Children's Home, Residential special school run by MacIntyre Care in Buckinghamshire

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:

 Requirements relating to monitoring and fire safety have not been fully met.  It could not be demonstrated that in every case thorough checks on the suitability of the staff to work with children and young people have been undertaken.

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because:

 Not all staff have the required level 3 qualification, nor are all of those without a qualification studying for one.

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because:

 The job descriptions for night staff do not detail the expectations of them in their caring role.

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because:

 There has been a shortfall in ensuring that the environment does not pose a risk to young people who self-harm.

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because:

 Some shortfalls were found in the internal and external monitoring processes.

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because:

 Not all significant events have been notified to Ofsted.

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because:

 Some case records are incomplete and/or have incorrect information in them.

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because:

 Some care plans lack information provided by the occupational therapist.

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because:

 Some impact risk assessments, undertaken when a young person for placement is being considered, are incomplete.

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because:

 Relevant people are not consulted on the development of the location risk assessment, and there is limited consideration of the risks that there may be in the local community.

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because:

 There is insufficient challenge to local authorities when they have not planned effectively for a young person’s move out of the home.

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The children's home strengths

 The relationships between staff and young people are a strength, and young people trust staff.  Staff understand young people when they try to communicate their feelings through conventional means or through their behaviour.  Behaviour management has improved. There is a strong focus on using proactive means to support young people with their behaviour, through the effective use of de-escalation techniques, and this had led to a decrease in the use of physical interventions and seclusion.  There is good attendance in education.  Integrated care plans are used across the school and home settings, although some shortfalls were found in ensuring all professionals’ assessments are incorporated into the plans.  There have been improvements in the staff’s awareness of their and others’ roles in safeguarding practice, and their awareness of and practice in using epilepsy protocols have improved.  There have been no young people who have been missing.

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Statutory requirements

This section sets out the actions which must be taken so that the registered persons meet 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 persons must comply within the given timescales.

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Requirement Due date

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

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Requirement Due date

12(d) ensure that the premises used for the purposes of the home are designed, furnished and maintained so as to protect each child from avoidable hazards to the child’s health. This is with reference to ensuring that the environment does not pose a risk to young people who self-harm, and in particular with reference to head butting. 17 July 2016

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Requirement Due date

The registered person must recruit staff using recruitment procedures that are designed to ensure children’s safety. The registered person may only employ an individual to work at the children’s home, or, if an individual is employed by a person other than the registered person to work at the home in a position in which the individual may have regular contact with children, allow that individual to work at the home, if the individual satisfies the requirements in paragraph (3). The requirements are that the individual is of integrity and good character; the individual has the appropriate experience, qualification and skills for the work that the individual is to perform; the individual is mentally and physically fit for the purposes of the work that the individual is to perform; and full and satisfactory information is available in relation to the individual in respect of each of the matters in Schedule 2

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Requirement Due date

Ensure that an individual who works in the home in a care role has the appropriate qualification if, by the relevant date, the individual has attained the level 3 diploma for residential childcare (England) (‘the Level 3 Diploma’); or a qualification which the registered person considers to be equivalent to the 15 July 2016 level 3 diploma. The relevant date is, in the case of an individual who starts working in a care role in a home after 1st April 2014, the date which falls two years after the date on which the individual started working in a care role in a home; or, in the case of an individual who was working in a care role in a home on 1st April 2014, 1st April 2016 (Regulation 32(4)(5)).

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Requirement Due date

After consultation with the fire and rescue authority, the registered person must take adequate precautions against the risk of fire (Regulation 25(1)). 15 July 2016

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Requirement Due date

The registered person must without delay notify HMCI of all significant events in the home as defined in the corresponding regulation (Regulation 40(4)). 15 July 2016

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Requirement Due date

The registered person must maintain records (‘case records’) for each child which include the information and documents listed in Schedule 3 in relation to each child; are kept up to date; and are signed and dated by the author of each entry. This is with specific reference to ensuring that case records are accurately maintained (Regulation 36(1)(a)(b)(c)). 15 July 2016

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Requirement Due date

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

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Requirement Due date

13(2)(h) use monitoring and review systems to make continuous improvements in the quality of care provided in the home. This is with specific reference to improving the systems currently used and ensuring that the monitoring carried out by the independent visitor is rigorously undertaken and reports on their view of the quality of care and safeguarding practice. 15 July 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

 The specific responsibilities of the home towards supporting the health and well-being of each child should be agreed with the placing authority and recorded in the child’s placement plan. It is the joint responsibility of the registered person and the placing authority that this is agreed at the time of placement. This is with specific reference to ensuring that the outcomes of assessments carried out by professionals, such as occupational therapists, are integrated into the relevant child’s care plan (’Guide to the children’s homes regulations including the quality standards’, page 34, para 7.7).  The registered person should only accept placements for children when they are satisfied that the home can respond effectively to the child’s assessed needs, as recorded in the child’s relevant plans, and when they have fully considered the impact that the placement will have on the existing group of

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Recommendations

children (’Guide to the children’s homes regulations including the quality standards’, page 56, para 11.4).

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Recommendations

 The registered person should evidence what they have done to achieve engagement, including any actions taken to escalate concerns. This is with specific reference to challenging local authorities that have not developed a transition plan for a young person in a timely way (’Guide to the children’s homes regulations including the quality standards’, page 11, para 2.3).   Review the appropriateness and suitability of the location of the premises used for the purposes of the children’s home with reference to the non-statutory advice about the location assessment process (’Guide to the children’s homes regulations including the quality standards’, page 64, para 15.1).    Ensure that everyone working at the home understands their roles and responsibilities and what they are authorised to decide on their own initiative. This is with specific reference to developing job descriptions for night staff that

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Recommendations

clearly set out the expectations placed on them in their role (’Guide to the children’s homes regulations including the quality standards’, page 54, para 10.20). 

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Information about this children's home

This service is a residential special school registered as a children's home for young people with severe learning disabilities, and is run by a large independent organisation. The school accommodates up to 40 young people in seven separate houses, usually on a 52-week placement basis.

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Recent inspection history

Inspection date Inspection type Inspection judgement

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Recent inspection history

17 November 2015 Interim Sustained effectiveness

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Recent inspection history

1 December 2014 Interim Declined in effectiveness

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Requires improvement

Young people develop positive relationships with the staff who work throughout the day with them in the education and care settings. Staff know young people well and are alert to their individual signs of upset. Staff are proactive in calming them through the use of effective distraction techniques, before things become too distressing for them. They are also skilful at ensuring that one young person’s distress does not have an impact on the rest of the group, as far as is possible. Staff communicate with young people effectively, using their preferred means of communication, such as the picture exchange communication system and sign language. Staff understand what the young people are trying to communicate. Young people develop their skills in communicating effectively with others and make their views known. Staff listen to their wishes, establish their feelings and make sure that they feel that they are listened to. Some impressive work has been

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Requires improvement

undertaken to support young people to develop their communication skills. For example, one young person has been able to widen significantly his ability to make his views heard through the use of a computer application. This has opened up many opportunities for him. Attendance in education is good; all young people attend the on-site school. Staff are very good at supporting those young people who struggle with the transitions from home to school and school to home. They patiently explain to the young person what is happening and encourage them, successfully, into school or back home.

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Requires improvement

The therapy team works closely with staff, to develop and implement therapeutic learning plans based on each young person’s needs. These are used across the day in the education and care settings. This integrated approach to care and education provides a consistent approach to looking after each young person. However, occupational therapy assessments for some young people have not been integrated into these plans, and some refer to guidelines from the occupational therapist, which were not available for staff to refer in order to support the young person. Medication administration is a complex task, due to the wide range of and different dosages of medicines that young people need. There have been medication errors, but these have been identified and the manager has recently taken action to attempt to reduce the numbers of errors. A new system for the administration of medication is being trialled in one house.

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Requires improvement

There are good links with the therapy teams and psychiatrist. The work carried out in relation to young people’s mental and psychological health has led to some young people making good progress. For example, there have been significant improvements in some young people’s confidence, and this has led to their integrating with peers in the house and in the community. One young person has joined a youth club and taken part in a talent completion. This has been a significant improvement for him when considering his starting point. There is generally good support for young people to keep in contact with their families and other significant people. This may be over the phone or by the use of video calling. Some impressive work was carried out with a young person who struggles with returning to school when visiting his family home. A flexible approach has been taken to support his return back to school. Staff have worked

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Requires improvement

with parents to set up a routine that is familiar to him, so that he has a better understanding of what is happening. While impact risk assessments are carried out when a new placement is being considered, not all had been fully completed before admission. This means that some assessments have not been developed using full information in order that a clear conclusion about the viability of a placement could be reached. Due to the inaction of some local authorities, there are difficulties in achieving smooth transition arrangements for some young people who are due to move on from the home. The transition workers employed in the home try to progress planning for a young person leaving, to the best of their ability. They develop accessible plans for the young person, but without the benefit of knowing the setting to which they will move. These issues are followed up with the local authority but are not escalated to someone who can influence the decision-making.

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Requires improvement

This is of concern, as some young people who are approaching or have reached 18 have no firm transition plan.

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Requires improvement

The positive relationships that young people have developed with staff have created a nurturing environment. Young people trust them, and staff are attentive towards them. Young people approach staff confidently and are relaxed in their company. Staff are astute at recognising individual signs that a young person may be becoming distressed. Some young people show their distress in subtle ways that are not apparent to someone who does not know them well. Staff interpret these non-verbal clues effectively and address any issues that are worrying the young people. Risk management in relation to individual needs are, overall, effective. There is clear information to help staff to recognise trigger points, and they use effective diffusion techniques. They are skilful at ensuring that young people’s privacy and dignity are respected. For example, some young people have high levels of supervision, and staff respect their right to have time alone in their rooms. Staff

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Requires improvement

support young people who use protective clothing well, in a calm and efficient way that causes them the least distress possible.

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Requires improvement

Due to the young people’s needs, their concept of bullying is limited and restricted to hitting out rather than sustained targeting. Staff are highly aware of the potential for one young person to harm another through words or deeds, and they are usually able to address matters effectively before they escalate.

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Requires improvement

The arrangements for young people’s use of the internet ensure that they use it in a safe way and reap the benefits of the learning opportunities that the internet provides. Wi-fi access is restricted, and staff test out the parental controls from time to time, to ensure that it is being safely used. Training on supporting young people in their use of the internet is planned for staff. There has also been information that covers all aspects of using the internet safely developed for young people.

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Requires improvement

Young people who show self-harming behaviours are appropriately supported to decrease these. For example, thought was given to one young person’s behaviour and ways in which their medication may have an impact on this. Following consultation with health professionals, a change in the young person’s medication was made, and now he does not have to use his restrictive helmet as frequently. However, sufficient thought is not always given to reducing risks in the environment. There has been an emerging pattern of young people using a head- height window, which leads from the hall to the lounge in one of the houses, to head butt. One young person sustained a significant injury that required hospital treatment. Consideration has not been given to whether these windows could be altered in any way, to negate future risks to these or other young people.

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Requires improvement

There have not been any young people wandering out of sight of the staff since the last inspection. This is a positive reduction. Staff were seen to be very alert to where each young person was and whom they were with, and staffing levels are adjusted to enable close supervision of a young person when required.

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Requires improvement

The arrangements for behaviour management have been revised and are far more proactive. Behaviour management plans clearly set out how each young person shows their feelings through their behaviours. The focus of behaviour management is on diffusing situations. This means that issues are addressed before they escalate and require more punitive means of behaviour management. Staff are positive about this new model. They identify that, because there is more emphasis on diffusing situations, the use of physical interventions has decreased and they are only used as a last resort. There has been a further decrease in the use of seclusion over the year, because staff have developed diffusion skills. However, the monitoring system fails to capture all incidents of seclusion. For example, one incident categorised as a safeguarding matter involved an incident of seclusion, and this had not been included in the seclusion data. Thus, this incident has not been used when these

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Requires improvement

There has been an assessment of the suitability of the location. This is limited in its scope. The views of other key agencies and professionals have not been sought in its development, and there is little consideration of any risks that the local community may pose to young people. More-able young people may benefit from having short periods alone in the community, to develop their independence skills, but potential risks have not been identified and assessed.

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Requires improvement

Staff are confident about taking action when safeguarding matters arise. Managers carry out competency checks periodically on members of staff and these help to keep safeguarding uppermost in everyone’s minds. Staff are fully aware of their role in safeguarding young people and of the roles of other agencies and professionals. The leadership has plans to development safeguarding practice further, in that the house managers are being trained as safeguarding leads, to increase the number of people trained at an advanced level.

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Requires improvement

There are recruitment procedures for the employment of staff. There is no reference to the children’s homes regulations in these procedures. Staff files sampled showed that most staff have been through a thorough assessment process to assure their suitability to work with the children and young people. However, the checks for one professional carrying out monitoring work in the home were incomplete. A further shortfall was found in another file: the photo on a passport that was used for identity was not up to date, so it was not possible to verify the applicant’s authenticity.

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Requires improvement

The approach to fire safety in the houses is not rigorous. The following shortfalls were identified:  fire risk assessments are not all updated annually  changes made that had been recommended by the fire officer in one house have not been sustained  young people’s evacuation plans are not always updated when a young person has refused to evacuate the building  the evacuation plans do not all provide staff with clear instruction about how to deal with specific circumstances such as a child having a seizure during an evacuation  the fire doors in one house are being propped open  daily fire checks are not being logged. These shortfalls indicate a lack of awareness about the importance of fire safety.

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Requires improvement

There is an ongoing refurbishment programme in the residential settings, and this is beginning to make a difference to the quality of the environment. Staff report that there have been improvements in getting maintenance jobs done so that the houses are better maintained.

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Requires improvement

The home is managed by a permanent manager who is registered with Ofsted and holds appropriate qualifications. She has been in post since July 2014 and recently gained a level 5 diploma in health and social care. Since the last full inspection, a new responsible individual has been appointed, and she works closely with the manager. The leadership is passionate about improving outcomes for children and has made some improvements since the last inspection. Previous shortfalls regarding  staff’s awareness of epilepsy protocols  the arrangements for making records when a young person goes missing  staff’s awareness of safeguarding practice and the roles of various professionals in safeguarding children and young people  the arrangements for the supervision of staff  the arrangements for medication have all been met. However, there has been a failure to ensure that all of the requirements made at the last inspection have been met. Fire safety arrangements continue to be a

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Requires improvement

concern, and the monitoring by the independent visitor is not rigorous. The monitoring of the home has not been effective in identifying all of the shortfalls found during this inspection. There are shortfalls in the quality of the analysis of issues and a failure to sustain improvements made, for example the recommendations from the fire officer. The reports of the visit carried out by an independent person are not evaluative and do not report accurately and thoroughly on safeguarding matters. The visitor does not report what their view of the quality of care and safeguarding practice is. This is a large site with seven houses, and the organisation employs high numbers of staff to care for the young people. There are dedicated day- and night-staff teams. All but three members of the daytime staff have completed their studies within the timescales or are studying for a level 3 qualification. There are clear

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Requires improvement

plans to support the remaining three staff, who have not gained the qualification within the required timescales, to complete it. None of the night staff members and not all of the bank staff members have level 3 qualification, nor are they studying for one. The job description for the night staff members is not detailed enough. For example, it does not detail the expectations of them in their caring role. Staff reported that they have regular good-quality supervision, and this supports them in their respective roles. There is a wide range of training for staff, which helps to develop their knowledge and skills in caring for young people with complex needs.

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Requires improvement

It is good practice that, when staff leave, they are offered an exit interview so that they can give their views about working in the houses. It is not clear how this information is used to inform staff recruitment and retention. The manager, responsible individual and staff have developed some positive relationships with parents, other agencies and professionals, to support young people’s development. The registered person has not ensured that all notifications have been made to Ofsted, and this means that the regulator is unable to assess whether incidents have been dealt with effectively between inspections. Case records are maintained in the home but some are incomplete and some examples have incorrect dates in them.

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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

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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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