Children's Home run by 3 Dimensions Care Limited in Somerset

Unique reference number SC060758 Inspector Janice Hawtin Type of inspection Full Provision subtype Children's home

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Registered manager Adele Trinette Frost Date of last inspection 19/11/2013 2 of 11 Inspection date 21/08/2014

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Previous inspection satisfactory progress Enforcement action since last inspection None

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Overall effectiveness inadequate

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

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Overall effectiveness

Overall effectiveness is inadequate. Despite two previous requirements relating to the use of, and recording of physical restraint, records and interventions continue not to meet the required standard. Some records of physical restraint are unclear about which staff were involved, the duration of the holds or the location where the hold took place. Some poor behaviour management is evident, and one record details the use of a physical restraint to force compliance. This poor practice does not protect the rights and dignity of young people.

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Overall effectiveness

Although the Registered Manager has some oversight of the home and generally works from an office on the same site, she is not in day-to-day control of, or directly managing the home. This contravenes regulatory requirements. Two managers are employed to directly lead the home. Neither have applied to Ofsted for registration as required and lines of accountability, roles and responsibilities are unclear. This has led to serious shortfalls in the leadership and management of the home, including ineffective oversight of behaviour management and records of physical restraint, and a lack of appropriate support and formal supervision and appraisal for staff. In addition, there is a failure to review and to update fundamental documents such as the Statement of Purpose.

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Overall effectiveness

Within the wider organisation, the appointment of an independent person to 3 of 11 undertake quality assurance visits has increased the frequency of monitoring. However, this monitoring does not demonstrate effective scrutiny of behaviour management, physical restraint, or the staff's safeguarding knowledge. Oversight of the home by the registered manager is not robust and does not effectively evaluate the quality of the service provided; this compromises quality assurance and reduces the potential for identifying development needs.

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Overall effectiveness

Staff understand complex needs of young people. Careful planning is in line with placing authority expectations and contributes to the success of placements. Regardless of their starting point all young people make sustained improvements and progress in many areas of their lives. Young people have exceptionally good attendance at school and sustained growth in attainment levels. Clear expectations and firm boundaries contribute to young people acquiring life changing social and practical skills, for example, being able to leave their bedroom, or keep clothes on. A parent commented ‘I’ve got nothing but good things to say about this home, the staff are fabulous, they’ve given me my son back, and he is much happier’.

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Overall effectiveness

Young people are engaged in a wide and varied range of activities which support their learning and development. They are involved in both community projects and community activities alongside pursuing individual hobbies and interests. One young person who goes deep-sea fishing recently caught mackerel which was included as part of the evening meal. 4 of 11

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Information about this children’s home

This privately owned home provides care and accommodation for up to five young people, who may have emotional and behavioural problems. Some young people may also have specific learning disabilities.

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Information about this children’s home

The provision is registered with the Department for Education to provide education on site for young people who live in one of the three homes run by the provider.

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Inspection date Inspection type Inspection judgement

19/11/2013 Interim satisfactory progress 31/07/2013 Full good 19/02/2013 Interim satisfactory progress 10/05/2012 Full good

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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

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 that purpose of which shall include information listed as items 3 (a)-(i) and 4 (a) and (b) of this regulation. (Regulation 17B (3)and (4)) 30/09/2014

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Reg. Requirement Due date

17A (2001) ensure that any measure of restraint used on a child accommodated in the home is only for the purpose of preventing injury to any person 30/09/2014 5 of 11 (including the child who is being restrained) or preventing serious damage to the property of any person (including the child who is being restrained) (Regulation 17A(1)(a)&(b))

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Reg. Requirement Due date

(2001) ensure that the effective monitoring by the registered person of the matters set out in Schedule 6 takes place at least every 3 months.(Regulation 34 (1)(a-b)) 30/09/2014

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Reg. Requirement Due date

4 (2001) compile a statement of purpose which consists of a statement as to the matters listed in Schedule 1 and provide a copy to Ofsted (Regulation 4 (1)&(2)(a)) 30/09/2014

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Reg. Requirement Due date

7 (2001) appoint an individual to manage the children's home if the registered person is not, or does not intend to be in day to day charge of the children's home. In addition ensure the person in this role is the Registered Manager(Regulation 7 (1)(b)(iii)) 30/09/2014

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Reg. Requirement Due date

(2001) demonstrate to Ofsted that all person's employed in the children's home receive appropriate supervision and appraisal (Regulation 27 (4)(a)) 30/09/2014

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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

 ensure that all areas of the home provided a comfortable and homely environment and that risk reduction does not lead to an institutional feel (NMS 10.3)  ensure that the learning and development programme is evaluated for effectiveness, in particular that staff are clear about recording procedures following a restraint (NMS 18.2)  ensure that the independent person completing quality assurance visits under Regulation 33 is satisfied that the home has an effective approach to behaviour management, and routinely examines records of restraint and logs of missing person's reports (Children Act 1989 Guidance and Regulations, Volume 5: Children's Homes 3.12)  ensure all staff understand what they must do if they receive an allegation that someone may have harmed a child (MNS 20.1)  ensure staff support and encourage young people to make and keep a record of their time in the placement. (NMS 22.6) 6 of 11

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Outcomes for children and young people good

Young people make significant progress in developing emotional well-being and confidence. Often from a very difficult starting point, they develop socially acceptable behaviour, communication skills and begin to benefit from the opportunities that these improvements bring.

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Outcomes for children and young people good

Contact with families supports young people’s knowledge and understanding of their background and promotes their sense of identity. Attachments with relatives are sustained and reinforced where appropriate. This includes the provision of joint activities arranged by the home for young people, their siblings and other family members.

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Outcomes for children and young people good

Some extremes of debilitating behaviour exhibited by young people have reduced significantly. Those young people who were not able to leave their bedroom or keep clothes on are now dressing appropriately and able to take part in activities out in the community. In addition, young people develop and improve their communication skills; as a result some rely less on the use of echolalia to process listening, or on the use of toy characters to communicate.

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Outcomes for children and young people good

Young people benefit from full time, exceedingly good attendance at school and they continue to progress towards expected target levels. Bespoke packages of education are provided and enable young people to develop important life and social skills alongside academic and practical skills.

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Outcomes for children and young people good

Young people are encouraged to make choices whenever the opportunity arises. They commonly make decisions about clothing, food and activities, but also make known their views about more complex issues, for example, future placements to inform planning meetings.

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Outcomes for children and young people good

Young people are involved in a wide range of activities that support their learning including membership of specialist community group and clubs. They enjoy holidays which broaden their experiences, and support the development of friendships. Young people commonly enjoy trips to theme parks, adventure parks, sea fishing and involvement in local carnival committees.

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Outcomes for children and young people good

Independence skills are maximised. Dependent on their ability, young people have varying knowledge and skills in understanding and acting on the importance of staying healthy. They eat a healthy diet and take part in regular exercise. Young people are not engaged in risk taking behaviours such as smoking, drinking alcohol or use of illicit drugs. 7 of 11

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Quality of care adequate

Each young person has an individualised behaviour management plan which has led to a reduction in both difficult and dangerous behaviour. For the most part, behaviour management is focused on changing behaviour through positive interventions and rewards. On a small number of occasions, interventions by staff have exacerbated difficult situations. This has resulted in the need to use physical restraint on young people to avoid them causing injury or serious damage to property.

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Quality of care adequate

Staffing numbers are high with at least a one-to-one, but also a two-to-one ratio for some young people, depending on the complexity of their needs. Each young person has a dedicated, limited number of care workers who provide consistency and familiarity. This provision encourages positive attachments and generally fosters a good understanding of young people's needs.

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Quality of care adequate

Care planning is thorough and meets the expectations of the placing authority. Staff will advocate and challenge decisions on behalf of young people. Recent interventions undertaken on young people’s behalf have seen the stability of placements improve, and secured additional care services.

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Quality of care adequate

Young people know how to make a complaint. Staff are also skilled in interpreting behaviour linked to emotional problems or discomfort and respond to reduce young people's anxiety and distress. This is particularly evident when they are dealing with young people who have high needs autism and complex communication needs.

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Quality of care adequate

Young people interact well with one another; the home is spacious and divided into two distinct areas, each with its own lounge, dining area, kitchen and access to bedrooms. Consequently, it is possible to separate young people and avoid conflict. This also reduces the impact on other young people when an individual is having some difficulties, but allows for social interaction and developing communication skills at other times.

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Quality of care adequate

Staff take account of the feelings and wishes of young people. Bedrooms are personalised by young people and meet their individual taste and needs. It is possible to determine which bedroom belongs to each young person by the décor, fittings and belongings. This gives young people a real sense of ownership and belonging. One young person commented ‘I really like it here, it’s much better than the last place I lived’.

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Quality of care adequate

Some communal areas of the home are personalised with pictures of young people. However, corridors and bathrooms lack a homely feel. In one of the kitchens risk reduction has led to some unnecessary and institutionalised health and safety signs. This detracts from what is otherwise a comfortable and welcoming environment.

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Quality of care adequate

Young people have access to the services they require to develop and promote their 8 of 11 health and emotional well-being. Alongside routine health checks and preventative health care, young people have access to a range of specialists including speech and language therapists, psychological, and occupational therapists.

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Quality of care adequate

Arrangements for dealing with medication are safe and effective; medicines are stored in a safe in a locked office. A policy is in place to ensure that young people who are capable of self-administering medication can do so safety and without compromising their welfare or that of other young people.

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Quality of care adequate

The home is located in a rural area, close to several small villages, community facilities, and within reach of a large city when using the home’s own transport. The home is spacious and well-equipped; it has a large fenced garden with enough space to play ball games. The garden also has fruit trees and a large fish pond which young people have some responsibility for looking after.

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Keeping children and young people safe inadequate

Records of restraint do not contain the information required to evidence that measures used are appropriate, reasonable and proportionate. Contrary to regulations one physical restraint has been used to force compliance. Several physical restraints relating to the same incidents are recorded in one record. It is not clear which staff were involved in each hold, or the duration of each restraint. A number of behaviour management interventions by staff are not effective or recognised de-escalation techniques. As a result, some inappropriate responses by staff have exacerbated situations, leading to a need to use physical restraint. While there is no evidence of harm to young people this practice does not protect their welfare or safety. The home has been asked at two previous inspections to ensure that interventions and restraint records are improved.

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Keeping children and young people safe inadequate

Two new members of staff who have completed induction training are not fully clear about how to act should an allegation be made by a young person. Although they say they would have sought help from senior members of staff, both stated they would inform alleged abusers of the allegation. Evidence could be compromised and/or investigations could be corrupted.

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Keeping children and young people safe inadequate

The organisation has recently produced additional guidance and checks for agency staff who may be employed in the home. This provides for robust vetting checks and essential induction information which includes checking safeguarding knowledge and clarity around roles and responsibilities. Vetting and recruitment checks for permanent employees are robust.

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Keeping children and young people safe inadequate

All visitors to the home are checked to ensure they have a right to enter. Staff are aware of the particular vulnerabilities of young people and what makes them feel safe. Staff have built an enclosed den above the bed of a young person who sometimes feels safer in small places. Another young person has a tent in their 9 of 11 bedroom which they can use when they are feeling anxious. This attention to individual need helps young people to feel safe and secure. Young people have dedicated workers allocated to them and are able to express any discontent. One young person commented ‘I like most of the staff here and we get on well’.

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Keeping children and young people safe inadequate

Incidents of young people going missing from this home are rare. The policies in place are compliant with the local safeguarding board joint police protocols which contribute to keeping young people safe and returning them quickly, should any incidents occur.

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Keeping children and young people safe inadequate

The environment is physically safe and secure. The front door is kept locked as some young people have no understanding of danger and have tried to leave using this exit. However, young people who do not need this restriction can leave through one of several other doors. Doors throughout the building have fire safety devices and will close automatically should alarms go off. Fire detection systems are in place so that staff and young people can get out of the building quickly in the event of a fire.

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Leadership and management inadequate

The Registered Manager is not in full time day-to-day control of the home. There have been some complications with registering a person who was recruited to undertake this role. This person is not presently working. A recently recruited manager ‘in training’ currently has oversight of the home. She has experience of work in similar settings and understands the complexities of managing a children’s home and a large number of staff. The strengths and weaknesses of the home are understood by her and she demonstrates a determination and commitment to improve the home. A development plan is in place: although it contributes to some practice developments it will not address current shortfalls.

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Leadership and management inadequate

The Statement of Purpose has not been reviewed or updated since 2012 and therefore does not meet current requirements. Consequently, the written information provided to parents, commissioning bodies or regulators is neither up to date nor comprehensive. A director of the organisation was in the process of addressing this shortfall prior to the inspection.

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Leadership and management inadequate

Requirements relating to physical interventions have now been made following three consecutive inspections visits. These have not been suitably addressed. Despite the organisation’s review and changes to the logbook kept for recording physical restraint records, and the provision of additional staff training, records remain in part ambiguous and do not provide the required information.

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Leadership and management inadequate

The home employs a sufficient number of staff to look after the young people in its care. It is not possible to determine if the frequency and quality of supervision for staff is appropriate or if annual appraisals take place. The inspector was told that some records are locked away and that the key was held by one individual who was 10 of 11 not available during the inspection. Arrangements for the supervision of the Registered Manager, managers of the home, and directors who are involved in the care and control of young people are vague. This muddies accountability and prevents effective oversight of the home.

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Leadership and management inadequate

The programme of induction, mandatory and specialist training available to staff and contributes to them meeting the needs of young people, who without exception make measurable progress in this home. However, there is not an effective supervision process or support system in place to test staff’s understanding and knowledge particularly of record keeping or safeguarding training.

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Leadership and management inadequate

Leaders and managers are in regular communication with parents, staff, and commissioners. This communication underpins clarity about the aims and objectives of placements. Staff work in close partnership with other agencies to deliver effective services, and support to meet young people’s needs. Partnership includes consultation with social workers, specialist therapists, and education providers and provides for continuing evaluation, and evidencing of the progress made by young people.

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Leadership and management inadequate

Independent visits completed on behalf of the registered provider have recently improved in frequency. Reports do not evidence effective oversight of behaviour management, complaints or missing from home records. Consequently is not possible for the independent visitor to determine that the quality of care provided is wholly suitable and promotes the welfare of young people.

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Leadership and management inadequate

Young people’s individual records are clear and up to date; they contribute to understanding the life and history of young people. Planning documents, risk assessments and school information are readily available so that staff are clear about the needs of the young people they care for.

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Leadership and management inadequate

Monitoring by the Registered Manager has not been effective in identifying shortfalls of this inadequate provision. Leaders and managers expressed disappointment and regret about the findings of this inspection. It is clear from discussions and their obvious enthusiasm about the progress made by young people that leaders and managers are determined to address the deficits swiftly. 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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