. This allows social activities to be planned to support educational work taking place. Staff are very clear that education is a very important part of the overall service they provide for young people. They are clear that ensuring young people engage in education is one of their priorities due to the long term benefits an education will have on a young person's life opportunities. Young people's needs are being met as fully as possible at this difficult time. Family contact is given very high priority and staff make robust efforts to offer young people individual or group activities in which they have a clear interest. Individual needs are well known to the core staff though they may not be quite so well known to staff

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Quality of care

from the sister home in the organisation who are supporting this home while there are ongoing staffing issues. However, staff take great care to share as much information as possible with newer colleagues to ensure a consistent approach to meeting all areas of individual need wherever possible.

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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's surveys and comments made indicate they do not feel safe in this home at this time. This is a clear impact of the challenging group dynamic and current staffing issues which have come together to have a major impact on young people's perceptions of the home. Social workers differ in their views on this. One reports she is, 'Happy my young person is safe and that this is the best placement for her;' another says, 'I am happy with the home and what is going on for him here. His needs are clearly being met. I am absolutely confident that he is safe here.' However a third states, 'We have been concerned by the number of hospital admissions there have been recently. These are not necessarily the fault of the staff but are a clear escalation in behaviour. We had real concerns this week about an incident and feel her behaviour has escalated to a point where they cannot keep her safe and meet her needs. It is fair to say our concerns about her placement have

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Safeguarding children and young people

grown over time.' This concern is shared by staff and managers in the home who acknowledge they are not certain they can protect some young people from themselves due to their increased self-harming and risk taking behaviour. Plans are being put in place to access additional support and to consider alternative placements to ensure young people's needs can be met and they can be kept safe.

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Safeguarding children and young people

A range of health and safety checks are regularly carried out to ensure young people are safe from accidental injury while at the home. However there are significant gaps in the frequency of a number of fire checks; specifically weekly testing of fire alarms, monthly checks of fire fighting equipment and regular checks and servicing of the emergency lighting system. New admissions to the home have not yet been involved in a fire drill or emergency evacuation of the home since moving here. This means staff cannot be certain they would know and be able to follow emergency evacuation procedures should an emergency situation arise.

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Safeguarding children and young people

There have been seven incidents of young people going missing from this home since the last inspection in June 2013. This indicates an increase in frequency and may be symptomatic of young people feeling unsafe. The home has a clear protocol in place for staff to follow when young people go missing and this is closely linked to Police procedures. This ensures young people are responded to consistently and quickly should they leave the home without permission. Good work is done to discuss behaviours and options with young people when they return but his has not had a significant impact on reducing absences.

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Safeguarding children and young people

Staff work hard to model positive behaviour to young people and they show a clear ability to behave appropriately in one to one situations. This has not been successful when working with the whole group of young people as there is a very strong group dynamic with some young people manipulating the behaviours of others to their own ends. This has led to there being 66 restrictive physical interventions carried out since the last inspection. These have been appropriate to the behaviours seen and to prevent young people injuring themselves or others. Restraint has become a behaviour management tool as young people are failing to respond to very clear, well-balanced early interventions from adults to de-escalate behaviours before restraint becomes necessary. There are some omissions in the recording of restraints including the signature of staff making the record which could lead to future issues should a complaint or allegation result from the restraint situation. Also deputy care

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Safeguarding children and young people

managers are not consistently completing the restraint records in line with the home's policies and procedures relating to records and notifying appropriate parties. This can potentially lead to social workers and parents not being aware that the child has been restrained and understanding the behaviour that led to this. There have been 17 serious incidents which did not lead to a restraint. These are clearly recorded in the main but there are some gaps where the full name of the young person has not been recorded and the name of the staff involved has not been clearly recorded as required.

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Safeguarding children and young people

Recruitment checks on new staff are robust and very clearly recorded. The visitors book is well used and visitors are collected from reception and chaperoned by the member of staff they have come to visit. This ensures young people are kept safe from the potential of harm or abuse from adults who work with them or who visit the home.

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Safeguarding children and young people

One allegation of a serious nature has been made during this period. This was reported to appropriate authorities and outside agencies including Ofsted, social workers and safeguarding teams. The social worker of the young person involved is very happy that this has been fully investigated and resolved. She does not feel the allegation can be substantiated and is very clear she feels her young person is safe in this placement. This shows the home take these issues seriously and respond appropriately when there are serious concerns about the safety of young people brought to their attention.

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Safeguarding children and young people

This home provides a very large, spacious and pleasant environment for young people. Within the home there are systems in place to ensure knives are locked away and a good standard of building security is in place. However, young people have recently begun to show increased levels of risk taking behaviours including actual or attempted self-harm. This has included young people cutting themselves, attempted use of ligatures and attempts to overdose on over the counter medication. The staff have put plans in place to reduce young people's access to medication and have increased the level of staffing when young people go off site. Social workers say, 'The risk assessment was updated and sent to me. I looked at this with my manager and we were happy to sign this off. They followed up with appropriate medical attention but I don’t believe the tablets were necessarily taken. They did everything they could and I feel the response was appropriate to the situation.' This shows good

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Safeguarding children and young people

learning and responses to situations but the frequency of this type of incident is concerning. Staff are vigilant in their work with young people and ensure they know their whereabouts at all times. However they have been unable to effectively reduce the self-harming incidents which have been occurring. There is a feeling that recent behaviours are not deliberate attempts to seriously self-harm and it is fully acknowledged the risk to young people is linked more to inadvertent damage through their actions rather than any serious intent. This does not however mean this risk cannot be taken seriously. Much of the work so far carried out has been reactive rather than proactive management of risk taking situations and there are genuine concerns about the homes ability to ensure young people are adequately safeguarded at this time.

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Leadership and management

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

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Leadership and management

In terms of the day to day management of the home the Registered Manager, newly appointed manager designate and Principal of the sister home have been working tirelessly alongside staff to support them in the management of young people. This has shown a shoulder to shoulder approach to staff who have appreciated the support at this difficult time. Unfortunately the fact managers have been covering shifts has had a significant negative impact on their ability to undertake the management role within the home.

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Leadership and management

The most significant area of progress made by the home since the last inspection has been the appointment of new staff. A new manager designate has been brought in and a head of care and two deputy care managers were appointed as internal promotions. These are seen as high quality appointments and will enable the home to move forward. Unfortunately one deputy care manager has left, one has been unable to work for a period of time and the previous vacancies plus those brought about by internal promotions have not been filled. Coupled with annual leave this has led to significantly reduced staffing numbers being available. Staff from the sister home have helped out when possible but questions have to be asked about the long term planning to fill gaps which were identified some time ago. The need to provide one to one staffing when young people have been in hospital has had an additional impact on this and has led, at times, to staff working 24 hours without a break which

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Leadership and management

is unsafe for all concerned. Proactive steps are now being taken to bring in experienced staff to work on fixed term contracts until the staff vacancies are filled. Directors plan to ensure they appoint high quality, experienced staff while they nurture newer and less experienced members of staff to work at the level senior managers and the organisation expect.

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Leadership and management

Two recommendations from the previous inspection have not been met. One of these relates to fire drills. The second to the reporting of monitoring of the home. While regular external monitoring of the home has been taking place and reports sent to Ofsted the internal monitoring systems have not been as robustly implemented. This is clearly seen in the repeated gaps noted in restraint records for example. Additionally, though the home has been open for almost one year, no reports of managers monitoring have been forwarded to Ofsted as required.

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Leadership and management

Placing authorities are clear the home is working towards its statement of purpose and that the practice within the home meets the aims and objectives set out. There are some concerns however about their ability to work with a number of young people who seriously self-harm. This aspect of behaviour is not clearly outlined in the statement of purpose but is covered in the fact the home works with young people with mental health issues. The manager designate is giving some thought to amending the wording of the range of needs the home work with. She feels they need to look clearly at working with young people with emotional and behavioural difficulties alongside young people who may have an autistic spectrum disorder. Additionally thought needs to be given to their ability to work with young people who self-harm though she feels this could be addressed by specific, targeted training for all staff. This shows good awareness of what the home is good at and areas where it

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Leadership and management

may need to look to improve on current practice.

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Leadership and management

There are no concerns about the financial viability of this provider. The home is well maintained in the main and there is a clear system in place to respond to damage within the home in a timely manner. Decisions have been taken about the appropriate time at which to advertise current staff vacancies and these have been based around market forces not financial implications.

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Leadership and management

All established staff have received regular, good quality training in all mandatory areas; behaviour management, safeguarding, fire safety, first aid and food hygiene. For new staff who have not yet completed all these courses training is booked to take place in September. Additional training has also been provided during team meetings to look at behaviour management, identifying behaviours, strategies to address behaviours and the ABC of behaviour. This shows managers are clear staff should be as well- equipped as possible to manage the behaviours they are being faced with. Most staff receive regular supervision and they are clear that there is an open door policy to managers outside planned sessions. However, newly appointed staff do not routinely have regular formal supervision nor have they begun to complete the children's workforce development council's induction standards.

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Leadership and management

Young people's records are very clearly recorded and are laid out in a manner which would make it quite easy for a young person to understand what was happening for them in the home should they wish to access their files. Daily living plans, risk assessments and action plans are regularly reviewed and updated. This clearly shows progress made in targeted areas and will allow young people to fully understand progress they have made as a result of living in this home.

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Leadership and management

The number of notifications of significant events received by Ofsted was a major reason in this inspection of this home being brought forward. Many notifications relate to incidents of self-harm and safeguarding as already mentioned. They have not always shown a clear action plan or risk assessment modification to fully respond to the situation reported but this is being addressed by managers. A number of notifications were significantly delayed in being reported to Ofsted. It is important these are sent through promptly so Ofsted, as a regulator, maintain an overview of what is happening in the home. This is particularly important when there are concerns about behaviour management and the safeguarding of young people.

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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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