Children's home SC1183618

Good

The children's home provides effective services that meet the requirements for good.

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The children's home provision is good because:

 This is the first inspection since registration of this home in October 2015. The home provides a bespoke service to cater for the complex needs of one young person. In a relatively short space of time, the young person has made progress in many areas of his life including education engagement, communication and independence skills. Notably, the young person is described by those who know him best as ‘happier and much less anxious’.  Consultation and work in partnership with parents and a wealth of professional stakeholders contribute to the safety of and development of positive experiences for the young person. A professor of child and adolescent psychiatry described the staff team as ‘doing a brilliant, if not impossible job, with real enthusiasm’.  The young person is increasingly safe because of the support and supervision provided by the staff team. Behavioural specialists are employed, and critical analysis of the young person’s behaviour is being

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The children's home provision is good because:

undertaken to inform care practice and interventions better.  The staff team and acting manager have a positive can-do attitude. Without exception, those who contributed to this inspection describe the staff team as ‘dedicated and caring’.  Most of the shortfalls identified during this inspection are process and systems issues such as recording. While these are important issues and must be improved, it is not possible to determine if there is a significant or any impact on the young person.  The young person continues to make progress albeit some small steps at a time. Professionals assistance is on hand to try to understand his behaviour and to respond to his needs. He is also able to maintain family relationships, develop skills and progress towards greater independence.

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Statutory requirements

This section sets out the actions which must be taken so that the registered person 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 must comply with the given timescales.

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Requirement Due date

35: Behaviour management policies and records Ensure that, within 24 hrs of any measure of restraint, a record is made which includes the detail as required in section (3)(a)(i-viii) of the regulation, and that, within 24 hrs of the use of any restraint, the registered person (i) has spoken to the user about the measure and (ii) has signed the record to confirm its accuracy (Regulation 35(3)(a)(i-viii) (b)(i-ii)). 13/05/2016

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Requirement Due date

37: Other records Ensure that the information as set out in Schedule 4 is kept in relation to the children's home and is kept up to date. In particular, records of visitors to the home and the reason for their visit, a copy of the staff rota of persons working in the home and a record of the actual rotas worked (Regulation 37(1)(2)(a)(b)). 13/04/2016

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Recommendations

To improve the quality and standards of care further, the service should take account of the following recommendations:  As outlined in 10.1, the registered person should plan staffing levels to ensure that they meet the needs of the child and can respond flexibly to unexpected events eg staffing shortages. In particular, ensure that at all times sufficient staff are available (’Guide to the Children’s Homes Regulations, including the quality standards’, page 54 paragraph 10.15).

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Recommendations

 The registered person must have a system in place so that all staff including the manager receive supervision of their practice from an appropriately skilled and experienced professional. In particular, that the frequency of supervision is in line with the timescales detailed in the home’s statement of purpose (’Guide to the Children’s Homes Regulations, including the quality standards’, page 61, paragraph 3.12).  The registered person should ensure that all staff are familiar with the home’s policy on record keeping and understand the importance of careful, objective and clear recording. Information should always be recorded in a way that will be helpful to the child (’Guide to the Children’s Homes Regulations, including the quality standards’, page 62, paragraph 14.4).

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Information about this children's home

The home is registered to provide care and accommodation for up to one child with emotional and/or behavioural difficulties and/or learning difficulties.

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Recent inspection history

Inspection date Inspection type Inspection judgement

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Recent inspection history

First inspection since registration of the home in October 2015

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good

Carefully transition planning was in place months before the young person moved in. A core team of staff visited the young person frequently to get to know him prior to the move. Consultation in partnership with the family and professional stakeholders was essential in making sure that the environment was suitably adapted. The complex care needs of the young person were determined and specialist support services were put in place. The young person has settled well into the home with the help of a core team of staff and support from parents. He particularly benefits from being close to his family. They visit on a regular basis. This allows the young person to spend time with adults who are important to him. His siblings also visit, and he has been able to meet some for the first time. Some of these interactions are very positive with the young person showing a real interest in and affection for siblings

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good

The young person is attending school daily. Teacher reports of his progress are positive, and he is engaging in learning. The social worker reported, ‘School has been a massive success. He attempted the school discos and stayed for half an hour with other children. This is a huge development.’ The environment suits the needs of the young person. There is plenty of space and room for the large numbers of staff and for family when they visit. The risks associated with self-injurious behaviour have been reduced, where possible with the addition of padding to areas of the home. A large combined lounge and kitchen is perfect for the needs of the young person. He can smell and see food being cooked. This meets his sensory needs and has improved his appetite. He has gained much-needed weight since admission to the home. Social skills have improved. For example, he is sitting at a table to eat with others. The young person is encouraged to try new activities. The staff play in front of the

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good

young person to try to engage him. This has varying degrees of success, depending on how the young person is feeling. He has learnt to make sandwiches and snacks and particularly enjoys cooking activities. Recently, he is showing recognition of some local places he visited years ago. Both staff and parents take him out and about, but he is often less anxious when staying in the home. Parents are quite pleased about this and feel that it demonstrates that he feels comfortable and at home here. Plans are in place to install a large trampoline in the garden of the home, as this is something he has previously enjoyed. The young person has gained independence skills. He is encouraged to, and learning to make choices. He frequently chooses the staff whom he wants to work closely with him, and will choose clothing and activities. Staff respond effectively to try to avoid any unnecessary anxiety when the young person makes his feelings

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good

known Healthcare is comprehensive and a number of specialist providers including child and adolescent mental health services (CAMHS) are involved. The young person attends regular routine health checks and appointments. The use of prescribed medication to reduce anxiety and to manage the young person’s behaviour has been reduced, and plans are in place to reduce this further. Deprivation of liberty, which includes restrictive practice, is necessary to keep this young person safe. These restrictions are subject to court judgements and are carefully considered and reviewed. Long-term care planning is aimed at reducing constant supervision and full-time dependence on adults. The staff team considers issues of privacy constantly. They have not shied away from dealing with issues emerging concerning the young person reaching puberty. Concerns are taken seriously and are resolved as quickly as possible. It has proved

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good

difficult to establish and maintain a full staff team. Usually at least one member of the core staff team is on duty. However, a parent was particularly concerned to visit the home and to find staff on duty who were all unfamiliar. Arrangements have now been made to make sure that parents have the opportunity to meet staff prior to them starting work at the home.

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requires improvement

On every occasion, the use of physical interventions meets the criteria of safeguarding the young person or others from injury. However, records of restraint do not capture all the information required. Consequences and outcomes not recorded is one of several omissions. Records do not provide for effective reflective practice or ensure that all is being done to minimise the use of these restrictive techniques. Leaders and managers have failed to provide effective monitoring of these records. Missing information has gone unchecked. Recently, a member of staff used an unauthorised physical restraint on the young person. Although no harm was done, the use of unauthorised restraints can be dangerous. When alerted to this issue, the acting manager took immediate and effective action to avoid a repeat and informed stakeholders about the incident. Behaviour management records are not complete. They lack detail of triggers to

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requires improvement

difficult behaviour. Daily logs lack clarity about purpose, and there is inconsistency in recording some behaviours which could assist in planning to reduce medication. Whether the young person needed physical contact during the night, or how often, is not generally noted. The young person lives in an environment where his physical safety is of paramount importance. He is increasingly safe because of the actions that staff take to protect him. Adaptations to the home are continually under review and, if necessary, additional changes are made when new risks become evident. The young person is likely to need lifelong support from others. Currently staff are in close proximity at all times. There is evidence that his anxiety has reduced and this in turn reduces difficult and self-injurious behaviour. Staff continue to collect information about behaviour so that this can be analysed by behavioural specialists. They also review opportunities to allow him as much freedom and

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requires improvement

privacy as possible. Advocacy for the young person is provided in several ways. Parents visit on a frequent basis and raise any concerns they have. Several independent stakeholders have oversight of the care provided, the social worker visits on a regular basis, and the placing authority holds fortnightly meetings with representatives of the home. This monitoring is effective in safeguarding the young person and enabling stakeholders to reflect on the care provided and the restriction of liberty issues. Arrangements for the safe storage and administration of medication are in place. The organisation’s duty office is contacted before the administration of any painkillers. It keeps a record of all those administered to avoid too many being given. This provides an additional safeguard, given the large numbers of staff caring for the young person. All staff hold a first aid qualification and so are able to

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requires improvement

respond effectively and quickly to any medical issues. Safer recruitment practice protects the young person and avoids unsuitable adults working in the home.

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requires improvement

The registered manager recently resigned. Prior to his departure, he was instrumental in setting up a bespoke and carefully considered service to meet the complex individual needs of a young person. It has proved difficult to recruit and maintain a full staff team since the home opened, and more recently to recruit to the vacant management post. Staffing vacancies have resulted in some staff working extremely long shifts and on occasion over 50 hours a week. This is not best practice in what can be a stressful and emotional environment. On at least one occasion, all new staff were on duty with the young person, and on the first morning of inspection staffing numbers were one fewer than needed to meet placing authority expectations. It was not possible to discern the impact of these issues on the young person who has particular favourites within the team. His choice of working with favoured staff does not correlate to the staff’s experience, qualifications or the length of time that

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requires improvement

they have been employed. Leaders and managers are failing to ensure that all staff receive regular supervision. This does not fully support personal development, staff’s ability to raise concerns, and monitoring of staff’s well-being, given the complex and often stressful working environment. A lack of regular supervision also has an impact on accountability and opportunities for professional challenge. Staff can access independent confidential emotional support from a mental health expert. There are gaps in some important records. Not all are kept up to date, accurate or effectively. Daily records and logs lack clarity about their purpose, and recordings do not match the need to detail routines, especially in the mornings. This information is important to those analysing behaviour and those considering a reduction in medication. The statement of purpose sets out the values and objectives of the home. It has

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requires improvement

been kept under regular review to describe the service accurately. The physical environment is maintained to a high standard, and parents are particularly pleased, commenting that ‘this feels like a home, there is plenty of space and we are made to feel welcome’. Significant incidents are reported to appropriate authorities, and the necessary action is taken to learn from any issues and to avoid a repeat. The acting manager implemented as many changes as possible in response to some of the shortfalls identified at this inspection. The visitors’ book and restrain recording format were updated straight away. Arrangements for the induction of newly employed staff support their ability to understand the presenting needs of the young person. Alongside mandatory training, specialist training is provided to enable staff to fulfil their responsibilities. A high staff turnover has contributed to less than 5% of the current team holding a

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requires improvement

childcare qualification. Most are now registered to undertake these qualifications in the near future. Leaders and managers commonly review risks. Listening to parents, partners and professionals from specialist agencies plays an important part in providing a considered holistic service to the young person and in reducing risk where possible. Independent monitoring of the home takes place on a regular basis. Reports are informative, and many of the issues identified mirror the findings of this inspection. Plans to improve the home are ongoing, and there is capacity for continuous improvements, particularly as sufficient care staff have recently been recruited.

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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’.

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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 children looked after 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

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What the inspection judgements mean

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

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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 that 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 whom 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

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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 .

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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

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

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Information about this inspection

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

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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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