Children's Home run by PCT Care Services Limited in Norfolk

Inadequate

There are serious and/or widespread failures that mean children and young people are not protected or their welfare is not promoted or safeguarded

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The children's home provision is inadequate because:

 The management of enuresis has not been effective. Staff have not dealt with this sensitively in order to preserve children’s dignity and confidentiality.  Children have not been given appropriate clothing.  The home has not been maintained to a suitable standard, there is damage to some areas and some furniture is broken. This does not provide a welcoming environment for children to live in.  The high turnover of staff continues. This limits children’s ability to form relationships with all staff and lessens their sense of stability.  The arrangements for managing medication when children are away from the home are not effective.  Children are not being supported effectively in all areas of their preparation for independence.  Some children’s requests for an independent visitor have not been followed up by staff.  Staff have not kept the environment sufficiently safe. Hazardous materials, such as white spirit, have been left in places where children can access

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The children's home provision is inadequate because:

them.  Children’s risk assessments do not contain sufficient information to help staff to identify and reduce some areas of risk. These include internet safety while away from the home and understanding about safe and appropriate behaviour.  Some specific issues, such as staff lone working while on holiday with children and children self-administering medication, have not been appropriately risk assessed.  Records of restraints and sanctions are not complete and do not enable managers and staff to consider how they can reduce the high incidence of restraint.  Some notifications of serious incidents have not been sent to Ofsted.  Monitoring has been ineffective in identifying shortfalls in the quality of care provided to the children.  Managers have not been effective in addressing the shortfalls identified at the previous inspection.  There is no appropriate induction process for staff to help them to

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The children's home provision is inadequate because:

understand their roles in looking after children.  Some action points from the fire risk assessment have not been addressed.  There is no registered manager in post.

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The children's home strengths

 Throughout some challenging times at the home, children’s education, attendance and engagement have continued.  One child has been supported to maintain her significantly reduced levels of risk-taking behaviour.

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Statutory requirements

This section sets out the actions that must be taken so that the registered persons 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 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 the management of enuresis, the provision of clothing, support for children and the condition of the home, the registered person should ensure that (2)(b)(iii) each child is treated with dignity and respect; (c)(i) the premises used for the purposes of the home are designed and furnished so as to meet the needs of each child. 30/09/2016

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Requirement Due date

12. The protection of children standard * In order to meet the protection of children standard, with particular reference to the safe storage of substances, the use of comprehensive risk assessments and risk assessments for specific issues, the registered person should ensure that (2)(a)(i) 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; (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. 30/09/2016

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Requirement Due date

13. The leadership and management standard In order to meet the leadership and management standard, with particular reference to the consistency of staffing, the impact of the stability of the home on children, finding alternatives to reduce restraint of children, using appropriate and effective sanctions and monitoring of the service, the 30/09/2016 registered person should (2)(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; (h) use monitoring and review systems to make continuous improvements in the quality of care provided in the home.

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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. This relates to medicines that are taken when children are away from the home on contact or visits to friends. (Regulation 23(1)) 30/09/2016

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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. This relates to the implementation of actions identified in the fire risk assessment. (Regulation 25(2)(b) 30/09/2016

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Requirement Due date

The registered provider must appoint a person to manage the children's home. (Regulation 27(1)) 30/09/2016

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Requirement Due date

The registered person must ensure that all employees complete an appropriate induction. (Regulation 33 (4)(a)) 30/09/2016

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Requirement Due date

The registered person should ensure that within 24 hours of the use of a measure of control, discipline or restraint in relation to a child in the home, a record is made which includes the effectiveness and any consequences of the use of the measure, and that within 48 hours of the use of the measure, the registered person, or a person who is authorised by the registered person to do so (‘the authorised person’) has spoken to the user about the measure and has signed the record to confirm it is accurate (Regulation 35(3)(a)(vii)(b)(i)(ii)). * 30/09/2016

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Requirement Due date

The registered person must notify HMCI and each other relevant person without delay if there is an allegation of 30/09/2016 abuse against the home or a person working there. A notification made under this regulation must include full details of the matter. (Regulation 40(4)(c)(5)(a)(i))

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Requirement Due date

The registered person must ensure that an independent person visits the children's home at least once each month and that the reports of the independent person who visits the children's home set out, in particular, the independent person’s opinion as to whether children are effectively safeguarded and whether the conduct of the home promotes children's well-being. (Regulation 44(1)(4)(a)(b)) 30/09/2016

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Requirement Due date

The registered person must complete a review of the quality of care provided for children at least once every six months. The system used in order to complete a quality of care review must include evaluation and provide for ascertaining and considering the opinions of children, their parents, placing authorities and staff. (Regulation 45(1)(2)(5)) 30/11/2016

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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 recommendations:  Ensure that children have access to appropriate advocacy support. (‘Guide to the children's homes regulations including the quality standards’, page 23, paragraph 4.16)

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Information about this children's home

This children’s home provides care and accommodation for up to six young people with emotional and/or behavioural difficulties and learning disabilities. The home is owned by a private company.

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Recent inspection history

Inspection date Inspection type Inspection judgement

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Recent inspection history

18/03/2016 Interim Declined in effectiveness

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Recent inspection history

02/02/2015 Interim Improved effectiveness

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Inadequate

This is the second full inspection of the home, following an inspection judgement of ‘inadequate’ overall in June 2016. This inspection has found the home to provide an inadequate quality of care. Leaders and managers have failed to sufficiently address previously highlighted shortfalls, and further shortfalls have been identified. Children have not received the quality of care that they should rightfully expect. This has an impact on their experiences and progress and has the potential to put them at risk. Staff do not consistently treat children with suitable dignity and respect. Some aspects of children’s care have not been age-appropriate or sensitive. In particular, the management of enuresis has been ineffective and one child’s bedroom was left smelling of urine, and some stained clothing had been left in her bedroom. Inappropriate mattress protection meant that urine soaked into her mattress. Staff

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Inadequate

took her mattress outside to dry. Thus, other children would have been aware of what had happened. This did not protect the child’s dignity and self-esteem. Children’s clothing has not been age appropriate. This does not help children to develop a sense of identity or feelings of self-worth. The quality of accommodation has an influence on children’s day-to-day experiences. There have been some decoration and attempts to brighten the environment. For example, the bathroom has been painted and stickers applied to the walls. However, the carpet is stained and worn and does not fit properly. During the inspection, there were no soap or towel in the bathroom, and some clothing had been left on the floor. Other carpets are dirty and there is damage to some walls. Two of the children’s bedrooms did not have lampshades, some furniture in bedrooms was damaged, a door handle in the living room was broken and broken toys and a broken garden chair were left outside. The toys and chair

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Inadequate

were cleared away during the inspection. This is not good enough for children in care. Photographs of children and some of their pictures have recently been put on the wall to brighten the home and give a sense of ownership. One child showed off her bedroom, which she said she really liked. Another child has been involved with decorating her bedroom with staff. This has made her room nicer and has involved her in her environment and helped her to learn new skills. This type of activity has helped in the building of relationships between children and staff. While some work has been done to brighten the home and to make it more child friendly, this has not been sufficient, and parts of the home do not contribute to a sense of belonging and worth for children. There are some good relationships between some staff and some children. Children will seek out staff to talk to them about things that are on their mind, or

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Inadequate

are a concern to them. However, there continues to be a high turnover of staff, with four staff leaving and four new staff starting since the previous inspection 11 weeks ago. This limits children’s ability to make new and meaningful relationships with the whole staff team. It also detracts from a sense of stability for the children. All children are in education. One child, who is 16, is due to start a new college course in September 2016. She is pleased about this. Another 16 year old is due to start in the sixth form of her special school. She spoke of going to buy new shoes ready for this. Throughout some challenging times at the home, children’s education attendance and engagement have continued. This contributes to their educational attainment and helps them to develop relationships away from the home. Staff make routine health appointments for the children and support them to attend. One child spoke about her forthcoming trip to the dentist, which she was

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Inadequate

apprehensive about. She asked her key worker if she would hold her hand while there, and the key worker reassured her. One child has begun to develop her independence. This has included taking responsibility for her own medication at times when she is away from the home, as agreed at her looked after child review. Staff have been providing some support for this, including texting the child to remind her when she needs to take her medication. However, due to a lack of clear notes from the review and clear written guidance for staff, this process has not been made clear to ensure that the child receives her prescribed medication. Staff keep records to reflect when medication is given to the child to hold, but these records are not comprehensive and some pages are missing. This was a jointly agreed attempt to allow the child more freedom, to help her develop her independence and to take age-appropriate

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Inadequate

risks. The lack of clear guidance, sufficiently detailed risk assessment along with incomplete records have meant that some safeguards to ensure that the child receives appropriate medication as prescribed for her have not been in place. The child is developing other self-care skills. Her pathway plan progress report states that ‘you have a true sense of self and take care of your appearance’. It goes on to record that she has developed well in personal care, cooking is ongoing, education is going well, and she is supported with family contact. One aim for her is to develop her budgeting skills. Staff have not taken opportunities to help her with this, for example by supporting her to buy her own toiletries rather than them being included in the weekly shop. Children are able to express their views. One child wanted to move bedroom as she was being disturbed at night by another child. This has taken place. An

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Inadequate

independent reviewing officer spoke of the home being open to negotiation with a child over the things that she wanted to happen, but also to identifying where the limit of this was and telling the child. Two children have expressed a wish to have an independent visitor, but managers are unclear what has happened about this. Lack of a clear follow up by the home has meant that the children have been left waiting for the process to be completed. Children have opportunities to take part in a range of activities, including learning to play instruments, learning to swim and going on trips and holidays with staff. These provide some good day-to-day experiences.

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Inadequate

Staff do not keep the environment in which children live sufficiently safe. A shed in which paint and white spirit were stored was left open, so children would have been able to gain access to these potentially hazardous materials. At the previous inspection, the manager had failed to ensure that all of the action points from a fire risk assessment had been addressed. While most of them have been completed now, the broken tag on a fire extinguisher has not been replaced. While this in itself presents a low risk, it is an easy matter to address and not doing so questions the effectiveness of the overall approach to safety. The process for risk assessment has been reviewed. Children’s individual risk assessments are still not sufficiently comprehensive. For example, the risk assessment for a child who spends a lot of time away from the home covers her internet use being monitored when at the home, but does not address the

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Inadequate

likelihood of her accessing the internet away from the home or the need for education to help her to keep herself safe. The risk for a child whose behaviour with males is viewed as inappropriate is recorded as high. The actions in response to this include monitoring her and making other professionals aware, but there is nothing on helping her to understand about risk and appropriate behaviour. There is no comprehensive risk assessment for a child to self-administer her medication. Some children have been away on holiday with staff. One child went alone with one member of staff. There was a risk assessment for the holiday, but it did not cover lone working for an extended period of time. The risk assessments are now kept in a separate file for each child. The new system makes it easier for staff to find and read the risk assessments, and they have all been recently reviewed. However, the lack of comprehensive risk assessments does limit the safeguards for

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Inadequate

children, particularly given the number of new and inexperienced staff. Records of restraints are still not fully completed, despite this being raised at the previous inspection. They are recorded on a computer, with an expectation that they are printed to go on children’s files, but this is not happening in a timely way. Some of the records on the computer do not contain evidence that staff have been spoken with by a manager about the incident and do not have a manager’s signature to say that the record is accurate. The children’s homes (England) regulations 2015 require that this is completed within 48 hours. Records from 1 August 2016 were not printed off as of 23 August 2016, and do not have this information in them. The number of restraints has been very high, with 71 in the previous 11 weeks. Continuing high levels of restraint have a disturbing impact on all children who live in the home. While there are some records of children being spoken with following

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Inadequate

a restraint (but not in every case), these are very brief and superficial. Lack of meaningful discussions with staff and children after incidents of restraint means that managers are missing opportunities to help children to develop an understanding of their behaviour and for staff to be able to consider ways of reducing the number of restraints used. Records of sanctions are not sufficiently detailed. Some do not explain clearly the behaviour that led to the sanction. Others do not provide full information about the sanctions used. Failure to record restraints and sanctions properly reduces the ability of managers and others to monitor the incidents concerned. However, records do show more use of restorative practices, as set out in the home’s statement of purpose. Managers do not send notifications of significant events to Ofsted in a timely way, despite this being raised at the previous inspection. This prevents Ofsted, as the

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Inadequate

regulator, from making decisions about when matters need to be followed up to ensure children’s safety. However, referrals to safeguarding agencies are made appropriately. Some children have spoken with staff about matters that concern them, including safeguarding matters relating to outside of the home. These have been appropriately passed on to other agencies. Allegations and concerns about staff have been passed to the designated officer. This identification of safeguarding matters and the knowledge of how to refer them help to ensure that concerns are appropriately investigated. New staff are subject to appropriate recruitment processes, which help to ensure that children are looked after by suitable adults. Some children’s behaviour becomes increasingly safe while they are at the home. One child has shown and maintained a significant reduction in self-harming behaviour and suicide attempts. There have not been any incidents of children

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Inadequate

going missing from care since the previous full inspection 11 weeks ago. Children’s individual risk assessments set out the specific risks to each of them should they go missing. They contain appropriate guidance for staff on how to respond to help keep missing children safe. This is a positive development since the previous inspection, which helps to ensure that responses from staff to children who go missing are appropriate. Judgement grade

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Inadequate

The manager in post has submitted an application to Ofsted to be registered, but the assessment of his suitability has not been completed. He has tendered his resignation and is working his notice away from the home. The responsible individual, who has experience as a registered children’s home manager, is overseeing the management of the home while a permanent manager is recruited. There have been significant failings in the home, which have not been identified or effectively addressed by the manager in post. This has left some children receiving some very poor care. Monitoring processes, such as the visits carried out by an independent person, have also failed to identify the shortfalls, despite a number of them having been raised in the previous inspection report. Failing to effectively monitor incidents of restraint has left children being restrained frequently. The failings in monitoring, along with the number of previous requirements that have

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Inadequate

not been met, question the effectiveness of the leadership and management of the home and reduce the quality of care for children. The monitoring processes in place have not been effective in maintaining a suitable level of care for children living in this home. There is an independent person who visits the home, but he has not done so every month. There was no visit in June 2016. Further, the independent person does not always include in his report his view on whether children are effectively safeguarded and whether the conduct of the home is promoting children’s welfare. The manager has completed a review of the quality of care, but this has not included an evaluation of his findings. Further, the approach taken has not provided for ascertaining or considering the opinions of children, their parents, placing authorities and staff. Consequently, the review has not effectively considered all available information in order to identify the ways in

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Inadequate

which the operation of the home could improve. There has been progress made in some areas. A placing team manager spoke of an improvement in the information provided by the home. Some children are making progress at the home, but others are not having their needs appropriately met. The service and the placing authority have recognised that this is the case for one child who is due to move imminently. Due to the high turnover of staff, there are a number of new and inexperienced staff. One new member of staff spoke of an appropriate induction, which allowed him to understand his role. His induction records support this. However, the induction records for another member of staff who started on 6 July 2016 contain only their name and start details. There is no evidence of any induction being provided. This matter was raised at the previous inspection in respect of other staff, yet this failing is repeated. It shows that the system for helping new staff to

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Inadequate

work effectively and safely with children is not working consistently. There have been training and discussions in team meetings to help staff to understand some aspects of their roles.

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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 that 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

The National Archives, Kew, London TW9 4DU, or email: psi@nationalarchives.gsi.gov.uk .

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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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