Children's home run by Cambian Autism Services Limited in Hammersmith and Fulham

Inadequate

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

p.2

The children’s home’s provision is inadequate because:

 Leaders and managers fail to implement the child protection policy. There are no effective systems in place to ensure that children and young people are safeguarded. These failures were present during the full inspection in June 2016. Leaders and managers have failed to rectify these shortfalls swiftly enough.  Staff fail routinely to record serious incidents. The lack of records means that leaders and managers do not have sufficient oversight of serious incidents occurring in the home. Some children and young people expressed concern to inspectors about the use of physical restraint.  Leaders and managers fail to implement systems that enable them to monitor the quality of care. Information is not readily available for leaders and managers to scrutinise and identify emerging patterns and trends. The registered manager’s review of the quality of care is three months overdue.  Arrangements for the supervision of staff fail to meet the expectations set

p.3

The children’s home’s provision is inadequate because:

out in the home’s statement of purpose. Staff supervision does not enable staff to reflect on their practice. Staff performance is not appraised annually.  Some children and young people raised concerns about the number of agency staff caring for them. One young person said, ‘We just don’t know who we are going to wake up to in the morning.’  Weaknesses remain in the planning arrangements as they do not detail all the information staff require to care for children and young people.

p.3

The children’s home strengths

 Children and young people have access to a wide range of activities, both in and out of the home. Some children and young people engage in groups and work experience in the local community.

p.3

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 within the given timescales.

p.4

Requirement Due date

6: The quality and purpose of care standard

p.4

Requirement Due date

In order to meet the quality and purpose of care standard, the registered person must ensure that staff: (2)(b)(iv) provide personalised care that meets each child’s needs, as recorded in the child’s relevant plans, taking account of the child’s background. In particular, ensure that the needs of children and young people are detailed in these care plans. 01/11/2016

p.4

Requirement Due date

12: The protection of children standard*

p.4

Requirement Due date

(2) In order to meet the protection of children standard, the registered person must ensure: (a) that staff: (iii) have the skills to identify and act upon signs that a child is at risk of harm (v) understand the roles and responsibilities in relation to protecting children that are assigned to them by the registered person (vi) take effective action whenever there is a serious concern about a child’s welfare (b) that 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 In particular, ensure that leaders’ and managers’ oversight and monitoring protects children and young people from harm. Also that leaders and managers ensure that the child protection policy is followed effectively. 01/11/2016

p.4

Requirement Due date

13: The leadership and management standard*

p.4

Requirement Due date

In order to meet the leadership and management standard, the registered person must: (a) lead and manage the home in a way that is consistent with the 01/11/2016 approach and ethos, and delivers the outcomes, set out in the home’s statement of purpose (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. In particular, ensure that leaders and managers have effective monitoring systems in place to protect children and young people. Also ensure that children and young people are cared for by a consistent staff team. 33: Employment of staff

p.4

Requirement Due date

(4) The registered persons must ensure that all employees: (b) receive practice-related supervision by a person with appropriate experience (c) have their performance and fitness to perform their roles appraised at least once every year. In particular, that leaders and managers use supervision and appraisal to monitor staff performance and protect children and young people from harm. (Regulation 33 (4)(b)(c)) 01/11/2016

p.5

Requirement Due date

35: Behaviour management policies and records

p.5

Requirement Due date

(3) The registered person must ensure that: (a) 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: (i) the name of the child (ii) details of the child’s behaviour leading to the use of the measure (iii) the date, time and location of the use of the measure (iv) a description of the measure and its duration (v) details of any methods used or steps taken to avoid the need to use the measure (vi) the name of the person who used the measure (‘the user’), and of any other person present when the measure was used (vii) the effectiveness and any consequences of the use of the measure, and (viii) a description of any injury to the child or any other person, and any medical treatment administered, as a result of the 01/11/2016 measure. (b) Within 48 hours of the use of the measure, the registered person, or a person who is authorised by the registered person to

p.5

Requirement Due date

do so (‘the authorised person’): (i) has spoken to the user about the measure (ii) has signed the record to confirm it is accurate, and (iii) within five days of the use of the measure, the registered person or the authorised person adds to the record confirmation that they have spoken to the child about the measure. In particular, that any incident resulting in physical intervention, authorised or not, is recorded as described above. Children and young people have access to an effective debrief following any restraint irrespective of their communication method. (Regulation 35 (3)(a)(i)(ii)(iii)(iv)(v)(vi)(vii)(viii)(b)(i)(ii)(c))

p.6

Requirement Due date

(1) The registered person must complete a review of the quality of care provided for children (‘a quality of care review’) at least once every six months. (2) In order to complete a quality of care review, the registered person must establish and maintain a system for monitoring, reviewing and evaluating: (a) the quality of care provided for children (b) the feedback and opinions of children about the children’s home, its facilities and the quality of care they receive in it, and (c) any actions that the registered person considers necessary in order to improve or maintain the quality of care provided for children. (3) After completing a quality of care review, the registered person must produce a written report about the quality of care review and the actions which the registered person intends to take as a result of the quality of care review (‘the quality of care review report’). (4) The registered person must:

p.6

Requirement Due date

(a) supply to HMCI a copy of the quality of care review report within 28 days of the date on which the quality of care review is completed, and (b) make a copy of the quality of care review report available on request to a placing authority, if the placing authority is not the parent of a child accommodated in the home. (5) The system referred to in paragraph (2) must provide for ascertaining and considering the opinions of children, their parents, placing authorities and staff. (Regulation 45 (1)(2)(a)(b)(c)(3)(4)(a)(b)(5)) 01/11/2016 * These requirements are subject to statutory requirement notice.

p.6

Information about this children’s home

This national private organisation provides care and accommodation for children and young people with autistic spectrum disorders and learning disabilities. It operates as a residential special school which also provides accommodation for students requiring 52 weeks boarding and is therefore registered as a children’s home for 40 placements.

p.8

Recent inspection history

Inspection date Inspection type Inspection judgement 01/08/2016 Monitoring visit N/A 20/06/2016 Full Inadequate 26/01/2016 Interim Improved effectiveness 18/05/2015 Full Good 28/01/2015 Interim Improved effectiveness 28/08/2014 Full Adequate

p.8

Inadequate

The significant shortfalls identified in the protection of children and young people have a negative impact on their overall experiences and progress in this home. There is a failure to implement systems to protect children and young people from harm. Therefore this judgement is limited to inadequate.

p.9

Inadequate

Care plans are not yet capturing the level of detail required for staff to understand how to meet the needs of children and young people. Care plans have the most basic information, such as a diagnosis, healthcare needs or a list of preferred activities. Leaders and managers have not recognised the need to develop the information so that staff can understand what this means to a child, a young person or their family. There is, however, some improvement in the identity section, which now provides a clear sense of children’s and young people’s personalities and identities.

p.9

Inadequate

Leaders and managers have not established effective systems to evidence the progress that children and young people make. When children and young people know the staff caring for them, there are some warm and nurturing relationships developing. Some staff talk with warmth and affection about children and young people and can easily identify the progress these young people are making. Some parents also recognise the progress their children are making while residing in the home.

p.9

Inadequate

Communication aids, such as objects of reference, schedules and picture exchange communication systems, are now more widely used across the home. Staff have a good understanding about which methods of communication best suit the child or young person they are caring for. Children and young people are responding well to this.

p.9

Inadequate

Staff engage children and young people in meaningful activities in and around the home. Children and young people can make use of the large garden that surrounds their home. There is an outdoor gym, scooters, a parachute and go-karts, which are easily accessible for all. Staff have fun and join in or instigate games. Children and young people also have the opportunity to gain access to activities out in the community, such as swimming, community groups, laser-quest, discos, shopping and sports. There are high staffing ratios per child, supported by agency staff. This enables children and young people to enjoy a wider range of activities in the community, with staff support. The atmosphere in the home has become calmer, particularly around mealtimes, which had previously been chaotic. Tables are now set and all staff sit and eat with the children and young people to ensure that mealtimes are more relaxed. Leaders

p.9

Inadequate

and managers have worked with the new maintenance team to set out plans to improve the environment. This plan includes improving the decor to create a more homely feel. ‘Observation windows’, which were in some of the bedrooms, are now covered up. Children and young people can access their own en suite bathrooms now without needing to ask for them to be unlocked. Children’s and young people’s bedrooms are personalised to suit their personal tastes.

p.10

Inadequate

Children and young people have access to day-to-day, universal healthcare services, such as doctors, dentists and opticians. The home employs a nurse who is responsible for the children’s and young people’s healthcare needs and medication. A therapy team is in place, consisting of a clinical psychologist, a speech and language therapist and an occupational therapist. Clinicians within the wider organisation also visit children and young people in the school and provide their expertise.

p.10

Inadequate

There continue to be widespread failures in the protection of children and young people. Staff are not consistently following child protection procedures when safeguarding concerns arise. Inspectors found a number of safeguarding concerns, which staff failed to report to the designated safeguarding leads or external professionals, such as social workers and the designated officer.

p.10

Inadequate

Staff now make clear records of any marks or bruising on children and young people. Leaders and managers have established a system to ensure that they have oversight of these records. Despite this, monitoring of these records by the registered manager is weak. On one occasion, the registered manager failed to identify that a young person had sustained injuries following a restraint. During the inspection, two children and young people raised concerns about the use of restraint, saying, ‘It hurts when they (staff) hold me,’ and, ‘It doesn’t hurt very much when they (staff) hold me.’

p.10

Inadequate

The supervision of staff fails to protect children and young people. Staff do not receive regular supervision, even when there has been a recent allegation or investigation concluded and the member of staff returns to work. Supervisors do not recognise when a concern about staff practice or competency needs to be escalated as a safeguarding concern. Leaders and managers took effective action to manage a safeguarding concern raised by the inspectors during the inspection. This action included following the child protection policy, a referral to the designated officer and instigating the organisation’s disciplinary procedure.

p.10

Inadequate

There are significant weaknesses in the recording of serious incidents. This is the second full inspection that has identified that staff are not routinely recording all serious incidents that occur. As a result, leaders and managers do not have an accurate understanding of the severity and frequency of incidents and are unable to take remedial action to keep everyone safe.

p.11

Inadequate

Leaders and managers do not have a strategic oversight and understanding of incidents and restraints that occur. Incidents are not always recorded, and those that are, are maintained on children’s individual files. Leaders and managers do not maintain a central record of these incidents and are therefore unable to identify or track patterns and trends. During the inspection, it took three days for leaders and managers to confirm the number of incidents and restraints that had occurred since the previous full inspection in June 2016. Systems are not secure and do not help leaders and managers to monitor the home effectively or to evaluate the impact of the quality of care that children receive.

p.11

Inadequate

Senior leaders meet regularly to review and discuss incident reports. The impact of these meetings, in determining and making improvements to the care that children receive, is in the early stages of development. This system requires further rigour by leaders to become wholly effective. Leaders and managers are good at identifying when documents are missing information, and there is now a clear focus on ensuring that children and staff are provided with the opportunity to discuss the incident.

p.11

Inadequate

Overall, behaviour support plans and risk assessments provide staff with useful information to help them to manage some complex behaviours. However, it is not evident that staff follow these plans. For example, one incident record shows that staff did not ‘ignore’ a child’s specific behaviour as required by their plan, but chose to intervene, which resulted in the incident escalating .

p.11

Inadequate

Staff responses to children during incidents can escalate the situation. Other incidents have occurred where leaders and managers have not identified key weaknesses in the staff team’s practice. As a result, requirements to change and/or improve staff practice are not dealt with.

p.11

Inadequate

Leaders and managers have taken effective action to ensure that recruitment processes are more robust. Staff are vetted appropriately prior to undertaking work in the home. A review of employment agencies’ practice in relation to safer recruitment has been undertaken. During the inspection, one member of agency staff was not on the single central record of recruitment and the registered manager took three days to identify this member of staff. Once the shortfall was realised, it was resolved immediately.

p.11

Inadequate

The registered manager has been in post since October 2015. She has previous experience of managing children’s homes and has suitable qualifications for the role. Leaders and managers established a development plan following the inspection in June 2016 to rectify the shortfalls identified. This development plan has not come to fruition, as there continue to be widespread failures in the protection of children and young people.

p.12

Inadequate

The registered manager is failing to implement effective monitoring systems to ensure that there is good oversight of the day-to-day care that children and young people receive. The quality of care review is overdue by three months. It is difficult to establish what progress children and young people make, as there are no records to show evidence of targets, goals and achievements.

p.12

Inadequate

Staff do not receive regular supervision or have an annual appraisal to explore their performance and practice. Leaders and managers do not have good oversight of supervisions or appraisals. New staff receive a comprehensive induction to their role. However, this is not the case when internal staff are promoted to new posts within the home. Staff attend training regularly, such as behaviour management, first aid and safeguarding. Children and young people are concerned at the number of different staff caring for them. In one home in particular, young people were visibly anxious about which staff were coming in, asking questions such as: ‘Who is working with me?’ Leaders and managers recognise that they are managing a number of vacancies and use bank and agency staff to cover the shortfalls. This keeps staffing ratios high. However, the vacancies have a detrimental impact on the consistency of care that children and young people receive.

p.12

Inadequate

The registered manager is making efforts to improve communication with parents and becoming more visible when they visit the home. There is now a monthly newsletter for families.

p.12

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’.

p.13

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

p.13

What the inspection judgements mean

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

p.13

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. 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

p.14

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 .

p.14

Information about this inspection

achieve excellence in the care of children and young people, and in education and skills for learners of all ages. It regulates and inspects childcare and children’s social care, and inspects the Children and Family Court Advisory and Support Service (Cafcass), schools, colleges, initial teacher training, work- based learning and skills training, adult and community learning, and education and training in prisons and other secure establishments. It inspects services for children looked after and child protection. If you would like a copy of this document in a different format, such as large print or Braille, please telephone 0300 123 4234, or email enquiries@ofsted.gov.uk . You may reuse this information (not including logos) free of charge in any format or medium, under the terms of the Open Government Licence. To view this licence, visit www.nationalarchives.gov.uk/doc/open-government-licence , write to the Information Policy Team,

p.15

Information about this inspection

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

p.15

Information about this inspection

Interested in our work? You can subscribe to our monthly newsletter for more information and updates: http://eepurl.com/iTrDn .

p.15

Information about this inspection

T: 0300 123 1231 Textphone: 0161 618 8524 E: enquiries@ofsted.gov.uk W: www.gov.uk/government/organisations/ofsted

p.15