Esther House

Requires improvement

The children's home is not yet delivering good help and care for children and young people. However, there are no serious or widespread failures that result in their welfare not being safeguarded or promoted.

p.2

because:

 Records of investigations carried out do not provide a clear view about the actions taken and the decision making. This means records do not demonstrate the robustness of the investigations.

p.3

because:

 On one occasion the home failed to notify HMCI of a serious incident that took place in the home.

p.3

because:

 Complete records are not maintained about how complaints have been dealt with. This means there is no record of the action taken and what the outcome was.

p.3

because:

 The police were not consulted about the recent placement of a young person despite there being an agreement this would occur.

p.3

because:

 Key work sessions are not always carried out following a significant events and are variable in quality. This means that young people are not always being offered advice, support and guidance, for example regarding alcohol use or self-harming

p.3

because:

 House meetings are not always carried out at the stated frequency and this means that young people do not have a regular arena to voice their views and air their differences.

p.3

because:

 The alarm system on bedroom doors does not allow them to be independently switched off. There was no policy made available regarding this and this information is not contained in the Statement of Purpose. This potentially impacts on the privacy of those young people who do not need such a system to safeguard them.

p.3

because:

 The Statement of Purpose does not include all points in the regulations, is not clearly written and does not provide a good view about what young people can expect from this home.  When a young person misses or refuses their prescribed medication this is not being clearly recorded.

p.3

because:

 The recording of the use of a measures of control or restraint do not detail: the effectiveness of the measure; the details of any injuries; or the medical attention provided when an injury has occurred. Additionally records do not show if the manager has spoken to the user of the measure and the young person and he is not signing the record in every case.

p.4

because:

 Not all records made and maintained are accurate or are of a good quality

p.4

The children's home strengths

Young people like living in the home and say they trust staff and confide in them. The relationships between young people and staff are overall good.

p.4

The children's home strengths

Young people achievements are celebrated.

p.4

The children's home strengths

Young people are involved in developing their care and behaviour management plans.

p.4

The children's home strengths

While there are some shortfalls in some areas of recording the care plans for young people are of a good quality and guide staff in caring for the young people.

p.4

The children's home strengths

Young people develop the practical skills needed to live more independently.

p.4

The children's home strengths

Incidences of physical interventions are low.

p.4

The children's home strengths

The physical environment is of a good standard.

p.4

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 (England) Regulations 2015 and the Guide to the children's homes regulations including the quality standards. The registered person(s) must comply with the given timescales.

p.5

Requirement Due date

In order to be able to demonstrate there has been effective handling and monitoring of a complaint the registered person should ensure:

p.5

Requirement Due date

that a record is made of any complaint, the action taken in response and the outcome of any investigation. (Regulation 39 (3)) 10/07/2015

p.5

Requirement Due date

In order that monitoring devices are not used for young people who do not require them to ensure their safety and well-being the registered person must ensure:

p.5

Requirement Due date

devices for the monitoring or surveillance of children are only used if the monitoring or surveillance is for the purpose of safeguarding and promoting the welfare of the child concerned, or other children and the monitoring or surveillance is no more intrusive than necessary, having regard to the child’s need for privacy. (Regulation 24 (a) and (d)) 10/07/2015

p.5

Requirement Due date

In order that there is a clear and full record of the use of a measure of control, discipline or restraint in relation to a child in the home the registered person must ensure:

p.5

Requirement Due date

a record is made which includes; the effectiveness and any consequences of the use of the measure; a description of any injury to the child or any other person, and any medical treatment administered, as a result of the measure. (Regulation 35 3 (a) (vii), (viii) 10/07/2015

p.5

Requirement Due date

To ensure that it can be shown that staff and young people have had an opportunity to discuss a measure of control the registered person must make sure that: 10/07/2015 within 48 hours of the use of the measure, the registered person, or a person who is authorised by the registered person to do so, has spoken to the user about the measure; and has signed the record to confirm it is accurate. Within 5 days of the use of the measure, the registered person or the authorised person adds to the record confirmation that they have spoken to the child about the measure. (Regulation 35 3 (b) (i) (ii) (c))

p.5

Requirement Due date

In order to be able to effectively demonstrate there has been effective handling and monitoring of an allegation the registered person should ensure:

p.6

Requirement Due date

clear and comprehensive records are kept of an allegation of abuse or neglect, and the action taken in response. (Regulation 34 2 (d)) 10/07/2015

p.6

Requirement Due date

In order that the statement of purpose is a clear and useful document the registered person must:

p.6

Requirement Due date

ensure the statement of purpose covers the matters listed in Schedule 1. (Regulation 16 (1)) 10/07/2015

p.6

Requirement Due date

In order that Ofsted is kept informed about significant events occurring in the home the registered person must:

p.6

Requirement Due date

notify HMCI and each other relevant person without delay if there is an allegation of abuse against the home or a person working there or there is any other incident relating to a child which the registered person considers to be serious. (Regulation 40 4 (c) and (e)) 10/07/2015

p.6

Recommendations

To improve the quality and standards of care further the service should take account of the following recommendation(s): Ensure that children, in every case, are offered advice, support and guidance on health and well-being to enable them to understand, and work to change negative behaviours; this is with specific reference to ensuring that house meetings are held at the stated frequency and keywork sessions take place in a timely way to ensure issues that are relevant for the young people at any point in time are addressed. (Guidance to the Children’s Homes Regulations including the Quality Standards April 2015) (7.18) Ensure that records are made of occasions when prescribed medication is refused. (Guidance to the Children’s Homes Regulations including the Quality Standards April 2015) (7.15)

p.6

Recommendations

Ensure the home only accepts placements for children where they are satisfied that the home can respond effectively to the child’s assessed needs and where they have fully considered the impact that the placement will have on the existing group of children; with specific reference to consulting with the police in respect to placements being considered. (Guidance to the Children’s Homes Regulations including the Quality Standards April 2015) (11.4)

p.7

Recommendations

Ensure all recording is carefully undertaken, objective, and clear; with specific reference to: ensuring updated risk assessments are clear to the reader; records of searches of a room or belongings are carefully and fully documented; missing from care logs record the date and time a young person returned, if a keywork session has been undertaken and if visits from an independent person have taken place. (Guidance to the Children’s Homes Regulations including the Quality Standards April 2015) (14.4)

p.7

Information about this children's home

This children's home is registered to take up to four young people with emotional or behaviour difficulties. The home is owned by a private organisation. The organisation is registered to provide education to young people it cares for.

p.8

Recent inspection history

Inspection date Inspection type Inspection judgement

p.8

Recent inspection history

09/02/2015 CH - Interim Sustained effectiveness

p.8

requires improvement

There are lost opportunities to gain young people’ views and to provide them with support and guidance about issues that are worrying them or incidents they have been involved in. Young people do not discuss issues as a group as often as is planned they should do therefore there are lost opportunities for them to meet as a group and air their differences. Keywork sessions are not always being held when it has been identified one is needed, for example, following a significant incident. Therefore young people are not always getting support and guidance when it is most timely. The quality of keywork sessions is variable and it is not consistently clear how or if issues raised have been addressed.

p.9

requires improvement

Young people know how to complain and do make complaints but it is difficult to assess if complaints are dealt with appropriately and to the young person’s satisfaction because the recording is poor. In one case there were no records detailing who had dealt with the complaint, what action was taken and what the outcome was.

p.9

requires improvement

The home accepts placements on an emergency basis. Local authorities do not always provide, and sometimes do not have, adequate information about a young person’s needs and behaviour. To assist the decision making about a placement the local police have agreed to support the organisation by providing it with any information they have about a young person being considered. For a recent placement made the home did not consult with the police and lost the opportunity to gain valuable information about the young person’s needs. This information would have supported the decision making about the viability of the placement in light of all young people’s needs.

p.9

requires improvement

Young people are welcomed sensitively when they arrive at the home. They form some positive relationships with staff. A young person said, ‘The staff really do care and help, they listen and they are there for you.’ Staff communicate well with young people and have an understanding about how their emotional well- being impacts on their behaviour. Young people present staff with some significant challenges and staff are responsive to these; they respect them and work to help them come to terms with the difficulties they face. A young person said, ‘I love it here, it’s the best care placement I have ever had.’

p.9

requires improvement

Young people are involved in developing their care plans, some are quite vocal about what they feel would help them. Staff respect these wishes, where appropriate, and this helps them feel their views are valued. Young people understand their life story better and develop a better sense of their identity and recognise their achievements. They have useful records of their progress to look back on which they have developed with staff. Their achievements, however small, are celebrated and appropriately rewarded and this helps to build their self- esteem and desire to achieve in life.

p.9

requires improvement

Young people are generally physically healthy and understand the need to attend routine health appointments to maintain their health. They need high levels of support for their complex emotional needs and staff support them to try and make good use of the children and adolescent health services (CAMHS) available to them. A young person said her emotional well-being has improved since living in the home, ‘because they care.’ Where a mental health service is not available to a young person who requires this support, the manager and the social worker have challenged the service.

p.10

requires improvement

Overall the arrangements for medication are safe because it is securely stored and accurately recorded when administered. It is not recorded when a young person has refused or not taken their medication and this is a missed opportunity to monitor this effectively so that action can be taken if refusals are impacting on a young person’s health. Young people, for whom it has been assessed as safe, self-administer some of their medication.

p.10

requires improvement

Young people are supported well in keeping to their preferred routines and have some structure to their day. One is in employment and enjoys this; this has been a real achievement for her. It has helped to increase her self-confidence and means she is learning to manage her own money. Another young person is seeking work and being supported by staff in this. Her social worker said previously she had not engaged in seeking work and it is positive that she is now doing so. A third young person is schooled by the organisation’s school and education is provided in a flexible way. Lessons are based on her interests and, to suit her needs, they do not take place in a school room. Her engagement in education is good when compared to her past experiences. The fourth young person is relatively new to the home and her education package has not been finalised by the local authority. The home provides her with opportunities to learn

p.10

requires improvement

and she is undertaking AQAs and pieces of work set by the teachers. During the inspection there was a music lesson that three of the young people joined in with, it was clear that they all enjoyed this session.

p.10

requires improvement

Mealtimes in the home are relaxed periods of the day when staff and young people come together and discuss the day and plan the evening’s activities. Young people enjoy various activities of their choosing and a current favourite is ice skating. They also enjoy evenings at home watching DVDs, of their choosing, together.

p.10

requires improvement

Overall young people have appropriate relationships with their peers. Young people do fall out from time to time but they work to address their differences with the support of staff. Relationships with family members are maintained through visits to them in line with the placing authority plans and for young people who are approaching 18 years old they have begun to manage their own contact with their family and friends.

p.10

requires improvement

Some young people are shortly to move into more independent living. They have developed many of the practical skills they will need to live independently. For example, they do their own washing, make and keep some of their health appointments and manage their money. Staff and other agencies such as CAMHS, have worked with them on building up their emotional resilience and there had been a decrease in self-harming behaviours. There has been a very recent increase in young people using alcohol and self-harming and this has been linked to them having anxieties about moving out of the home. Staff and the CAMHS workers are working to support them with these current anxieties. Since the last inspection one young person has left the home and has been placed in another of the organisation’s homes following a safeguarding issue. This was a move made to ensure the safety and well-being of all the young people.

p.11

requires improvement

Safeguarding issues are referred to safeguarding agencies and action is taken to safeguard young people. The home acted appropriately when a young person had been subject to a serious assault and ensured she was safeguarded. However, comprehensive records in relation to the action taken and the outcome of the matter are not always maintained and this makes it difficult to establish if all issues arising have been dealt with effectively in every case.

p.11

requires improvement

Young people do go missing from the home, on occasions, the frequency of these incidents fluctuates. Staff take action to bring them home and have followed them when they have left the home. When young people have been missing from home a worker from a national charity comes to meet with them to discuss the reasons they went missing; this provides them with an opportunity to disclose any issues or worries they have. There is an awareness of the risks of young people being sexually exploited and detailed risk assessments are developed and implemented in relation to this. However, there are failures in the recording of missing incidents. For example, the date and time the young person returned is not always recorded neither is if a keywork session and visit from an independent visitor took place. This incomplete recording makes it difficult to effectively monitor the support a young person has had following a period of being missing.

p.11

requires improvement

To support the management of young people who go missing each bedroom has a door alarm to alert staff when a young person leaves their room; this system is set up so that all door alarms are activated or off. This means that if a young person is not at risk of being missing overnight the alarm for them cannot be switched off and their privacy may be compromised. The manager could not find the policy in relation to the door system so there was a lack of clarity about the rational for this system. The home has, however, gained consents to the use of this system from social workers.

p.12

requires improvement

A young person’s room or belongings may be searched when there are concerns about them bringing alcohol or other items into the home. However, the logs of searches are poor. Some are incorrectly dated and when a young person’s bag is searched a detailed record of this is not made.

p.12

requires improvement

Sanctions for young people are appropriate and in line with the behaviour. However, there was no written evidence in the log that the manager had monitored the sanctions or that he has discussed the sanction with the young person. This is a lost opportunity to monitor the effectiveness or the appropriateness of the sanction being given and to establish what the young person’s views are.

p.12

requires improvement

Incidents of restraint are low, there have been only three since the last inspection and all were used to avoid a young person causing harm to themselves. There are shortfalls in the recording of these interventions. Young people’s views are not routinely recorded. When an injury has been sustained there are no details recorded of the injury or of the medical treatment given. This makes it difficult to establish if the young person understands why the intervention was necessary and what medical treatment they received.

p.12

requires improvement

A young person said, ‘I definitely feel safe here, the safest I have ever felt.’ Young people are comfortable with the staff who are caring for them. They confide in staff about issues that are worrying them. A social worker said, ‘when X is in crises she is able to communicate her worries to them (the staff), this is the most positive aspect: communication.’ Risks relating to young people’s needs are understood by staff and a risk assessment approach is taken to managing the behaviours young people display. Risk assessments are updated in line with changing needs. For example, when young people are moving into more independent living or an incident occurs. Following the review of a risk assessment some assessment documents contain conflicting information. For example, in one assessment under ‘support needed’ it states a young person has supervised spending. However, this young person earns and manages her own

p.12

requires improvement

money now. This conflicting information could be confusing for new or agency staff who do not know the young people. Bullying incidents are taken seriously and followed up with young people. A young person said she had fallen out with another young person but said, ‘we are working on our relationship, I know I was wrong but we are sorting it out.’

p.12

requires improvement

Young people have complex emotional needs and often their behaviour is challenging and may include misuse of alcohol and self-harm. They are consulted about the support they feel would help them to manage their behaviour. Staff understand triggers for their self-destructive behaviour and use de-escalation techniques to try to avoid situations occurring; there are varying levels of success. Some young people have developed a better self-awareness and understand how to deal with their frustrations and on occasion do this successfully.

p.13

requires improvement

The environment is safe and provides a pleasant environment for young people to live in. Staff are appropriately vetted before they work in the home to make sure they are suitable people to work with young people.

p.13

inadequate

There has been no registered manager for the home since October 2014. As a result of this lengthy period of uncertainty about the management arrangements leadership and management are judged as inadequate. The person currently managing the home is the registered manager for another of the organisation’s homes. He is, suitably experienced and has a level five qualification in caring for children and young people.

p.14

inadequate

As the manager has not managed the home for a significant length of time it is too soon to comment on the quality of his overall monitoring of the home. Shortfalls have been identified during this inspection in monitoring some logs and records. However he has addressed the requirement and recommendation made as a result of the last inspection. Young people’s care plans now detail the action staff should take when considering if medical attention is required. The plans are drawn up in consultation with young people and identify and address their needs and wishes. Consents from social workers to the use of door alarms have been gained. He has also developed a plan to drive improvement over the next year and this includes actions that are identified through other monitoring processes such as the external monitoring. Some recording was as identified having shortfalls but overall case records for young people provide them with a useful

p.14

inadequate

view of their time in the home. Some attention is required to the maintenance of some of the home’s logs.

p.14

inadequate

Notifications of significant events are not always made to Ofsted which means the regulator does not have full oversight of issues arising in the home.

p.14

inadequate

The statement of purpose for the home does not include some of the detail required by regulations and it incorrectly states the home provides accommodation and care for boys; is a lengthy document that is not easy to read.

p.14

inadequate

The manager has an understanding about how young people have progressed as a result of living in the home. For example, he identified that some have developed a greater self-awareness that has supported them to reduce their self- harming behaviours. A social worker commented in relation to a young person, ‘overall the placement has had a positive impact on her.’

p.14

inadequate

The manager is developing working relationships with other agencies, for example the police and social workers. Monthly meetings are held with police and these provide a good avenue for developing joint working. Social workers are kept informed about young people and communication with them was described, by them, as being good. He has challenged mental health services that are not providing a service to a young person who requires it.

p.14

inadequate

The physical environment in the home is maintained to a good standard, it is safe and sufficiently resourced; young people are provided with a pleasant and relaxing environment. Not all staff have the required level three qualification but all are undertaking the qualification or are waiting to be enrolled on a course. Staff are supported by the manager through regular supervision. Training undertaken by staff include statutory training such as Safeguarding and dealing with Child Sexual Exploitation. They have also undertaken additional training based on the needs of the young people, for example caring for young people who self-harm.

p.14

What the inspection judgements mean

The experiences and progress of children and young people are at the centre of the inspection. Inspectors will use their professional judgement to determine the weight and significance of their findings in this respect. The judgements included in the report are made against Inspection of children's homes: framework for inspection.

p.16

What the inspection judgements mean

An outstanding children's home provides highly effective services that contribute to significantly improved outcomes for children and young people who need help and protection and care. Their progress exceeds expectations and is sustained over time. A good children's home provides effective services that help, protect and care for children and young people and have their welfare safeguarded and promoted. In a children's home that requires improvement , there are no widespread or serious failures that create or leave children being harmed or at risk of harm. The welfare of looked after children is safeguarded and promoted. Minimum requirements are in place, however, the children's home is not yet delivering good protection, help and care for children and young people. A children's home that is inadequate is providing services where there are widespread or serious failures that create or leave children and young people being

p.16

What the inspection judgements mean

harmed or at risk of harm or result in children looked after not having their welfare safeguarded and promoted.

p.16

Information about this inspection

Inspectors have looked closely at the experiences and progress of children and young people living in the children's home. Inspectors considered the quality of work and the difference adults make to the lives of children and young people. They read case files, watched how professional staff work with children, young people and each other and discussed the effectiveness of help and care given to children and young people. Wherever possible, they talked to children, young people and their families. In addition the inspectors have tried to understand what the children's home knows about how well it is performing, how well it is doing and what difference it is making for the children and young people who it is trying to help, protect and look after. This 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 Children's

p.17

Information about this inspection

Homes (England) Regulations 2015 and the Guide to the children's homes regulations including the quality standards. the guidance raising concerns and making complaints about Ofsted, which is available from Ofsted's website: www.gov.uk/government/organisations/ofsted . If you would like Ofsted to send you a copy of the guidance, please telephone 0300123 4234, or email enquiries@ofsted.gov.uk .

p.17

Information about this inspection

achieve excellence in the care of children and young people, and in education and skills for learners of all ages. It regulates and inspects childcare and children's social care, and inspects the Children and Family Court Advisory and Support Service (Cafcass), schools, colleges, initial teacher training, workbased learning and skills training, adult and community learning, and education and training in prisons and other secure establishments. It inspects services for looked after children and child protection. If you would like a copy of this document in a different format, such as large print or Braille, please telephone 0300 123 4234, or email enquiries@ofsted.gov.uk . You may reuse this information (not including logos) free of charge in any format or medium, under the terms of the Open Government Licence. To view this licence, visit www.nationalarchives.gov.uk/doc/open-government-licence , write to the Information Policy Team,

p.18

Information about this inspection

The National Archives, Kew, London TW9 4DU, or email: psi@nationalarchives.gsi.gov.uk .

p.18

Information about this inspection

Interested in our work? You can subscribe to our monthly newsletter for more information and updates: http://eepurl.com/iTrDn .

p.18

Information about this inspection

Store Street Manchester M1 2WD T: 0300 123 1231 Textphone: 0161 618 8524 E: enquiries@ofsted.gov.uk W: www.gov.uk/government/organisations/ofsted

p.18