Children's Home run by Amelia’s House Limited in Brent

Unique reference number SC448693 Inspection date 30/10/2013 Inspector Angus Mackay 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

This privately run home can accommodate up to four young people 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 adequate .

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Overall effectiveness

This is a new setting which has undergone changes in the management. The home provides a relaxed, friendly environment, with a strong focus on communication with young people. The home provides good outcomes for children and young people who have behavioural problems and often significant leaning difficulties. Young people previously considered to be non-verbal and aggressive have developed a basic vocabulary and respond positively to staff interventions. Positive health changes have included good weight control and a managed reduction in the use of medication to control behaviour. One social worker commented, ‘I am really pleased with the work done by the home, for the first time in the young person’s life he has settled well.’

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Overall effectiveness

The staff group is small but highly committed to improving outcomes for the young people in their care. Young people are comfortable in the home and display affection and warmth towards the staff. Staff are knowledgeable about the young people’s cultural and care needs and are creative and enthusiastic in their work.

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Overall effectiveness

The home responds well to comments on the service and several changes, to systems, recording and planned training, were made during the inspection. There are five requirements made to improve the service to young people. Appropriate changes were made to risk assessments, behaviour management plans and individual support plans during the inspection ensuring consistency in staff interventions. There have been no physical interventions but staff have not been trained in an accepted method of intervention and the recording system was not compliant with regulations. Training was arranged during the inspection and recording systems corrected. Supervision provided to staff is poor and is not in line with the standard outlined in the Statement of Purpose. Staff have first aid training booked but currently there are some shifts where there is no person with a suitable first aid qualification. Other shortfalls identified were a lack of permissions for medical treatment, very basic

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Overall effectiveness

external and internal monitoring of the conduct of the home, a lack of up to date information from placing authorities, not all staff have practiced an emergency fire drill and a need to continue to monitor staffing levels.

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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) improve record keeping on children's files, so that the information kept is more detailed, relevant and kept up to date. This in particular relates to individual support plans, behaviour management plans and risk assessments (Regulation 28) 31/01/2014

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Reg. Requirement Due date

(2001) ensure that all persons employed receive appropriate training and supervision (Regulation 27 (4) (a)) 31/01/2014

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Reg. Requirement Due date

(2001) ensure that at all times, at least one person on duty at the children's home has suitable first aid qualification(Regulation 20 (2) (e)) 31/01/2014

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Reg. Requirement Due date

17B (2001) ensure that within 24 hours of the use of any measure of control, restraint or discipline in a children's home, a written record is made in a volume kept for the purpose which shall include all of the information (a)-(i)(Regulation 17B (3) (a)-(i)) 31/01/2014

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Reg. Requirement Due date

17B (2001) ensure that where a measure of restraint is used on a child the record under paragraph(3) must include the duration of the measure of restraint and any methods used to avoid the need to use that measure.(Regulation 17B (4) (a) (b)) 31/01/2014

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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 that children's health is promoted in accordance with their placement plan and staff are clear about their responsibilities and decisions are delegated to them and where consent for medical treatment needs to be obtained (NMS 6.5)  ensure that each child has prior written permission from a person with parental responsibility for staff to administer first aid and non-prescription medication (Volume 5, statutory guidance, paragraph 2.54)  ensure you have a copy of the child's Personal Education Plan, where this has been produced as a separate document from the education module of the child's care plan (Volume 5, statutory guidance, paragraph 2.118)  ensure that all staff and children are familiar with and have practiced the emergency escape plan (NMS 10.9)  ensure that the overall number, competence and deployment of staff and number and deployment of staff, both as a staff group and on individual shifts,

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Recommendations

can fulfil the home's Statement of Purpose and meet the individual needs of all children resident in the home (NMS 17.1)  ensure that regulation 33 visits observe the care provided, the practice of staff, inspect compliance with regulations, systems and processes and the quality of the environment. The visit must wherever possible include private interviews with children or young people living in the home and staff. Parents relatives or carers should also be interviewed where appropriate. A written report on the conduct of the home must be prepared after the visit and made available to HMCI, the registered manager, and anyone else with responsibility for the management of the home (Volume 5, statutory guidance, paragraphs 3.12 and 3.13)  ensure that the monitoring of the matters set out in Schedule 6 is improved. This will enable the provider to identify any trends and issues of concern so that all

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Recommendations

those involved in running and working in the home can continually improve the quality of care they are providing. (Volume 5, statutory guidance, paragraph 3.14)

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Outcomes for children and young people

Young people with severe communication difficulties make substantial progress in verbal skills within the home. Those previously identified as non-verbal gradually develop an ever increasing vocabulary. Young people engage positively with staff in activities designed to improve their communication including repeating words in stories, saying yes or no and singing songs. At meal times young people form basic sentences to ask for their meal and say please and thank you. One social worker commented on one young person, ‘prior to going to the home he was non-verbal but now can make simple sentences and communicate verbally.’

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Outcomes for children and young people

Young people enjoy stability in the home and display positive behaviours and basic good social interactions with others. Young people placed in the home due to placement breakdowns, involving violent incidents, are settled and do not display aggressive behaviours. Young people respond positively to early staff verbal interventions and clear unambiguous messages. Young people respond to staff checking their understanding and those previously said to be non-verbal use simple yes or no responses. Young people are developing good relationships with others based on the reinforcement of their success in communication. One social worker commented, ‘The home are managing his behaviour but are also developing his potential as an individual and meeting all of his needs.’ Young people make significant progress in improving behaviours which were impeding their social integration. Targets include avoiding inappropriate touching and

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Outcomes for children and young people

extreme sexualised behaviours. Young people make tracked progress over short periods of time successfully eradicating these behaviours. Young people work closely with staff and other agencies such as child and adolescent mental health services, to address extreme behavioural issues. This has led to dramatic improvements in behaviour and a managed reduction in the use of controlled medication. Young people engage positively in this programme which is closely monitored by staff. As a result young people are more energetic and respond to verbal interventions rather than relying on medication.

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Outcomes for children and young people

Young people are enthusiastic about the recreational opportunities within the setting and join in a wide range of activities. They demonstrate progress through participation in diverse activities including simple ball games, dancing, walking and swimming. Young people who were overweight have weekly targets, which they work to, increasing activity, eating controlled portions and reducing weight. Young people show continuous progress in meeting these health targets. Young people also build on their limited social skills through these activities, learning how to share and engage positively with others.

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Outcomes for children and young people

Meals are healthy and nutritious and meet young people’s preferences, as well as religious and health requirements. Young people develop self-help skills ranging from learning how to use eating implements, through to helping to clear up, or wash dishes. They also learn how to wait for their turn, how to ask for different things and to say please and thank you. For some young people learning to pour a drink is significant progress. Young people work on new targets, once they have achieved existing ones long enough for them to be able to continue to maintain them without staff reinforcement. Consequently young people are gradually increasing their self- help and life skills.

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Quality of care

All young people are registered with local health services to ensure that they get dental, optical and medical care appropriate to their needs. Where necessary or desirable, staff work closely with specialist services, including child and adolescent mental health services, to meet the needs of the young people. Staff store and issue medication safely. Staff have modified recording to show a running total of medication held, improving the safe storage and disposal of medicines. Not all permissions for medical treatment were on young people’s files although local authorities confirmed that these are in place. Only two staff hold an appropriate first aid qualification. Training is planned for all remaining staff to ensure there is always at least one person on duty at the children's home that has a suitable first aid qualification. Young people have a range of health care targets which the manager consolidated into one health care plan during the inspection. Young people receive

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Quality of care

good health care which recognises their personal and cultural needs as well as their specific health needs. Targets are regularly reviewed and modified in line with progress or consultation with relevant professionals. As a result young people experience good health care which addresses all of their identified needs.

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Quality of care

The home encourages young people to eat healthily and ensure that meals are balanced, culturally appropriate and enjoyable experiences for young people. Care and health plans identify foods which young people like to eat but also those they do not eat, for religious or medical reasons. Meals are freshly prepared and young people assist in shopping for ingredients. Where young people have limited or no verbal skills staff engage them in choosing meals, in ways which they can understand. This improves young people's engagement in their own care and ensures they eat healthy and culturally appropriate meals.

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Quality of care

Staff maintain good contact with young people’s schools and attend all meetings and social events there. Staff follow educational targets in young people’s individual educational plans reinforcing learning from school. There is good sharing of information between schools and the home particularly around behaviour management. Staff contact the school seeking homework for young people and imaginatively use activities within the home leading to a gradual improvement in young people’s verbal skills.

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Quality of care

Staff enthusiastically join in activities with young people leading to a similar response from the young people. Young people have significant health and communication difficulties and staff provide activities which aid young people’s development. Activities in the home include art work, tracing letters, story reading and word development, puzzles, dancing, singing, playing music and use of the soft room or garden. Out of the home young people enjoy more physical activities including walks, going to the local running track, swimming and yoga. Staff are very knowledgeable about the particular interests of young people ranging from bouncing a ball to making up musical sounds. Staff are also highly aware of the triggers to incidents which are often young people’s frustration at difficulties in communication. The staff are very good at communicating with the young people as a result no serious incidents have occurred. Young people are developing their comfort in social

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Quality of care

situations, improving verbal and dexterity skills and having fun with these activities.

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Safeguarding children and young people

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

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Safeguarding children and young people

Young people show confidence in staff and are relaxed in their presence. Non-verbal young people show affection towards staff who respond appropriately. Social workers confirm that young people are safe in the home. The home has comprehensive policies and procedures to address all forms of bullying. Currently there is no bullying in the home but staff remain vigilant ensuring young people enjoy safe care. The manager maintains a close control on new admissions, recognising the vulnerabilities of young people accommodated, to ensure that she maintains a safe environment.

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Safeguarding children and young people

Young people receive constant prompts from staff in relation to their behaviours. During the inspection the manager implemented positive behaviour management plans, for young people, from the existing disparate records. The new plans make it much easier for staff to monitor progress against behavioural targets. Staff are aware of triggers and signals of unwanted behaviours taking a firm, caring and consistent approach in addressing them. Consequently there have been no serious incidents and no restraints. Staff had not been trained in the use of restraint and records for recording restraints were incorrectly laid out. During the inspection the log book was corrected and training was confirmed for the following week. These deficits have not impacted on young people as there have been no restraints.

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Safeguarding children and young people

Staff are aware of the triggers leading to individual young people going missing and respond appropriately. Staff are aware of the individual risks young people present but have not always formalised the protective factors and triggers to behaviours in risk assessments. This limits the effective monitoring of young people’s progress and potentially places them at risk. Low numbers of young people and staff knowledge of triggers and protective factors has kept young people safe. During the inspection risk assessments were formalised and expanded. There have been no instances of young people going missing.

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Safeguarding children and young people

The environment is physically safe. Fire drills are regular and all young people have taken part in an emergency evacuation. It was not possible to know if all staff had practiced an emergency evacuation as no staff names were recorded against fire drills. External security is enhanced by closed circuit television and controlled door access. Staff protect young people from inappropriate contacts by the controlled entry and scrutiny of identification, prior to the admission of visitors to the home.

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Safeguarding children and young people

The home has suitable recruitment and appointment procedures, ensuring safer selection of suitable people to work with the young people. All staff have all appropriate checks in place. The home has current policies which the staff apply providing safe care for the young people. In particular, the child protection policies are in line with local procedures and the home has all appropriate and required policies and procedures to guide staff interventions. Staff have received training in child protection, from the local safeguarding children board. Staff demonstrated an adequate understanding of how to apply this training in their practice with young people. Consequently young people receive appropriate care, from suitable staff ,in a safe environment, ensuring their wellbeing is paramount.

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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

Since the registration of the home the Registered Manager has left. The registered person is currently acting as manager of the home and has an application in progress with Ofsted to be registered. The manager maintains a business plan for the home which sets clear targets for the continuation of the service. The manager monitors the quality of care within the home and has supplied, to HMCI, an evaluation of the first six months of operation of the home. The manager receives external monitoring reports on the conduct of the home and sends these reports to HMCI monthly. Both the internal and external monitoring reports lack detailed information and do not cover all required areas. Consequently the reports fail to provide useful analysis and evaluation of the activity of the home necessary to aid the improvement of the service. The small size of the home allows the manager to have an adequate understanding of the strengths and weaknesses of the service to ensure young

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Leadership and management

The manager has regularly revised the Statement of Purpose ensuring it reflects the service provided by the home. However, the frequency of staff supervision is not met by the home. Staff do not receive supervision of a high quality with the regularity specified in the Statement of Purpose. Staff do have regular appraisals and do feel supported by the manager. For example, staff say that following safeguarding training the manager checked their understanding of the course and its application in their work. The lack of staff supervision hinders their development and limits the structured improvement of the care provided to young people.

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Leadership and management

The manager employs a small staff team which she plans to expand in line with the continuous development of the home. The current rota only works due to the flexibility of the staff team in particular the manager. The home has a structured training programme designed to enable staff to provide good quality and safe care to young people. The training programme includes courses specific to the needs of the young people accommodated. At the time of the inspection not all essential training had occurred but was planned to occur in the following week. This has not impacted negatively on the care of the young people but leaves staff and young people vulnerable.

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Leadership and management

The young people’s guide provides clear information about the home including complaints procedures, rules and external supports available to young people. The home is currently redesigning the booklet to ensure that it can be read by young people using other communication methods such as picture exchange communication systems.

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Leadership and management

Records on young people were not complete lacking some key information such as most recent review minutes, consent forms and some education information. During the inspection the placing authority conformed that they would supply this information immediately. Care, behaviour and health plans contain useful information but this is not recorded in consistent formats. The manager and staff updated these during the inspection providing clear, structured, helpful information capturing the good work being done.

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Leadership and management

The home is well maintained and previously identified hazards have been addressed. The garden and summer house provide good additional recreation spaces. Consequently the young people enjoy safe recreational and living space.

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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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