Children's home run by Cambian Childcare Limited in Stockport

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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because:

 Records within the home do not detail what work is being undertaken with the young person to develop her emotional resilience.

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because:

 Staff do not consistently give the young person her medication as prescribed.

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because:

 The young person takes responsibility for some of her own medication, but she has not always managed this well. As a result, the home has not demonstrated that they have effectively reviewed her ability to take her medication safely.

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because:

 The young person has a specific health need which staff have not adequately assessed so that they can offer the necessary support and advice.

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because:

 The manager has not effectively risk assessed the occasions when there has only been one staff member on duty to ensure that the young person’s needs are met.

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because:

 The home welcomes the young person’s family into the home and this has included her mother staying overnight. But this good practice is not supported by a robust assessment of risk. Therefore, staff are not clear about their roles and responsibilities in this area if an incident were to occur.

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because:

 The home’s complaint procedure is not effective, because the manager does not take any formal action on any verbal concerns raised with them by young people or professionals.

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because:

 Staff report that the young person’s behaviour fluctuates, because some staff give in to her demands. Therefore, the structures and boundaries within the home are not robust.

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because:

 Monitoring of the care with the home by the registered manager does not provide an accurate picture of how the home is operating. It does not adequately identify and address shortfalls in practice to safeguard and support young people.

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because:

 The home’s location risk assessment does not identify all the known risks within the community. This does not ensure that young people are suitably placed here.

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because:

 The home’s statement of purpose does not currently reflect the service, because it has not been updated after changes within the company.

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because:

 The home has regular staff meetings, but they are not used effectively to discuss research and practice issues, policies and procedures or the knowledge that staff have gained from online training.

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The children's home strengths

 The young person is now attending education regularly. Her grades have improved and she is due to sit several exams in the spring term. In addition to this, staff support her on a daily basis, due to her health needs. This means that she is fully safeguarded in school and is having the same opportunities as her peers.

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The children's home strengths

 The young person has not been reported missing from the home for a significant period of time. This is because staff have worked closely with her and other professionals to ensure that she understands the risks. As a result, she has been removed from the child sexual exploitation register.

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The children's home strengths

 When first placed, the young person’s behaviour gave concern in all areas. The home was able to identify that some of these behaviours were due to the lack of contact with her family. Good contact plans show that she sees them regularly and she has progressed in several areas.

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The children's home strengths

 The home has a good transition plan in place. This includes information on all placements being explored, and regular meetings to discuss the impact of her specific health need.

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The children's home strengths

 There is a well-qualified, trained and supported staff team in place.

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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

The registered person must keep the statement of purpose under review and, where appropriate, revise it. This is specifically in relation to omitting or updating the current situation in regards to therapists working within the home (Regulation 16(3)(a)). 30 June 2016

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Requirement Due date

In order to complete a quality of care review the registered person must establish and maintain a system for monitoring, reviewing and evaluating the quality of care provided for children and any actions that the registered person considers necessary in order to improve or maintain the quality of care provided for children (Regulation 45(2)(a)(c)). 30 June 2016

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Requirement Due date

The registered person must review the appropriateness and suitability of the location of the premises used for the purposes of the children’s home. This is specifically in relation to assessing the known risks within the locality and evaluating crime statistics in regards to the impact on young people or the community (Regulation 46(1)). 30 June 2016

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Requirement Due date

The registered person must ensure that a record is made of any 30 June 2016 complaint, the action taken in response, and the outcome of any investigation (Regulation 39(3)).

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Requirement Due date

The registered person must ensure that medicine which is prescribed for a child is administered as prescribed to the child (Regulation 23(2)(b)). 30 June 2016

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Requirement Due date

The registered person must ensure that medicine may be safely self-administered by that child (Regulation 23(3)(b)). 30 June 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: 13(2)(g)(i) 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 needs of children are best met. This is specifically in relation to information sharing and discussion within staff meetings. 30 June 2016

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Requirement Due date

In order to meet the health and well-being standard the registered person must: 10(1)(a) ensure that the health and well-being needs of children are met. This is specifically in relation to their emotional health and the support required. 30 June 2016

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Requirement Due date

In order to meet the positive relationship standard the registered person must: 11(1)(a)(b)(c) ensure that children are helped to develop, and to 30 June 2016 benefit from, relationships based on mutual respect and trust; an understanding about acceptable behaviour; and positive responses to other children and adults.

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Requirement Due date

In order to meet the protection of children standard the registered person must ensure— 12(2)(a)(i) that staff assess whether each child is at risk of harm, taking into account information in the child’s relevant plans, and, if necessary, make arrangements to reduce the risk of any harm to the child; This is specifically in relation to having a robust risk assessment around the young person’s pregnancy. 30 June 2016

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Requirement Due date

In order to meet the protection of children standard the registered person must ensure— 12(2)(a)(v) that staff understand the roles and responsibilities in relation to protecting children that are assigned to them by the registered person. This is specifically in relation to having a robust risk assessment in place when lone working with children. 30 June 2016

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Requirement Due date

In order to meet the protection of children standard the registered person must ensure— 12(2)(a)(i) that staff assess whether each child is at risk of harm, taking into account information in the child’s relevant plans, and, if necessary, make arrangements to reduce the risk of any harm to the child.

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Requirement Due date

This is specifically in relation to having a robust risk assessment in place when family members stay overnight at the children’s home. 30 June 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 that staff have the knowledge and skills to recognise and be alert for any signs that might indicate a child is in any way at risk of harm. The registered person should ensure that skills in safeguarding are gained, refreshed and recorded in the homes workforce plan (‘Guide to the children’s homes regulations including the quality standards’, page 43, paragraph 9.12).

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Recommendations

 Ensure that emergency admissions are not taken unless the home's Statement of Purpose and its capacity and support systems mean that it has the capability to care for children admitted at very short notice while continuing to offer high quality care to children already living in the home.

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Recommendations

This is specifically in relation to identifying what information would be required from the local authority in an emergency admission (‘Guide to the children’s homes regulations including the quality standards’, page 15, paragraph 3.6).

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Information about this children's home

This privately run children’s home can accommodate one young person with emotional or behavioural difficulties.

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Recent inspection history

Inspection date Inspection type Inspection judgement

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Recent inspection history

10 February 2016 Interim Sustained effectiveness

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Recent inspection history

20 February 2015 Interim Sustained effectiveness

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Requires improvement

The young person gave variable answers to the inspector on the care that she receives at the home. Initially, she was complimentary and discussed all the good things about the home. For example, she said that staff were great, she was happy here and that school was going well. But, later in the day she became upset and raised several issues with the inspector. These issues are addressed throughout this report. The young person has a specific health need. This is adequately addressed within her health plan, but the impact on her emotional health has not been fully explored. Staff said that she can become extremely upset or angry on a daily basis without any warning. The home has not assessed the risks of this or her health need on her or staff. This does not ensure that everyone is aware of the strategies and actions to take when incidents arise. Also, the local authority is undertaking an assessment of her needs to identify a suitable semi-independence placement.

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Requires improvement

Therefore, the lack of recording in this area will not assist them to identify the right provision. In contrast to this, the young person was a prolific self-harmer prior to being place here. She has not self-harmed for a significant period of time. This is because staff have discussed with her different ways of expressing herself, the implications on her long-term health and her body image, and this is reflected in how settled she is in this home. The young person takes several medications. She self-administers some and another is given by staff. The young person said, ‘I am supposed to get my green inhaler twice a day and staff do not do this.’ The home’s records show that on some occasions she had only been offered it once a day. Staff were not clear whether the medication was ‘as and when required’ or twice daily, as per the prescription label. As a result, she is not receiving her medication in line with her

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Requires improvement

prescription. In addition to this, an assessment of the risks of her self- administering her supplements has not been completed or reviewed after an incident at school, when she gave the tablets to other students. This neither safeguards her or members of the public, nor assesses whether she is mature enough to take on this responsibility safely. The young person’s history of attending education, prior to coming to this home, was poor. As a result of this, she was behind her peers academically. The home quickly sourced alternative provision that addressed her individual needs. When this broke down, another provision was found quickly. Staff completed several key- worker sessions around her behaviour, choices, career opportunities and the importance of a good education. She is now attending frequently, although she has had some time off for medical appointments. She regularly completes homework at the home and she is supported in this by staff. This has significantly improved her

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Requires improvement

abilities and she is scheduled to take six exams in the spring term. This means that her opportunities to gain entry into a college or employment have improved. In addition to this, she has completed a variety of additional courses such as food hygiene and communicating effectively, which have been certificated. This will enhance her opportunities further in the future. The young person’s behaviour was of significant concern when she was first placed. The good relationships and interaction with staff enabled her to discuss the reasons why. She said that the lack of contact with her family made her angry and run away. Therefore, the home was very proactive in sorting out firm contact arrangements with several family members. Good contact plans show that these arrangements and the young person’s behaviour have improved because of this. An outstanding area of practice is that her mother has been able to stay overnight

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Requires improvement

at the home on several occasions. This means that they have been able to improve their relationship and have individual time together. However, the manager has not assessed the risks of this. Therefore, there is no clear guidance on what agreed action staff need to take if an incident were to occur. The young person said that she was confident in being able to raise a concern or complaint at the home. However, this was not apparent in the home’s records on the day of inspection or in professional feedback. A number of months ago there was an incident between the young person and a member of staff. Initially, she said that she did not want him working with her. She then retracted this and accepted that her behaviour had been unacceptable, and apologised. But, over the months she has raised this verbally again to staff on several occasions and she has recently raised it with her social worker. The social worker informed the manager.

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Requires improvement

The manager said, ‘She will often focus on one staff member when she is angry and when she wants her own way, then retract statements. We have tried to give her the message that we are all here for her.’ However, the manager has neither undertaken any mediation work with the two parties as good practice nor formally addressed this issue through the complaints procedure. This does not ensure that all verbal complaints are robustly responded to and that clear action is taken. The young person is working towards independent living. She receives a set budget to plan her weekly expenses, such as for shopping, activities and essentials. The young person said that she felt confident in these areas because staff encourage and support her to make the right choices. For example, staff will show her how to make things from fresh ingredients rather than purchase processed foods that can be more expensive. The local authority is looking at several options for the young person to move on

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Requires improvement

to. The home has a good transition plan in place that considers all of these options. A very recent meeting has concluded and identified the best possible option, and the transition plan is currently being updated.

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Requires improvement

The young person said that she is safe at this home and that staff discuss safety issues with her on a regular basis. She is proud that she has not been reported as missing for a significant period of time. She said that this was to down to staff sorting out her contact with her family and that she now understands the risks that she put herself in. There is a clear reporting protocol in place that highlights the young person’s risks and vulnerabilities. It gives staff clear guidance on the actions to take if an incident were to occur. As a result, the young person has been removed from the child sexual exploitation register. A professional said, ‘This is a significant improvement and she will call staff to say if she is late or if arrangements have changed.’ In general, there are some good risk assessments in place around the young person’s behaviour. They clearly show the level of risk, strategies and actions for

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Requires improvement

staff to take, and include the young person’s views, wishes and feelings on the subject. These are reviewed regularly with the young person. This means that she has been able to identify when some risks are no longer an issue or when more work needs to be done. This means that some risks have been significantly reduced and no longer need monitoring, for example her behaviour in the community. In contrast to this, the home has not assessed or identified emerging risks as they have arisen, such as her specific health need, self-medication and overnight stays. This does not ensure that emerging risks are robustly monitored to keep all parties safe. The young person has not been held for her or others’ safety. There is a robust risk assessment in place that states that restraint is not to be used, due to her current health condition. It gives staff good advice on the different actions and de- escalation strategies to use if an incident were to occur.

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Requires improvement

The young person has benefited from good incentive and reward schemes at the home. She said, ‘The manager put in place an incentive scheme where I can earn extra money for items for my semi-independence. It is great. I have money saved in the bank and have bought loads of things.’ A professional said, ‘There is a significant improvement in her behaviours from when she was first placed. This is because of the good practice within the home. However, there is still some work to be done.’ This was also reflected by staff, who said that she had come a long way from having an outburst or incident every day, when first placed, to occasional ones now. There are behaviour management plans are in place that cover specific behaviours and day-to-day care. But staff say that that they are ineffective, because not all staff follow them. One member of staff said, ‘Some shifts can be difficult because some staff give in to her demands for an easy life. She will dictate

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Requires improvement

who is taking her to contact or out shopping. This means that some staff have a difficult shift when they are trying to put the boundaries in place.’ Another member of staff said, ‘It has affected relationships within the team and with her.’ There was an overall consensus within the staff team, when speaking with the inspector that she has learned that by displaying some aggressive behaviour she may get what she wants. This does not ensure that the young person receives care from a consistent staff team and that she understands the boundaries within the home. On hearing this information, the manager took decisive action and called a staff meeting for the next day. He said he was going to have an open forum and have another manager chair the meeting. A list of issues would be drawn up and a response agreed upon. This would be circulated to the social worker and discussed with the young person. This will ensure that everyone is working towards the same

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Requires improvement

plan and that they understand their role in these matters. There have been no safeguarding issues to report to the relevant professionals. Staff demonstrated that they were clear about their roles and responsibilities in reporting any incident. They receive regular training in safeguarding, child exploitation, e-safety, and health and safety. This is regularly updated to ensure that they are kept up to date with changes in legislation, law and practice. However, some training is completed online, and the manager has not assessed the staff’s retention or understanding of the content. For example, one member of staff was not clear on the signs and symptoms that may indicate that a young person is at risk of child sexual exploitation. The home is well maintained. There is good attention to any identified health and safety issues, such as replacing small broken items and general repairs to the property. The young person, staff and visitors to the home regularly complete fire

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Requires improvement

evacuations so they know what to do in an emergency. This ensures that everybody is safe and that the young person lives in a homely environment. Judgement grade

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Requires improvement

There is a new registered manager in place. He was registered with Ofsted in January 2016. He is current completing his level 5 diploma in leadership and management. He has several years’ experience of working with young people and has progressed through the company from a care worker to being successful in a management role. He is also the registered manager of another two single- placement homes. He is supported by several team leaders and divides his time equally between the homes. He recognises that he needs to develop as a manager, and has recently sought additional support from the responsible individual for the home and from experienced registered managers within the company. He has identified his own development plan to assist him in his role. There is a well-qualified, trained and stable staff team in place. Staff said that they receive regular supervision and that their development is appraised annually. Staff

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Requires improvement

meetings are regular, but the records show that only the young person’s care is discussed. There is no reference to discussions on current social issues, research and its implications for care practice, training events or staff’s understanding of the policies and procedures of the home. This does not ensure that staff have the opportunity to discuss and reflect on topics that are relevant to their roles. The young person is cared for by two staff members who complete a 24- hour period. The young person said that there were times when only one member of staff was on duty. She said that she did not feel comfortable with some of the staff and required more attention than one could give her. Records show that there has been the odd occasion that this has happened, due to staff sickness and bereavement. However, while an on-call duty manager was available if required, the manager has not formally assessed the risks around staff working on their

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Requires improvement

own. This does not ensure that young person’s concerns are addressed formally, or that she and staff are fully safeguarded. Overall, the home’s statement of purpose mostly represents the care and provision offered at the home. However, the company has recently gone through some changes that have impacted on how time allocated for therapy and the input of clinicians are assigned to the homes. Currently, the information provided suggests that all young people receive therapy and that a clinician is at the home to provide support and advice to staff, but this only happens if they are assessed as needing this input. It also states that there is an assessment of needs completed every 28 days, yet the manager said that they do not do this anymore. The previous assigned clinician’s details are in the staff details, although she no longer works for the company. This does not ensure that professionals have clear information on

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Requires improvement

what the service offers. In addition to this, at the last inspection the home was asked to identify what information would be required from the local authority in an emergency placement. This has not been completed, and is thus repeated. The home has a review of the home’s location in place, but it does not address all the known risks within the community. For example, there is a park opposite the home, waterways and a bridge nearby. Staff have also received statistical information from the police on crimes within the area and a comparison with other areas. However, the manager has not evaluated these to show what this would mean in considering a placement or the impact on a new referral to the home. For example, a statistic shows that the community is 96% white British. Therefore, the manager would need to consider how the home would meet an individual’s needs if they were from a different culture.

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Requires improvement

The home seeks to work collaboratively with placing authorities. A social worker said that communication between them and the home was good. The home keeps them regularly informed of all situations and they felt that it managed the young person’s needs well. The company has identified a new service to undertake regulation 44 visits. The first visit was an introduction to the home, and a basic report was completed on the quality of care. In the past, reports have been of a good standard and are received in a timely fashion by Ofsted. But the manager’s monitoring of the home is not robust enough to demonstrate continuous improvement. For example, the report gives a list of dates rather than evaluating the content of the record. Bar charts have not been evaluated to demonstrate the trends, patterns or progress of the young person, and the actions to identify improvement are overall statements such as ‘provide a nurturing environment’ rather than how this is going to be done.

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Requires improvement

However, the manager was proactive and took immediate steps to address some of the concerns raised at the time of inspection. For example, several risk assessments were completed and ready to discuss at the staff meeting the following day.

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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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