Children's home run by Cambian Signpost Limited in Hammersmith and Fulham

children and young people since the most recent full inspection

This home was judged good at the full inspection. At this interim inspection Ofsted judges that it has declined in effectiveness .

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children and young people since the most recent full inspection

The effectiveness of leadership and management in the home has declined since the previous inspection. Weaknesses identified at this inspection include poor and inaccurate records about the use of restraint, unsatisfactory action to protect young people who go missing from the home and insufficient notifications made to Ofsted about all serious incidents that have occurred since the previous inspection.

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children and young people since the most recent full inspection

The responsible individual has also identified serious management concerns that she is investigating further. The responsible individual‟s initial response to these concerns has been rigorous and includes alternative interim management arrangements. She has provided Ofsted with a comprehensive action plan to improve the leadership of the home, safeguarding of young people and the quality of care.

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children and young people since the most recent full inspection

The registered manager has failed to inform Ofsted and other required agencies of all significant events that have occurred since the previous inspection. For example, on one occasion, a young person threw objects at staff, including large and heavy items, damaged cars and attempted to set fire to a barn. On another occasion, a young person put herself at risk by continually attempting to run into a busy road. Staff members restrained the young person to try to keep her safe. These are significant high-risk incidents that put young people and staff at risk of serious harm.

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children and young people since the most recent full inspection

Staff member‟s responses to young people‟s high-risk behaviours is to use restraint. This has resulted in a significant increase in the use of restraint since the previous inspection. The restraint records are not always clear and concise, and do not always include a description of the action staff take before using restraint. In addition, the use of restraint is not always recorded as an individual event, but is sometimes documented collectively in one incident record. As a result of this under-reporting, senior managers are not provided with accurate information about the actual number of restraints and the types of holds being used by staff. Young people‟s views are not always sought after restraint is used. No injuries to young people have been recorded as a result of the use of restraint. However, there has been an increase in injuries to staff involved in the restraint.

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children and young people since the most recent full inspection

A serious concern is being investigated by safeguarding agencies. The responsible individual responded swiftly to the concerns, referring the information to the local area designated officer. She is working in partnership with external safeguarding agencies in respect of these concerns.

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children and young people since the most recent full inspection

Staff do not always take effective action when young people go missing. They do not always follow young people‟s individual missing from home protocols. For example, on one occasion, staff failed to report one young person missing to the police within the required timescales, and they did not attempt to contact the young person on their mobile phone. On another occasion, it is not evident that staff made any attempts to search for a young person who was missing. When young people return home from being missing, they do not always receive an opportunity to discuss the incident with staff, or receive an independent return home interview.

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children and young people since the most recent full inspection

Leaders and managers have not taken swift enough action to remedy a recommendation made at the previous inspection in August 2015. The recommendation required leaders and managers to convene an urgent meeting with a young person‟s placing authority and the local police to develop strategies for managing persistent missing from home incidents. The meeting was not convened until October 2015. The minutes of the meeting and the agreed strategy plan was not available in the home at the time of the inspection. A further risk management meeting took place in February 2016 and a missing from home protocol was developed at the meeting. This protocol gives staff guidance on the action to take if the young person goes missing. However, the registered manager has been unable to obtain a copy of the final minutes of the meeting that took place despite requesting them from the placing authority.

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children and young people since the most recent full inspection

The registered manager has not ensured that there are suitably qualified and experienced staff on duty at all times. For example, on one occasion, two staff members who were in their probation period were deployed to work together. During this shift, a young person displayed challenging behaviours that put himself and staff at serious risk of harm and resulted in an incident which is being investigated. By not having experienced staff on duty at all times, young people and staff are placed at risk.

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children and young people since the most recent full inspection

The registered manager has reviewed the quality of care provided in the home. This review is not sufficiently analytical or evaluative. The review fails to effectively identify actions to reduce the safeguarding risks.

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children and young people since the most recent full inspection

Staff members do not always receive regular good quality supervision or feel that they have been well supported by leaders and managers in the home. The registered manager had identified the supervision weakness and an additional manager was brought in to help. Another recommendation that was made at the previous inspection has not been acted on. The registered manager was asked to review the arrangements for the use of alarms on young people‟s bedroom doors. The responsible individual confirmed that the registered manager has not been acted on by the registered manager.

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children and young people since the most recent full inspection

The responsible individual has started an internal audit to see what can be learnt from the placement of one young person who is no longer living in the home. The young person displayed high-risk behaviours and the responsible individual determined that these needs could not be met by the staff team. As a result, a decision was made to end the placement. This decision was taken in full collaboration with the placing authority to ensure that there was a well-planned, and sensitive end to the placement. Incidents of serious challenging behaviour and the use of restraint have decreased since the young person moved. The home is currently more settled and the two young people living there said that they feel safe.

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children and young people since the most recent full inspection

An improvement since the previous inspection is that the registered manager has consulted with the young people. One young person asked for a bigger bed and this has been provided for him. The young person said „I am really happy with my new bed‟.

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children and young people since the most recent full inspection

Staff continue to encourage and support young people to attend school and emphasise to the young people the value of a good education. Staff help young people develop practical skills to become more independent. Young people are encouraged to take responsibility for domestic tasks such as cleaning, laundry and cooking skills.

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children and young people since the most recent full inspection

Staff support young people to participate in their favourite leisure and recreation activities, and ensure that young people have an enjoyable holiday. One young person gave 10/10 for a recent holiday. Young people are supported to keep in regular contact with their families.

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Information about this children's home

This service provides care and accommodation for up to four young people who have a sensory impairment and emotional or behavioural difficulties. The service is run by a private organisation.

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Recent inspection history

Inspection date Inspection type Inspection judgement

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Recent inspection history

11/03/2015 CH - Interim Sustained effectiveness

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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 (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.

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Requirement Due date

In order to meet the protection of children standard the registered person must

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Requirement Due date

(1) ensure that children are protected from harm and enabled to keep themselves safe (2) (a) (v) ensure that staff understand the roles and responsibilities in relation to protecting children that are assigned to them by the registered person (2) (a) (vi) take effective action whenever there is a serious concern about a child‟s welfare (2) (a) (vii) ensure that staff are familiar with and act in accordance with, the home‟s child protection policies (2) (b) ensure that the home‟s day-to-day care is arranged and delivered so as to keep each child safe and to protect each child effectively from harm. In particular, following young people‟s individual missing from home protocols 31/03/2016

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Requirement Due date

13: The leadership and management standard

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Requirement Due date

In order to meet the leadership and management standard the registered person must

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Requirement Due date

(2) (a) lead and manage the home in a way that is consistent with the approach and ethos, and delivers the outcomes, set out in the home‟s statement of purpose (2) (c) ensure that staff have the experience, qualifications and skills to meet the needs of each child (2) (d) ensure that the home has sufficient staff to provide care for each child (2) (f) understand the impact that the quality of care provided in the home is having on the progress and experiences of each child and use this understanding to inform the 31/03/2016 development of the quality of care provided in the home (2) (h) use monitoring and review systems to make continuous improvements in the quality of care provided in the home

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Requirement Due date

Ensure that the registered person may only use devices for the monitoring or surveillance if the monitoring or surveillance is no more intrusive than necessary, having regards to the child‟s need for privacy. In particular, review the need for door alarms to be fitted on young people‟s bedroom doors (Regulation 24 (1) (a) (d)) 31/03/2016

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Requirement Due date

Ensure that staff have the appropriate experience, qualifications and skills for the work that the individual is to perform. In particular, a thorough understanding of children‟s individual missing from home protocols (Regulation 32 (3) (b)) 31/03/2016

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Requirement Due date

Ensure that all employees receive practice-related supervision by a person with appropriate experience. In particular, that staff receive regular supervision in line with the home‟s statement of purpose (Regulation 33 (4) (b)) 30/04/2016

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Requirement Due date

35: Behaviour management policies and records

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Requirement Due date

Ensure that within 24 hours of the use of a measure of control, discipline or restraint in relation to a child in the home that each restraint that is used is recorded separately which includes the name of the child, details of the child‟s behaviour leading to the measure, the date, time and location of the measure, a description of the measure and its duration, the name of the person who used the measure (“the user”), and of any other person present when the measure was used, the effectiveness and any consequence of the measure and a description of any injury to the child or any other person, and any medical treatment administered, as a result of the measure. Within 48 hours of the use of the measure, the registered person, or a person who is authorised to do so (“the authorised person”) has spoken to the user about the measure and has signed the record to confirm it is accurate and within 5 days of the use of the

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Requirement Due date

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) (a) (i) (ii) (iii) (iv) (v) (vi) (vii) 31/03/2016 (viii) (b) (i) (ii) (c))

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Requirement Due date

Ensure that the registered person notifies HMCI if there is any other incident relating to a child which the registered person considers to be serious (Regulation 40 (4) (e)). 31/03/2016

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Recommendations

To improve the quality and standards of care further the service should take account of the following recommendation(s):  Ensure when a child returns home after being missing from care or away from the home without permission, the responsible local authority must provide an opportunity for the child to have an independent return home interview. Homes should take account of information provided by such interviews when assessing risks and putting arrangements in place to protect each child.

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Recommendations

(The Guide to the Quality Standards, page 45 paragraph 9.30)

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Recommendations

 Ensure that staff are familiar with the home's policies on record keeping and understand the importance of careful, objective and clear recording.

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Recommendations

(The Guide to the Quality Standards, page 62 paragraph 14.4)

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What the inspection judgements mean

At the interim inspection we make a judgement on whether the home has improved in effectiveness, sustained effectiveness, or declined in effectiveness since the previous full inspection. This is in line with the Inspection of children's homes: framework for inspection.

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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 focused on the effectiveness of the home and the progress and experiences of children and young people since the most recent full inspection.

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Information about this inspection

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 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 .

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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,

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Information about this inspection

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Information about this inspection

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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

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