Children's home run by Virgin Care Limited in Camden

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.

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The children's home provision requires improvement because:

The management and administration of medication in this short-break service is not sufficiently robust. A recent repeated error in the administration of medication to a child being exposed several shortfalls that require improvement. These shortfalls relate to the home’s operating procedure for the administration of medication, the thoroughness of staff practices in responding to planned changes in prescribed medication and the subsequent administration of medication, and also in staff’s response when medication administration errors were identified. The manager’s overview of important protocols and records relating to the management of a young person’s behaviour is not sufficiently effective. For example, there are shortfalls in relation to the practice of covert administration of medication and in a risk management plan, both relating to the same young person. The staff debriefing following serious incidents is not always included in

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The children's home provision requires improvement because:

the record of the incident, which does not comply with the expectation that staff are spoken to with 48 hours of the incident. This is especially important by way of support when, for example, staff are assaulted. The quality of food provided to children and young people is not of a consistently good standard. While some home-cooked and nutritious meals are provided, there is an over-reliance on processed and ready-made provisions. Staff training records are not of a good quality and are not fit for purpose, in that they do not evidence the training that staff have attended. Those that were accessible during the inspection were confusing, out of date or incomplete. It was not clear during the site visit if the issue was a lack of training provision or poor- quality records. The responsible individual acknowledged the shortfalls of current training records and advised that improvements are in hand. Following the visit,

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The children's home provision requires improvement because:

evidence of staff training was provided to the inspector which confirmed that the shortfall is in the recording, and not the provision, of staff training. The manager’s review of the quality of care is detailed, but lacks reflection on how the review has informed future improvements to the quality of the service and how these will benefit young people.

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The children's home strengths

The short-break service is making good progress in many areas. Despite the limitations of the building, staff have been effective in creating a child-friendly and attractive environment. Children and young people have access to a wide range of play equipment and materials. Outside space has been creatively designed to provide children and young people with opportunities to play safely. Relationships between young people and staff are excellent. Staff know and understand the young people’s diverse needs really well. They plan effectively for their stays to ensure that they enjoy their experience and have opportunities they might otherwise not have. Staff understand how vulnerable the children and young people in their care are. Mostly, their liaison with parents is good. One parent said that she was ‘absolutely delighted with the service’ and that her daughter ‘loves visiting’. Staff feel well supported through practice-related supervision, which is felt

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The children's home strengths

to be a strength of the registered manager. Good attention has been given to ensuring that the manager and staff are achieving their diploma qualifications in residential childcare within the required timescales.

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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 ‘Guide to the children's homes regulations including the quality standards’. The registered person(s) must comply within the given timescales.

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Requirement Due date

10. The health and well-being standard: In order to meet the health and well-being standard, with particular reference to children having healthy and nutritional meals during their stay, the registered provider must ensure that (1)(a) the health and well-being needs of children are met. 31 May 2016

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Requirement Due date

13. The leadership and management standard: In order to meet the leadership and management standard, with particular reference to the review and updating of agreed protocols, the registered person must (2)(g) demonstrate that practice in the home is informed and improved by taking into account and acting on research and developments in relation to the ways in which the need of children are best met and (h) use monitoring and review systems to make continuous improvement in the quality of care provided in the home. 31 May 2016

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Requirement Due date

The registered person must ensure that children can access all appropriate areas of the children's home's premises; and any limitation placed on a child's access to any area of the home's premises is necessary and proportionate; is kept under review and, if necessary, revised.

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Requirement Due date

In particular if staff lock themselves in the office to keep themselves safe, the agreed protocol and the subsequent record of the incident must be clear and detailed (Regulation 21(b)(c)(ii)(iii)). 31 May 2016

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Requirement Due date

The registered person must make arrangements for the handling, recording, safekeeping, safe administration and disposal of medicines received into the children's home. 20 May 2016 In particular, the registered person must ensure that medicine which is prescribed for a child is administered as prescribed to the child for whom it is prescribed (Regulation 23(1)(2)(b)).

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Requirement Due date

The registered person must ensure that all employees undertake continuing professional development.

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Requirement Due date

In particular, the home should maintain staff training records that clearly evidence that all mandatory and specialist areas of training have been completed (Regulation 33(4)(a)). 31 May 2016

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Requirement Due date

The registered person must ensure that within 48 hours of the use of a measure of control, the registered person has spoken to the user about the measure.

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Requirement Due date

In particular, in the event of a member of staff being assaulted, a full debriefing should be carried out and recorded which should outline the support provided to that member of staff (Regulation 35(3)(b)(i)). 31 May 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):  Medicines must be administered in line with a medically approved protocol. Where the home has questions or concerns about a child's medication, they should approach an expert such as a General Medical Practitioner, community pharmacist or designated nurse for looked-after children (‘Guide to the children's homes regulations including the quality standards’, page 35, paragraph 7.15).

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Recommendations

 The registered manager's review of quality of care should enable the registered person to identify areas of strength and possible weakness in the home's care, which will be captured in the written report. The report should clearly identify any actions required for the next 6 months of delivery within the home and how those actions will be addressed. The whole review process and the resulting report should be used as a tool for continuous improvement in the home (‘Guide to the children's homes regulations including the quality standards’, page 65, paragraph 15.4).

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Information about this children's home

The home is registered to provide care and accommodation for up to five children who may have sensory impairment, learning disabilities and physical disabilities. Care and accommodation are provided on a short-break and flexible basis.

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Recent inspection history

Inspection date Inspection type Inspection judgement

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Recent inspection history

25 January 2016 Interim Improved effectiveness

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Requires improvement

Arrangements for the management and administration of medication are not consistently safe and effective. A recent error in the administration of medication to a child exposed several shortfalls. Medication is not consistently checked and signed in by using a thorough enough means to identify and act on any changes or discrepancies. Staff failed to join up information and act on changes that had been notified, as planned, by the young person’s consultant. Staff are not consistently following the operating procedure for the administration of medication, which clearly states that ‘staff will not participate in administering medication that is not correctly supplied as per the medication authorisation sheet’. When recent errors in administration were identified, the medical advice was not taken as the member of staff did not receive clear instructions to do so. This practice is not in the best interests of children and young people. The pattern of short breaks varies with

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Requires improvement

each child and young person. Currently, there is no expectation in place that, if a young person has not visited recently, staff will liaise with families immediately prior to a planned stay to ascertain any changes in needs, including any changes to medication. While staff receive regular training in medication, the impact and effectiveness of such training must be thoroughly evaluated in the light of this recent incident.

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Requires improvement

The provision of meals in this setting is not of a consistently good standard. While it is recognised some good work is being done in this area, namely widening some young people’s dietary range to include healthier choices, this is not being achieved consistently enough. There is an over-reliance on processed provisions and unhealthy options, as was evident from items contained in the kitchen cupboards. This shortfall may relate to some members of staff not having the confidence, time or skills to prepare homemade and nutritional meals and, if so, these issues will need to be addressed to improve outcomes for children and young people.

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Requires improvement

The home is well equipped, both internally and externally, with an excellent range of toys, games and craft materials. Children and young people benefit from a choice of communal areas and a playroom which has a large touchscreen computer. The garden offers children and young people the opportunity to play freely and safely while under the careful supervision of staff. They have a swing, a trampoline and an excellent range of ride-on and sensory toys. Children and young people are supported in a variety of ways to communicate their views and choices. For example staff, were seen to be using an electronic tablet to enable young people to make their teatime choices. Social stories and picture strips are used to inform and prepare children and young people for planned activities, such as administering medication or going out on a trip. Where young people can communicate verbally, this is encouraged and praised.

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Requires improvement

Care plans are detailed and personalised. They are child- and outcome-focused, and demonstrate effective working together practices with parents and other professionals. Children and young people are treated with care and respect. They experience care that is sensitive and responsive to their identity, disability and communication needs.

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Requires improvement

A recent error in the administration of medication, repeated four times by three different members of staff before being detected by a fourth member of staff, has exposed the need for more robust procedures and practices to keep children and young people safe.

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Requires improvement

In addition, the manager’s oversight of important protocols and young people’s plans that relate to their safety requires improvement. For example, the covert administration of medication to one young person, while in principle authorised by a paediatric consultant, is not carried out by staff exactly as detailed. There is a need for complete transparency in relation to this practice. Any adjustments that staff feel are necessary to encourage the young person successfully to take their medication should be discussed and consented to by medical staff and parents. A second example is a risk management plan. This refers to ‘measures to minimise risk’, but this is not detailed enough about the practice of staff withdrawing from a young person and locking themselves in the office to keep themselves safe. The staff debriefing following serious incidents is not always included in these records, although it is understood to take place during supervision.

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Requires improvement

In other respects, children and young people who have short breaks at this service are helped and protected effectively. Good attention is given to focusing on individual needs, compatibility and mix. A flexible and responsive approach is taken and, currently, the service is providing a highly bespoke package to one young person who has complex and challenging behaviours. The parent was particularly complimentary about the staff team, commenting on their ‘commitment’ and saying that they ‘understand’ his son, who really ‘benefits’ from his short breaks. Staff benefit from a combination of face-to-face and e-learning training opportunities that inform and support their safe working practices. Training is provided in basic life support and anaphylaxis, conflict resolution, behaviour management, safeguarding, medication and fire safety awareness. Staff are positive about their training opportunities. They are aware of the vulnerabilities of

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Requires improvement

the children and young people in their care, and are mindful of their safeguarding responsibilities. They know what to do in the event of any safeguarding concerns. Staff are carefully selected and vetted. The files of staff recently appointed are well organised, and evidence appropriate checks have been carried out. The manager verifies references. Not all files contain copies of all certificates of training and qualifications.

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Requires improvement

The registered manager is making progress to improve standards, but some aspects of management oversight require further improvement to achieve a consistently good standard. For example, a more robust approach is needed to ensure that staff are following agreed protocols, that important updates in information relating to young people are effectively actioned, and that risk management plans are detailed and clear.

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Requires improvement

The registered manager has appropriate experience and a level 5 diploma in leadership and management of residential adult homes. She has nearly completed an equivalent qualification in residential childcare. Very good attention has also been given to ensuring that the staff team achieve a level 3 diploma within the expected two-year timescale. Staffing levels are sufficient and flexibly arranged. Staff feel well supported through ongoing training, staff meetings and practice- related supervision. Neither staff training records nor certificates on their personal file held at the home fully evidence what staff have achieved or, indeed, what refresher training is due.

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Requires improvement

The staff team provides a good level of consistency. Staff know the children and young people well. Where additional staffing is required, the home can access bank staff and will use the same member of the bank team to work with specific young people. Good attention is given to matching skills with the needs of young people. Emphasis is placed on providing children and young people with opportunities to enjoy and benefit from their experience of a short break. On one of the days of the inspection young people were to enjoy the summer evening by picnicking and having the opportunity to play with ride-on toys.

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Requires improvement

Relationships with parents are good. They feel confident about leaving their child for their stay. They are able to express concerns and complaints. When this occurs, the company aims to seek an early resolution in the best interests of young people.

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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 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

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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 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

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Information about this inspection

Homes (England) Regulations 2015 and ‘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 0300 123 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, work- based 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

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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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