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Unique reference number SC370956 Inspector Judith Longden Type of inspection Full Provision subtype Children's home

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Registered person BetterCare Keys Limited Registered person address Laganwood House 44 Newforge Lane Belfast BT9 5NW Responsible individual Heather Ann Laffin Registered manager Peter Andre Gale Date of last inspection 05/03/2014 2 of 11 Inspection date 19/08/2014

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Previous inspection good Enforcement action since last inspection There has been no enforcement action since the last inspection. However, this inspection was bought forward as a result of concerns in relation to the notifications received in relation to self-harm incidents.

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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

Young people make some progress in a number of areas of their lives as a result of living at this home, especially in learning new skills and in their education. However, the extent of their progress is impeded by the continued use of temporary staff and the manner in which staff are deployed in the home. The provision and quality of training and gaps in supervision also means some staff are not sufficiently knowledgeable to support young people to progress to their full potential.

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Overall effectiveness

The home is adequately maintained and any damage is repaired in a reasonable timeframe. The décor is chosen with young people and provides a comfortable environment. Record keeping continues to be an issue in this home; although restraint records indicate which staff were involved, other incident records do not always clearly indicate who was involved in the incident and some records are not signed by staff.

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Overall effectiveness

Young people say they feel safer in the home when staff they know are present. A 3 of 11 number of policies and procedures are in place to safeguard young people, however there is no policy setting out the steps the home takes to prevent young people from being absent. There are also some gaps in recruitment checks in relation to agency staff qualifications. Self-injurious behaviour continues to be an issue for young people but the frequency of incidents has reduced and team managers from placing authorities have said they are happy with how the home manages risk-taking behaviours.

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Overall effectiveness

The Registered Manager monitors the events in the home and produces reports but these do not provide an evaluative review and do not provide evidence of consultation with others. A total of six requirements have been made as a result of this inspection.

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Overall effectiveness

A key strength of this home is the commitment of the core staff team, with a number of the shortfalls focussing on the use of temporary staff and the impact this has on young people. When asked what would make this home better, one young person said, 'I would like it back as a home and staff that stay the same.' 4 of 11

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Information about this children’s home

The home is privately owned and is registered to provide care for a maximum of four young people with emotional and behavioural difficulties.

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Inspection date Inspection type Inspection judgement

05/03/2014 Full good 09/01/2014 Full inadequate 13/11/2013 Interim inadequate progress 23/07/2013 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) prepare and implement a missing child policy setting out the steps taken in relation to the children's home to prevent children accommodated there from being absent without permission (Regulation 16(4)(b)) 08/10/2014

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Reg. Requirement Due date

(2001) ensure that the employment of any persons on a temporary basis at the children's home will not prevent children from receiving such continuity of care as is reasonable to meet their needs (Regulation 25(2)) 08/10/2014

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Reg. Requirement Due date

(2001) ensure full and satisfactory information is available in respect of each of the matters specified in schedule 2 (Regulation 26(3)(d)) 08/10/2014 5 of 11 (2001) ensure that all persons employed by him receive appropriate training, supervision and appraisal (Regulation 27(4)(a)) 08/10/2014

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Reg. Requirement Due date

(2001) maintain in respect of each child who is accommodated in a children's home a record in permanent form which includes the information, documents and records specified in Schedule 3 relating to that child, is kept up to date and is signed and dated by the author of each written entry (Regulation 28 (1)(a)(b)(c)) 08/10/2014

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Reg. Requirement Due date

(2001) establish and maintain a system for improving the quality of care provided in the children's home which shall provide for consultation with children accommodated in the home, their parents and placing authorities. (Regulation 34 (1)(b) and (3)) 08/10/2014 6 of 11

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Outcomes for children and young people adequate

Young people make sound progress in their education attendance and attainment given their starting points. Some young people have completed their examinations and are awaiting their results. Young people have completed courses with staff in the home in subjects such as food hygiene which has enabled them to develop skills to help them in their independence. Achievements in academic studies and life skills are celebrated which encourages young people to continue to study and learn. Young people are encouraged to undertake daily chores in the home as part of their independence programme and as a result they learn some basic skills for adulthood.

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Outcomes for children and young people adequate

Young people are encouraged to eat healthy meals. They help with the shopping, preparation and cooking of meals. This means they eat a healthy diet and learn new skills. One young person has successfully given up smoking which has made them feel much healthier as a result. However, other young people continue to smoke and there has also been some instances of offending behaviour in relation to drugs which has resulted in a caution for a young person. This means not all young people are achieving good health.

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Outcomes for children and young people adequate

Young people enjoy a number of activities in the home and local area and have enjoyed day trips further afield during the summer holidays. One young person has learnt to swim as a result of regular trips to the pool with a member of staff from the home.

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Outcomes for children and young people adequate

Young people benefit from improving contact arrangements. These arrangements are clearly specified in their plans and regularly monitored due to concerns and risks. Contact is often supported by the home. This means young people benefit from improving relationships with their family.

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Outcomes for children and young people adequate

Although young people recognise the progress they make, they also clearly identify the impact the use of temporary staff and the lack of training has on their progress and how it affects their confidence and self-esteem. One young person said, 'the worse thing is different staff don’t know how to help us emotionally, don’t know how to handle us, staff need training, they need support from senior staff.'

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Quality of care adequate

Young people live in a home where the physical environment, the quality of décor and furnishings of the home, provides a welcoming environment. However, young people say there is a 'bad vibe' about the home and, 'it is no longer a nice home but feels like a care home.' They say this is because of the constant change in personnel, 7 of 11 use of agency staff and staff from other homes and the lack of understanding of their needs shown by some of these staff. The home has, indeed, used a large number of agency staff in recent weeks as a result of increasing the number of young people in the home and a rise in the number of incidents. However, this means young people do not always know who is in the home, the level of competence is not always sufficient and not all staff have the required training. As a result the needs of the young people are not always met.

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Quality of care adequate

The home is adequately maintained and repairs are undertaken within a reasonable timeframe. Some young people vent their feelings by writing on the walls of their bedrooms. This is often redecorated by the young person sometimes with the help of other young people. One young person has suggested using chalk boards across one whole wall of a bedroom as an 'expression wall' instead of damaging the paintwork of a bedroom.

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Quality of care adequate

Young people are aware of the complaints process. They say they believe their complaints are taken seriously but some say they are made to feel they should not have complained. Some young people say they are listened to and are involved in their care but others say they do not feel involved, however all young people participate in regular house meetings. Young people have requested that future meetings be for young people only and no staff be present, they say they will take their own minutes and forward any action points to staff after the meeting. This means young people begin to take responsibility for their care and how the home operates.

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Quality of care adequate

Young people's care plans identify their individual needs and how these needs will be met by the home. Risk assessments are prepared for each young person and updated following incidents. The home works with a range of medical professionals to ensure young people's health needs are met. This means young people benefit from personalised care management procedures. However, the standard of record keeping continues to be an issue in this home; incidents of self-injurious behaviour and absence to do not always indicate which staff were involved in the incident, this means there is no evidence to indicate that staff are suitably trained to manage these incidents. In addition, risk assessments are not always signed by staff to indicate that updates have been read, and there are inconsistencies in the various records of the same incident. This was a recommendation at the last inspection and a requirement is made as a result of this inspection.

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Quality of care adequate

Young people benefit from mainstream education or alternative education packages that are more suitable for their individual needs. Extra curricular activities such as attendance at the school 'prom' are encouraged. This ensures the young people feel part of the school youth culture.

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Quality of care adequate

A social worker commented that, 'apart from staffing issues we are happy with the home, the young person has good relationships and is very settled.' 8 of 11

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Keeping children and young people safe adequate

Young people who live in this home have a history of risk-taking behaviours such as self-injurious behaviour, sexual exploitation and absence from the home. Since living in this home the frequency of some of these behaviours has decreased for all young people. A social work team manager said, 'I am very impressed with how they are managing the young persons safety. Their incidents of self-harm and risk of sexual exploitation has reduced considerably since living at this home.' Young people have also expressed that they feel safe in the home, but have specified they feel safer when it is staff they know well and staff who have been trained in managing self- harm. However, a number of temporary staff are used and not all staff are suitably trained to meet young people's needs.

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Keeping children and young people safe adequate

Young people sometimes display challenging behaviour and the majority of staff are trained to manage this. Restraint is rarely used and where it is used it is recorded and the use of the hold is detailed. Debriefs following restraint are held with staff and young people but the detail of the debrief is not always recorded. This means it is not clear what understanding has been gained from the incident. The use of positive and negative consequences following incidents of poor behaviour means young people learn from their actions.

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Keeping children and young people safe adequate

The home has a range of policies and procedures in place to safeguard young people. Staff have been trained in safeguarding and are aware of their role in the process. Allegations and complaints about staff are referred to the relevant agencies and dealt with appropriately.

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Keeping children and young people safe adequate

The home has individual risk assessments and protocols agreed with the police for each young person in the event of them being absent from the home. There had been a brief period where there had been an increase in absence following the admittance of a new young person to the home. This seems to have settled again, with fewer absences in recent weeks. Any incidents are recorded and young people are responded to positively on their return. However, the home does not have a written policy or protocol on how it prevents absence from the home and a requirement is made to ensure it provides evidence on the work it does to prevent absence.

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Keeping children and young people safe adequate

The staff recruitment process is generally well managed, young people are involved and have recently taken part in staff interviews. However, there are some gaps in recruitment checks, particularly in relation to the training information provided for agency staff and the dates they completed their training. There are also gaps in the qualification information for some agency staff. This means there is the potential for young people to come into contact with adults who may not be trained or qualified to the standard required in areas of child care.

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Keeping children and young people safe adequate

Regular health and safety checks are carried out to ensure the building is safe. Regular fire drills are held so young people and staff know what to do in the event of 9 of 11 a fire.

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Leadership and management adequate

The Registered Manager has been in post since September 2013 and has a degree in Social Work, NVQ 4 and the Registered Managers Award. Although the manager indicates he is motivated and says he wants to improve the service the home has actually declined since the last inspection. A total of six requirements have been made as a result of this inspection. These are in relation to training, supervision, use of temporary staff, records, monitoring, missing from home and recruitment.

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Leadership and management adequate

The home is currently utilising a number of temporary staff from other homes and from agencies. Some of these staff, including a shift leader, have not completed courses in self-injurious behaviour, challenging behaviour or sexual exploitation. These are all behaviours exhibited by young people in this home. In addition, agency staff records do not indicate the dates of training so it is not evident whether training is recent or up to date. Training provided by the home for staff is often in the form of short courses over a period of a day or e-learning. It is not clear that the content of these courses is sufficiently detailed to provide staff with the skills required. This means the needs of young people may not be met by the staff in the home.

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Leadership and management adequate

Staff supervision is not always held on a regular basis. Some staff have not been supervised for several months. There are also gaps in the supervision of the Registered Manager. This means the staff are not always supported to provide a service to young people.

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Leadership and management adequate

The Registered Manager monitors a number of records and incidents within the home to identify patterns and trends. For example, he has identified a particular pattern for one young person with the use of ligatures and is linking this with a likely trigger in order to try and prevent future occurrences. Reviews of care are prepared every three months but these lack depth and do not provide an evaluative report on the quality of care. In addition, they do not provide evidence of consultation with young people. This means the views of young people may not be heard in relation to the quality of care provided. All significant events relating to the protection of young people are notified as appropriate and actions taken as required. An independent person undertakes visits to the home as required.

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Leadership and management adequate

The home's statement of purpose has been reviewed and updated. The home also has a young person's guide. This means staff, parents, young people and other agencies are clear on the aims of the service and the facilities it provides. The home has an adequate development plan in place and the manager has also established an improvement folder that highlights the strengths of the service and the areas that 10 of 11 require improvement. The development plan highlights the need for a stable staff team in order to drive improvement. 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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