Children's Home, Residential special school run by MacIntyre Care in Buckinghamshire

Unique reference number SC043994 Inspector Emeline Evans Type of inspection Full Provision subtype Residential special school (>295 days/year)

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Registered person MacIntyre Care Registered person address MacIntyre Care 602 South Seventh Street Milton Keynes Buckinghamshire MK9 2JA Responsible individual Brenda Maria Mullen Registered manager Maria Elizabeth Tole Date of last inspection 11/09/2013 2 of 11 Inspection date 09/07/2014

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Previous inspection satisfactory progress Enforcement action since last inspection none

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Overall effectiveness adequate

Outcomes for children and young people adequate Quality of care adequate Keeping children and young people safe adequate Leadership and management adequate

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Overall effectiveness

Since the last inspection there has been a period of change for the staff who work at the service and the management team. There have been a number of interim management arrangements which has had an impact on the staff team. The staff and managers have been working hard to try and achieve consistency for the young people.

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Overall effectiveness

Young people achieve satisfactory outcomes across the homes and some make good progress. This helps them be as independent as possible. However, due to staff vacancies there has been a reliance on relief and agency staff. The priority of staff in recent months has been to ensure young people are safe and secure and therefore outcomes have been mixed. Young people are making use of communication systems to express their wishes and needs and positive relationships with professionals are in place to ensure a holistic approach is achieved. Young people are supported by a staff team who are familiar with their needs and vulnerability. As a result, safety is a central to all aspects of care planning, shift planning and staffing arrangements.

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Overall effectiveness

Areas of shortfall were identified within this inspection and are reflected in the overall judgement. These include a need to ensure impact risk assessments are thoroughly completed prior to young people being admitted, staff supervision, 3 of 11 appraisals and specific training to be addressed. There is a need to review the use of seclusion and to have clear reduction plans in operation, to review the use of electronic monitoring to ensure privacy is maintained. Areas of maintenance and repair within the homes are also required. A number of recommendations have been made to further improve the quality of care.

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Overall effectiveness

Young people and staff are now being supported by a new management team. This team has only recently formed but has already begun to explore areas for development and progress. However, it was too soon to evaluate any of these proposals at the time of this inspection. Staff report that recent changes, including the departure of a number of permanent and experienced staff, have been challenging but they remain optimistic under the leadership of the new management team. 4 of 11

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Information about this children’s home

This service is a residential special school registered as a children's home for young people with severe learning disabilities and is run by a large independent organisation. The school accommodates up to 40 young people in eight separate houses, usually on a 52 week placement basis. Due to the length of the young people's stay at the school it is required to be registered and regulated as a children's home under the Care Standards Act 2000.

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Inspection date Inspection type Inspection judgement

11/09/2013 Interim satisfactory progress 02/05/2013 Full good 26/02/2013 Interim good progress 14/11/2012 Full adequate

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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 the children's home is conducted so as to promote and make proper provision for the safeguarding and welfare of children accommodated there. This specifically relates to ensuring impact risk assessments are thoroughly completed prior to admitting a child (Regulation 11(1)(a)) 25/08/2014

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Reg. Requirement Due date

17A (2001) ensure any measure of restraint may only be used on a child accommodated in a children's home as 25/08/2014 5 of 11 listed in Regulations and then only where no alternative method of preventing the event specified in Regulations is available. This specifically relates to reducing the number of seclusions used in the children's home (Regulation 17A(1)(a)(b)(c)

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Reg. Requirement Due date

(2001) ensure any use of electronic monitoring is no more restrictive than necessary, having regard to the child's need for privacy (Regulation 22(1)(d)) 25/08/2014

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Reg. Requirement Due date

(2001) ensure there is at all times a sufficient number of qualified, competent and experienced persons working at the children's home (Regulation 25(1)) 15/09/2014

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Reg. Requirement Due date

(2001) ensure that all staff receive appropriate training, supervision and appraisal; and are enabled from time to time to obtain further qualifications appropriate to the work they perform. In particular, training in restrictive practice (Regulation 27 4(a)(b)) 15/09/2014

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Reg. Requirement Due date

(2001) ensure all parts of the children's home used by children are kept clean and reasonably decorated and maintained. (Regulation 31(2)(e) 15/09/2014

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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

 enable all staff to understand, share and implement the homes ethos, philoso and approach to caring for children (NMS 3.4)  ensure staff are able to meet children's individual needs as set out in placeme plans by having updated plans available to staff (NMS 2.3)  ensure that there is a system in place to monitor the quality and adequacy of record keeping and take action when needed (NMS 22.1)  ensure the manager monitors all records to identify any patterns or trends in order to improve the quality of care provided. (NMS 21.2) 6 of 11

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Outcomes for children and young people adequate

Generally, young people make reasonable progress in developing their skills and self- confidence. Some young people make good progress. For example, they learn fundamental self-help skills such as toileting independently and the ability to accept and respond to peer interaction. This means that they are more able to live with others in an inclusive environment. However, outcomes for other young people has been limited at times due to staffing levels. Staff have been focused on keeping the young people safe and therefore young people’s individual goals have not been a priority. Staff work in partnership with parents and professionals to assess young people’s needs prior to moving into the home. However, impact risk assessments are not thorough to ensure the young people in each individual house are compatible. There have been some recent admissions to the home which have resulted in group dynamics changing and therefore new challenges for the staff team. Outcomes for

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Outcomes for children and young people adequate

these young people are difficult to measure as these young people are just beginning to settle into their new environment and engage with staff.

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Outcomes for children and young people adequate

The staff encourage and support young people to make healthy lifestyle choices through physical exercise and a nutritious diet. Young people are at times involved and are supported in food preparation; this assists in developing independent skills. Meal times are seen as social occasions and provide an opportunity to develop new social skills, and young people are encouraged and supported to make decisions in order to maximise their independence. Young people attend regular health appointments and are beginning to cope appropriately with medical check-ups. Young people receive appropriate support from the school nurses, occupational therapist and speech and language therapist all located on the school site. Outcomes of all medical treatments are well documented and monitored. This practice ensures individual health needs are identified and a holistic approach is achieved.

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Outcomes for children and young people adequate

Staff fully support young people’s education and young people generally have excellent attendance at the on-site school. Young people have access to a range of extra-curricular activities which provide them with additional learning opportunities. Communication between school and residential staff is good. This results in their progression and allows a consistent approach across the school and residential services.

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Outcomes for children and young people adequate

Young people have made some positive relationships in the local community, accessing local shops and leisure activities. This includes attending scout groups and horse riding, providing opportunities for social interaction. Young people are encouraged to contribute to the running of the home with some chores, for example, cleaning the tables and taking items of clothing to the laundry. These life skills assist young people in learning independence skills. 7 of 11

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Quality of care adequate

The young people benefit from good supportive relationships from the committed members of staff. Observations were indicative of some trusting relationships established between the young people and staff. However, relationships are not sustained in all instances due to staff providing support at times in others houses.

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Quality of care adequate

Although the vast majority of young people do not communicate verbally, their abilities to contribute to the running of the house are not undermined. For example, personal care routines and menu planning take into account young people's wishes and views. Communication systems are used to help young people make choices. Staff are proactive in responding to young people’s gestures and expressions, particularly when young people are feeling emotional. This is often the case before, during or after contact visits, when young people are feeling upset and anxious

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Quality of care adequate

Staff listen to any grumbles young people may have and action is taken to address these. Parents and significant others are encouraged and supported to advocate and voice concerns on young people's behalf. Measures are in place for responding to matters raised by parents.

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Quality of care adequate

Young people's care plans are comprehensive; they are tailored to young people's personal and diverse needs. Staff are generally aware of the content of placement plans and use these to guide everyday care. However, updated placement plans are not easily available within the home. This does not ensure staff are working to current outcomes of young people's statutory reviews or enable staff to fully support young people and understand the possible reasons for negative behaviours.

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Quality of care adequate

Young people’s health needs are being met. Staff work closely with a range of professionals on-site to support the young people’s health and emotional needs. Staff work very closely with these on-site professionals to communicate and respond appropriately to any concerns. This ensures continuity of care is achieved. One professional explained, ‘staff communicate well and this enables us to work together for the young people.’ Medications are locked secure cabinets and overarching medication policies and procedures are in place. Staff access training and their skills are assessed prior to administering medication.

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Quality of care adequate

The home is placed in a spacious setting, which offers various opportunities for young people to explore. There are presently seven separate houses providing accommodation across the site. Each house is comfortable and personalised according to the young people's needs and preferences. Young people are encouraged to choose the décor and furnishings in the living areas and to personalise their rooms with pictures and posters. This approach enables young people to feel an investment in their environment. However, some of the bathrooms are in need of repair, in particular the floor coverings. In addition, some bedroom doors’ locks have 8 of 11 been replaced which has resulted in holes in these doors.

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Keeping children and young people safe adequate

The routines and structures in place for individual young people support them in feeling safe and comfortable in their surroundings. Young people’s vulnerability is central to care planning, risk management and the supervision of young people for off-site activities. Staff interpret young people’s behaviours well and are therefore able to act upon any instances when young people are worried or upset.

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Keeping children and young people safe adequate

Staff have an appropriate understanding of behaviour management and look to de- escalate situations as much as they can. Generally, they look at the young person's mood and then try to be as flexible and positive as possible. The young people have comprehensive behaviour support plans in place. Since the last inspection, there have been a number of incidents of physical intervention used. In addition, due to some heightened behaviours brief episodes of seclusion have been used with some young people as an emergency measure to keep them or others safe. There are no individual plans in place to reduce this use of seclusion. The behaviour management team are working with the staff to monitor and if practical minimise the use of this measure and relevant parties have been involved in reviewing alternative strategies. However, the number of seclusions remains high. Guidelines are available on the use of seclusion; they clearly refer to legislation and the home’s philosophy on providing

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Keeping children and young people safe adequate

a proactive approach to caring for young people. However, in practice it is not clear if staff fully understand the ethos of the home. The staff team do work closely with the behaviour support professionals on site, but the exchange of information remains incomplete. There is some detailed analysis of incidents and physical interventions with the young people. This allows patterns, trends and triggers for behaviours to be identified and understood. Recording of these occasions of physical intervention is completed but is not very detailed and sometimes incorrectly recorded (for example in sanctions rather than physical intervention records). This means that important information may be overlooked.

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Keeping children and young people safe adequate

There is a wide range of safeguarding policies and procedures in place. The supervision provided by the high staffing levels minimises the risk of young people going missing. Procedures to follow are available for staff if such an incident should arise. All safeguarding matters are managed promptly and efficiently and, where appropriate, external professionals and agencies are consulted. Internal systems are comprehensive. When necessary, the registered provider instructs an internal review of practice and procedures to be carried out. This demonstrates that matters relating to young people's safety and well-being are acted upon and taken seriously.

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Keeping children and young people safe adequate

Managers and the organisation's human resources department have revised the 9 of 11 recruitment processes to ensure that there is a robust recruitment and selection procedure in place, which promotes the safety of the young people. The team has carried out audits on staff recruitment files to ensure where a member of staff has lived outside of the United Kingdom, further checks have been undertaken to establish their suitability to work with children. The new processes now in place will ensure all applicants for employment are fully vetted and cleared before taking up their positions at the home.

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Keeping children and young people safe adequate

The home is physically a safe environment for the young people and staff. All required safety checks on fire, gas, electrical and domestic appliances have been carried out. Effective maintenance systems ensure the home remains safe for young people and all who visit.

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Keeping children and young people safe adequate

Young people are protected through the implementation of a range of personalised risk assessments. These assessments include young people's health needs and environmental factors such as young people's lack of knowledge around personal safety. A small number of young people require close supervision for health reasons such as epilepsy. Electronic monitoring devices may therefore be used in bedrooms. However, at present these are monitored within a communal area and do not afford young people sufficient privacy. Parents and significant others are aware of these arrangements.

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Leadership and management adequate

Since the last inspection, the Registered Manager has resigned from this position to work elsewhere in the organisation. This has resulted in a number of interim managers undertaking this role. There is currently a vacant Registered Manager’s position. However, a permanent manager has been employed very recently with a view to completing an application to register with Ofsted as a matter of priority. The managers and staff team are committed and focused on improving the quality of care in the homes. The restructuring of the senior management team has now been completed and the managers are still in the early stages of identifying and redeveloping practice and processes. The management team understand the strengths of the service and know areas for development. There are comprehensive action plans and development plans in operation to clarify the future of the home with a focus on improving outcomes for young people.

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Leadership and management adequate

Staff are enthusiastic and committed to the young people in their care. They have formed good relationships with young people and speak positively about them. However, there is a high number of vacant positions across the homes. This has resulted in young people being supported by regular relief and external agency staff and the remaining permanent staff. There has become a reliance on relief staff and permanent staff working a high number of hours. Recruitment processes are underway to fill vacant posts. Improved systems are in place for ensuring the quality of supervisions has improved. However, there are a number of permanent staff who 10 of 11 have not received regular supervision or an annual appraisal of their work. The home has implemented an on-going staff development and training programme. Staff were complimentary about the range of training offered. Recent training has included undertaking supervisions and methods of communication. Staff who are in the

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Leadership and management adequate

process of completing their induction have completed training on restrictive practice. However, long standing staff have yet to complete this training.

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Leadership and management adequate

There are regular visits to monitor the conduct of the home under Regulation 33 of the Children’s Homes Regulations and the management team undertakes quality assurance monitoring checks in line with Regulation 34. There has been a gap in formal monitoring during interim management arrangements. Although it is clear some monitoring takes place by the management team, the information gathered is not well used to improve the quality of care provided. In addition, trends and patterns are not being fully evaluated. This does not enable immediate action to be taken to address any issues raised by this monitoring.

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Leadership and management adequate

The home has received some complaints since the last inspection. There is evidence to demonstrate these complaints have been fully investigated and the home has been proactive in working with all involved to resolve any further issues or concerns.

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Leadership and management adequate

There was one requirement and three recommendations arising from the last inspection report. All have been fully met. The manager has revised the behaviour management policy and this details statutory guidance in relation to restriction of liberty. Written records for medication have been revised and entries in all records are now signed and legible. In addition, changes to recruitment processes have been undertaken which are reported under the safeguarding judgement. Website: www.ofsted.gov.uk

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Leadership and management adequate

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Judgement Description

Outstanding A service of exceptional quality that significantly exceeds minimum requirements.

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Judgement Description

Good A service of high quality that exceeds minimum requirements.

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Judgement Description

Adequate A service that only meets minimum requirements.

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Judgement Description

Inadequate A service that does not meet minimum requirements.

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Information 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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Information 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 framework of inspection for children's homes.

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