Children's home run by Surrey County Council

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 is a very new service. In using the home, staff have identified that there are significant limitations in the accommodation. As a result, staff are now sleeping in the lounge rather than the office, as planned on registration. This prevents access to the kitchen during sleeping hours, both for young people and the waking night staff. The open plan design means that when there are two young people in the home, finding a private space other than a bedroom is not possible. This has the potential to compromise privacy. Additionally, the high temperature of the hot water in the bathroom could pose a scalding risk to young people.  The health and social care disciplines who jointly operate this service are identifying their differences and similarities. The current structure does not provide sufficient management time in the home and not all staff have a full understanding of the legal requirements of running a children‟s home. As a

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The children's home provision requires improvement because:

result, this inspection identified shortfalls in meeting the regulations. Many of these relate to ensuring that records are maintained.  The statement of purpose does not fully integrate the health and social care aspects to accurately reflect the unique service provided. Placement planning and risk assessments do not provide staff with sufficient written guidance to inform their care of young people. The templates for gaining consent to administer medication and use surveillance equipment are not comprehensive. Recruitment records available do not securely evidence that all the required checks have been done. The records of physical intervention do not contain all the necessary information.  The lack of management capacity also has an impact on the frequency of staff supervision. Staff do not have enough time to reflect on their practice or further their understanding of the needs of the children.

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The children's home strengths

 This is an innovative service that provides young people and their families with a resource at a time of crisis in their lives. The staff have maintained a strong focus on the individual needs of young people. This has informed their working and is leading to the ongoing development of the home.  The staff have effectively supported the young people through periods of crisis and enabled the vast majority to return home. Parents appreciate the recognition by staff of the urgency of their situation and the prompt action in the provision of a bed. Staff are skilled at engaging with young people in a style that they are comfortable with and can accept.  It is a significant achievement that the service has reduced the need for young people to become looked after by the local authority or be admitted to hospital.

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Statutory requirements

This section sets out the actions which 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 person(s) must comply within the given timescales.

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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. (Regulation 23 (1)) 31/10/2016

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Requirement Due date

The protection of children standard: In order to meet the protection of children standard, the registered provider must ensure 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. (Regulation 12 (2)(a)(i)) 31/10/2016 In particular, ensure that strategies to reduce identified risks are specific and detailed within individual risk assessments.

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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 the home, a record is made which includes a description of the measure and its duration. (Regulation 35 (3) (a)(iv)) 31/10/2016

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Requirement Due date

The registered person must recruit staff using recruitment procedures that are designed to ensure children‟s safety. The registered person may only employ an individual to work at the children‟s home, or if an individual is employed by a person other than the registered person to work at the home in a position in which the individual may have regular contact with children, allow that individual to work at the home, if the individual satisfies the requirements in paragraph. (3) The requirements are that full and satisfactory information is available in relation to the individual in respect of each of the matters in Schedule 2. (Regulation 32 (3) Schedule 2 (3)(4)(6))

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Requirement Due date

In particular, two written references, including a reference from the person‟s most recent employer, if any; if a person has previously worked in a position involving work with children or vulnerable adults, verification so far as reasonably practicable of the reason why the employment or position ended and a full employment history, together with a satisfactory explanation of any gaps in employment, in writing. 31/10/2016

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Requirement Due date

The protection of children standard: In order to meet the protection of children standard, the registered provider must ensure that the premises used for the purposes of the home are designed, furnished and maintained so as to protect each child from avoidable hazards to the child‟s health. (Regulation 12 (2)(d)) In particular, ensure that the hot water in the bathroom is at a safe temperature. 30/09/2016

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Requirement Due date

The registered person must compile in relation to the children‟s home a statement (“the statement of purpose”) which covers the matters listed in Schedule 1. (Regulation 16 (1) Schedule 1)

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Requirement Due date

In particular, ensure that the components of the health service 30/11/2016 operational policy are incorporated into the statement of purpose where relevant.

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Requirement Due date

The registered person must ensure that: the privacy of children is appropriately protected; children can access all appropriate areas of the children‟s home‟s premises; and any limitation placed on a child‟s privacy or access to any area of the home‟s premises is intended to safeguard each child accommodated in the home; is necessary and proportionate; is kept under review and, if necessary, revised; and allows children as much freedom as is possible when balanced against the need to protect them and keep them safe. (Regulation 21 (a)(b)(c))

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Requirement Due date

In particular, review the staff sleeping-in arrangements and consider how to provide space for private conversations and meetings. 30/10/2016

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Requirement Due date

This regulation applies to a child who is not looked after by a local authority. The registered person must prepare a placement plan for the child before the child is admitted to the home or, if that is not reasonably practicable, as soon as possible after the child is admitted to the home. The placement plan must set out, in particular how, on a day-to-day basis, the child will be cared for, and the child‟s welfare safeguarded and promoted by the home; the arrangements made for the child‟s care, education and health; and any arrangements made for contact with the child‟s parents, relatives and friends. The registered person must keep under review and revise the placement plan as necessary. In preparing or reviewing the placement plan the registered person must so far as reasonably practicable, having regard to the child‟s age and understanding, seek and take account of the child‟s views, wishes and feelings. (Regulation 18 (1)(4)(5)(7)(8a))

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Recommendations

To improve the quality and standards of care further, the service should take account of the following recommendations:  When establishing the home, the registered person must ensure that it is suitably located so that children are effectively safeguarded and can access services to meet needs identified in their relevant plans (see regulations 12(2) (c)). Under regulation 46, the registered person should review the appropriateness and suitability of the location and premises of the home at least once a year. The review should include the identification of any risks and opportunities presented by the home‟s location and strategies for managing these. Providers should refer to the non-statutory advice about the location assessment process: „Children's homes regulation amendments 2014‟, advice for children's homes providers on new duties under regulations that came in to effect in January and April 2014. („Guide to the children's homes regulations

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Recommendations

including the quality standards‟, page 64, paragraph 15.1)  The policy on protection of children from abuse and neglect should include arrangements in relation to dealing with allegations involving staff in the home, e-safety and to counter risks of self-harm and suicide. („Guide to the children's homes regulations including the quality standards‟, page 44, paragraph 9.19) In particular, establish a framework for monitoring young people‟s mobile phone use.  Homes must gain consent to any monitoring or surveillance by the placing authority in writing at the time of placement. The use of CCTV is regulated by the „Protection of Freedoms Act 2012 and the Surveillance Camera Code of Conduct (Home Office 2013)‟. („Guide to the children's homes regulations including the quality standards‟, page 16, paragraph 3.16) In particular, gain specific consent to the use of viewing panes in bedroom doors at night.  Those with a leadership and/or management role should be visible and

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Recommendations

accessible to staff and able to deliver their leadership and/or management responsibilities. Any registered manager employed in the home should have sufficient capacity to ensure that the Quality Standards are met for each child in the home. („Guide to the children's homes regulations including the quality standards‟, page 52, paragraph 10.7)  A record of supervision should be kept for staff, including the manager. The record should provide evidence that supervision is being delivered in line with Regulation 33(4)(b), and also ensure that staff learning and development opportunities are maximised through good use of staff meeting minutes. („Guide to the children's homes regulations including the quality standards‟, page 42, paragraph 13.3)

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Information about this children's home

 This local authority home, registered for two young people, is part of a jointly commissioned and funded multi-agency service that provides therapeutic support for young people who have complex mental health, education and social care needs that cannot be met by one agency alone. The residential element of this service offers support to young people in mental health crisis who need intensive support, but whose mental health does not require them to be admitted to a psychiatric ward or become a child looked after. Places are available to young people for up to 10 days at a time and enable partner agencies to better respond to young people's mental health needs out of hours.

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Requires improvement

The vast majority of young people who have stayed at the home to date are not looked after by the local authority. The records completed prior to or on admission, namely the pre-admission assessment and the exit plan, do not provide the detail required by regulation. For example, there is no detail for staff about how to meet the day-to-day needs of a young person or about how their given diagnosis impacts on their daily life and what this means for staff practice. Staff quickly get alongside the young people and elicit their needs and views, so the impact of the lack of detail is reduced.

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Requires improvement

Parents report different experiences of transitions into the home. One described a visit by a nurse, who was very helpful and explained the process clearly. Another felt that liaison between the day service and the home was a little disjointed‟. The moving out plan is integral to the care plan and is kept under review to ensure that it is achievable and right for the young person. This is not routinely reflected in the records.

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Requires improvement

The systems for recording the administration and stock control of medication have some weaknesses. Daily records do not fully support some decision making, for example the administration of medication given as required. The parental consent forms do not give staff all the necessary permissions to meet the health needs of young people while in the home.

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Requires improvement

Staff provide a consistent and calm environment for young people in crisis. This provides them with opportunities to stabilise and enables them to return home with any necessary additional support or services within a maximum of 10 days. The staff team have been successful in working with young people and their families to achieve this objective. Staff meet the presenting needs of young people with warmth, understanding and reassurance. One young person wrote „Everyone is amazing. They make sure you have everything you need and are really helpful‟. A parent said that the placement achieved the objective of giving her child a safe space.

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Requires improvement

Staff are skilled at developing relationships with young people in a short time. They tailor their communication with young people according to their frame of mind; for example, by giving opportunities to use cards and symbols when the young people are unable to find the words. A parent observed that the staff engaged well with their child, who had a good time while at the home. This parent described trips out and opportunities to cook, as well as support and encouragement with self-care. He said his child liked the friendly environment and that staff were open to do things with the young people. Another parent commented that their child had previously expressed some racist views but a stay at the home has caused the young person to reconsider her views. She said, „I don‟t know why I thought that because all the staff are friendly and kind and want to help.‟

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Requires improvement

Although admission to the home is on health criteria, the team work effectively with other disciplines. For example, staff liaise effectively with education provisions to maintain school placements for young people and sensitively introduce young people to new placements if this is the plan.

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Requires improvement

Young people are admitted to the home in times of crisis, assessed as such by the dedicated specialist nurses. They complete pre-admission and risk assessments, often immediately before or as a young person moves in. These do not always give enough specific information and the impact risk assessments are insufficiently detailed. For example, they do not give clear direction about the strategies to be used to reduce risk or the time intervals for checking on a young person. In discussion and observation of staff, they demonstrate that they know and successfully implement the action necessary to reduce the identified risks. As a result, young people and their parents report that staff effectively promote their safety. One young person noted: „Staff are lovely; they keep you safe. I haven‟t felt scared here.‟

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Requires improvement

Information sharing between professionals is strong, particularly in respect of child sexual exploitation risks, and this includes the police who alert staff to potential location concerns. There have been few incidents of young people going missing and these have been reported and managed appropriately, with young people returning within a short time. However, the location risk assessment has not been updated in the light of these significant events, neither does it fully consider potential hazards in the local area. A welcoming and supportive staff team provide a calm environment for young people who arrive at the home at a time of crisis in their lives. All are aware that the placement is for an agreed time, up to a maximum of 10 days. Staff aim to build relationships with young people that enable them to manage and express their feelings safely, for example by reducing the incidents of self-harm. One young

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Requires improvement

person wrote to the inspector, „I can talk to some people if I need to. They make me happier.‟ In the four months that the home has been operating, there have been just two incidents of physical intervention. In both cases, this was used as a last resort and to prevent harm to the young person themselves or to others. A young person reported that the reason for being held was understandable and was talked about afterwards. One of the records did not provide details about the type of hold used. Therefore, the manager cannot determine if the hold was appropriate or in line with the behaviour management approach that the staff are trained in.

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Requires improvement

The team are skilled at reassuring the young people and providing protective factors in the delivery of care. For example, environmental hazards are removed promptly, access to the kitchen may be limited and young people do not have internet access in the home. This approach also informs how staff explain any searches of possessions that they may need to undertake. However, there is not a clear policy for reaching an agreement with the young people and their parents about the use and/or monitoring of mobile phones that may have internet access. This has the potential to compromise the safety and well-being of young people.

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Requires improvement

The recruitment records seen do not demonstrate careful vetting of staff prior to employment. Not all records: give a full employment history; have two references on file; evidence that gaps in employment have been explored; or that efforts have been made to verify the reason why an applicant left a post working with children. Staff understood that this information had been supplied, and it was not clear why it was not on file.

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Requires improvement

The security measures used at the home include door alarms, security lights and external CCTV. Internally, there are viewing panels on both bedroom doors. These are used when there is an identified need and with the knowledge and written agreement of the young people and their parents. However, the agreement does not cover monitoring by night staff when this may be required. This may compromise the privacy of young people without their consent.

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Requires improvement

Generally, there are sound health and safety systems in the home. Routine maintenance, servicing and testing of equipment and fire safety systems takes place as required. Although the manager believed that the hot water temperature was regulated, the hot water in the young people‟s bathroom has the potential to scald. Judgement grade

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Requires improvement

This is a new and innovative service. The statement of purpose and young people‟s guide do not fully reflect what the service is and does. The aims and objectives are stated separately in the statement of purpose for the home and the health service operational policy. This is reflected in the day-to-day running of the home as two services work in parallel, trying to work out how they fit together and complement each other. This is compounded by the line management structure and the differing accountabilities and responsibilities of the health and social care disciplines. It is evident that both are highly focused on meeting the needs of individual young people and promoting their welfare. Staff keep the needs of young people at the centre of what they do. In learning how to integrate the differing constructs, there has been a lack of oversight to ensure full compliance with all the applicable regulations. This part of the service is not registered with the Care Quality

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Requires improvement

Commission (CQC). Although nurses work in the home the registration with Ofsted exempts them from needing CQC registration here.

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Requires improvement

The suitably qualified and experienced manager is also the registered manager for an adjacent children‟s home. The service is funded for 10 hours of management time each week. The manager is spending more time than this in the home but this is still not sufficient to meet the regulatory responsibilities. The structure chart for the home shows that managerial responsibilities are shared by the registered manager and the assistant team manager for the service. However, the remit of the assistant team manager and her team of three nurses is separate to that of the social care team. This team comprises a senior practitioner, a senior residential worker and seven residential staff, all of whom work on shift, with a minimum of two on duty. Recruitment is underway for two more residential staff so that the home can open seven days a week. The nurses are based at the home and provide an out-of-hours service, through the emergency duty team, which may be in the

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Requires improvement

home or in the wider community, dependent on their assessment of where the need is greater.

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Requires improvement

This home was registered for two young people in April 2016. Staff sleeping in were to use the office. Since working in the home, staff found that the allocated office space was insufficient and more desk space was needed. To achieve this, the staff now sleep on a sofa bed in the lounge. Consequently, the lounge is locked at night, which also prevents access to the kitchen by the waking night staff and young people. The team have developed ways of working around this. In addition, staff and visitors have noted that the open plan design of the ground floor and lack of any other available room do not provide a space for private conversations (other than bedrooms) when there are two young people staying in the home. These arrangements are not acceptable. Staff report that they feel well supported. However, the frequency of formal supervision is not easily demonstrated and is difficult to achieve when both the

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Requires improvement

supervisor and supervisee are working on shift. Other support systems for staff include team meetings and handovers between shifts. Team meetings are held regularly. The standing agenda items ensure that safeguarding and anti- discriminatory practice is discussed at each meeting. These aspects of the meetings are well recorded but minutes of other discussions do not provide enough information for those staff not at the meeting, and actions arising aren‟t allocated nor given a timeframe. Handovers cover relevant issues, allocate clear responsibilities and ensure that staff know what they need to in order to provide safe care for the young people resident.

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Requires improvement

Six staff hold an appropriate level 3 qualification. Those without the qualification are due to enrol on a relevant programme. Staff benefit from training tailored to equip them to meet the needs of young people who are likely to use the service. At the time of this visit, the whole team were looking forward to a week of training in a therapeutic model.

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Requires improvement

Visits by the independent person have not been at the required frequency, with two visits combined in one report for the four months that the home has been open. This has not been sufficiently supportive of the manager in actively monitoring the matters required or securing improvement. The provider has taken steps to address this shortfall and the first visit by a newly contracted organisation is scheduled this month.

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Requires improvement

There is some variation in the standard of recording. Some recording provides a detailed picture of the young people, but some is lacking in detail and does not effectively cross reference other records to give a comprehensive and understandable account of events and actions. The register of young people does not show the statutory provision (if any) under which the child is accommodated.

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What the inspection judgements mean

The experiences and progress of children and young people are at the centre of the inspection. Inspectors will use their professional judgement to determine the weight and significance of their findings in this respect. The judgements included in the report are made against „Inspection of children's homes: framework for inspection‟.

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What the inspection judgements mean

An outstanding children's home provides highly effective services that contribute to significantly improved outcomes for children and young people who need help and protection and care. Their progress exceeds expectations and is sustained over time. A good children's home provides effective services that help, protect and care for children and young people and have their welfare safeguarded and promoted. In a children's home that requires improvement , there are no widespread or serious failures that create or leave children being harmed or at risk of harm. The welfare of children looked after is safeguarded and promoted. Minimum requirements are in place. However, the children's home is not yet delivering good protection, help and care for children and young people. A children's home that is inadequate is providing services where there are widespread or serious failures that create or leave children and young people being

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What the inspection judgements mean

harmed or at risk of harm or result in children looked after not having their welfare safeguarded and promoted.

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Information about this inspection

Inspectors have looked closely at the experiences and progress of children and young people living in the children's home. Inspectors considered the quality of work and the difference that adults make to the lives of children and young people. They read case files, watched how professional staff work with children, young people and each other and discussed the effectiveness of help and care given to children and young people. Wherever possible, they talked to children, young people and their families. In addition, the inspectors have tried to understand what the children's home knows about how well it is performing, how well it is doing and what difference it is making for the children and young people who 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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