Children's Home run by Creating Care Choices Limited in Lewisham

Unique reference number SC025657 Inspector Angus Mackay Type of inspection Full Provision subtype Children's home

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Registered person Creating Care Choices Limited Registered person address 38 Castle Drive Ilford Essex IG4 5AE

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Responsible individual Harjit Singh Sanghera Registered manager POST VACANT Date of last inspection 12/11/2013 2 of 12 Inspection date 08/07/2014

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Previous inspection good progress Enforcement action since last inspection none

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Overall effectiveness inadequate

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

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Overall effectiveness

This inspection identified that there are significant breaches of regulations and failures to meet national minimum standards which negatively impact upon the welfare and safety of children and young people. These shortfalls have resulted in wide-ranging requirements and recommendations being made. Strict timescales have been set to ensure that all matters are addressed promptly in order to improve the quality of care for all children and young people using this service.

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Overall effectiveness

Safeguarding practice is inadequate and requires immediate action with shortfalls in: staff recruitment; the provision of personal intimate care; and the recording of restraints and serious incidents. Leadership and management are inadequate and require immediate action with shortfalls in: the registration of the manager; staff training; and an improvement in the accuracy and quality of records. In addition young people attend regular health care appointments but the home does not accurately maintain health care plans and medical permissions. The manager commenced work on rectifying these deficits during the inspection.

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Overall effectiveness

Successive managers have been hindered in developing care practice and improving the life experiences of the young people by not being provided with adequate budgets to fund the running and improvement of the home. However young people enjoy the company of staff who are diligent in the provision of care and affection to 3 of 12 the young people. 4 of 12

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Information about this children’s home

This privately run children's home is registered to provide care and accommodation for up to three children on short break arrangements and no more than four young people resident in the home. The home is registered to care for children and young people who may have learning disabilities and/or physical disabilities. However, the building is not fully accessible or adapted, meaning that the placement of children and young people with significant mobility problems would not be appropriate.

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Inspection date Inspection type Inspection judgement

12/11/2013 Interim good progress 06/06/2013 Full adequate 30/10/2012 Interim inadequate progress 25/07/2012 Full inadequate

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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

4 (2001) ensure that the children's home is conducted in a manner which is consistent with it's statement of purpose. In particular that staff have specific budgets allocated to them in relation to: the meeting of individual cultural needs including the purchase of food, posters, books and toys; preparation for independence work; and resourcing of leisure activities (Regulation 4(6)) 26/08/2014 5 of 12 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 (Regulation 17B(3)(a)- (i), (4)(A)(B)) 26/08/2014

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Reg. Requirement Due date

(2001) ensure that you do not consider a person fit to work in the children's home unless full and satisfactory information is available in relation to him in respect of each of the matters specified in Schedule 2 in particular that there is a satisfactory written explanation of any gaps in employment (Regulation 26(3)(d)) 26/08/2014

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Reg. Requirement Due date

(2001) ensure that staff receive appropriate training and they are enabled from time to time to obtain further qualification appropriate to the work they perform in relation to: the provision of intimate care; safeguarding and child protection of children with disabilities; physical intervention; and the use of appropriate forms of communication (Regulation 27 (4)(a)(b)) 26/08/2014

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Reg. Requirement Due date

(2001) ensure that all persons employed receive appropriate appraisal (Regulation 27 (4)(a)) 26/08/2014

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Reg. Requirement Due date

(2001) maintain an accurate record in respect of each child who is accommodated in the children's home, including the information, documents and records specified in Schedule 3, so that the information kept is more detailed, relevant and kept up to date. This in particular relates to individual support plans, health care plans, and risk assessments (Regulation 28) 26/08/2014

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Reg. Requirement Due date

(2001) review the appropriateness and suitability of the location of the home at least once in each calendar year consulting with and taking into account the views of, such local bodies or persons the registered person considers appropriate. (Regulation 31 (1A)(b)(1B)) 26/08/2014

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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 p 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. 6 of 12  ensure that 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) 7 of 12

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Outcomes for children and young people adequate

Children and young people make some progress in developing a positive self-view. They are affectionate and relaxed with staff and show by their interactions that they are happy in the home. Children on short breaks are happy to come to the home and parents say their children return home, “happy and clean.”

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Outcomes for children and young people adequate

Young people develop some basic self-help and independence skills. They maintain individual photographic files evidencing their progress in: dressing; making beds; shopping; preparing meals; and tidying the house. The extent of their progress is difficult to track due to the lack of clear targets and poor recording of their progress. Young people are using the photographic evidence in reviews and college applications to evidence their range of independence skills. A social worker commented that this would be more helpful if it evidenced in more detail exactly how much the young person can do by themselves and how much assistance they require.

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Outcomes for children and young people adequate

Young people who live in the home attend school or activity centres. School reports show young people make progress in improving their communication skills. All children in the home have limited verbal skills and use Makaton and picture exchange system (pecs) as their main way of communicating. Staff use pecs and some very basic makaton to communicate with young people but their lack of skill and knowledge in these areas limits their ability to support the work done elsewhere on communication. However young people do make limited choices in food, activities and carers. They attend a monthly meeting where they record their: views on the home; activities they like; food they like; and plans for the home such as new decor. This allows young people a limited influence on the home.

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Outcomes for children and young people adequate

Young people can make changes to their bedrooms and include pictures or have bedding and toys of their choice. However the lack of a budget for the home means that bedrooms remain very basic and lack warmth and personalisation. Some young people require a low stimulus setting and their rooms are adequate for their needs. Most young people, including those on short stays, require some choice in meeting their cultural needs as outlined in the statement of purpose with the purchasing of pictures, posters, toys and foods of their choice.

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Outcomes for children and young people adequate

Young people benefit from positive interactions with others in the home and through socialising in the community. They engage in trips to public places such as activity centres, the library, swimming pools and the local park. Young people develop confidence in using public transport and in mixing with the wider community through these activities. However social workers criticise the lack of more imaginative or stretching activities for the young people, which are included in the statement of purpose, such as horse riding. The opportunities for young people to engage in a wide range of activities, which would aid their social inclusion, is restricted by the lack 8 of 12 of long term planning supported by an adequate budget. In addition staff do not consistently use visual daily timetables with the young people as requested by social workers. This reduces the engagement of the young people in understanding the

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Outcomes for children and young people adequate

routine of their day and inhibits the young people requesting changes to activities.

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Outcomes for children and young people adequate

Young people engage in keyworker sessions where they explore family links and personal needs. Social workers praise the contacts the home forms with families a typical comment being, “they communicate very well with the family.” Young people on short stays are able to maintain contact with home and families. Young people maintain appropriate family links and connection with their cultural identities through this work.

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Quality of care adequate

Young people enjoy their time in the home. Staff safely manage the interactions between short stay young people and full time residents. One parent commented, “The new manager is very aware and how to integrate children. I really like it if there are children who can mix they can play together. The manager always controls this and will ensure the children in the home all get on together or rearranges the visit for another time.”

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Quality of care adequate

Young people receive encouragement and help from staff to express their views about the running of the home. Staff have developed skills at involving the young people in making choices about their own care and in the running of the home, including those young people who are non-verbal. All children use pecs and Makaton when at school. There are limited examples of the use of pecs in the home and only one member of staff is competent in the use of Makaton. This potentially restricts the opportunities for young people to fluently converse with staff.

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Quality of care adequate

Placement plans and risk assessments are detailed and provide a clear picture of the young people in the home. They identify areas of work and protective factors to aid staff in their safe care. However they lack clearly identified targets, timescales or identification of who is responsible for implementing them. Consequently broad target areas often do not reflect the progress young people have made and the work staff are now doing with them.

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Quality of care adequate

All young people in residence are registered with local health care services. Records show young people have attended medical appointments, optician tests and received dental treatment. Each young person has a small entry in their placement plan detailing any health issues they have. However there are no health care plans and the manager was unable to locate medical permissions for treatment or first aid. The lack of health care plans means that there is no clear indication of ongoing work with young people. For example one member of staff was able to detail the impact of new medication on one young person, over several weeks, and feed this information back to the prescribing doctor resulting in a change to the dosage. However this 9 of 12 information was not recorded or tracked in any records. The lack of appropriate recording lessens the effectiveness of staff interventions and potentially leaves young

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Quality of care adequate

people vulnerable to missing appointments or mistreatment.

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Quality of care adequate

Medication is accurately recorded, stored and issued ensuring the safe care of young people. The home record controlled drugs in a separate bound and numbered log book. All medication is regularly checked and the issuing and receipt of medication is countersigned by a second member of staff. The safe treatment of the young people is ensured by the good controls of medication.

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Keeping children and young people safe inadequate

Children’s social workers are confident that they are safe in the home. Children interact comfortably with staff and enjoy their company. One parent said, “I feel children are safe there. I would not let mine go there if they were not.” The atmosphere in the home is relaxed and staff interact appropriately with young people. However staff lack appropriate up to date training in safeguarding and child protection. New staff have received inadequate induction and not all of them are aware of how to keep children safe. Guidelines on the provision of intimate personal care were not available to staff and not all staff knew their content. Care plans do not contain detailed information on the provision of personal intimate care to young people. For example: they do not detail how many staff should be involved; if there are gender issues to consider; or any other considerations about washing personal areas of the young person. Consequently staff have mixed understanding of how to

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Keeping children and young people safe inadequate

provide this highly sensitive care. These deficits leave staff and young people vulnerable to unsafe interactions and diminish the safe care of young people.

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Keeping children and young people safe inadequate

The number of recorded restraints has reduced dramatically since the last inspection. However records of restraint are not accurate and at least one restraint has occurred which was not recorded in the restraint log. The record for recording serious incidents is not made in a suitable volume and consequently a permanent record, which can be checked, is not available. Not all staff are trained in managing physical interventions. The safe care of young people is compromised by these omissions.

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Keeping children and young people safe inadequate

Staff employed to work with the young people are not always suitably vetted. One file showed that gaps in employment were not explained in writing and there was no record of them being explored at interview. All other checks are in place including disclosure and barring services checks. However the lack of sufficient rigour in the application of recruitment guidelines leaves children vulnerable to being cared for by unsuitable people.

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Keeping children and young people safe inadequate

High staffing levels and close engagement with young people ensures that they do not go missing from the home or on trips. There have been no occasions where young people have gone missing in the last year. The manager ensures that young people's safety is enhanced by the staff application of detailed risk assessments. The 10 of 12 staff ensure that they use these risk assessments to support the expansion of the activities programme for young people. The lack of sufficient funding for activities reduces the breadth and quality of excursions into the community. However young people do gain enjoyment and increased confidence in public situations from this safely managed social mobility.

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Keeping children and young people safe inadequate

The manager ensures that young people live in a safe and appropriately maintained environment. Fire drills are regular and enhance the safe care of the young people. Security measures ensure the external security of the building without compromising the privacy of the young people. Door alarms ensure that staff are aware if anyone leaves the building allowing them to take appropriate measures to safeguard young people.

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Leadership and management inadequate

The manager was appointed after the last interim inspection of the home. She has extensive experience in residential settings including short break provisions for children with learning and physical disabilities. Parents and social workers say that she has improved the quality of care within the home. The manager has appropriate qualifications including a residential managers award and an NVQ level 4. However the manager has failed to commence her registration with Ofsted despite being in post for six months. This failure to complete the registration process has not allowed Ofsted to determine if she is a fit person to manage the children’s home.

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Leadership and management inadequate

The manager has put in place a system to monitor the matters in Schedule 6 and has supplied a report on the conduct of the home to Ofsted. The report demonstrated a reasonable understanding of the strengths and weaknesses of the home and highlighted new initiatives to improve the care of the young people. However the report did not identify the shortfalls in safeguarding, recording and care practice, identified during this inspection. The manager has not maintained the development plan for the home making it more difficult for her to track progress in the development of the home and care practice.

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Leadership and management inadequate

The registered provider has appointed an independent person to visit and report on the children’s home. No reports were supplied for the four months following the last inspection, but since April 2014 these have been regular. Reports benefit from including the comments of parents and relatives of children placed enhancing their engagement in improving the care of their children. However the reports have failed to alert the registered provider, or Ofsted, to the shortfalls in the service identified during this inspection.

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Leadership and management inadequate

The manager does not have an allocated budget for the home. The registered provider liaises with the manager on a weekly basis to organise money for activities and any requested improvements to the environment and service provided to young people. Food is purchased and supplied by the registered provider and is of good 11 of 12 quality, fresh and varied. The choice of food reflects the preferences of the young people and includes a variety of fruit and vegetables. However the lack of a suitable budget for the home means that these highly dependent young people cannot get involved in selecting and buying food outside the home. This does not allow them to gain useful social and life skills in community settings.

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Leadership and management inadequate

The home is clean, tidy and well maintained. The manager ensures that all health and safety requirements are met. Staff have delegated responsibilities engaging them in the effective monitoring and improvement of the environment. However the gradual improvements to the environment cannot be properly planned due to the lack of a clear budget for the home.

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Leadership and management inadequate

Staff receive regular supervision of a high quality. Staff enjoy working in the home and say they are well supported by the manager. The manager has not yet conducted staff appraisals and has not got an up to date training programme. Staff do not receive sufficient training to enable them to provide good quality, safe care to young people. For example training in safeguarding, child protection and physical intervention is not up to date and some staff have never received this training. Staff are enrolled to start an appropriate level 3 qualification but this has not yet commenced. Induction training does not include the Children’s Workforce Development Council’s Induction standards or satisfactory guidance on the provision of personal care.

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Leadership and management inadequate

Not all records are appropriately maintained. Files do contain some creative additions to the placement planning which provide photographic evidence of young people’s progress. However the lack of clear targets and recording of progress hinders the understanding of each young person’s life in the home.

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Leadership and management inadequate

The manager has updated the statement of purpose and supplied this to Ofsted. However the provider does not meet the aims and objectives outlined there. For example staff training identified in the statement of purpose has not been maintained.

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Leadership and management inadequate

The failure to fully address the requirements and recommendations from the last inspection has contributed to the decline in effectiveness of the service. Website: www.ofsted.gov.uk

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Leadership and management inadequate

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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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