Children's Home run by PCT Care Services Limited in Norfolk

Unique reference number SC471856 Inspector Louisa Bayley Type of inspection Full Provision subtype Children's home

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Registered person PCT Care Services Limited Registered person address Old Hall Farm, Silfield Road Silfield WYMONDHAM Norfolk NR18 9NH Responsible individual Michael Darren Millage Registered manager Angela Jane Reith Date of last inspection N/A 2 of 12 Inspection date 24/07/2014

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Previous inspection N/A Enforcement action since last inspection There has been no enforcement action in this home.

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Overall effectiveness adequate

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

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Overall effectiveness

This is the first inspection of the home since registration by Ofsted in November 2013.

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Overall effectiveness

Staff in this home provide young person focused care, with attention to individual needs and characteristics. Staff promote young people’s rights to access services and opportunities. Consequently, young people develop a positive identity, grow in confidence and reduce risky behaviours.

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Overall effectiveness

Staff build positive relationships with young people; this provides a good foundation for young people to feel safe and secure. Young people in this home present with highly challenging behaviour. However, social workers and parents describe the manager and staff as going ‘above and beyond the call of duty’ to promote young people’s safety. Young people say they feel safe and identify staff they can talk to openly.

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Overall effectiveness

There have been no compliance investigations or concerns since Ofsted registered the home.

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Overall effectiveness

There are issues in the leadership and management of the home. There is a lack of 3 of 12 clear definition and understanding of responsibilities and roles between the responsible individual and the Registered Manager. A lack of clear communication from the responsible individual to the manager has resulted in delays in addressing health and safety issues and damage in the home. There are maintenance issues that the responsible individual has not addressed. This means young people live in a home that is not well maintained and appears institutional in some areas.

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Overall effectiveness

The inspection identified a number of shortfalls including an absence of information in the Statement of Purpose, lack of consultation with parents within external monitoring, lack of robust arrangements in medication recording, incomplete information in a recruitment record, lack of information about young people admitted to the home and failure to submit internal monitoring reports to Ofsted. The shortfalls have not compromised young people’s safety. However, there is the potential that safety could be undermined in future if the manager does not take action to secure improvement.

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Overall effectiveness

Areas identified for improvement include following up restraint with offers of medical support, ensuring sound employment practice is in place, accurately recording supervision, effective monitoring and adhering to policies and procedures. 4 of 12

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Information about this children’s home

This children's home provides care and accommodation for up to six young people with emotional and/or behavioural difficulties and learning disabilities. The home is owned by a private company.

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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 at all times conducted in a manner which is consistent with its statement of purpose, with specific reference to staff supervision (Regulation (4) (6)) 29/08/2014

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Reg. Requirement Due date

5 (2001) keep under review and, where appropriate, revise the statement of purpose and notify HMCI of any revision of the statement of purpose within 28 days (Regulation 5 (a) (b)) 29/08/2014

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Reg. Requirement Due date

(2001) make suitable arrangements for the recording, handling, safekeeping, safe administration and disposal of any medicines received into the children’s home and a written record is kept of the administration of any medicine to any child (Regulation 21 (1) (2) (c)) 29/08/2014

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Reg. Requirement Due date

(2001) ensure that all parts of the home to which children have access are so far as reasonably practicable free from hazards to their health or safety (Regulation 23 (a)) 29/08/2014

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Reg. Requirement Due date

(2001) ensure that any activities in which children participate are so far as reasonably practicable free from avoidable risks (Regulation 23 (b)) 29/08/2014 5 of 12 (2001) ensure that for each person working in the home full and satisfactory information is available in relation to him in respect of each of the matters specified in Schedule 2 (Regulation 26 (3) (d) Schedule 2) 29/08/2014

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Reg. Requirement Due date

(2001) maintain in the children’s home the records specified in Schedule 4 and ensure that they are kept up to date, with specific reference to an admissions and discharge register (Regulation 29 (1) Schedule 4 (1) (a)(b)(c)(d)(e)(f)) 29/08/2014

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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, of sound construction and kept in good structural repair externally and internally and kept clean and reasonably decorated and maintained (Regulation 31 (2) (b) (d) (e)) 29/08/2014

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Reg. Requirement Due date

(2001) interview, with their consent and in private, such of the children accommodated there, their parents, relatives and persons working at the children’s home as appears necessary in order to form an opinion as to whether the conduct of the children’s home promotes the wellbeing of the children accommodated there (Regulation 33 (8) (a) (ii)) 29/08/2014

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Reg. Requirement Due date

(2001) supply to HMCI a report in respect of any review conducted by him for the purposes of paragraph (1), and make a copy of the report available on request to placing authorities where the placing authority is not the parent of a child accommodated in the home. (Regulation 34 (2)) 29/08/2014

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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, when there has been physical restraint, children’s homes must be able call on medical assistance as required and children are always given the opportunity to be examined by a registered nurse or medical practitioner (NM 3.16)  ensure the employer is fair and competent, and operates sound employment practices and good support for its staff and volunteers (NMS 19.1)  keep a written or electronic record detailing the time and date and length of e supervision held for each member of staff, including the registered person. Th record is signed by the supervisor and the member of staff at the end of the supervision (NMS 19.5) 6 of 12  regularly monitor, in line with regulations, all records kept by the home to ensure compliance with the home’s policies, to identify any concerns about specific incidents and to identify patterns and trends. Immediate action is taken to address any issues raised by this monitoring (NMS 21. 2)

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Recommendations

 ensure all staff’s work is consistent with these Regulations and NMS, the home’s policies and procedures, with specific regard to the frequency of staff supervision. (NMS 21.3)  ensure that managers and staff are clear about their roles and responsibilities. The level of delegation and responsibility of the manager and staff, and the lines of accountability, are clearly defined. In particular, ensure there is clear definition of the roles and responsibilities of the responsible individual and the Registered Manager (NMS 21.4) 7 of 12

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Outcomes for children and young people good

Young people access education and work placements. Where formal education arrangements have not commenced, young people work with the staff on educational projects, visits and experiences. They engage with the organisation’s teacher, who provides support in the interim. Individuals who were previously refusing to attend school or educational provision have attended education every day. Individuals who were unable to read or write have developed literacy skills. Young people have successfully engaged in work experience, increasing attendance from one session per week to five. Consequently, young people make good progress educationally.

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Outcomes for children and young people good

Young people develop their confidence and sense of identity. They overcome physical barriers, such as speech and language difficulties, increasing their self-esteem and contributing to improving their social interactions.

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Outcomes for children and young people good

Individuals develop an understanding of their health needs and health risks, including mental health, sexual health, pregnancy and sexually transmitted infections. They engage with specialist professionals, accessing targeted support to empower them to take more responsibility to make healthy choices.

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Outcomes for children and young people good

Young people enjoy positive family contact, where this is appropriate for them. They make informed choices about the staff they would like to key work for them, supporting them to build positive relationships and secure attachments.

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Quality of care adequate

Young people say that staff in this home take the time to get to know them. One young person said ‘they do not just assume they know everything about me.’ Staff demonstrate good knowledge of the young people, including their wishes and preferences. This enables young people to develop trust and positive attachments with those who care for them.

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Quality of care adequate

Staff actively seek young people’s views and accommodate their requests. Young people say they make choices in how they personalise their bedrooms, the activities they access and the food they eat.

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Quality of care adequate

The manager and staff provide highly individualised care, based on individual needs and preferences. They involve young people in decision making about their care and ensure that they meet individual interests with enthusiasm. Staff support young people to access opportunities relating to their interests and their rights. Young people contribute to their care plans and behaviour management plans. This 8 of 12 encourages them to work towards goals they feel in control of and able to achieve.

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Quality of care adequate

The inspection identified a lack of robust recording and oversight of medication. Sample stock checks and a review of records demonstrated that the medication stock audits were inaccurate. Recording is unclear and there is no consistent oversight of the medication. This compromises the ability to identify where errors have occurred and take appropriate action. Inaccurate recording gives rise to the potential to administer incorrect dosages and could undermine young people’s safety.

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Quality of care adequate

Staff take a creative approach to promoting young people’s health and awareness of health issues. They facilitate contact with specialist health professionals and ensure that young people access the health services they need. The manager has accessed a programme for young people whereby they look after a computerised, life-like baby. This gives young people insight into the responsibilities of parenthood in an interactive way.

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Quality of care adequate

Staff understand the importance of education. They work well with education providers and work placements to support young people to develop in an academic and practical sense. Staff actively challenge pre-existing information about young people, avoiding assumptions and thereby ensuring young people can achieve their potential. They give support to enable young people to manage in school, making the difference between non-attendance and full engagement.

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Quality of care adequate

Young people enjoy a range of activities, based on their preferences and skills. They access community based clubs, such as skating, enjoy beach trips, visits to the lifeboat, swimming and meals out. Staff employ a range of strategies to address violent play, offering more positive choices and alternatives. This helps young people to engage their imagination.

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Quality of care adequate

The accommodation is adequate. However, there are aspects of the home that are poorly presented, look institutional and do not provide a homely feel. There is water damage to the ceiling, old carpets that smell musty in some bedrooms and the wall in the rear garden is not complete. The rear garden has a large patch of earth that looks unsightly and unwelcoming. The kitchen and the downstairs bathroom appear tatty and unwelcoming. This does not provide young people with a sense of pride in their surroundings or encourage them to value their home.

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Keeping children and young people safe adequate

Young people in the home say they feel safe. Social workers and parents say that staff exceed expectations in order to protect young people from unnecessary risks. The staff work well with external professionals to plan strategies and approaches that support young people to reduce their risk taking behaviours. This includes a reduction in incidents of self-harming and going missing. 9 of 12 There have been two incidents of missing from care since the home opened. Staff understand the action to take if a young person goes missing. They have good relationships with the local police, and share information with them appropriately in order to protect young people.

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Keeping children and young people safe adequate

There have been no incidents of bullying. Staffing ratios ensure that there is minimal opportunity for bullying to occur.

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Keeping children and young people safe adequate

There have been no allegations against staff. Staff understand safeguarding procedures; they have all accessed safeguarding training at the appropriate level, commensurate with their given responsibilities. This supports them to recognise and take action where there are safeguarding concerns.

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Keeping children and young people safe adequate

Staff use sanctions to support young people to take responsibility for unwanted behaviour. The records reflect that sanctions are proportionate and include young people’s views. The manager reviews the sanctions to ensure they are fair and effective.

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Keeping children and young people safe adequate

Staff use reward systems to encourage positive behaviour, with rewards that are individual to young people. Consequently, young people improve their behaviour because the goals and rewards have meaning for them.

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Keeping children and young people safe adequate

Staff use restraint rarely and only as a last resort, with four incidents since the home opened. Staff employ recognised techniques that they are trained to use, in order to prevent individuals harming others. The use of restraint is justified and recorded. However, staff do not offer young people a medical check-up following restraint. This means young people do not benefit from this intended safeguard.

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Keeping children and young people safe adequate

The records for staff reflect that recruiting staff obtain and verify references and carry out the required recruitment checks. However, some information is missing, such as verification of gaps in employment history and documentary evidence of qualifications. This is not the case in all recruitment records; however, lack of consistent and thorough recording of checks has the potential to undermine safe recruitment practices.

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Keeping children and young people safe adequate

Health and safety checks for the premises are in place and up to date. Staff and young people participate in fire evacuations and know the procedures in the event of an emergency.

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Keeping children and young people safe adequate

The responsible individual has not taken action to promptly address hazards and risks in the home. He did not address a fault with the water system as a matter of urgency. Lack of clear communication to the manager resulted in a three-day delay in remedial action, despite having a plumber attend the home the day after the fault occurred. There has been a delay in replacing broken windows. This has the potential to attract further damage in the home. 10 of 12 Staff have raised issues about the suitability and reliability of the car used to transport young people. Records in the home reflect that it has broken down three times since April 2014. This has the potential to cause safety issues when staff take young people out.

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Leadership and management adequate

A permanent, experienced and qualified manager commenced in post in August 2013. Ofsted registered her as the manager of the home in November 2013 and the home opened in February 2014. The manager has a relevant level four and level five qualification. She has a good understanding of the needs of young people, is young person focused and has promoted positive outcomes for young people.

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Leadership and management adequate

External monitoring takes place monthly. The independent visitor takes account of young people’s views, talks to staff and reviews records in the home. However, they do not consult with parents and therefore do not gain a whole view of the care provided. Overall, the monitoring is supportive and contributes to oversight of the quality of care and identification of some shortfalls.

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Leadership and management adequate

The manager completes internal monitoring on a monthly basis. The monitoring identifies actions to take to secure improvement and a record of when actions are achieved. However, the monitoring has not identified shortfalls such as the medication errors, or gaps in supervision, meaning it is not wholly effective.

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Leadership and management adequate

The manager has not reviewed the Statement of Purpose in line with amendments to the regulations. This means information that is now required, such as the details of health services provided and the supervision arrangements for specialist staff, is not detailed. The arrangement for the supervision of new staff is detailed as fortnightly. However, this is not the practice in the home. Consequently, the home is not operating in line with the Statement of Purpose. The manager has not submitted any amended versions of the document to Ofsted. This means Ofsted do not have an up to date view of the home.

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Leadership and management adequate

Staff in the home receive an induction and a good level of training. They access additional training to support them to meet the specific needs of young people. All staff have completed, or are enrolled on, the level three diploma in care. This helps to ensure that staff acquire the theoretical and practical knowledge they need to support young people.

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Leadership and management adequate

The policy for supervision states that staff, once they have completed their probationary period, will have monthly supervision. The manager has only had two supervision sessions since she has been in post. This does not provide the level of support needed when setting up a new home and the challenges that it brings. The central record of supervision does not include the manager; it is unclear and does not support the manager to have effective oversight of supervision. 11 of 12 The manager does not have a register in place to reflect the young people admitted to and discharged from the home. This information is required in order to provide accurate details of young people living in the home and a safeguard if this information is required in the future, once young people have moved on.

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Leadership and management adequate

There have been a number of issues relating to the leadership and management of the home. Staff completed their induction training and were subsequently told by the responsible individual they would not be paid for it. Following discussions, they were paid some months later. This did not impact directly on the young people. However, this does not contribute to high morale and does not support staff to feel fairly treated, which is likely to have an indirect impact on young people. There is a lack of clarity between the manager and the responsible individual about the autonomy the manager has to authorise spending of amounts over fifty pounds. This has caused issues whereby the manager has not been able to authorise repairs that require immediate attention in the home. Lack of clear communication between the responsible individual and the Registered Manager has the potential to undermine the effective running of the home and compromise the quality of care for young people.

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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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