Children's home run by South West Mental Health Ltd in Somerset

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:

 This home requires improvement, because not all the regulations for children’s homes are met. The manager has not effectively or critically scrutinised the records of significant incidents to identify where practice can improve. While these are important issues and must be improved, it is not evident that the weaknesses impact on the current young people living in the home, although previous residents were affected.

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The children's home provision requires improvement because:

 The education arrangements for the two young people require improvement. One young person is tutored at the home for two days a week and the education arrangements for the second young person have yet to be established.  The extent to which young people are protected requires improvement to be good. Not all significant matters, including complaints and self-injurious behaviours, are shared with safeguarding agencies and/or reported to Ofsted. In addition, the outcomes of child protection concerns are not always comprehensively recorded.

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The children's home provision requires improvement because:

 The vetting of new staff requires improvement to evidence how managers have determined that new staff are suitable to work in the home.

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The children's home strengths

 The manager and staff team have a positive, ‘can-do’ attitude. They are motivated and enthusiastic about the young people whom they care for. Those who contributed to this inspection describe the staff team as ‘dedicated, resilient and caring’.

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The children's home strengths

 The two young people living in the home continue to make progress, albeit in small steps. Effective links are established with local healthcare services. The staff are provided with clinical supervision. This helps them to try to understand the young people’s behaviour and to respond to their needs.

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The children's home strengths

 Young people are developing and strengthening their relationships with family members. Staff support and encourage family contact. Where appropriate, they supervise visits in accordance with young people’s individual care plans.

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Information about this children's home

The children’s home is operated by a private company. It is registered to provide care and accommodation for up to five young people who may have mental health disorders.

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Recent inspection history

Inspection date Inspection type Inspection judgement

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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

12; The protection of children standard In order to meet the protection of children standard, the registered person must; (2)(a) ensure staff

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Requirement Due date

12: The protection of children standard (v) understand the roles and responsibilities in relation to protecting children that are assigned to them by the registered manager (vi) take effective action whenever there is a serious concern about a child’s welfare; and (vii) are familiar with, and act in accordance with, the home’s child protection policies (b) the home’s day to day care is arranged and delivered so as to keep each child safe and to protect each child effectively from harm; 29 July 2016

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Requirement Due date

13: The leadership and management standard In order to meet the leadership and management standard, the registered person must: (2) (a) lead and manage the home in a way that is consistent with the approach and ethos, and delivers the outcomes, set out in the home’s statement of purpose; (c) ensure that staff have the experience, qualifications and skills to meet the needs of each child; (e) ensure that the home’s workforce provides continuity of care to each child; (f) understand the impact that the quality of care provided in the home is having on the progress and experiences of each child and use this understanding to inform the development of the quality of care provided in the home; (g) demonstrate that practice in the home is informed and improved by taking into account and acting on— 29 July 2016 (ii) feedback on the experiences of children, including complaints received; (h) use monitoring and review systems to make continuous

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Requirement Due date

improvements in the quality of care provided in the home.

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Requirement Due date

35: Behaviour management policies and records

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Requirement Due date

The registered person must ensure that, within 24 hours of any measure of restraint, a record is made which includes the details in section (3)(a)(i-viii) of the regulation, and that, within 24 hours of the use of any restraint, the registered person (i) has spoken to the user about the measure and (ii) has signed the record to confirm it is accurate (Regulation 35(3)(a)(i-viii) (b)(i-ii)). 29 July 2016

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Requirement Due date

40: Notification of a serious event The registered person must notify HMCI and each other relevant person without delay if there is any other incident relating to a child which the registered person considers to be serious. (Regulation 40 (4)(e)) 29 July 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):

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Recommendations

 Ensure that all incidents of control, discipline and restraint are subject to systems of regular scrutiny to ensure that their use is fair and the principles as set out in 9.35 are respected (‘Guide to the children's homes regulations including the quality standards’, page 46, paragraph 9.36).

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Recommendations

 Ensure that the company maintains good employment practice. The registered person must ensure that recruitment, supervision and performance management of staff safeguards children and minimises potential risks to them. In particular, ensure that prospective employees record full information on the application form, including the months and years when their previous periods of employment started and ended; that additional references are obtained where required and that records evidence how managers have decided prospective staff are suitable to work in the home. (‘Guide to the children’s homes regulations including the quality regulations’, page 61, paragraph 13.1).

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Recommendations

 The registered person should ensure that all staff are familiar with the home’s policies on record keeping and understand the importance of careful, objective and clear recording. Information should always be recorded in a way that will be helpful to the child (’Guide to the children’s homes regulations, including the quality standards’, page 62, paragraph 14.4).

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Requires improvement

This is the homes first inspection since registration in November 2015. The home provides care for young people who have high-risk behaviours that pose a risk to themselves or others. Despite two young people’s placements ending because their needs could not be met, the admission process is rigorous, and contributes to leaders and managers making considered placement decisions.

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Requires improvement

Senior managers who are healthcare professionals ensure that a comprehensive assessment is undertaken when considering a new placement into the home. They review referral information, visit the young people, consult with external professionals and, if appropriate, meet with previous placements, parents and family members.

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Requires improvement

Following the end of one young person’s placement senior managers identified weaknesses in their links to the child and adolescent mental health teams. They have taken action to establish a better working relationship that will benefit young people.

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Requires improvement

Young people’s challenging behaviour is not always managed well. There are examples of staff’s actions escalating young people’s behaviour. At times, this has resulted in the police being called and, on one occasion, a young person being criminalised. Conversely, there are some good examples of staff supporting young people well, preventing them from hurting themselves.

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Requires improvement

The education arrangements for the two young people in placement require improvement. The registered manager, who has been a strong advocate in trying to resolve this deficiency, has been persistent in pursuing educational services. Although not successful to date, she has liaised with the local authority and virtual school head to ensure that the young people’s educational requirements are given priority. A discussion with a placing social worker confirmed that a tutor is now being sourced to provide education for one young person until a suitable school placement can be identified. She confirmed that a contributing factor for the delay is associated with school holidays and the limited resources available within the local area.

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Requires improvement

High staffing levels mean that young people are provided with one-to-one care. The staff team know the young people well, and encourage them to achieve and make progress. Staff are focused and enthusiastically support young people to achieve their potential. They are successful in supporting young people to maintain regular and positive contact with family members. Both young people are encouraged to try new activities that broaden their interests and promote healthy lifestyles. One young person enjoys horse riding, while another benefits from enjoying time on the beach because of living near a seaside resort, as well as walking a dog in the nearby woods.

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Requires improvement

There is varied practice in managing safeguarding concerns. Some concerns have been managed well and reported in line with policies and procedures. However, during a small number of incidents, a young person has made comments about staff that could be allegations. Leaders and managers did not consult with safeguarding agencies about these comments to consider what action needed to be taken. Some records of child protection concerns do not comprehensively document the outcome of the concern. In response to these weaknesses, the registered manager has booked herself on an allegation management course facilitated by the Local Safeguarding Board.

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Requires improvement

Safer recruitment processes require improvement to be good. Although a risk assessment was undertaken, the manager has not kept written records to evidence her discussion with a member of staff about a declaration on a disclosure and barring check. References for staff are sought and verified, but some references provide limited information. In these cases, additional references are not routinely requested. Some staff have not provided specific dates of their previous employment history. At times, the month of employment is omitted. Managers have not insisted on this information being provided. As a result, it is not evident how leaders and managers have decided that staff are suitable.

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Requires improvement

For one young person, the use of physical intervention has decreased considerably since being placed at the home. This is a result of the care team’s ability to understand the young person’s needs and to communicate effectively with her using sign language. Staffs’ approach with this young person has kept her safe and resulted in decreased incidents of attempted self-harm.

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Requires improvement

Staff receive regular clinical supervision from a mental health professional to try to help them to understand the young people’s individual needs. As a result, staff have a sound understanding of self-harm and young people’s mental health needs. They work collaboratively with external agencies to ensure young people receive the support they require to support their emotional health and wellbeing.

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Requires improvement

Staff act effectively to protect young people when they feel angry or upset and then leave the home. Staff follow young people and encourage them to return to the home. Staff spend time with young people trying to understand the reasons why they are upset and help them to find ways to manage these feelings appropriately. There has been one incident of a young person going missing from staff’s sight during one of these incidents. The staff phoned the police and searched for the young person who returned quickly and without harm.

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Requires improvement

Young people are provided with good opportunities to talk with adults about their views. The independent visitor always speaks privately with young people. The manager has ensured one young person meets regularly with an interpreter to help her to express her views and to discuss incidents that have occurred. Young people are confident at raising complaints and could identify adults who they trust to listen to them.

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Requires improvement

Arrangements for the safe storage and administration of medication are working effectively. Daily handovers include staff undertaking a medication audit. Any errors identified in the records are swiftly corrected. All staff have received training from a local chemist in administering and dispensing medication. In addition, they hold a first aid qualification and are able to respond quickly to any medical issues.

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Requires improvement

Young people live in a home that is well cared for and maintained to a good standard. Following incidents of attempted self-harm staff have taken effective action to ensure the environment is safe and secure.

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Inadequate

Senior leaders’ and managers’ oversight of the practices in the home has not been rigorous. The registered manager’s review of incidents has not been sufficiently challenging to identify weaknesses, and to learn lessons to remedy and improve staff practice.

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Inadequate

Records of restraint do not capture all the information required. They do not consistently reflect the actions taken by staff to manage and prevent incidents from escalating. The manager’s monitoring of these records has not identified these weaknesses. An incident report states that a young person was targeting a senior manager. The senior manager failed to recognise this behaviour was escalating because of her presence. She did not disengage herself and allow the care team to manage the situation. As a result, the police were called and the young person was charged with assault. Subsequently, the home terminated the young person’s placement as they felt they could not keep him and other people safe from similar behaviours occurring again. Immediately after the inspection, the registered manager analysed this incident and a number of others and completed a detailed report on how, moving forward, she would robustly scrutinise records. The manager identified the importance of

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Inadequate

reflective practice, what lessons could be considered after each incident, and the importance of tracking patterns and trends in behaviours. She informed the inspector that her monitoring of significant incidents is critical to improving the care team’s skills and abilities. The manager’s report demonstrated that she is able to analyse incidents effectively and identify ways to improve the quality of care in the home. However, the impact of this is yet to be tested.

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Inadequate

Not all significant incidents are reported or shared with the appropriate authorities. One young person’s complaint was not reported to the local authority designated officer, because he retracted it and refused to complete a complaints form. An incident of the police being involved when a young person went missing, and a number of incidents of significant self-harm attempts have not been notified to Ofsted as required.

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Inadequate

The statement of purpose sets out the values and objectives of the home. It has been kept under regular review to describe the service accurately. However, the home does not have a police intervention policy. One young person’s behaviour support plan specifically advised staff to call the police in response to certain behaviours. The registered manager states that she does not advocate criminalising young people yet she failed to challenge this plan. As a result, the police have been called to manage young people’s behaviour.

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Inadequate

Independent monitoring of the home takes place regularly. Reports are generally informative, however, the independent visitor’s monitoring has not identified the weaknesses found at this inspection. The independent visitor confirmed that the manager acts promptly to remedy any actions that arise from his visits.

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Inadequate

The physical environment is well maintained. Adaptations have been made to meet the needs of individual young people who are deaf. Plans to improve the home are ongoing, and there is capacity for continuous improvements, particularly as sufficient care staff have recently been recruited. This will reduce the need for and the use of agency staff to support the home’s rota.

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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.

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What the inspection judgements mean

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.

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What the inspection judgements mean

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.

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What the inspection judgements mean

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 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.

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Information about this inspection

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 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

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Information about this inspection

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Information about this inspection

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