Children's Home run by Meadows Care Limited in Oldham

Unique reference number SC066072 Inspector Stella Lovie Type of inspection Full Provision subtype Children's home

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Registered person Meadows Care Limited Registered person address Egerton House Wardle Road ROCHDALE Lancashire OL12 9EN Responsible individual Niel David Shelmerdine Registered manager Catherine Veronica Donnelly Date of last inspection 20/03/2014 2 of 12 Inspection date 10/09/2014

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

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Overall effectiveness

The home was only adequate in its last full inspection in December 2013, though had progressed to good progress by the time of the interim inspection in March 2013. However, it is evident that many of the themes identified in that previous full inspection in respect of young people being disengaged from staff, education and structured activities still persist to this day, and have become entrenched. This includes young people commenting adversely on frequent staff changes. Some young people continue to feel they are disadvantaged by other young people being more demanding. This has progressed to some young people feeling unsafe and threatened by peers on occasions. As a result young people’s outcomes are poor.

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Overall effectiveness

Young people continue to display highly challenging behaviour that is not managed effectively with positive and proactive behaviour management strategies. Continuity of care is compromised by frequent changes of staff and over-reliance on reserve staff. Overall, quality of care is inadequate, and has neither consistently promoted young people’s welfare, nor always kept young people safe.

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Overall effectiveness

In the last full inspection, the Registered Manager identified that staff sometimes used restraint inappropriately. Since then, young people have been harmed by inappropriate restraint and staff have been dismissed accordingly. Given that leaders play a large part in defining organisational culture by what they say and what they 3 of 12 do, some senior managers have not always set the right tone for their shared endeavour to promote young people’s safety.

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Overall effectiveness

Management information is not routinely used to assess performance as part of a performance management culture. Monitoring gives too little critical information about operational performance and the achievement of key targets. Supervision is not effectively tackling drift in placement planning and lack of procedural compliance. Some staff are not sufficiently skilled or motivated to cope with the complexity of young people’s needs. Consequently, young people have been harmed and continue to be placed at risk. Consequently, a number of breaches of regulation are identified which require urgent attention. 4 of 12

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Information about this children’s home

This privately owned home provides care for three young people with emotional and behavioural difficulties. This home is also registered as a school.

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Inspection date Inspection type Inspection judgement

20/03/2014 Interim good progress 17/12/2013 Full adequate 07/02/2013 Interim good progress 14/08/2012 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

(2001) ensure that the children's home is conducted so as to promote and make proper provision for the safeguarding and welfare of children accommodated there (Regulation 11(1) (a)) * 03/11/2014

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Reg. Requirement Due date

(2001) ensure that the children's home is conducted so as to make proper provision for the care, supervision, support, and where appropriate, treatment, of children accommodated there (Regulation 11 (1) (b)) * 03/11/2014

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Reg. Requirement Due date

(2001) ensure that there is at all times sufficient number of suitably qualified, competent and experienced persons working at the children's home, with specific regard to ensuring continuity of care to 03/11/2014 5 of 12 meet the children's needs (Regulation 25 (1)) *

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Reg. Requirement Due date

(2001) maintain a system for monitoring the matters set out in Schedule 6 at least once in every 3 months, and ensure it serves to improve the quality of care provided in the children's home, and provides for consultation with children accommodated in the home (Regulation 34 (1) (a) (b) (3)) * 12/12/2014

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Reg. Requirement Due date

(2001) ensure that children accommodated in the home are provided at all reasonable times with access to a telephone which they may use without reference to persons working in the home on which to make and receive calls in private (Regulation 15 (4) (a)) 03/11/2014

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Reg. Requirement Due date

(2001) ensure that all persons employed by the registered person receive appropriate supervision and appraisal (Regulation 27 (4) (a)) 03/11/2014

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Reg. Requirement Due date

(2001) ensure that an independent person critically examines and scrutinises the way that the children's home is carried on or managed, specifically to evaluate the quality of care and whether the children are effectively safeguarded and the conduct of the home promotes the wellbeing of the children accommodated there (Regulation 33 (3) (a) (b) (8) (i) (ii)) 03/11/2014

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Reg. Requirement Due date

(2001) ensure that the children's home complies with Regulatory Reform (Fire Safety) order 2005 (Regulation 32 (1A)) 03/11/2014

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Reg. Requirement Due date

(2001) ensure that all parts of the children's home used by children are kept in good structural repair externally and internally, and kept reasonably decorated and maintained, with particular regard to the driveway, the kitchen, re-painting of damaged walls and doors, trip hazards re flooring. (Regulation 31 (2) (d) (e)) 03/11/2014

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Reg. Requirement Due date

*These requirements are subject to a compliance notice

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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 have prompt access to doctors and other health professionals, including specialist services, when they need these services, with specific regard to referrals to drug and alcohol services (NMS 6.4)  ensure that the care and support provided to children minimises the risk that they will go missing and reduces the risk of harm should the child go 6 of 12 missing, with specific regard to meeting with relevant agencies to plan strategy when there is a serious pattern of going missing (NMS 5.1)  ensure that the registered person works with the responsible authority to ensure effective sharing of information, including consultation with previous care homes that children have lived in (NMS 22.7)  ensure that each child's Placement Plan is monitored by a key worker within the home, with specific regard to timely up-dating of that plan in relation to children's statutory reviews. (NMS 25.2)

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Outcomes for children and young people inadequate

Young people live in an unsettled and volatile home where they experience many changes of staff. This inhibits their opportunities to develop their emotional resilience. Episodes of highly challenging behaviour over recent months by some young people impact adversely on all the young people living in the home. It affects their sense of safety and well-being. As one young person said: ‘It’s great here now. It didn’t used to be when the other young person lived here. I stayed in my room then most of the time as the home was so chaotic. I used to be bulled and didn’t feel safe. I had to eat off plastic plates as so much stuff had been smashed. Staff tried to deal with it but things could just go mental over nothing, over stuff like the wrong baked beans.’

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Outcomes for children and young people inadequate

All the young people smoke and choose not to engage meaningfully with cessation programmes. Some young people use various illegal drugs in association with going missing from the home. These lifestyle choices do not help them to enjoy good health. That is compounded by their poor cooperation with routine health appointments such as dental checks. It has also meant that crucial prescribed medication regimes are not consistently followed. This has not promoted their mental health. Young people’s lack of engagement with menu planning means that they eat a generally unstructured and poor quality diet which again impacts adversely on their health.

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Outcomes for children and young people inadequate

Young people’s participation in therapeutic support is variable. Some young people take good advantage of the chance to take time out of the home and talk about their feelings and their past. That said, it has not been effective in helping them to think through their choices for the future, and has resulted in their last minute refusals to move to planned new placements. They comment that they have not felt listened to or understood. Other young people simply refuse to engage with any therapeutic interventions. Consequently, young people have not acquired the skills to regulate their emotions and behaviours, resulting in frequent conflict and some criminalised outcomes. Progress in developing social skills is minimal and they remain at high risk of social exclusion.

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Outcomes for children and young people inadequate

Young people have the opportunity to enjoy bespoke education packages but again do not all avail themselves of this. Attendance ranges from reasonable to poor. Attainment therefore has not been at predicted grades, though some young people have sat exams and achieved well enough to secure college placements. At the point of inspection, these placements are uncertain though as young people refuse to cooperate with their placement planning.

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Outcomes for children and young people inadequate

Young people have very little involvement with constructive activities in their local community. They have not had the opportunity this year to enjoy a summer holiday away from the home. This does not promote socially acceptable behaviour or help to 8 of 12 develop social networks. That said, some young people have developed friendships with peers in other homes within the organisation. This encourages them to go out more and spend less time in their room. Contact with family is appropriately supported by the home so that young people can maintain significant attachments which are vital to their sense of well-being.

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Outcomes for children and young people inadequate

Relevant young people are supported to acquire practical skills such as shopping to a budget and preparation of simple meals. This begins to help them to prepare for adult life. However, support to acquire key life skills is limited, with the result that young people have not felt ready at the final moment to move forward in accordance with their care planning.

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Quality of care inadequate

Young people have not yet learned suitable negotiation skills for all the situations they find themselves in. Inappropriate demands, threats and intimidation have been unwanted features of young people’s behaviours, resulting in police assistance being needed. The building of constructive relationships with staff is compromised by frequent changes to the core staff team and use of many reserve staff from elsewhere in the organisation. Relationships between peers in the home are fractious and challenging. Consequently, some young people have hidden in their rooms to protect themselves, and have been relieved when peers have gone missing for protracted periods.

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Quality of care inadequate

Staff do not set clear, consistent and appropriate boundaries for young people. This is partly because there are so many different staff working in the home. It clearly impacts on their commitment and attachment to the young people. The Registered Manager commented on staff’s ‘apathy’. Basic care tasks in the home such as putting the bins out to be emptied, and ensuring toilet paper and towels are available for young people, are not regularly completed. This creates an impression of indifference and neglect. As one social worker commented: ‘At times, some of the residential staff were unenthusiastic. I think it would improve the service if there were consistent, familiar staff for the young people. During the latter part of my young person’s placement, he reported a quick succession of staff providing limited continuity of care. Also staff at times could not answer basic questions about his care which posed

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Quality of care inadequate

concern about the handover of information.’

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Quality of care inadequate

Communication between staff is not always maintained and restricts the support provided to young people. Direct work to help young people with their emerging emotional and behavioural difficulties is insufficient. For example, swearing and abusive sexualised comments by young people go mostly unchallenged. This sets up an atmosphere of volatility and tension that can culminate in yet more antisocial behaviour. Some young people have not been encouraged to address their drug use through referral and engagement with specialist services. This again demonstrates the lack of proactive attention to young people’s needs. 9 of 12 Placement planning for some young people has been of a poor standard. For example, young people have been admitted on an emergency basis without the home obtaining essential information to keep them safe until the initial placement planning meeting is held. Those meetings have not been held for nearly two weeks

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Quality of care inadequate

after admission in contravention of the provider’s own standard to hold such meetings within 72 hours of admission. This has meant that key information is not shared in a timely fashion and risks in relation to known behaviours such as drug use and child sexual exploitation are not appropriately assessed and managed. Placement plans are not always up-dated in relation to statutory reviews. This inhibits staff in communicating with young people about their care planning and does not help prepare them for the future.

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Quality of care inadequate

Staff are unable to motivate young people to participate regularly in meetings to discuss how the home is run and to plan activities. This limits the opportunities for young people to constructively express wishes and views and to have a sense of ownership about their home. Young people know how to make a complaint and confirm that they feel able to do so. However, they do not have access to a telephone without needing to ask staff. This does not enable them to freely contact other adults, including the provider, should they wish to raise a concern about their treatment in the home. This is a significant shortfall as staff practice in the home in recent months as been poor enough to result in several disciplinary proceedings.

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Quality of care inadequate

Staff provide opportunities to take part in purposeful and enjoyable activities but young people do not always select to do the activities on offer. This can lead to boredom, unsocial behaviours and conflict. There is minimal attention paid to raising young people’s awareness of the diverse society they live within. This does not promote tolerance or social cohesion.

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Keeping children and young people safe inadequate

Young people sometimes experience bullying from peers in the home and this means that their sense of well-being and safety can be very low. The lack of a consistent staff team means that it is difficult to be confident that young people would be able to identify an adult they could talk to if they felt unsafe as so many adults have come and gone in the home in recent months.

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Keeping children and young people safe inadequate

Staff have been unable to apply consistent positive behaviour management strategies. Young people’s behaviour can be extremely challenging and staff sometimes feels unable to manage it effectively. This has led to the home appropriately giving notice on some young people. Provider safeguarding policies and procedures are not always followed by staff. For example, knives in the home have not consistently been checked as secure; morning and night-time welfare checks of young people believed to have consumed drugs are not always undertaken; and measures to help keep young people safe at night when staff are asleep have been 10 of 12 defective. This represents a failure to make proper provision for the safeguarding and welfare of young people.

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Keeping children and young people safe inadequate

While there is minimal use of restraint, it has sometimes been used inappropriately. This has led to young people receiving injuries, and justifiably making allegations against staff. The Registered Manager has on those occasions acted swiftly in accordance with statutory guidance, and in partnership with relevant agencies, to provide suitable protection to young people. However, the provider has undermined the constructive message that this robust action gave by allowing a more senior manager with a clear conflict of interest to challenge associated disciplinary process. This not does promote a strong safeguarding culture within the organisation.

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Keeping children and young people safe inadequate

The quality of risk assessment is too variable. Young people are admitted to the home without adequate information about known risks such as sexual exploitation, eating disorders and drug use. These are important deficits as young people’s safety is thereby compromised.

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Keeping children and young people safe inadequate

Records demonstrate that there have been high and increasing levels of young people going missing from the home. Staff take action to try to locate the young people and to keep in contact. They also work closely with the police to manage such situations. However, strategy meetings with relevant agencies are not held to review associated risk, understand why they go missing, and devise plans to reduce the frequency of these events. This does not promote young people’s safety.

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Keeping children and young people safe inadequate

Evidence suggests that the home conducts careful and robust recruitment checks to deter unsuitable people from having access to young people. That said, there is an unfortunate sequence of necessary disciplinary proceedings in relation to unsafe and inappropriate practice by staff in the home. This has contributed to the overall unsettled situation in the home.

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Keeping children and young people safe inadequate

The physical environment of the home is not completely safe. Recommendations from an external fire risk assessment completed nine months ago have not been completely adhered to. Similarly, trip hazards identified in an external health and safety risk assessment have not been amended. This again does not promote young people’s safety.

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Leadership and management inadequate

The Registered Manager of the home is suitably experienced. She is in process of completing her leadership and management qualification but is significantly behind schedule with this. She attributes this to having to ‘spread herself too thinly’. She manages two homes within the organisation, and is consequently dependent on effective deputy manager arrangements in order to be confident that she is day to day control of the home. Unfortunately, the manager reports that she has not felt able to trust either of her last two deputies, both of whom have left the home in 11 of 12 relation to issues about their practice. This impacts adversely on her ability to have adequate oversight of staff practice and young people’s needs, and to effect change where required. She said: ‘I’m in a mess. I feel like things are out of control.’ It is of concern that there is not much evidence of senior manager knowledge and

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Leadership and management inadequate

involvement in this home to raise standards and address serious issues of concern. This means that the home lacks sustained and effective leadership which impacts on the overall care provided.

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Leadership and management inadequate

As previously stated, there is no consistent staff team in the home. Some shifts have been completely covered by reserve staff from other homes. This leads to poor continuity of care. The Registered Manager said: ‘That has been the big problem here, routines and consistency.’ It is evident in repeated discussions in staff team meetings. However, staff supervision records fail to evidence robust attention to these practice issues, and some staff do not receive regular supervision. Staff also do not all receive annual appraisal. This does not help staff to raise their game and improve the quality of care provided. On the other hand, staff training appears to be thorough and is much valued by them. Unfortunately, it has not translated into more effective practice with the young people.

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Leadership and management inadequate

Quality assurance arrangements have failed to fully address the sustained problems in the home. Reports by the independent visitor are not critically constructive enough to help to bring about positive change. Similarly, the Registered Manager’s quarterly monitoring reports fail to identify the very real concerns she was able to articulate during the inspection. She has a sound understanding of the weaknesses in the home but has not been able to make a positive difference to them. Her monitoring reports lack meaningful consultation with young people, some of whom gave a clear account, when asked, about the negative impact of staff changes and lack of safety in the home in recent months. This means an important source of information is missed in that overview. It does not promote critical reflection or encourage problem solving. Consequently, managerial oversight is insufficiently robust and does not lead to

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Leadership and management inadequate

The statement of purpose is clear and accessible. However, the home is not conforming in practice with it’s assertions on how they keep young people safe and promote their welfare. The home is not well-maintained and decorated. This means it has not met the one recommendation from the interim inspection. For example, old, abusive graffiti is still visible on a recently admitted young person’s bedroom door. This does not promote their sense of well-being or of being valued. Various parts of the home require re-decoration and up-dating as it presents as tired and neglected. This includes attention to a very rough, steep driveway up to the house which is difficult to negotiate, and will be even more so in winter. These deficits show a lack of provision of a safe and nurturing physical environment. 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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