Children's Home run by Keys Child Care Limited in Warrington

inspection

Following a monitoring visit in February 2016, two compliance notices were issued under section 22A of the Care Standards Act 2000. These relate to regulation 12, the protection of children standard; and regulation 13, The leadership and management standard, of the Children's Homes (England) Regulations 2015. Both the notices were satisfactorily addressed by the second monitoring visit in April 2016.

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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:

 There is no permanent manager appointed. This means that there is inconsistent oversight of the home that limits its capacity to improve.  The detailed development plan is not yet evaluated for effectiveness in driving sustainable improvement.  Managers have not acted firmly to involve one child’s placing authority effectively in ensuring that missing from care strategies are promptly reviewed.  Managers are committed to driving forward improvements but recognise that there is still much to be achieved, including improving the induction and initial training of staff, and embedding staff’s understanding of autism and learning disability to better support young people’s needs.  A majority of staff are unqualified, and untrained in the specific approaches used by the home. This limits their capacity to deliver high quality care practice.

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The children's home strengths

 Two placing authorities confirm that the home is having a positive impact on the lives of young people.  Senior managers are challenging and helping staff to reflect on their learning and practice and have created a more open culture within the home.  Relationships between staff and young people have improved through sharing activities that are tailored to individual tastes and preferences and recognise young people’s unique needs.  Staff recognise the importance of young people’s education, and support them to achieve success.

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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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14: The care planning standard

In order to meet the quality standard the provider must—

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14: The care planning standard

(2)(a) ensure that children are admitted to the home only if their needs are within the range of needs of children for whom it is intended that the home is to provide care and accommodation, as set out in the home's statement of purpose 30 June 2016

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needs are met

In meeting the quality standards, the registered person must, and must ensure that staff— (a) seek to involve each child’s placing authority effectively in the child’s care, in accordance with the child’s relevant plans, in particular that strategy meetings are regularly reviewed, and the virtual head is involved when necessary 30 June 2016

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6: The quality and purpose of care standard

(1) The quality and purpose of care standard is that children receive care from staff who— (2) (b) (vi) help each child to develop resilience and skills that prepare the child to return home, to live in a new placement or to live independently as an adult 30 June 2016

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10: The health and well-being standard

1) The health and well-being standard is that— (a) the health and well-being needs of children are met; in particular by updating health care plans, to ensure staff know what to do when young people refuse their medication 30 June 2016

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23: Medicines

( 1) The registered person must make arrangements for the handling, recording, safekeeping, safe administration and disposal of medicines received into the children’s home. 30 June /2016

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45: Review of quality of care

(2) In order to complete a quality of care review the registered person must establish and maintain a system for monitoring, reviewing and evaluating— (a) the quality of care provided for children; and (c) any actions that the registered person considers necessary in order to improve or maintain the quality of care provided for children. In particular, any outcomes arising from the impact of staff training and development of new recording systems. 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 recommendations:

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Recommendations

 Ensure that all young people are consulted regularly on their views about the home’s care, to inform and support continued improvement in the quality of care provided, and to help them to feel part of those improvements (Guide to the children's homes regulations including the quality standards’, page 22, paragraph 4.11).

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Recommendations

 Ensure that expectations of standards of behaviour are clear and unambiguous so that young people understand how to improve, and how and when they will be rewarded for progress they make (Guide to the children's homes regulations including the quality standards’, page 39, paragraph 8.11).

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Information about this children's home

The service is run and managed by an established private provider. The home is registered to provide care and support for up to four young people with emotional and behavioural difficulties.

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Recent inspection history

Inspection date Inspection type Inspection judgement

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Recent inspection history

10 September 2015 Full Requires improvement

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Recent inspection history

4 March 2015 Interim Improved effectiveness

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Requires improvement

Staff have worked with all young people to address their key issues. As a result, two have made some progress in their safety, education and emotional well-being. One young person has demonstrated an uneven pattern of progress due to the impact of emotional upset. Staff are building increased levels of trust with all young people. This is evident in a more stable and relaxed home, where they spend some time together, have lively but appropriate conversations with staff, and enjoy a range of activity and interests. Social workers and a missing from home support worker say that staff are good at keeping them informed about young people, and are working with them to help young people make progress.

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Requires improvement

All young people have an educational placement. Two are attending regularly, and have made very good progress. One young person represented his views and wishes at an education review meeting. He wrote a letter, explaining that he would like an extra year to improve beyond the entry level maths and English he has achieved. He accepted the situation well when this was not possible, and spoke instead about looking forward to finding the right college that would help his progress to continue. He is proud of himself, and staff are proud of him, because he is building a more positive future.

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Requires improvement

Another young person said that the best thing about school was everything about it. He has earned recognition for his enthusiasm and development in various school awards. He proudly told the inspector that even after he had been in hospital for a planned operation, he returned to school the next day because he enjoys it so much. The school effectively addresses his specific learning needs and staff are using the school’s strategies and approaches to help him to be more settled in the home. This consistency helps him to manage his feelings, and has helped him to transfer some of his progress to his family relationships, which he says are the most important thing in the world to him. The home has a key role in supporting successful contact with them.

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Requires improvement

Staff have supported another young person to make a change in his school placement, and this process was underway during the inspection. Due to his non- attendance since the Easter holidays, and risks associated with that locality when he is frequently missing, staff have identified a school out of area. He is keen to start his new school, and staff believe that this will help to break unhealthy relationships and patterns of behaviour that place him at risk. Despite his non- attendance being over five weeks, the placing authority virtual head has not been involved, and this has delayed the outcome that is being pursued. Managers have used a number of strategies to help him to feel more settled in the home, and change their approaches when they do not work. They are supporting him to have contact with some members of his family. They are working with them to ensure that they follow his agreed plans, such as upholding his safe phone and internet

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Requires improvement

use contract, and setting out reward plans to encourage him to achieve attendance at school and youth justice sessions. They are helping him to stay in touch with an old friend from his home area. Persistence and consistency have enabled him to take the step to try a new school, which is a first stepping stone to greater stability.

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Requires improvement

Most young people have re-engaged with key workers and with other staff, and with young people’s meetings. One young person joins in on a more irregular basis, and staff have no clear plan to ensure that he is regularly updated on the content of meetings that he misses. This limits his ability to contribute to the day- to-day life of the home, and does not reflect staff enthusiasm for helping him to become more comfortable within it. Young people have contributed to ongoing improvements to each bedroom, design and completion of a comfortable lounge and play room, and equipment and activities that interest them, such as complicated origami, model car racing, playing in sports teams, and as special treats, going to watch professional football matches. Staff have yet to devise clear plans for each young person to take appropriate steps towards becoming independent.

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Requires improvement

There are missed opportunities for staff to support young people to organise their routines to include tidying up, sharing in shopping and cooking, and achieving safe independent travel. This means they are not practising skills that are essential for their futures.

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Requires improvement

All young people are learning to think about the impact of their behaviour upon themselves and upon others. Consequently, they are more receptive to the efforts of staff to help them to identify positive measures, such as going for a walk, or removing themselves from a room, if they are feeling stressed. While not always successful, there have been fewer occasions when their behaviour has deteriorated to being outside of staff management capability. This has resulted in a settled and more stable home environment, and fewer incidents of restraint.

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Requires improvement

Managers have reviewed systems and procedures in the home to enable staff to improve how they help to keep young people safe. They have addressed immediate shortfalls, such as inadequate risk management plans. The plans are now succinct and include regularly updated documents that inform staff what to do to help prevent harm, to divert and minimise episodes that may cause harm, and to respond effectively when they believe young people to be at risk of harm. Staff have a clearer understanding of young people’s needs, and are being more persistent in finding ways to help them to engage in the support available to them. They are working with missing from care professionals, with social workers, therapists and with the police, to help the young people to stay safe.

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Requires improvement

Despite efforts to encourage one young person to settle in the home, he has reverted to past behaviour of not attending school, and being missing for most of the day and evening, only contacting the home when he wishes to return. He is identified as at risk of criminalisation, and has been previously identified as at risk of sexual exploitation. Managers have worked with the police and other professionals to ensure that any absence is responded to effectively. Staff follow clear procedures for trying to contact, locate and engage him. Local protection professionals are aware of his needs, because the home communicates with them to enable him to be considered at their weekly multi-professional meeting. They share details about his known associates and the area he frequents, to improve his protection.

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Requires improvement

Staff have reviewed previously helpful strategies, including promoting and supporting family contact, welcoming his friends to the home, and setting up activity opportunities such as football and sports, and trips to see friends. However, he continues to have high levels of being missing, and is unwilling to disclose information about his activities. He has an independent visitor who tries to meet with him on his return to the home, but he has more recently withdrawn from their relationship. His social worker said, ‘They (the home) do not know where he is or what he is doing. He is not safe.’ The multi-professional plans in place to support him have not been updated within agreed timeframes because professionals have been unable to agree a date. The home has been chasing a review, but they have not escalated their concerns to effect a resolution. This places him in a position of increasing risk, as there is drift in actions such as a

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Requires improvement

referral to complete an assessment of risk for sexual exploitation, which should inform professional discussion and plans.

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Requires improvement

Young people are following staff guidance, and are learning to become more tolerant of each other. Episodes of bullying and upset have reduced as staff encourage young people to play together, and share conversations at mealtimes. One young person said, ‘I get on better with the others now… I am learning to take no notice of when they say things I don’t like, and they are getting used to me.’ He sees staff as central in helping him to manage his feelings and behaviour, and had made progress in understanding his responsibility when he has hurt somebody. This progress means that he is building a range of self-help skills to improve his social relationships, and is increasing his confidence and self-esteem. The overall reduction in frequency and severity of incidents demonstrates that positive staff input is having a positive effect. Staff observed that because they are being more consistent and clear with young people, they are less likely to escalate

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Requires improvement

behaviour in an attempt to get their own way. As a result, the number of physical interventions has reduced because staff are quicker and more effective in diverting and defusing behaviour that causes concern. Young people think about how they can manage their stress and upset without hurting others, such as using a pillow to vent their frustration, or going outside to ‘cool off’.

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Requires improvement

Staff and young people devise and review rewards that will help them work towards improvements. Because young people help to identify these strategies, they more readily use them to self-regulate. However, some of the schemes have too many elements for staff to evaluate young people’s progress in each area, to assess whether the reward has been earned. This has created a lack of clarity about how much flexibility is involved in recognising effort over achievement. This undermines the consistent approach that staff are trying to embed. Managers routinely review records of restraint and incidents, and their evaluation is shared with staff so that practice can improve.

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Requires improvement

The home is demonstrably calmer and more welcoming, and this also helps young people to feel safe and relaxed within it. It was evident during the inspection that young people are learning to negotiate their wants and wishes, because they are beginning to trust that staff will respond fairly and promptly to their requests. For example, a young person who had previously resorted to threat and demand, talked instead about the merits and rationale of being allowed safe access to an internet site so that he could learn more about his hobby of origami. He patiently waited for a response, and was engaged in agreeing the rules of access. This approach meant that he could experience safe internet activity as appropriate to his age.

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Requires improvement

Risks associated with young people’s mental health and welfare are more clearly defined, and reviewed alongside the programmes of support that are in place, such as therapy or medication. However, not all staff are trained in the safe administration of medication. This has created occasional error in records, and lack of clarity about when medication is changed. This has not affected the welfare of young people. One young person refuses one of his medications from time to time. Staff have not explored the impact of this with medical professionals, and have no plan in place to manage any potential harm that his refusal creates. Judgement grade

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Inadequate

There has been no registered manager in post since January 2015. Two managers have withdrawn their application to register with Ofsted since July 2015. Although the organisation is seeking to appoint, there is no permanent manager in place. This means there is inconsistent oversight of the home, and that limits its capacity to improve. This has created a pattern of progress and decline that has been reflected in the uneven progress made by young people. Managers have set up systems of communication and oversight that increases the reliability of their assessment of care practice. They are committed to sustain improvement and stability. However, it is early days, and there has been insufficient monitoring of the impact of these changes on the quality of care being provided to assess whether progress will be sustained.

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Inadequate

Through the efforts of the operations manager and recently appointed temporary manager, a plan has been implemented to address serious shortfalls found at the monitoring visit in February 2016. Requirements made at the last inspection have been addressed through a comprehensive improvement plan that is in its early stages of implementation. This includes: assessing staff skills and development needs, improved supervision and a move to reflective practice; a review of care planning documentation; and training in the approach to attachment and positive care model that is set out in the home’s statement of purpose. Progress against two compliance notices has improved the safety and welfare of young people because staff have increased understanding of how to respond to the varied needs of young people in the home.

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Inadequate

Staff say that they have improved the quality of care they provide due to a clearer team-based approach, and access to training in a variety of subjects such as sexual exploitation, positive and pro-active behaviour support, and the impact of young people’s past experiences on their well-being. They say that leaders are driving change as a result of professional discussion and consistent approaches to young people. Although they do not consistently consider how training improves their practice, staff are able to identify where their practice has improved, such as how they implement behaviour management rewards. Due to the breadth of development need, there is still a long way to go to ensure that the team is fully competent. Some training needs have not been identified, such as safe administration of medication. This has prevented staff from being fully competent to undertake this task. During the inspection, managers addressed the shortfall by

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Inadequate

enrolling staff on an urgent programme to ensure that there are sufficient staff on duty to safely administer medication.

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Inadequate

Recording is providing a clearer and more up-to-date picture of young people’s lives. Managers are monitoring care plans, and highlighting when staff fail to include new information. Records of one-to-one sessions and young people’s meetings are linked to their daily experiences and challenges. However, time is needed to embed the positive changes being made. All placing authorities confirmed that the home provides them with timely and informative reports about young people. Managers are proactive in securing appropriate records such as transition plans and education reviews, so that young people can be supported to make progress. However, managers have not escalated their concerns when other professionals failed to engage effectively with one young person’s protection and education plans. This has impaired their ability to promote his needs and safety.

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Inadequate

Staff participate in consultation with the organisation’s therapeutic professional, to provide effective care to young people who live there. A revised healthcare plan integrates information about therapy, specialist support, and general health, so that staff have a clearer picture of young people’s holistic needs. This is yet to be evaluated for impact and effectiveness. Managers have also revised pre-admission procedures, to ensure that all risk assessments are completed prior to young people being offered places. As there have been no admissions to the home, it is not possible to judge the effectiveness of these improvements, and so the requirement remains.

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Inadequate

A significant proportion of the team is relatively inexperienced and unqualified. There is increased stability in the rota, and this has been mirrored in increasingly stabilised relationships between staff and young people that have underpinned the progress that some young people are making in many areas of their lives. Ensuring that staff acquire a suitable qualification remains as a priority, with all staff enrolled on appropriate courses, including management development. The manager meets with the assessor to ensure that staff who are already pursuing their qualification are making progress.

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Inadequate

Independent visitors comment on the recent improvements in the quality of relationships, engagement and progress of young people, and the structure and layout of the home. Managers incorporate their suggestions for further improvement into short action plans, such as focusing on the content of direct work sessions, or reviewing how young people are rewarded. Further plans to improve the home mean that a new kitchen is being installed during the coming weeks. Staff say this is important, because young people are keen to live in a comfortable home, and fabric improvement has helped them to invest in keeping the home in good condition.

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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 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 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

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Information about this inspection

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Information about this inspection

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Information about this inspection

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