Children's Home run by Pathway Care Solutions Ltd in Nottinghamshire

Unique reference number SC390190 Inspection date 11/09/2013 Inspector Catherine Honey Type of inspection Full Provision subtype Children's home

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Date of last inspection 24/07/2013 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

This is a privately operated children's home. The home is registered to accommodate up to three children with emotional and/or behavioural difficulties.

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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

At the previous inspection on 24 July 2013, the home was judged inadequate with five requirements and one recommendation made. All requirements and the recommendation have been met. However, this inspection has identified further shortfalls and the overall effectiveness of the home is judged as inadequate.

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Overall effectiveness

Most young people make adequate progress at the home. Young people say they feel safe and display positive relationships with staff. The home provides a level of care that promotes positive outcomes for most young people. Some young people are making progress in achieving positive outcomes in relation to their health, such as by engaging in smoking cessation. However, some young people have suffered a recent deterioration in their psychological health. Although staff consistently try to engage and promote positive outcomes, the effectiveness of their care is limited for some young people.

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Overall effectiveness

While all requirements from the previous inspection are met, there are continuing aspects of concern in relation to poor fire safety, young people's health needs, and training for staff. Additionally this inspection identifies regulatory shortfalls in the area of leadership and management in respect of the review of the quality of care, failure to make notifications to Ofsted and poor quality supervision. Managers do not ensure that health and safety requirements are met, for example, not all young people have experienced a drill in relation to the safe exit of the building in an emergency, a fire drill was directed by the manager, but not undertaken. In addition, the front door is not secure. Managers have been unable to ensure that all staff achieve the minimum qualification for working with children, but are taking action through performance management about this. In addition, the home has used persons not directly involved in the health care of a child for health advice, there

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Overall effectiveness

have been delays in young people receiving sufficient bedroom furniture and staff management of challenging behaviour risks criminalising children. There has also been a delay in the commencement of an internal investigation into an allegation. As a result, the welfare and protection of young people is not adequately safeguarded. This does not evidence the home’s capacity to continually improve.

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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

(2001) ensure that the requirements of Regulatory Reform (Fire Safety) Order 2005 are complied with. This is in relation to regular fire drills and children knowing what to do in an emergency situation (Regulation 32 (1A) (b)) 09/10/2013

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Reg. Requirement Due date

(2001) ensure that all parts of the children’s home used by children are secure from unauthorised access (Regulation 31 (2) (b)) 09/10/2013

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Reg. Requirement Due date

(2001) ensure that if, in relation to a children’s home, any of the events listed in column 1 of the table in Schedule 5 takes place, the registered person shall without delay notify the persons indicated in respect of the event in column 2 of the table (Regulation 30) 09/10/2013

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Reg. Requirement Due date

(2001) ensure the system for reviewing the quality of care shall provide for consultation with children accommodated in the home, their parents and placing authorities (Regulation 34 (3)) 16/10/2013

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Reg. Requirement Due date

(2001) ensure that each child is a registered patient with a general medical practitioner who provides primary medical services. (Regulation 20 (2) (a)) 09/10/2013

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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 home provides a comfortable and homely environment. This is in relation to avoiding delays in providing young people with sufficient storage facilities (NMS 10.3)  ensure the home’s approach to care minimises the need for police involvement to deal with challenging behaviour and avoids criminalising children unnecessarily (NMS 3.22)  ensure investigations into allegations or suspicions of harm are handled fairly, quickly, and consistently in a way that provides effective protection for the child, and at the same time supports the person who is the subject of the allegation (NMS 20.8)  ensure that all care staff have attained a minimum level 3 qualification (NMS 18.5)  ensure staff are provided with regular supervision by appropriately qualified and experienced staff (NMS 19.4)  work with the responsible authority to ensure effective sharing of information held in the home’s records about the child and information held in the

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Recommendations

responsible authorities records. (NMS 22.7)

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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

Outcomes for young people are generally adequate, although for some young people there has been a recent decline in their emotional wellbeing resulting in a reluctance to engage in usual daily activities. Most young people engage in active lifestyles in order to promote healthy living. Young people who smoke are encouraged to stop and are engaging with smoking cessation services. Most young people generally enjoy good health, although for some there has been a deterioration recently. Young people are involved in menu planning and benefit from a healthy, balanced diet.

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Outcomes for children and young people

Young people have access to a range of activities in the community such as football clubs. This means young people develop confidence and new skills and are able to form friendships. Young people also benefit from regular contact arrangements with their families. During contact, where appropriate, parents are encouraged to spend time with young people in the home or by engaging in activities in the community.

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Outcomes for children and young people

Young people's attendance at school and educational achievement is generally adequate. Some young people have recently engaged in college courses and are enjoying the educational and social opportunities that come with this. Young people who are not currently attending a provision are supported by tutors in the home to complete work that is suitable for their educational level. As a result, young people are working towards achieving their educational potential.

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Outcomes for children and young people

Young people undertake some activities in the home, as appropriate to their age, to develop basic practical and life skills such as cooking, tidying their rooms and cleaning. Others are engaged on independence programmes. This means young people receive adequate support which helps them prepare for adulthood.

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Outcomes for children and young people

Young people enjoy positive relationships with staff and are encouraged to develop a more positive self-view and improve their emotional resilience. For example, young people talk to staff about sensitive issues or issues they are worried about. This means young people develop trusting relationships with staff and are more able to talk about and understand their background.

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Quality of care

There are positive relationships between the staff and young people. This enables young people to feel valued. Young people state that they are generally happy living in the home with one young person giving the home, ‘A score of nine out of ten.’

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Quality of care

Professionals working with the home give generally positive feedback about the care provided. They also say that staff work well with them and that despite complex and challenging behaviours, the care provided during the whole length of young people's time in placement has a positive impact. However, some professionals cite communication difficulties and a delay in accessing important information and documents about their young person.

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Quality of care

Most young people’s health care is generally well supported and there is good multi- agency working with some health professionals such as those involved in mental health. However, where staff have specific concerns about the health of a child, they do not always contact a primary health practitioner such as a GP or nurse, using a health professional working within the management structure of the provider organisation instead. It is therefore unclear who is responsible for health matters or if consultation is then fed back to the GP for the child’s records. This practice also raises concerns around conflict of interest and poses a risk to the continued health of young people. Therefore, systems in the home are not always effectively ensuring all young people receive consistent care overseen by their registered GP.

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Quality of care

Since the last inspection, arrangements for the recording, handling, safekeeping, safe administration and disposal of medication have been reviewed. Medication is now disposed of more promptly and recording systems are more clear. This means the arrangements for dealing with medication are safe and effective.

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Quality of care

Young people’s education is adequately promoted by the staff and the management team. Young people who are reluctant to get up for education are consistently encouraged. Staff are proactive at organising education placements for newly admitted young people. In the meantime, young people are encouraged to engage in meaningful activities which helps maintain their daily routine in preparation for returning to school.

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Quality of care

Young people are encouraged to care for their bedrooms and personalise them if they wish. However, where storage facilities such as wardrobes or drawers have been damaged, there is a delay in young people receiving replacements meaning they have limited storage space for their belongings. The home is generally well maintained and young people enjoy close access to local shops and facilities.

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Quality of care

Young people are able to express their feelings and views informally to staff and managers at any time, as well as by using key work sessions. They have opportunities to discuss things such as their day-to-day care, behaviour, the house rules and changes to menus. This means young people have the ability to influence their care and the running of the home and are learning the art of compromise. Young people are aware of the formal complaints procedure and this is described to them on their arrival using the children's guide. There have been no complaints from young people since the last inspection as they prefer instead to discuss issues with staff and resolve matters without resorting to formal processes.

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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 do not go missing from the home and do not report bullying as being a problem in the home. Staff have had recent safeguarding training. They are aware of what to do in the event of a safeguarding concern and how to use whistleblowing processes. Young people say they feel safe. However, where allegations have been made against care staff and the Local Authority Designated Officer has recommended an internal investigation, there has been a delay in starting the investigation. This means young people and staff are still awaiting an outcome and the system is not efficient.

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Safeguarding children and young people

Young people's behaviour in general is positive. Staff effectively use distraction and escalation techniques to try and refocus young people if they are becoming agitated. However, on some occasions when young people's behaviour has become challenging, the police have been called to help staff manage behaviour. This approach is disproportionate and indicates that staff do not have the confidence to adequately manage young people’s behaviour. This approach puts young people are risk of being criminalised.

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Safeguarding children and young people

The service undertakes a number of checks to ensure staff recruited to the home are suitable. Appropriate employment processes prevent unsuitable people having access to children.

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Safeguarding children and young people

Since the last inspection, the fire risk assessment has been updated and fire doors are no longer propped open. This means smoke and flames are less likely to spread in the event of fire. Fire alarm systems are checked as required and other health and safety checks such as portable appliance testing is completed as required. However, there are insufficient fire drills to ensure that all young people know how to evacuate the home. In addition, although the need for a fire evacuation practice has been identified by the Registered Manager, the drill has not been carried out. This means adequate precautions are not taken to ensure young people are protected from fire.

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Safeguarding children and young people

The front door to the home is not secure from unauthorised access. The locking mechanism means the door is often left unlocked meaning the home can be accessed from the outside without challenge. When the door is locked, young people or visitors have to request to be let out meaning young people’s liberty is being unnecessarily restricted. This system is not safe or effective.

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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

The last inspection of this home resulted in a judgement of inadequate. The home has sufficiently rectified previously identified breaches in regulation. However, further shortfalls have been identified at this inspection. These factors show the home has a limited capacity to improve.

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Leadership and management

The requirement to ensure that all staff complete recognised induction training has been addressed. While not all staff have completed the training, specific help and support has been offered to staff to aid their study and new staff are accessing recognised induction training. The requirement to ensure each child has access to medical treatment has been addressed. There is now more emphasis on asking young people if they require medical assistance following a restraint and other systems have been improved in this regard. However, this progress is limited by a further shortfall found in staff not approaching a young person’s primary medical professional when health advice was needed. The requirement to ensure fire doors are able to prevent the spread of fire has been addressed, however a further shortfall around fire safety was found in the lack of the regularity of fire drills. The requirement for ensuring the safe administration of medication has been met and the

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Leadership and management

general welfare of young people has been improved by staff receiving safeguarding training and other processes within the home being improved, however this progress is limited by the shortfalls found in this inspection.

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Leadership and management

A recommendation to ensure all new staff hold or are working towards a level 3 qualification has been met. However, further shortfalls were found in the levels of qualifications of existing members of staff. Significant incidents are not consistently notified to Ofsted. There have been three notifiable events since the last inspection which have not been notified to Ofsted. Therefore, the regulator cannot accurately assess how the home responds to incidents or allegations or determine whether appropriate action is being taken to safeguard young people’s welfare.

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Leadership and management

Professionals consulted during the inspection gave mixed feedback on the quality of communication they receive from the home. Some citing communication as very good and others that communication is poor. As a result some professionals are not kept up to date with the care of the young person they are working with. Consultation with placing authorities is not effective. Managers have identified consultation as an area for improvement. The provider sends reports giving an overview of quality of care in the home to Ofsted. However, the views of young people, placing authorities and parents are not reflected. As a result, the quality of care cannot be fully evaluated.

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Leadership and management

The home has a clear Statement of Purpose which is reviewed regularly to ensure accurate information is available to parents and placing authorities. The home provides each young person with a children's guide which details the service offered and telephone numbers for young people to contact for support and advice. Young people are introduced to this document on their admission. This ensures young people are clear about the care and service provided.

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Leadership and management

Young people are cared for by a staff team who bring a variety of skills and experience to the service. The staff rota ensures young people's needs can be met through the provision of sufficient staff numbers. Staff access training in areas such as food hygiene, health and safety, medication and physical intervention, though not all staff have completed or are working towards a level 3 qualification meaning young people may not be cared for by appropriately qualified staff. Although staff have annual appraisals of their performance, supervision is irregular. Staff state they feel adequately supported by regular team meetings and contact with the management team. However, short discussion sessions are often held in place of formal planned supervision, which restricts the quality and content of these important meetings. This means that staff may not be appropriately guided to provide for group and individual planned care.

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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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