Children's home run by Horizon Care Limited in Cannock Chase

Inspector Maria McGranaghan

Previous inspection judgement Sustained Effectiveness

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Inspector Maria McGranaghan

Enforcement action since last inspection None

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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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This children’s home provision requires improvement because:

 Young people do not benefit from well planned and consistent care.  While placement plans are regularly updated, there is little evidence of how the home work with young people to achieve their documented goals.  Basic health care plans do not address some young people’s difficulty in attending important appointments.  Behaviour management is inconsistent. Behaviour management plans fail to provide individual strategies for managing disruptive behaviours.  Records of consequences are not routinely recorded.  There are regular episodes of disruptive and aggressive behaviour resulting in staff being assaulted and damage to the home.  Some young people’s complaints are not routinely recorded or followed through with an appropriate outcome.  Young people’s wishes and feelings with regard to their individual plans are not routinely sought.  Risk assessments do not detail how the home manages risk or the steps to be

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This children’s home provision requires improvement because:

 Young people are frequently missing from the home. Steps to ascertain their whereabouts are unsuccessful.  Young people with a history of child sexual exploitation do not have specific plans to monitor or reduce any concerns relating to potential exploitation.

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This children’s home provision requires improvement because:

 Records of incidents of bullying are not in place. Therefore, incidents cannot be regularly monitored and reviewed. Action to address bullying incidents is inconsistent.

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This children’s home provision requires improvement because:

 Young people who engage in drug using activities are not suitably challenged. Action to reduce drug use is inconsistent.

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This children’s home provision requires improvement because:

 Friends and acquaintances are not known by staff in order to ensure the safety of young people.

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This children’s home provision requires improvement because:

 Young people’s free time is not reviewed or monitored to ensure their continued safety.  The Registered Manager does not provide the scrutiny required in the monitoring and review of the care provided in the home, therefore areas for development are not routinely identified.  Fire risk management is not updated to reflect changes in the home’s practice.  Impact assessments are completed for new admissions to the home, however strategies are not put in place to manage concerns at the point of admission.

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The children’s home’s strengths

 Young people attend the organisation’s school on a regular basis and make progress from their initial starting points.

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The children’s home’s strengths

 Daily activity planners are in place to encourage young people to try out different activities.

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The children’s home’s strengths

 Family contact is suitably maintained and supported

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The children’s home’s strengths

 The home is maintained to a good standard.

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The children’s home’s strengths

 Staff present as enthusiastic about their role in the home.

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The children’s home’s strengths

 Young people are consulted on certain matters regarding the running of the home.

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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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Reg. Requirement Due date

12 (2) (a) (i) ensure 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 that child. Regulation (12 (2) (a) (i)) 30/08/2016

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Reg. Requirement Due date

12 (2) ( c) ensure that the home’s day-to-day care is arranged and delivered so as to keep each child safe and protect each child effectively from harm (Regulation 12 (20 ( c)) 30/08/2016

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Reg. Requirement Due date

13 (2) (f) ensure managers understand the impact of 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 (Regulation 13 (2) (f)) 09/09/2016

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Reg. Requirement Due date

14 (1) (a) ensure young people receive effectively planned care (Regulation 14 (1) (a)) 09/09/2016

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Reg. Requirement Due date

25 (2) (b) ensure the registered person works in line with the Regulatory Reform (Fire Safety) Order 2005 and any regulations made under it Regulation 25 (2) (b)) 30/08/2016

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Reg. Requirement Due date

10 (1) (a) (b) (c ) ensure the health and well-being needs of young people are met. Young people receive advice, services and support in relations to their health and well-being and are helped to lead healthy lifestyles (Regulation 10 (10 (a) (b) ( c)) 09/09/2016

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Reg. Requirement Due date

39 (3) ensure the registered person keeps a record of any complaint made by a young person and the action, response and outcome of any investigation (Regulation 39 (3)) 09/09/2016 40 (4) (e) ensure the registered person notifies without delay incidents which relate to a young person which the registered person considers to be serious (Regulation 40 (4) (e)) 09/09/2016

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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 staff understand what they must do to prevent bullying by other young people. Staff should be able to recognise and address signs of bullying. The Registered persons must ensure that procedures for dealing with allegations of bullying are in place and staff have the skills required to intervene, protect and address bullying behaviour effectively. (The Guide to the Quality Standards 8.16 page 39 paragraph 8)

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Recommendations

 ensure that where there is a possibility that a child will run away or go missing from a children’s home placement, their placement plan should include a strategy to minimise this risk. (The Guide to the Quality Standards 9.24 page 45 paragraph 2)

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Recommendations

 ensure the behaviour management strategy is understood and applied at all times by staff, and must be kept under review and revised where appropriate (The Guide to the Quality Standards 9.34 page 46 paragraph 4)

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Recommendations

 ensure the registered person is responsible for leading a team which provides high quality of care for all children living in the children’s home. They must lead and manage the home in a way that delivers the ethos, outcomes and approach as set out in the home’s Statement of Purpose. They should also play a key role in shaping the ethos of the home through developing a culture of high aspiration for children which is demonstrated through the care, resources and opportunities offered to the children (The Guide to the Quality Standards 10.4 page 52 paragraph 3)

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Recommendations

 ensure that each young person is provided with support to communicate their views, wishes and feelings and participate as fully as possible in all aspects of their care planning and daily care (The Guide to the Quality Standards 4.6 page 22 paragraph 2)

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Recommendations

 ensure that young people are actively encouraged to read their records and to add further information to them (The Guide to the Quality Standards 14.6 page 62 paragraph 4)  ensure that the registered person reviews all incidents of control, discipline and restraint and provides regular scrutiny to ensure their use if fair and suitably recorded (The Guide to the Quality Standard 9.36 page 46 paragraph 6)

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Recommendations

 ensure that any individual appointed to carry out visits to the home as an independent person must make rigorous and impartial assessment of the home’s arrangements for safeguarding and promoting welfare of the young people in the home’s care (The Guide to the Quality Standards 15.5 page 65 paragraph 4)

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Recommendations

 ensure the registered managers monitoring of the home includes a review that focuses on the care provided by the home, the experiences of the young people living there and the impact the care is having on outcomes and improvements for the young people. (The Guide to the Quality Standards 15.2 page 64 paragraph 5)

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Recommendations

 ensure staff continually and actively assess the risk to each child and the arrangement in place to protect them, with particular regard to initial impact assessments. Where there are safeguarding concerns, their placement plan, agreed between the home and the placing authority, must include details of the steps the home will take to manage any assessed risk on a day-to-day basis (The Guide to the Quality Standards 9.5 page 42 paragraph 5)

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Information about this children’s home

This home is run by a private organisation and is registered to provide care and accommodation for three young people with emotional and behavioural difficulties.

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Recent inspection history

Inspection date Inspection type Inspection judgement 04/02/2016 Interim Sustained Effectiveness 28/07/2015 Full Good 13/02/2015 Interim Sustained Effectiveness

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Requires Improvement

Since the last interim inspection in February 2016 there have been two young people discharged from the service and two new residents admitted to the home. The manager has undertaken a fit person interview and is now registered with Ofsted. Young people living at the home have a history of non-engagement within educational services. All young people attend the organisation’s off-site education provision, and attendance, on the whole, is consistent. Young people make steady progress and have successfully completed basic skills examinations in Maths and English. One young person said, ‘I like school. I want to complete my GCSEs and do well.’ Staff say, ‘Young people receive a high level of support and this helps them to make progress in education.’ All young people have regular contact with family members. Contact is arranged and supported by staff to take place either in the children’s home, in the area the child is

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Requires Improvement

from or in a mutually agreed place. Where appropriate staff provide supervision in order that contact is positive and beneficial for the young person. Consequently, young people maintain contact with those who are important to them. Young people’s individual placement plans are reviewed and updated monthly. Targets are highlighted with a view to encourage and support positive outcomes. However, these plans do not state what work needs to happen to help young people achieve these targets. Likewise, keywork sessions do not relate to individual plans or review the progress toward each assessed target. Young people say ‘I haven’t seen my plan, I don’t know what is on it.’ Consequently, the identified individual needs of young people are not consistently addressed. A requirement is made in respect of this matter. Young people are registered with local health care professionals and, on the whole, attend routine appointments without concern. However, young people do not benefit

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Requires Improvement

from a detailed health care plan to address, emotional, physical and social needs. For example, strategies to enable some young people to attend medical appointments where they refuse. Likewise, where young people frequently use cannabis, there are no strategies in place to assist in reducing this behaviour or concerns documented about the impact on their physical and mental health. As a result, young people’s health is not suitably assessed, monitored or reviewed. Likewise, the home is supported by an in-service psychologist who visits the home frequently. Some young people engage in this service and staff are provided with detailed assessments which include next steps and behavioural support methods. Likewise, the psychologist attends occasional staff meetings to discuss and support young people’s progress in the home. However, strategies for next steps are not incorporated within the young people’s daily plans. The registered manager said, ‘We

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Requires Improvement

are aware of the assessments and although there has been a delay, we are working towards implementing the suggested targets.’ As a result, some young people are not benefitting from the professional psychological support offered in the home. A requirement is made in respect of this matter. Young people confirm they know how to make a complaint and they are taken through this process upon admission. A young person said, ‘We make complaints but don’t always know if anything happens.’ Some records of complaints are inconsistent. For example, an initial response letter for a complaint is held on a resident’s file but is not recorded in the homes record of complaints. Furthermore, the complaint did not have an outcome or documentation to support a suitable investigation. A staff member said, ‘Young people make complaints all the time and many are discussed in the young people’s meetings but not always recorded in the

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Requires Improvement

home’s log.’ Consequently, systems to ensure all complaints are managed in accordance with the home’s policy are inconsistent. A requirement is made to address this matter. Young people are encouraged to suggest and attend activities ranging from snowboarding to the gym. In house activities are also made available such as board games, cards, pamper nights and DVDs. Young people say, ‘I have been on a few activities and they were alright. Providing there is nothing else going on, staff will always try and take some of us out.’ Daily activity planners are displayed in the home and young people were observed checking out the activity plans for the day. Weekly house meetings take place where young people are invited to suggest how the home can develop. Comments include suggestions on décor, board games and menus. As a result, new board games were purchased, menus now include a second option and the décor is in line with young people’s suggestions. However, young

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Requires Improvement

people are not consulted with regard to their individual plans. Placement plans, health care plans, risk assessment and behaviour management plans are developed and reviewed by staff. The registered manager said, ‘The young people are not interested in their plans and do not engage with staff if they try to discuss them with them.’ As a result, young people are not consulted on the purpose of their individual plans or how they are to achieve their goals. A recommendation is made to address this matter.

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Requires Improvement

Since the last inspection there have been two new admissions to the home. The registered manager undertakes impact risk assessments prior to admission in order to make a decision of the suitability of potential new admissions. However, where new residents have a history of instability, missing from home and child sexual exploitation, managers do not suitably consider how they are to meet the young person’s presenting needs. For example, by setting up plans to reduce risk at the point of admission. Consequently, managers and staff work on a reactionary approach to the risk factors presented by young people. A recommendation is made to address this matter.

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Requires Improvement

Generic risk assessments are completed for most young people in the home. Assessments identify risks including, missing from home, child sexual exploitation and behaviours including fire setting and aggression. Risks are reviewed monthly by managers and staff. However, assessments do not identify how risks are to be managed, what strategies are to be used or what methods are in place to reduce risks. The registered manager said, ‘All staff know what to do because we discuss it in the team meetings.’ Although there are records of discussions regarding aggressive behaviours, there are no clear directives regarding the management of the risks within the assessments. A staff member said, ‘There are inconsistencies between how staff manage things and I understand that we need to address this.’ Consequently, the risk management processes within the home are not effective in addressing and suitably managing risks. A requirement is made in respect of this

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Requires Improvement

Young people are regularly missing from home. Incidents of missing range from several hours to several days. Managers and staff follow protocols including searching for the young person and reporting them as missing to the relevant agencies. When young people return to the home, safe and well interviews are consistently undertaken. However, missing from home plans are not in place to identify strategies for the reduction of missings or identified work on managing the risk of being missing. Likewise, records of young people being missing are inconsistent. For example, the number of incident reports relating to a missing episode do not tally with the record of incidents occurring. As a result, there is a lack of clarity among staff with regard to the overall reduction and management of those young people who are frequently missing from home. A recommendation is made to address this matter.

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Requires Improvement

Some young people find great difficulty in managing their own behaviour. This results in frequent bouts of aggression, assault and damage. Staff say, ‘We try and diffuse or ignore behaviour but sometimes we are assaulted. However, there are no behaviour management plans in place. Discussions with the registered manager and staff highlight that sanctions are imposed, such as vehicle bans and restricted pocket money, although they are not formally recorded. Currently, the response to young people’s behaviour is reactionary rather than planned. Consequences are inconsistently applied and there are no clear agreed boundaries for which young people can work toward. A recommendation is made to address this matter.

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Requires Improvement

Records of incidents of bullying are not held in the home. However, there is evidence of keywork sessions that refer to incidents of bullying from a victim’s perspective. A young person said, ‘Staff try and deal with it but generally the young people will go and spend time in their room to get away from it.’ The failure to record incidents of bullying means that they cannot be monitored or reviewed for patterns or trends or if they have been effectively managed. A recommendation is made to address this matter.

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Requires Improvement

Staff encourage young people to develop friendships away from the home. Some young people are provided with travel passes in order to meet friends and spend time with them. However, staff are unclear where young people are travelling too, who they are spending time with or what they are doing. Young people are not checked to ensure their continued safety. Staff say, ‘Some young people are secretive and don’t want us to know their business. On most occasions they come home in time for curfew.’ However, evidence suggests that some young people return under the influence of cannabis. The registered manager said, ‘While we suspect they are under the influence, we cannot prove it.’ The day-to-day arrangements for young people fail to take into account risk factors specifically when young people are away from home. A requirement is made in respect of this matter.

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Requires Improvement

There are occasions when young people’s behaviour poses a risk to themselves or others. On some of these occasions staff have used suitable physical intervention as a measure to safeguard young people. Records evidence that measures used are minimal and last for a short space of time. On the whole young people and staff are provided with a debrief to discuss the reasons for the intervention and to evaluate the outcome. However, the records are inconsistent. For example, incident reports detailing behaviours warranting the use of physical intervention do not marry up with the formal records of intervention. Consequently, inconsistent record keeping results in a lack of clarity, monitoring and review of the use of physical intervention in the home. As a result, a recommendation is made to address this matter.

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Requires Improvement

The registered manager has over twenty years’ experience working with children and young people in a residential setting. She is qualified at NVQ level three and is enrolled on the level five diploma in leadership and management The registered manager has managed this home on a temporary basis previous to becoming the permanent manager.

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Requires Improvement

Internal and external monitoring takes place at regular intervals and reports are provided to Ofsted in accordance with regulation. However, both the internal and external monitoring reports do not identify inconsistent practice specifically regarding placement planning and managing risk. Critical monitoring is essential to ensuring consistent quality of care in the home and highlighting areas for development. A recommendation is made in respect of this matter.

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Requires Improvement

Fire drills and service tests are carried out in order to protect young people in the event of a fire. Firefighting equipment such as fire extinguishers and fire blankets are held in the home and regularly checked. However, some of this equipment is stored in a locked cupboard. The Fire Safety Officer said, ‘Where the home is experiencing difficulty with young people misusing extinguishers it can be deemed safer for equipment to be stored in a locked cupboard providing extinguishers are equally distributed on all floors, risk assessments are updated and all staff are aware of the location in which they are stored.’ While staff are aware of the location of extinguishers, risk assessments are not updated and there is not an even distribution of extinguishers on the three floors of the property. Consequently, in the event of a fire a clear formalised plan is not in place to guide staff should access to the locked

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Requires Improvement

cupboard be blocked. A requirement is made to address this matter.

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Requires Improvement

Young people are supported by a diverse staff team. The majority of staff are qualified at NVQ level three and most have experience in working within a residential setting. Young people say, ‘I like most of the staff, we get on ok. I can talk to them if I need to and they will help me.’

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Requires Improvement

Staff confirm they are now in receipt of regular supportive supervision. They feel that the registered manager is helpful and approachable and will offer advice and guidance regularly. According to managers and staff, on-line staff training takes place at regular intervals. A record of training undertaken was not available at the time of inspection and therefore could not be reviewed.

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Requires Improvement

Young people’s records are securely held within the home to protect confidentiality. While records are regularly reviewed the registered manager does not identify deficits in the recording and planning for care as identified within this report. It is clear that the registered manager has spent time supporting staff and young people since becoming the manager of the home. However, the focus must now be on ensuring all records lead the way forward in the care of young people living in the home. A requirement is made to address this matter.

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Requires Improvement

Notifications of serious events are not routinely forwarded to Ofsted in accordance with regulation. For example, young people who are missing for extended periods of time, including those who are at risk of child sexual exploitation. Failure to forward this information to Ofsted means that the regulatory body does not receive a consistent overview of concerns within the home or how they are being managed. A requirement is made in respect of this matter.

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Requires Improvement

At the last interim inspection in February 2016 no requirements or recommendations were made. In order to address the shortfalls in practice eight requirements and ten recommendations are made to improve practice.

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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 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.

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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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