Children's Home run by North East Autism Society in Durham

Unique reference number SC458754 Inspector Steve Pearson Type of inspection Full Provision subtype Children's home

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Registered person North East Autism Society Registered person address Units 15 & 16 Lumley Court Drum Industrial Estate; Birtley CHESTER LE STREET County Durham DH2 1AN Responsible individual John Joseph Phillipson Registered manager Gemma Goodey Date of last inspection 13/03/2014 2 of 15 Inspection date 24/09/2014

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Previous inspection good progress Enforcement action since last inspection Ofsted conducted a compliance investigation visit on 10 April 2014 and, as a result of its findings, issued four compliance notices. Ofsted conducted a monitoring visit on 20 May 2014 and established that the registered persons had met all requirements made in those notices.

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Overall effectiveness inadequate

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

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Overall effectiveness

Children's safety is not being protected. Since the previous inspection, inadequate care practice on two occasions has had a direct negative impact on the safety and welfare of children. The registered persons' responses to both incidents were not adequate and left young people at risk. Since the previous inspection Ofsted has issued four compliance notices. This was because of serious concerns about the registered persons' responses to allegations of harm and concerns about the recording of information.

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Overall effectiveness

The registered persons met the requirements by the time of the subsequent monitoring visit. Since then, they have again breached four regulations that led to Ofsted issuing compliance notices and making requirements.

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Overall effectiveness

Leadership and management arrangements are inadequate. Less than half of the 3 of 15 staff are permanent. Staff turnover is high and more than half of the permanent staff in place a year ago have left. The reliance on agency staff is too great. As a result, young people are not receiving the levels of consistency that children, particularly those with autism, require. Only a third of the permanent staff are qualified in caring for young people. Sometimes none of the staff on duty overnight are permanent or qualified. There is therefore a great concern that sometimes the staff on duty are not sufficiently skilled or experienced.

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Overall effectiveness

There is a limited capacity for continuous improvement. Since the previous inspection Ofsted have issued seven requirements. Ofsted were so concerned at the time that four of the requirements were issued as compliance notices. The registered persons had met the requirements by the time of the subsequent monitoring visit. Since then they have once again breached four of the regulations that led to requirements being made. Internal and external monitoring of care quality is not good enough and does not lead to improvements in the standard of care provided.

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Overall effectiveness

Outcomes for young people and the quality of care are positive. Parents speak highly about the dedication of the Registered Manager and staff and the benefits that their children gain from living at the home.

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Overall effectiveness

As a result of the current inspection Ofsted has made nine requirements and eight recommendations. Due to the level of concern, Ofsted is issuing compliance notices in relation to three of these requirements. These are about ensuring appropriate staffing arrangements; ensuring the safe supervision and protection of children and ensuring investigations of harm are concluded within a reasonable period of time. 4 of 15

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Information about this children’s home

The home is owned and operated by a charitable organisation. It is registered to provide care and accommodation for up to nine young people with learning disabilities.

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Inspection date Inspection type Inspection judgement

13/03/2014 Interim good progress 31/07/2013 Full good 15/05/2013 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 there is always a sufficient number of suitably qualified, competent and experienced persons working at the children’s home. This means there must always be a member of staff on duty on each floor who has completed their induction period and passed their probationary period and who is qualified to level 3 in the Diploma in Social Care for Young People (Regulation 25(1)). 16/10/2014

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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. In particular this means making proper provision for the care and 16/10/2014 5 of 15 supervision of children (Regulation 11(1))

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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. In particular this means ensuring investigations into allegations of harm are completed in a timely manner (Regulation 11(1)(a)) 16/10/2014

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Reg. Requirement Due date

(2001) establish and maintain a system for monitoring the matters set out in Schedule 6. In particular, the issues to be monitored must reflect those described in the amended Children's Homes Regulations 2001 and the reports should be completed in a timely manner after the evaluated period has ended (Regulation 34(1)(a)) 30/09/2014

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Reg. Requirement Due date

(2001) notify Ofsted if any of the relevant events listed in column 1 of the table in Schedule 5 takes place. In particular, this relates to referral pursuant to section 35 of the Safeguarding Vulnerable Groups Act 2006 of an individual working at the home (Regulation 30(1)) 30/09/2014

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Reg. Requirement Due date

(2001) maintain in the children's home those records required by legislation. In particular this relates to a roster of the day to day hours actually worked by all employees which makes clear the start and finish times of shifts, the floor on which each shift took place and which staff undertook sleep-in shifts (Schedule 4, item 11). (Regulation 29(1)) 30/09/2014

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Reg. Requirement Due date

4 (2001) ensure that the children’s home is at all times conducted in a manner which is consistent with its statement of purpose. In particular this means that the Registered Manager must receive supervision every two months and the Registered Manager and staff must receive an annual appraisal (Regulation 4(6)) 16/10/2014

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Reg. Requirement Due date

(2001) prepare and implement a written policy which sets out the procedure to be followed in the event of any allegation of abuse or neglect. The procedure shall in particular provide for consideration to be given to the measures which may be necessary to protect children in the children’s home following an allegation of abuse or neglect (Regulation 16(2)(e)) 16/10/2014

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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 does not prevent children from receiving such continuity of care as is reasonable to meet their needs. (Regulation 25(2)) 18/02/2015 6 of 15

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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 emotional needs of each young person are recorded in their residential placement plan (NMS 3.7)  ensure the home provides a homely environment. In particular this relates to ending the requirement for staff to supply their own food for meals taken with young people; ensuring doors with spring-closers do not slam loudly and providing light switches which do not need a key for activation (NMS 10.3)  ensure the home’s design promotes children’s health and well-being especially with regard to ventilation in the lounge of a downstairs apartment; and the reduction of echoes around the home, especially on the first floor (NMS 10.2)  ensure information about each child is recorded clearly. In particular this means each young person's risk assessment should clearly explain how the risk of harm arising from each individual hazard is to be reduced (NMS 22.5)  send a copy of every regulation 34 monitoring report to HMCI within 28

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Recommendations

days of completion (Volume 5, statutory guidance, para 3.14)  ensure that staff are equipped with the skills required to meet the needs of the children and purpose of the setting. In particular this means provision of training in relevant communication methods such as Makaton, Picture Exchange Communications System (PECS) and sign language (NMS 18.1)  ensure that new staff undertake the Children’s Workforce Development Council’s induction standards, commencing within seven working days of starting their employment and being completed within six months (NMS 18.3)  identify in the written annual development plan for the future of the home any planned changes in the operation or resources of the service, or confirm the continuation of the home’s current operation and resource. (NMS 15.2) 7 of 15

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Outcomes for children and young people adequate

Young people make reasonable progress from their point of admission. Their potential for improvement has been hindered by the unsettled staffing arrangements and some serious breaches in the quality of care provided. One young person said, ‘Overall, I'm doing a little better now.'

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Outcomes for children and young people adequate

Over time, young people become more settled and content. This was summed up by one parent who said, 'My child is well-supported by competent staff who have a good understanding of his needs. Since their placement there they appear genuinely happier and less anxious about life. This has been reflected in fewer incidents and physical interventions.’ Another parent said, 'Since residing at Cedar House, restraints have been few and far between which is a reflection of how settled my child is there.'

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Outcomes for children and young people adequate

Young people become more independent over time. Several young people gain great benefit from being able to live in a self-contained apartment. These have superb facilities and young people succeed in gaining independence skills. One parent said, 'My child has the fantastic opportunity of living in one of the apartments. This has enabled them to develop some independent living skills such as vacuuming, cleaning and using the washing machine.' Another parent said, 'My child now uses the toilet.'

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Outcomes for children and young people adequate

Young people maintain and improve their physical health over time. Those children who had refused to take medication prior to admission to the home now take it willingly because they are more relaxed and settled. Emotional health improves also. For example, a parent said, 'My child's level of aggression and anxiety have lessened over the last year. They feel secure at the home.'

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Outcomes for children and young people adequate

Young people also gain emotional well-being because the Registered Manager and staff fully support them to maintain and develop contact between the young person and their family. This was summed up by one parent who said, 'I have never felt unwelcome at the home and we are always greeted nicely at the door. They willingly provide extra support so that I can go out for walks or take my child for a meal if I visit alone.'

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Outcomes for children and young people adequate

Young people have full attendance in full-time education. They carry a communication book between the children's home and the school and staff at either location can add written comments. This helps to promote continuity of educational themes in the home and helps inform school staff about any important issues. A young person said, 'I'm not doing as well in education because I struggle to answer the questions.’

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Quality of care adequate

8 of 15 The quality of care is satisfactory and there are some minor shortfalls. The overall quality of care is being held back due to the staffing difficulties. There have also been two significant incidents of concern caused by poor staff practice. These incidents mean it is not appropriate to rate the quality of care as being any better than adequate. Parents rate the quality of care positively. For example, one parent said, 'The staff don't just "do their job", they genuinely care about my child and s/he calls them his/her friends.'

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Quality of care adequate

Young people feel the staff are interested to know their views and feel they have a say in how the home is run. For example, one young person said, ‘If we make suggestions the staff do try to do them for us.’ The staff involve parents as well. One parent said, 'I believe my views and recommendations are always respected and listened to.'

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Quality of care adequate

Young people behave well and get on well with each other. The Registered Manager and staff have the flexibility to use the two floors of the home to ensure the mix of young people is appropriate. A young person said, 'There isn't any bullying here'.

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Quality of care adequate

Each young person has a clear health plan. This primarily addresses physical needs and does not focus sufficiently on how the staff should promote each young person's emotional needs. Young people receive support and expert guidance from a range of professionals including an epilepsy nurse, a psychiatrist, speech and language therapists, an occupational therapist, an autism assessment manager and a community nurse.

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Quality of care adequate

Young people take part in a wide range of activities within the environment of the children's home and in the community. There are a range of good facilities next to the home which the staff enable young people to make good use of. These include a bouncy castle, a park and a gym. The staff also take young people on holidays away from the home for a few days and nights. Young people thoroughly enjoy these and have good fun.

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Quality of care adequate

The home is appropriately designed and has very good facilities. A young person said, 'I have my own apartment. This allows me to spend time on my own when I choose. The staff are friendly and a nice atmosphere is created.' As a result of a recent incident which involved poor supervision of young people, the registered persons are re-assessing the physical layout of furniture and fittings on one of the floors.

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Quality of care adequate

Some features and practices reduce the homeliness of the environment. For example, some doors slam loudly when closing automatically; some light switches can only be activated by a key and the staff have to bring their own food in for most mealtimes. There are also some minor flaws in the design of the building. Specifically, the lounge in one of the downstairs apartments has poor ventilation. Upstairs there are a lot of echoes due to a lack of sound-absorbing materials. Issues related to sound and noise is of particular relevance to children with autism who often prefer a peaceful 9 of 15 atmosphere.

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Quality of care adequate

Each young person has a care plan which is kept up-to-date by a key worker. The plans are rich in detail and are clearly personalised to the needs of each individual young person. The plans identify targets for young people to achieve and these help them to develop positively. A parent said, 'Staff have recognised areas which need to be worked on, such as getting dried after a bath, and have included this in personal goals for my child to achieve.'

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Keeping children and young people safe inadequate

Children's safety is not being promoted adequately.

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Keeping children and young people safe inadequate

Since the previous inspection two significant incidents of concern have arisen. On the first occasion, a young person was inappropriately restrained and this led to the registered persons taking disciplinary action against the relevant employees. This incident led to Ofsted making a compliance visit to the home on 10 April 2014. As a result of that visit, Ofsted issued four requirements associated with safety. Three of these requirements were made in compliance notices because of the concerns Ofsted had. By the time of the subsequent monitoring visit, the registered persons had met all the requirements. Since then the registered persons have again breached two of the regulations which led to the requirements.

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Keeping children and young people safe inadequate

Ofsted issued the compliance notices for three reasons. Firstly, the registered provider's child protection procedures were not followed. This meant the registered persons started investigating the incident before informing the local authority designated officer (LADO). The procedures state it is not the responsibility of the staff working at the home to investigate allegations of harm. It makes clear that it is the role of the LADO to oversee the management and investigation of all allegations. By starting to investigate before informing the LADO, the investigation and any further statutory actions could have been compromised.

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Keeping children and young people safe inadequate

Secondly, the issue of concern was not reported to the local authority in whose area the home is located until the fourth day after the incident. The registered provider's procedures require that concerns should be reported without delay. The result of the delay jeopardised a prompt and appropriate response from the safeguarding agency whose role it is to investigate allegations of harm. Therefore, a child’s safety and welfare was compromised.

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Keeping children and young people safe inadequate

Thirdly, after the incident, the member of staff against whom the allegation of inappropriate restraint had been made, continued to work (a waking night shift) after the Registered Manager had received the allegation. The staff member worked alone for the duration of the shift. Another staff member was on duty doing a sleep-in duty, and therefore was not awake or present for the duration of the waking night duty. Therefore children’s safety was compromised by being exposed to a member of 10 of 15 staff who was potentially a risk to children. The member of staff was then suspended without prejudice two days after that shift having not worked any more shifts at the home.

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Keeping children and young people safe inadequate

At the compliance visit, Ofsted made a further requirement because of concerns about safety. This was because the records of the restraint, required by legislation, were illegible. Additionally, the date recorded for the restraint was different to the date given when the incident was reported. This compromises children's welfare as poor recording restricts the monitoring and inspection of the documentation.

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Keeping children and young people safe inadequate

The registered provider conducted a three month investigation into the alleged inappropriate restraint. This lasted too long. As a result of the delays in the investigation, the registered provider suspended a second member of staff four months after the incident. Disciplinary action then followed. The delay in suspending the second member of staff exposed young people to unacceptable risk.

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Keeping children and young people safe inadequate

By the time Ofsted conducted a monitoring visit on 20 May 2014, the registered persons had met the requirements made at the previous compliance visit. Since then the registered persons have again breached two of the regulations that led to the issuing of the compliance notices.

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Keeping children and young people safe inadequate

These breaches arose because of a second serious incident arising since the previous inspection. In the incident, several staff failed to supervise a young person safely despite the known risks and procedures for promoting safety. This led to another young person receiving a significant injury.

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Keeping children and young people safe inadequate

The home's child protection procedures are not robust because they do not contain guidance on issues required by legislation. Specifically, there is no guidance in the policies and procedures about considering measures which may be necessary to protect children following an allegation of abuse or neglect.

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Keeping children and young people safe inadequate

Staff occasionally need to use physical restraint to safeguard children's welfare. A young person said, 'Sometimes staff restrain young people but it’s for the right reason’. The staff confirmed that they only restrain young people if the welfare of the young person or others is at risk. The recording of restraints is appropriate and the Registered Manager and independent visitor monitor the records to identify any concerns.

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Keeping children and young people safe inadequate

The Registered Manager and staff assess and record the risks that may foreseeably affect young people and how such risks are to be reduced. These risk assessments are not fully clear because the guidance about how to minimise risks is not directly linked to each issue of concern.

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Keeping children and young people safe inadequate

The premises are safe. Professional technicians regularly service the electrical equipment, gas appliances and equipment for preventing, detecting and extinguishing fires. Appropriate recruitment arrangements are in place which help to 11 of 15 ensure that staff employed to work with children are suitable.

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Leadership and management inadequate

Leadership and management arrangements are dangerously weak.

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Leadership and management inadequate

At the previous inspection on 13 March 2014 Ofsted judged that the home was making good progress. Ofsted made a recommendation that the staff leading shifts should have substantial relevant experience and should have passed their induction and probationary periods. This recommendation has not been met because the staff on duty often do not meet these criteria. Consequently, Ofsted is making this a requirement at the current inspection.

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Leadership and management inadequate

At a subsequent compliance visit on 10 April 2014, Ofsted issued seven requirements, four of which were made as compliance notices. Ofsted only issues compliance notices when concerns are very serious.

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Leadership and management inadequate

Ofsted then carried out a monitoring visit on 20 May 2014 and all the requirements had been met. Consequently the quality of care improved. For example, children's safety was better because the registered persons ensured the local authority designated officer was informed before any investigation into alleged harmful practice took place; the registered persons informed all relevant persons of significant events in a timely manner and recording of restraints was clearer, thereby providing greater accountability.

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Leadership and management inadequate

Since the monitoring visit, the registered persons have gone on to breach once again two of the regulations which led to Ofsted issuing the compliance notices. The registered persons have also breached two other requirements which Ofsted made at the compliance visit and which were originally met by the time of the monitoring visit. These requirements relate to leadership and management of the home and concern unclear records of shift rosters and the failure to inform Ofsted of significant events. The failure to adhere to four recently-issued requirements, two of which were made in compliance notices, shows a lack of capacity to maintain improvement.

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Leadership and management inadequate

At the compliance visit of 10 April 2014, Ofsted identified a wide range of concerns associated with leadership and management. There was a failure to respond appropriately to an allegation made against a member of staff; child protection procedures were not kept to; a concern was reported to the local authority designated officer late; parents, the placing authority and Ofsted were informed of the allegation late; suspension as a neutral act was late in being carried out, thereby compromising the safety of children; and the documentation in the children's home was poor including inconsistent recording in rotas and restraint records. These 12 of 15 cumulative concerns led to Ofsted issuing a compliance notice because the home was not being managed with sufficient care, competence and skill.

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Leadership and management inadequate

Staffing arrangements are inadequate. The use of temporary (agency and casual staff) is too high. Less than half of the staff are permanent. In the two full weeks before the inspection, on 8 out of 14 overnights, none of the staff working in the home were permanent. On two of those occasions all of the staff were unqualified in caring for children. On all eight occasions, the staff on duty had not completed their induction training to the necessary standard set by the children's homes national minimum standards, and the staff had not completed their probationary periods. This level of inexperience and lack of training puts children at risk.

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Leadership and management inadequate

The team of 24 staff are not sufficiently qualified or experienced. Only around a third of permanent staff are qualified to the necessary level three or above. Those recruited to deputise for the Registered Manager did not had sufficient relevant experience at the time of their appointment.

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Leadership and management inadequate

The level of staff turnover is unacceptably high. More than half of the permanent staff in place a year ago have left. The management of the home discuss with each person the reason for leaving and forward the feedback to the human resources department. The high numbers of temporary staff and high levels of turnover mean children are not receiving the levels of consistency that they require. This is particularly necessary for children with autism.

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Leadership and management inadequate

The leadership and management of the home are not effective at monitoring the quality of care provided and addressing shortfalls. Shortfalls about the shortage of permanent staff, staff turnover and the low numbers of qualified staff have been evident for many months. Internal and external formal monitoring has not emphasised their significance. Recommendations and actions to address the issues are not evident in the monitoring reports. Nevertheless the Registered Manager has a clear motivation to improve and has sought strategic support. Additionally, one young person said, 'The manager of the home is very dedicated and is always looking to improve and encourage staff team to do better.'

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Leadership and management inadequate

The Registered Manager is not monitoring and reporting on the full range of issues required by legislation which came into effect five months ago. This means shortfalls in important areas may not be identified or put right. When the reports are written they are not always sent to Ofsted quickly enough. This means it is more difficult for the regulator to keep abreast of how the home is performing.

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Leadership and management inadequate

The Registered Manager has been in post since 12 September 2013. They have the necessary experience and qualifications for their role. They are leaving in early December 2014. This means the home will be seeking its third manager since opening 19 months ago.

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Leadership and management inadequate

The Registered Manager and staff are not receiving sufficient support. The home's 13 of 15 Statement of Purpose states that all staff will receive an annual appraisal of their performance. None of the staff have had an appraisal since the home opened 19 months ago. The Statement of Purpose also states that the staff will receive supervision every two months. The Registered Manager and the senior staff do provide supervision at this frequency. All staff spoken with feel well-supported by the Registered Manager. However, the Registered Manager has not received formal supervision for over three months. The home is therefore not meeting the expectations described in the Statement of Purpose. This is a breach of regulations because the Statement of Purpose is a legally-binding document which sets out how the home will function. The impact is that performance management and support arrangements are not adequately robust.

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Leadership and management inadequate

The staff rotas do not make clear when staff started and finished their shifts. There is therefore insufficient accountability for the hours worked by different employees. This is a second breach of a regulation which led to Ofsted making at requirement at the compliance visit on 10 April 2014.

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Leadership and management inadequate

The registered persons are failing to inform Ofsted of all significant events. In particular there have been two separate occasions when they have made referrals to the Disclosure and Barring Service but did not inform Ofsted. This means the regulator is unable to monitor any serious concerns and how well the registered persons are managing them. This is a second breach of a regulation which led to Ofsted making at requirement at the compliance visit on 10 April 2014.

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Leadership and management inadequate

The staff receive training in a wide range of relevant subjects. They rate the quality and value of this training highly. A parent suggested that further training in how children communicate would be helpful. All staff receive communication training in their induction period but all staff spoken with agreed that refresher training in this subject would be helpful. Induction training is not of sufficient quality because some new staff have not yet enrolled on induction training which meets the standards set by the Children's Workforce Development Council.

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Leadership and management inadequate

The home has an annual development plan. This is not sufficiently robust because it does not contain a confirmation about the home's budget or function for the next business year ahead. Consequently there is also less assurance that the registered provider is planning ahead for the longer term future of the home.

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Leadership and management inadequate

The home is adequately resourced. Many staff said that salaries are poor and that this has led to many staff leaving.

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Leadership and management inadequate

The Registered Manager ensures the physical environment in the home is maintained to a high standard.

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Leadership and management inadequate

Records are generally clear and are up-to-date. The staff film and photograph young people to provide memories for them when they are older. The staff contribute effectively to young people's care plan reviews and enable young people to attend. 14 of 15 One young person said, 'I've been to my care review and I was able to say what I thought about things.' 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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