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 27/08/2014

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Previous inspection good 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

The home has made significant progress in addressing the breaches of regulations identified at the last inspection. In particular they have rectified the safeguarding concerns and leadership and management issues. The home has appointed an experienced and appropriately qualified manager who has commenced addressing the deficits identified at the last inspection. Some issues require further time to embed them in staff practice or for training courses to be available. This includes the updating of care plans, risk assessments and health care plans. A comprehensive training programme is in place but not all training could be done in the short time between inspections. In addition the manager has not had time to update the statement of purpose or to evaluate the practice in the home and report on this. The health and safety risk assessment for the premises is due for review.

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Overall effectiveness

Inspectors were aware during this inspection that allegations of a child protection nature were being investigated by the appropriate authorities. Actions taken by the setting in response to the incident were considered (where appropriate) alongside other evidence available at the time of inspection to inform inspectors’ judgements.

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Overall effectiveness

The director of the company has now agreed appropriate budgets for the running of the home allowing them more freedom and control over short and long term developments. Young people can now be involved in more challenging activities and 3 of 12 in a wider range of social situations. Young people continue to enjoy dancing and singing with staff who provide warm and affectionate care to them. There were no young people on short breaks during the inspection. 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

(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: safeguarding and child protection of children with disabilities; physical intervention; and the use of appropriate forms of communication (Regulation 27 (4)(a)(b)) 28/11/2014

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Reg. Requirement Due date

28 maintain an accurate record in respect of each child 28/11/2014 5 of 12 (2001) 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) 5 (2001) ensure that the registered person shall (a) keep under review and, where appropriate, revise the statement of purpose and the children's guide; (b) notify HMCI of any such revision within 28 days (Regulation 5 (a) (b)) 28/11/2014

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Reg. Requirement Due date

(2001) supply to HMCI a report in respect of any review conducted by the home for the purpose of monitoring the matters in schedule 6 and in improving the quality of care provided in the children's home.(Regulation 34(2)) 28/11/2014

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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 the risk assessment for the whole environment is regularly reviewed. (NMS10.8) 6 of 12

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Outcomes for children and young people adequate

Young people living in the home all attend school or activity centres. Those who are not in school are being supported by their social workers and the manager of the home to pursue an appropriate college placement. School reports show that young people are making significant progress in: numeracy; fine motor skills; task focus; mobility; and improving speech, language and communication. One school report said, “This young person continues to make better than anticipated progress in personal, social and emotional development. This is due to the consistency of all professional working with them.”

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Outcomes for children and young people adequate

Young people are involved in making decisions about their own personal care. They can choose carers, in particular where intimate personal care tasks are required. Young people make choices of meals and can choose culturally appropriate meals. Young people aid in the preparation of meals and particularly enjoy baking. They can make decisions about their bedrooms but most require some assistance in personalising these spaces. Some young people have warm pleasant bedrooms where change has been introduced at their pace and they are happy with the outcomes. The new budgets for home improvements will allow young people more choice in improving relatively barren personal spaces. They gain engagement in the home and increase their stability through this personalising of their own spaces.

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Outcomes for children and young people adequate

Young people develop confidence and a range of self-help and social skills through their interactions with others in the home and trips into the community. They enjoy trips to public places such as: the library; swimming pool; bowling; local park; and activity centres. Daily planners and visual timetables are being reintroduced by the manger to increase the engagement of young people in understanding the routine of their day and providing predictability and order for those who require it. Young people’s care plan targets now include activities and the use of public transport, allowing them to track their progress in simple tasks such as the use of travel cards. Young people are developing improved confidence in public places through these improving activities. One social worker commented on the progress, “A year ago he could not have done this activity. His independence skills have progressed well through the trips out into the community.”

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Outcomes for children and young people adequate

Young people use keyworker sessions to explore family links and look at their personal needs and choices in food and activities. Young people maintain contacts with their own cultures through their choices in food and clothing and the maintenance of family contacts.

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Quality of care adequate

7 of 12 Young people are relaxed with staff and enjoy their company. Staff are knowledgeable about individual children and aware of all of their complex needs. One social worker said, “He has great relationship with staff and in particular his keyworker.” Young people have regular key working sessions where staff reinforce care plan targets and involve them in discussions about them. Young people learn how to form relationships and improve their social skills through these interactions.

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Quality of care adequate

Young people receive practical assistance from staff in expressing their views about the home and their care. Staff have developed ways of involving the young people in making choices about these issues and in making choices about food and activities including a limited use of images and some signing. All children use picture exchange system and Makaton when at school and some have limited verbal ability to communicate with others. Staff training now includes communication with young people, seeking to improve the opportunities for dialogue with young people and their engagement in making choices. Not all of this training has occurred.

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Quality of care adequate

Placement plans, health care plans and risk assessments are detailed and provide a clear picture of the young people, their background and their presenting problems. They identify areas of work, protective factors and initial targets. The manager is implementing a radical change adding clearer targets, timescales and who is responsible for implementing them. The plans include an evaluation tool allowing staff to track young people’s progress in achieving targets and ensuring new targets are set. Not all files have been modified to the new format. The new system more clearly matches the current work staff are doing with young people and allows them to show tracked progress and evidence regular reviews and target setting.

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Quality of care adequate

All young people are registered with local health care services. Records show young people have attended medical appointments, optician tests and dental treatment. Young people now have individual health care plans which clearly identify their presenting problems and how staff have to address these. Included in the health care plans is guidance to staff on the provision of personal care to young people. These plans are newly implemented and still require further detail to make them an efficient and comprehensive working tool for staff. However the care of young people is improved by this more systematic approach to the provision of health care.

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Quality of care adequate

Medication is accurately recorded, stored, issued and disposed of, ensuring the safe treatment of young people. Due to their level of understanding and ability no young people self-administer their medication. All medical permissions are in place including those for use of first aid. Staff are trained in the control and issuing of medication and have first aid qualifications which are being updated in the new training programme. The home maintains rigorous controls of medication in line with guidelines from the British Pharmaceutical Society, ensuring the safe provision of medical care to young people. 8 of 12

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Keeping children and young people safe adequate

Young people’s safe care is enhanced by improved care planning. In particular the recording of the delivery, and guidelines around the provision, of intimate personal care is improved. All staff have copies of the guidelines and care plans and health care plans contain more detailed advice to staff on the needs of each young person. The manager and staff recognise that the content of care plans requires further improvement but young people are now receiving consistent safe care. One social worker said of young person placed in the home, “I am confident he is safe there.”

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Keeping children and young people safe adequate

There have been no restraints since the last inspection. The record for recording serious incidents is now in a suitable volume providing a permanent record in line with regulatory requirements. The format for recording restraints has been improved to allow staff to provide a comprehensive record of the intervention, it’s effectiveness and outcomes. Staff training in the use of nonviolent physical intervention is planned throughout the next year to enhance the safe engagement between staff and young people. All staff have been trained in moving and handling as a response to a recent child protection investigation involving the movement of a young person. The safe care of young people is improved through these measures.

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Keeping children and young people safe adequate

Previous gaps in employment of staff have been explored by the home and written records are now in place on all staff files. All other checks are in place including disclosure and barring service checks. The safe care of vulnerable young people is enhanced by these improved recruitment procedures.

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Keeping children and young people safe adequate

High staffing levels and close engagement with staff ensure that young people do not go missing from trips or from the home. There have been no occasions where young people have gone missing since the last inspection. The manager and staff ensure that young people’s safety is enhanced by staff application of detailed risk assessments. The risk assessments are in the process of being enhanced with an evaluation sheet identifying risk levels and evaluating outcomes. The home is in the process of modifying all risk assessments to comply with the new model. The new system allows staff to monitor young people’s progress in risk reduction and safely adjust ways of working including staffing numbers.

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Keeping children and young people safe adequate

The manager ensures that young people live in a safe and appropriately maintained environment. The health and safety risk assessment for the building is now due to be reviewed. Fire drills are regular and aid the safe care of the young people. Security cameras enhance the external security of the building without compromising the privacy of the young people. Door alarms ensure that staff are aware if anyone enters or leaves the building allowing them to take appropriate measures to safeguard the young people. All visitors have their identity checked and are appropriately supervised during visits. Space is available for visitors to meet in private with young people, where appropriate. Social workers say that the home is excellent at supervising contacts and provides detailed reports on any such contacts, ensuring the safety of young people. 9 of 12 The home cooperates fully with all investigations arising from complaints about the

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Keeping children and young people safe adequate

service. Complaints are responded to appropriately and in a timely manner ensuring the safety of staff and young people. The home has successfully responded to a recent investigation implementing required changes to practice within the home ensuring the safer care of young people.

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Leadership and management adequate

The company have appointed a new manager for the home following the last inspection. The manager has only been in post for two weeks and received the inspection report on the home two days before this inspection. However the manager has commenced his registration with Ofsted and has made significant progress in planning for change in the home. Staff and social workers commented favourably on the initial progress made. The manager has appropriate experience and qualifications including: a level 5 qualification; advanced management qualifications; a graduate diploma in therapeutic childcare; and extensive positive experience working with children and families, including as a registered manager of children’s homes.

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Leadership and management adequate

The manager has agreed dedicated budgets for the home with the provider. The budgets have been set to allow the home to purchase food, plan activities and look to long term changes in the environment. The change will allow staff to develop independence training with young people engaging them in shopping and in planning changes to the home. Children will gain valuable life skills through this including: familiarity with the use of money; shopping for food; broader engagement in social situations aiding the development of language and social skills.

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Leadership and management adequate

The manager has established a system for monitoring the matters set out in Schedule 6 and for improving the quality of care in the home. He has commenced detailed weekly monitoring of all required areas including all staff recording systems. The manager has also completed an extensive training and development plan for the home which is supported, by this regular monitoring, to raise standards in the home and improve the care of young people.

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Leadership and management adequate

Following the failure of the previous independent visitor to alert the home to shortfalls in the service the provider has appointed a new independent visitor. The new appointee has extensive relevant experience and has already met with the new manager to review his extensive training and development plan for the home. The manager has now completed an initial development plan which includes a comprehensive training programme for all staff. The training programme will provide the staff team with the necessary knowledge and skills to work with the children in the home. For example training includes issues related to: autism and learning disabilities; race, religion and culture; communicating with children, including those with disabilities; provision of intimate care; developing independence skills; working with families; and specific child care approaches, knowledge and skills for their role. 10 of 12

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Leadership and management adequate

Although courses are planned, and many booked, most have not yet commenced.

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Leadership and management adequate

The home is well looked after with all areas clean, tidy and well maintained. Furniture in the home is comfortable and bedding in particular has improved with all young people having new mattresses and bedspreads. Staff have delegated responsibilities engaging them in the effective monitoring and improvement of the environment. With the establishment of dedicated budgets for the home staff are now able to plan long term improvements to the environment. Children will be involved in planning and implementing changes in particular to their own rooms.

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Leadership and management adequate

Staff continue to receive regular supervision of a high quality. Staff enjoy working in the home and are looking for a period of growth and stability for the home, under the direction of the new manager. The manager has revised the staff appraisal format and has commenced this process with staff. He plans to complete all appraisals by the end of the next month. In addition to the extensive training plan all staff either have an appropriate level three qualification or are engaged in the course. Some staff have safeguarding and child protection training which is current until October. The manager has arranged appropriate safeguarding training, for the whole team, with two adjacent local authorities. In addition training is planned for physical interventions using the non-violent crises intervention technique. New staff will take part in Children’s Workforce Development Council’s Induction standards and all staff

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Leadership and management adequate

have received guidance on the provision of personal care. These measures ensure that staff will be appropriately prepared to deliver high quality care to this group of young people.

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Leadership and management adequate

The manager has devised an improved format for young people’s files which ensures they contain clear targets and a measure showing progress in health, care and risk assessment targets. The clearer recording provides the basis for better care planning and recognition of targets which have been achieved. Young people are engaged in this process through key working and get praise and recognition for their tracked progress.

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Leadership and management adequate

Staffing of the home is in line with the statement of purpose and with delivering individual care plan targets. A number of young people are on two to one ratios when out of the home to ensure their safety. Where necessary, agency staff have been used to aid in this process and they are suitably prepared and inducted to ensure young people's safe care. The home is now meeting the aims and objectives outlined in the statement of purpose. However, the statement of purpose requires minor updating to reflect the changes in management. This does not impact on the care of the young people.

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Leadership and management adequate

The home has made progress in addressing the requirements and recommendations set at the last inspection. Due to the short period between inspections many of the required actions are planned and evidence was presented to support their implementation. For example safeguarding and child protection courses have been 11 of 12 booked as they become available over the next three months. Other requirements requiring urgent action have been completed enhancing the safeguarding and quality of care provided to the young people. 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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