Children's Home run by London Borough of Hillingdon in Hillingdon

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:

 The provider does not always identify protective factors and interventions in order to reduce risks to young people living in the home.   The provider does not have an agreed policy to describe how they help to protect young people from dangers in relation to use of the internet or social media.   Residential care plans do not clearly describe how staff are helping young people to stay safe and make progress.   Young people who are not in education are not consistently supported to establish healthy, structured routines in order to prepare them for education.   There is insufficient capacity within the current management team to ensure that staff receive regular formal supervision.   Systems in place to monitor the quality of care provided to young people are not sufficiently robust to identify shortfalls in key areas of practice and recording.   The administration, handling and recording of medications are not being

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The children's home provision requires improvement because:

carried out in line with the statutory guidance: ‘Managing medicines in care homes’ (March 2014).   Young people report that some staff do not relate to them in a way that displays emotional warmth, love and care. 

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The children's home strengths

 Young people feel safe in the home and get on well with each other. They report that they have positive relationships with ‘most of the staff team’. They appreciate the help and support that they receive from these staff members.   Most young people engage in education. They are highly motivated, have excellent attendance and make positive progress.   Young people currently living in the home seldom go missing. Staff are proactive and take action when young people are not where they are expected to be. They work effectively in partnership with the placing authority and take steps to ensure that they return home safely.   The senior management team has undertaken a comprehensive audit of the quality of care provided to young people. They have a good understanding of the strengths and weaknesses of the service and have ambitious plans in place to make improvements.   The deputy managers in the home are competent visible and model good

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The children's home strengths

practice for staff.   Young people who stay longer term move on positively and in a planned way to a placement that meets their needs.   Senior managers are aware of the shortfalls in service provision and have ambitious plans in place to improve the quality of care for young people.  

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Statutory requirements

This section sets out the actions that 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.

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12: The protection of children standard

(1) The protection of children standard is that children are protected from harm and enabled to keep themselves safe. (2) In particular, the standard in paragraph (1) requires the registered person to ensure − (a) that staff − (i) 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; and (v) understand the roles and responsibilities in relation to protecting children that are assigned to them by the registered person. This is with particular reference to ensuring that individual risk assessments for children clearly identify vulnerability factors and risk management strategies, in order to reduce the risk of harm to young people. 17/11/2016

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12: The protection of children standard

(1) 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)) 17/11/2016

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6: The quality and purpose of care standard

(1) The quality and purpose of care standard is that children receive care from staff who − (a) understand the children's home's overall aims and the outcomes it seeks to achieve for children; (b) use this understanding to deliver care that meets children's 17/11/2016 needs and supports them to fulfil their potential. (2) In particular, the standard in paragraph (1) requires the registered person to − (b) ensure that staff − (ii) protect and promote each child's welfare; and (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. Specifically, in order to meet this standard, the provider must ensure that residential care plans demonstrate how the home is providing support to promote the welfare of young people and helping them make progress.

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6: The quality and purpose of care standard

(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 6 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. Specifically, in order to meet this requirement, the provider must ensure that there is management oversight and systems in place to monitor practice in relation to recording on case files, sanctions and administration of medications. (Regulation 45(1)(2)(a)(b)(c)) 17/11/2016

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6: The quality and purpose of care standard

(4) The registered person must ensure that all employees − (b) receive practice-related supervision by a person with appropriate experience. (Regulation 33(4)(b)) 17/11/2016

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Recommendations

To improve the quality and standards of care further, the service should take account of the following recommendations:  Staff should continually and actively assess the risks to each child and the arrangements in place to protect them. Where there are safeguarding concerns for a child, their placement plan, agreed between the home and their placing authority, must include details of the steps the home will take to manage any assessed risks on a day-to-day basis. (‘Guide to the children’s homes regulations including the quality standards’, page 42, paragraph 9.5)  Care must be taken to ensure prescribed medicines are only administered to the individual for whom they are prescribed. Medicines must be administered in line with a medically approved protocol. Records must be kept of the administration of all medication, which includes occasions when prescribed medication is refused. Regulation 23 requires the registered person to ensure that they make

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Recommendations

suitable arrangements to manage, administer and dispose of any medication. These are fundamentally the same sorts of arrangements as a good parent would make but are subject to additional safeguards. Where the home has questions or concerns about a child's medication, they should approach an expert such as a General Medical Practitioner, community pharmacist or designated nurse for looked-after children. (‘Guide to the children’s homes regulations including the quality standards’, page 35, paragraph 7.15)  Children who wish to keep and take their own medication should be supported to, if they are able to do so safely. Staff should be mindful that children holding their own prescribed medication must only use it for themselves in accordance with the prescription. This should be evidenced with a risk assessment to ensure that young people can hold and self-administer medication safely. (‘Guide to the

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Recommendations

children’s homes regulations including the quality standards’, page 35, paragraph 7.16)

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Recommendations

 In addition to the requirements of this standard, the registered person has specific responsibilities under regulation 34 to prepare and implement policies setting out: arrangements for the safeguarding of children from abuse or neglect. The policy on protection of children from abuse and neglect should include arrangements in relation to safety and to counter risks of self-harm and suicide. All policies should be reviewed regularly and revised where appropriate. (‘Guide to the children’s homes regulations including the quality standards’, page 44, paragraph 9.19)  The capacity and competence of staff to build constructive, warm relationships with children that actively promote positive behaviour provides the foundations for managing any negative behaviour. Staff should have the skills to respond to each child's individual behaviour. Where necessary they should manage conflict, maintain constructive dialogues and react appropriately if challenged by a child

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Recommendations

in their care. (‘Guide to the children’s homes regulations including the quality standards’, page 39, paragraph 8.14)

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Information about this children's home

The home is operated and owned by a local authority. It is registered for up to 13 young people and specialises in looking after unaccompanied minors. It also has one bedroom that is used for emergency admissions.

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Recent inspection history

Inspection date Inspection type Inspection judgement

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Recent inspection history

19/01/2016 Interim Sustained effectiveness

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Recent inspection history

05/03/2015 Interim Sustained effectiveness

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Requires improvement

Young people in the home report that relationships with staff are inconsistent. They all indicate that they have a trusted member of staff that they can confide in and that most staff are very helpful, although some staff are less helpful. A young person commented that some staff ‘never smile’. Another young person said that some staff members ‘shout’. The impact of this is exacerbated because many of the young people in the home speak limited English. This means that, because they may not understand the language, body language and tone of voice carry more significant meaning for them. The registered manager has been away from her post for several weeks. The two deputy managers have assumed additional management responsibilities to cover her absence. They are both experienced and model good practice for the staff team, but the reduced management capacity has resulted in not all management tasks being undertaken.

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Requires improvement

Most young people in the home are highly motivated to engage in education. The provider advocates strongly within professional networks to identify suitable education placements. These young people have excellent attendance and achieve positive academic results. Some young people, who are not yet in education or are less motivated, do not always receive the support that they need to make progress. There was no clear plan in place for one young person to help her to establish healthy routines or engage in activities that would help prepare her for education. Incidents of challenging behaviour are rare, and young people report that they feel safe in the home and get on well with each other. One young person said, in respect of the other young people in the home, that ‘it [is] just like a family’. Young people are encouraged to shop, cook and learn to manage money. One young person described how she appreciated the help and support that staff have

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Requires improvement

provided to help her learn skills for independence. She is about to move on to supported accommodation and feels that she is well prepared to take this step. Young people who stay in the home for longer periods move on successfully and in a planned way. They access accommodation that meets their individual needs. The home has one emergency bed. This means that young people often arrive at short notice and move on quickly. This can be disruptive for longer-term residents. One young person reported that her belongings were stolen by a young person who came in overnight. She also reported that, more recently, there have been no problems with young people using the emergency bed and that she feels safe in the home. The provider has recently introduced an impact assessment tool for emergency referrals. They consider the needs of the young people already living in the home and ensure that they only admit young people when they are confident

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Requires improvement

that they can safely meet their needs. This has improved the experience of care for young people living in the home because they feel more secure. Young people have good access to healthcare, and staff ensure that they receive the treatment they need to stay healthy.

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Requires improvement

Individual risk assessments do not clearly explain why young people may be vulnerable or identify a clear plan to keep them safe. Not all staff have sufficient knowledge about the young people’s previous risk-taking behaviour. Without this, assessments of the level of risk are not based on reliable evidence. This can result in interventions to protect young people from preventable harm not being implemented consistently. This places young people at risk of harm. This also means that interventions to keep young people safe are sometimes more restrictive than they need to be and do not promote independence. In practice, staffing levels provide safe levels of supervision and monitoring to manage risk. Young people say that they feel safe. When young people engage in activities that are potentially unsafe, care plans in the home do not always demonstrate how staff intervene to support them. This misses a valuable opportunity to help young people to make informed decisions

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Requires improvement

and understand how to keep themselves safe. Staff are trained in how to protect young people from sexual exploitation and radicalisation. This means that they are alert to the dangers presented by the use of social media but they do not have a specific policy on how to protect young people from the risks associated with the internet and social media. Recording in relation to the administration of medication is poor. Staff sometimes record information in the wrong place. For example, they record prescribed medication on the non-prescribed medication sheet. Staff do not always clearly record why a particular medication was administered. In another example, it was not clear how a dose of controlled medication that had not been administered was disposed of. When young people are entrusted to administer their own medication, staff are not clear about how they have provided guidance to make sure that the young people can do this safely. This indicates that the management monitoring of

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Requires improvement

the administration of medications is not sufficiently robust to prevent errors. In practice, young people receive the required doses of the correct medication at the right time, and there have been no incidents of maladministration. When incidents raise concerns about the safety of young people, the home works effectively in partnership with the professional network to keep the young people safe. The home regularly consults with a qualified professional in adolescent mental health. This ensures that staff have a good understanding of the emotional needs of the young people, and their interventions are informed by expert opinion. They have strong links with specialist services to provide direct support to young people who may have suffered from past traumatic events. This helps young people to come to terms with their past and to develop coping skills to manage their anxieties in a way that helps them to move on and make progress.

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Requires improvement

Young people currently living in the home seldom go missing. Staff are attentive and keep track of their whereabouts at all times. Staff understand the risks for each young person in the event that their whereabouts are unknown. They have a clear safety plan to deal with such eventualities and take prompt action, in partnership with the professional network, in order to keep young people safe if they are absent or missing. Young people are generally well behaved. They understand what is expected of them, and staff support young people to improve their behaviour when required. There have been no physical interventions used in the home, and sanctions are used sparingly.

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Requires improvement

The registered manager has been away from her post for a number of weeks. The reduction in management capacity has resulted in some management tasks not being undertaken effectively. Senior staff in the home have not had recent formal supervision. The home is at full occupancy, and the staff team is experiencing some significant changes within the management structure. The lack of formal supervision for key staff creates a risk that they will not receive the support that they need to provide and maintain high standards of care for young people who have complex needs. The reduced management capacity has had an impact on the effectiveness of management monitoring systems. Not all care plans are up to date and they do not clearly demonstrate how young people are making progress as a result of the support that they receive from staff. The shortfalls in relation to the recording of medications and the quality of risk assessments indicate that management

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Requires improvement

oversight is insufficient to prevent errors or to prompt effective remedial action. The senior managers in the home have undertaken a comprehensive audit of systems and practice in the home. They have identified key areas for improvement and have an action plan in place to improve the service. Most of these actions are yet to occur and, therefore, have not yet had a positive impact on the quality of care provided to young people. Young people take part in range of positive activities. This includes physical activities, such as swimming, and recreational activities, such as trips out to the seaside. They know how to raise concerns and feel able to share their worries with trusted members of staff. They regularly contribute to house meetings and are able to influence how care is provided by the home. The two deputy managers in the home have taken on additional management responsibilities and are in day-to-day charge of the home. They are suitably

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Requires improvement

qualified and experienced to take on these extra duties. They are visible in the home and accessible to staff and young people. The deputy who facilitated this inspection demonstrated excellent insight into the needs of the young people in the home. She uses this insight to advocate for young people and to challenge the professional network effectively, to ensure that decisions are in the best interests of young people. She feels supported by her managers and reports that they are always available to provide help and guidance. The management team is managing a period of significant change. There are regular team meetings to involve the staff team in service development. Managers give clear direction to staff about areas of practice that need to improve. They robustly challenge when practice falls below the expected standards. Some staff report that they welcome the opportunity to learn and improve. Other staff are

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Requires improvement

more anxious about the changes and less positive. Despite these challenges, the staff team is working hard to ensure that the needs of young people take priority. The management team has made improvements to reduce the impact of emergency admission on the young people living longer term in the home. This has resulted in the group being more settled, and the incidents of challenging behaviour have significantly reduced. The outcomes for most young people living in the home are very positive. Most young people engage positively in education and make progress. They make positive relationships with peers and staff and move on in a planned way to suitable accommodation. All young people who gave a view during the inspection were able to comment positively about living in the home. They all said that they feel they have benefited from the help and support provided by staff.

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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

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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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