Children's home run by A & T Home Limited in Mid Suffolk

This monitoring visit

On 9 May 2016, an inspector undertook a full inspection. The overall judgement was inadequate. This was due to serious concerns about health and safety, medication management and leadership and management of the service. There were particular concerns in respect of staffing sufficiency, continuity of staffing, induction and staff training. Further concerns related to the lack of appropriate information, lack of effective risk management and lack of effective staff guidance on how to meet the children’s complex needs. Following a case review, Ofsted issued one compliance notice instructing the registered manager and responsible individual to lead and manage the service in a way that promotes young people’s welfare and delivers the outcomes set out in the home’s statement of purpose. The completion date for the notice was 24 June 2016. On 27 June 2016, a monitoring visit was undertaken by an inspector. This was to

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This monitoring visit

evaluate the progress made in meeting the actions set in the compliance notice. The visit found that the provider had taken insufficient action to ensure that there are enough staff to meet the children’s individual needs and that working practices promote the well-being and safeguarding of children. Agency staff continue to work inappropriately lengthy periods at the home without a break. For example, on two occasions in June, staff began work at 2pm on day one and completed their duty at 2.30pm on either day four or five, undertaking the ‘sleeping in’ duty on site each night. This does not allow staff an opportunity to leave the home and take a break from the demands of the children in this highly charged home. These working practices potentially have a significant impact on the staff members’ ability to provide safe and effective care. Staffing levels do not consistently ensure that staff are able to be responsive to

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This monitoring visit

meeting the individual needs of the children. For example, a risk assessment for one child identifies that a minimum of two staff members is required to provide support. However, during the monitoring visit, a member of staff was observed, on two occasions, undertaking activity outside of the home with the child on their own, in contravention of this risk assessment. This does not provide safe and effective care and it places children and staff at potential risk of harm. The provider has taken appropriate action to promote stability of the staff team. While staff rotas identify that 14 different care staff have been employed to work in the home since the inspection, the majority of these staff were employed prior to the inspection and are known to the children. The provider has recruited three new members of full-time permanent staff, two of whom have already taken up post, and some agency staff are in the process of transferring to direct flexible

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This monitoring visit

employment arrangements. Thus, consistency has improved and any changes occurring are part of establishing a stable staff team. While, on occasion, agency members of staff continue to be the only staff on duty, they are regular staff who are known to the children. Therefore, while concerns regarding training and establishing competence remain, the impact of relationship changes for the children is reduced. The provider has taken some, but not enough, action to ensure that staff receive suitable training. No staff have undertaken training in child sexual exploitation, and only three staff have completed the basic safeguarding e-learning. This means that staff may not have suitable knowledge to identify or respond to potential safeguarding risks. Six permanent members of staff have now undertaken first-aid training and five have undertaken epilepsy awareness. However, agency staff have not undertaken training in first aid or epilepsy awareness. On three occasions in

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This monitoring visit

June, there was no suitably trained person on shift to deliver first aid in the event of an emergency. One child has epilepsy and the lack of suitably trained staff means that staff may not have the knowledge and skills to respond to emergency situations effectively, potentially placing the children at significant risk. The provider has taken little action to improve the inadequate medication arrangements identified at the full inspection. The majority of staff members who are documented as having administered medication to children have not received training or had their competence in administering or managing medication assessed. This is of particular importance given that one child is prescribed daily medication to manage their epilepsy and emergency remedy medication in the event of a sustained seizure. These poor medication arrangements continue to place children at potential risk of harm from possible medication errors or from

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This monitoring visit

inability to administer emergency remedies safely. The provider has not taken sufficient action to ensure appropriate supervision, induction and guidance for staff. For example, when asked, they were unable to provide any evidence of how new staff, including agency staff, receive suitable information and guidance in respect of the children’s individual needs or procedures to follow in a fire or other emergency. Nor were they able to evidence any professional supervision for staff that reviews and promotes their individual competence. This means that staff may not receive appropriate support and guidance to enable them to perform their roles competently, which includes supporting the children effectively in an emergency. The provider has taken appropriate action to ensure that no child is admitted outside of the criteria set out in the statement of purpose. They have updated the statement of purpose to reflect the wider age range that the home will

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This monitoring visit

accommodate and have applied for a variation to the conditions of registration. The provider is now clear about the need to ensure that any admissions are compatible with the statement of purpose. The current staffing, training, and care arrangements do not, however, conform to the standards of care or therapeutic ethos stipulated in the statement of purpose. For these reasons, it is judged that the home is continuing not to operate in accordance with its statement of purpose. The provider has taken appropriate action to meet the requirement regarding the quality of accommodation, ensuring that young people’s health and safety are suitably protected. All household tools are now stored securely and loose bricks and rubble have been removed. The house is in the process of being redecorated, and fraying carpets have been replaced. Thus, the provider has ensured that young people enjoy safer and enhanced-quality accommodation.

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This monitoring visit

Overall, the lack of adequate staffing levels, induction and training have compromised young people’s safety and well-being, and the young people have not received the appropriate levels of care that any young person should be able reasonably to expect. For this reason, it is judged that the home has not met the leadership and management requirements set in the compliance notice. A further fourteen requirements made at the full inspection were not looked at during this visit, and are therefore repeated. Ofsted will continue to monitor the service.

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Information about this children's home

This children's home is run by a private company. The home is registered to provide a service for up to four children and young people. It is a task-focused assessment unit working with children aged from 7 to 11, helping them to reunite with their families and/or to secure permanence in their futures. The service has a therapeutic ethos, and ongoing family outreach services are available if required.

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Statutory requirements

This section sets out the actions that 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

6: The quality and purpose of care standard In order to meet the quality and purpose of care standard, with particular reference to providing children with a comfortable, good– quality, homely living environment, the registered provider must (2)(c) ensure that the premises used for the purposes of the home are designed and furnished so as to (i) meet the needs of each child; and (ii) enable each child to participate in the daily life of the home. 5 August 2016

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Requirement Due date

10. The health and well-being standard In order to meet the health and well-being standard, the registered person must ensure that (1)(a) the health and well-being needs of children are met. In particular, they must ensure that suitable epilepsy management protocols and guidance are in place to support children who have epilepsy. 5 August 2016

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Requirement Due date

10. The health and well-being standard In order to meet the health and well-being standard, with particular reference to staff refraining from smoking in view of children, the registered person must ensure (2)(a) (iv) that staff help each child to understand and develop skills to 5 August 2016 promote the child’s well-being.

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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 ensure that children are protected from harm and enabled to keep themselves safe, and ensure (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. In particular, they must ensure that individual missing-from-home risk assessments identify the actions that staff should take and the particular vulnerabilities of each child. 5 August 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; (d) ensure that the home has sufficient staff to provide care for 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. 5 August 2016

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Requirement Due date

The registered person must make arrangements for the handling, recording, safekeeping, safe administration and disposal of medicines received into the children’s home. In particular, they must ensure records of medication are accurate, that the stock held correlates with the record of medication held and that clear instructions are in place for the administration of emergency remedies. Furthermore, they must ensure that staff only administer medication when they have received suitable training, and their competency to do so has been assessed. (Regulation 23(1)) 5 August 2016

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Requirement Due date

The registered person must ensure that the requirements of the regulatory reform (fire safety) order 2005 and any regulations made under it are complied with in respect of the home. In particular, they must ensure that all staff who work in the home receive suitable instruction and that the fire risk assessment is maintained under review to reflect changes within the home. Furthermore, they must develop an 5 August 2016 individual emergency evacuation plan for each child. (Regulation 25(2)(b))

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Requirement Due date

The registered person must ensure that at all times, at least one person on duty at the home has a suitable first aid qualification. (Regulation 31 (2)(a)) 5 August 2016

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Requirement Due date

The registered person must only employ an individual to work at the children’s home if the individual is mentally and physically fit for the purposes of the work that the individual is to perform, and when full and satisfactory information is available in relation to the individual in respect of each of the matters in Schedule 2. In particular, they must ensure that suitable references are obtained and verified, and so far as is reasonably practicable verify the reason why any childcare employment or position ended, and identify and explore gaps in employment. (Regulation 32(3)(c)(d)) 5 August 2016

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Requirement Due date

The registered person must ensure that all employees receive appropriate supervision and undertake appropriate continuing professional development. In particular, they must ensure that all staff receive suitable training in restraint, safeguarding, fire awareness, child sexual exploitation, medication, epilepsy and first aid. (Regulation 33(4)(a)(b)) 5 August 2016

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Requirement Due date

The registered person must ensure that within 24 hours of the use of a measure of control, discipline or restraint in relation to a child in a the home, a record is made, and that within five days of the use of the measure, the registered person or the authorised person adds to the record confirmation that they have spoken to the child about the measure. In particular, they must ensure that clear and accurate records are maintained of all physical restraint. (Regulation 35(3)(a)(c)) 5 August 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. In particular, this is in relation to a copy of any education, health and care plan in relation to the child, containing signed consents for medical treatment. (Regulation 36(1)(a)) 5 August 2016

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Requirement Due date

The registered person must keep in relation to a children’s home the records specified in Schedule 4. In particular, this is in relation to a copy of the staff duty roster of persons working at the home, and a record of the actual rosters worked. (Regulation 37(2)(a)) 5 August 2016

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Requirement Due date

The registered person must supply to HMCI, at HMCI’s request, a statement containing a summary of any complaints made during the preceding twelve months and the action that was taken in response to 5 August 2016 each complaint. (Regulation 39(5))

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Requirement Due date

The registered person must notify HMCI and each other relevant person without delay of a significant event in the home. (Regulation 40(4)) 5 August 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 at least once in each calendar year, taking into account the requirement in regulation 12(2)(c) (the protection of children standard). In particular, they must evaluate the potential risks of the nearby canal and railway line. (Regulation 46(1)) 5 August 2016

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Requirement Due date

* These requirements are subject to statutory requirement notice.

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Recommendations

To improve the quality and standards of care further, the service should take account of the following recommendation:

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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. In particular, they should ensure suitable overview of any restraint by a person independent of the incident. ('Guide to the children's homes regulations including the quality standards', page 46, paragraph 9.36)

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Information about this inspection

The purpose of this visit was to monitor the action taken and the progress made by the children's home since its last Ofsted inspection. This inspection was carried out under the Care Standards Act 2000. in 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 this 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 children looked after 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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