Children's home run by Thoughts of Others Limited in Birmingham

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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because:

 Managers and staff do not adequately support young people when they move out of the home.  Staff do not always take appropriate action when young people go missing.  Staff are trained in some restraint techniques that cause pain. These techniques are inappropriate.  Young people do not consistently receive adequate medical support following incidents of restraint.  Some records and policies relating to restraint are insufficient.  Some systems relating to medication are weak.  Not all staff are suitably vetted prior to starting employment.  Aspects of management oversight, monitoring, and support to staff are inadequate.  Recording in some areas is poor.  Young people’s files are not stored appropriately.

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The children’s home strengths

 Young people make progress in some important areas of their life.  Some core staff develop strong, supportive relationships with young people.

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Statutory requirements

This section sets out the actions which must be taken so that the registered person(s) meets the Care Standards Act 2000, Children’s Homes (England) Regulations 2015 and the ‘Guide to the children’s homes regulations including the quality standards’. The registered person(s) must comply within the given timescales.

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Requirement Due date

5. Engaging with the wider system to ensure children’s needs are met

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Requirement Due date

In order to meet the engaging with the wider system standard, with particular reference to challenge, the registered person must ensure that: (c) if the registered person considers, or staff consider, a placing authority’s or a relevant person’s performance or response to be inadequate in relation to their role, challenge the placing authority or the relevant person to seek to ensure that each child’s needs are met in accordance with the child’s relevant plans. 02/01/16

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Requirement Due date

In order to meet the health and well-being standard, with particular reference to physical restraint, the registered person must ensure: (a) the health and well-being needs of children are met. 02/01/16

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Requirement Due date

In order to meet the protection of children standard, with particular reference to missing, the registered person must ensure that staff: (2)(a)(vi) take effective action whenever there is a serious concern about a child’s welfare. 02/01/16

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Requirement Due date

13. The leadership and management standard

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Requirement Due date

In order to meet the leadership and management standard, with particular reference to staffing and monitoring, the registered person must: (2)(c) ensure that staff have the experience, qualifications and skills to meet the needs of each child (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 02/01/16 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. 14. The care planning standard

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Requirement Due date

In order to meet the care planning standard, with particular reference to admissions and discharges, the registered person must ensure that children: (1)(b) have a positive experience of arriving at or moving on from the home. 02/01/16

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Requirement Due date

The registered person must ensure that restraint in relation to a child is necessary and proportionate. (Regulation 20 (2)) 02/12/16

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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)) 02/12/16

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Requirement Due date

The registered person must prepare and implement a policy (‘the behaviour management policy’) which sets out the measures of control, discipline and restraint which may be used in relation to children in the home. This is with specific reference to the use of ‘floor holds’. (Regulation 35 (1)(b)) 02/12/16

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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)) 02/12/16

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Requirement Due date

The registered person must maintain records (‘case records’) for each child which are kept up to date. (Regulation 36 (1)(b)) 02/12/16

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Requirement Due date

The registered person must ensure that case records are kept securely in the children’s home during the period when the child to whom the case records relate is accommodated there; and in a secure place after the child has ceased to be accommodated in the home. (Regulation 36 (2)(c)(d)) 02/12/16

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Requirement Due date

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. 02/12/16 (Regulation 45 (1)) The registered person must ensure that the system referred to in paragraph (2) provides for ascertaining and considering the opinions of children, their parents, placing authorities and staff. (Regulation 45 (5)) 02/12/16

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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 the environment is homely. (‘Guide to the children’s homes regulations including the quality standards’, page 15, paragraph 3.9)  Ensure that the design of the home provides staff that sleep in the home overnight with appropriate accommodation and facilities to do so. (‘Guide to the children’s homes regulations including the quality standards’, page 17, paragraph 3.26)  Ensure that the policy on protection of children from abuse and neglect includes arrangements in relation to dealing with allegations involving staff in the home. This is with particular reference to senior staff or staff who may be related. (‘Guide to the children’s homes regulations including the quality standards’, page 44, paragraph 9.19)  Ensure that restraint records also include interventions that restrict a child’s

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Recommendations

liberty of movement. Restrictions such as these, and all other restrictions of liberty of movement, should be recorded as restraint. (‘Guide to the children’s homes regulations including the quality standards’, page 47, paragraph 9.42)  Ensure that approaches to restraint recognise that children are continuing to develop, both physically and emotionally. Any use of restraint should be suitable for the needs of the individual child. The context in which restraint is used should also recognise that, as a result of past experiences, children will have a unique understanding of their circumstances which will affect their response to restraint by adults responsible for their care. (‘Guide to the children’s homes regulations including the quality standards’, page 48, paragraph 9.54)  Ensure that those commissioning training in restraint for children’s homes staff are satisfied that the training fits with their approach to restraint or existing

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Recommendations

restraint system, and is appropriate to the needs of the children the home is set up to care for. They should see evidence that any restraint techniques the training advocates for have been medically assessed to demonstrate their safety for use in a context of caring for children who are still developing, physically and emotionally. The registered person should routinely review the effectiveness of any restraint system commissioned. In particular, they should check the medical assessment of the system remains up to date. (‘Guide to the children’s homes regulations including the quality standards’, page 49, paragraph 9.58)  Ensure that the recruitment of staff safeguards children and minimises potential risks to them. (‘Guide to the children’s homes regulations including the quality standards’, page 61, paragraph 13.1)  Ensure that a record of supervision is kept for staff, including the manager. The

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Recommendations

record should provide evidence that supervision is being delivered in line with regulation. (‘Guide to the children’s homes regulations including the quality standards’, page 61, paragraph 13.3)  Ensure that staff understand the importance of careful, objective and clear recording. (‘Guide to the children’s homes regulations including the quality standards’, page 62, paragraph 14.4)

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Information about this children’s home

The home may only provide care and accommodation for up to two children with emotional and/or behavioural difficulties. A private provider operates the home.

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Recent inspection history

Inspection date Inspection type Inspection judgement 23/03/2016 Interim Improved effectiveness 01/10/2015 Full Good 24/02/2015 Full Good 21/07/2014 Interim Sustained effectiveness

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Requires improvement

One young person has recently moved from the home. She did not receive the support that she needed during this time. Planning was poor and she left important items behind. The placement she moved to was inappropriate and did not offer her adequate support. The registered manager failed to challenge the placing authority effectively about this. These shortfalls affected the young person’s relationships with staff, her feelings of safety and her experience of living in the home.

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Requires improvement

Despite this, while living in the home, young people develop strong relationships with some ‘core’ staff. This makes sure that young people generally receive individualised care. This helps them to make progress in some key aspects of their life. For example, their attendance at school improves in relation to their starting points. This helps them to achieve more academically. One young person’s teacher confirmed this, stating, ‘She is achieving well.’ Overall, young people’s confidence and emotional well-being also improve and they actively engage in therapeutic support. A young person’s social worker reflected, ‘She has made progress.’

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Requires improvement

Staff generally support young people to articulate their views. However, the home’s safeguarding policies lack important information. They do not address the difficulties that may arise should young people wish to complain, or make an allegation, about staff who are related to other staff or managers. This is particularly relevant to senior staff. Young people are aware of these relationships. Some young people have expressed concerns about this. This could affect their confidence to make a complaint, or their belief that managers will act impartially.

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Requires improvement

The outside of the home is nicely presented and welcoming. In contrast, some aspects of the interior require improvement. In some areas, there is insufficient evidence of cleaning and some rooms are untidy. In addition, there is a large padlock on a kitchen cupboard. These issues detract from creating a homely feel.

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Requires improvement

Staff support young people to develop some of the practical skills they need as they approach adulthood. They also help them to stay in touch with people who are important to them, if it is safe to do so. This is especially important to young people who may live a considerable distance from where they were born. Judgement grade

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Requires improvement

The management, understanding and assessment of risk is variable. Young people rarely go missing, due in part to high staff ratios. This is a significant improvement for some young people. This helps them to be safer and reduces risks in other areas, including the risk of exploitation. However, on one occasion staff failed to take effective action when a young person went missing. Specifically, they failed to adequately search for them or try to contact them. The staff that were due to support the young person during this time were reassigned to other homes owned by the provider. This left the young person unsupported and potentially at risk.

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Requires improvement

Incidents when young people hurt themselves reduce and staff understand the risks young people face in this regard. Young people’s behaviour generally improves. One social worker commented that a young person was previously, ‘Out of control’ but that staff had, ‘Really pulled her round… They managed her behaviour really well.’

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Requires improvement

At times, physical restraint is required in order to keep staff or young people safe. There are a number of concerns in this area. The restraint method used teaches techniques that cause pain to young people. Although there is no evidence that staff have ever used these techniques, they could. These techniques are not proportionate or appropriate for use in a children’s home. ‘Floor holds’ where young people are restrained on the floor are also taught. The home’s behaviour management policies, specifically the ‘policy for the use of physical restraint’ does not state that these holds may be used. This does not alert placing authorities, families or young people to this fact.

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Requires improvement

There is no formal, independent assessment that the restraint system used is appropriate for the needs of young people. This includes a lack of medical assessment for its use with young people who are developing physically and emotionally. In one case, the registered manager also did not consider whether a young person’s asthma would affect the safety of any restraint. This has the potential to affect the young person’s health and well-being. Young people’s past experiences are also not taken into account. This does not help staff to understand that, because of these experiences, young people will have a unique perspective, which will affect their response to staff restraining them. This is particularly important for young people who have previously been harmed by adults.

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Requires improvement

On some occasions, staff restrict young people’s liberty of movement, for example by preventing them from leaving the home. Managers do not currently consider these restrictions as restraint and staff do not have to record them. Other aspects of recording are also poor. On one occasion, the duration of one hold was not clear. Nor do staff adequately describe the measure of restraint used. Records also fail to evidence that young people receive adequate medical support following a physical restraint when they may have harmed themselves. This does not meet their health and well-being needs. These shortfalls limit the oversight of these incidents. They prevent analysis of their appropriateness and the support young people receive.

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Inadequate

An experienced registered manager is in post. She was registered in April 2015 and is currently completing the level 5 diploma in leadership and management for residential childcare.

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Inadequate

The support that staff receive is insufficient. The registered manager does not identify their training needs well. As a result, many staff do not have up-to-date training in key areas. This affects their skills and their ability to meet the needs of young people. Some staff are suitably qualified and hold the level 3 diploma in residential childcare or a suitable equivalent. Others are working towards this. They are currently within the required timescales for completion. Records of staff supervision are poor and fail to show that supervisions are appropriate. This reduces the registered manager’s oversight and her assessment of the strengths and weaknesses of the staff team.

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Inadequate

The registered manager does not have effective monitoring and review systems in place. Consequently, she is unable to assess whether the service is fully delivering the aims and objectives outlined in the statement of purpose. Formal ‘quality of care reviews’ are not completed in the required timescales. They lack detail and do not ascertain or consider the opinions of young people, their parents, placing authorities and staff. This limits the registered manager’s ability to identify the home’s weaknesses. It also limits her understanding of the impact that the quality of care provided in the home is having on the progress and experiences of young people.

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Inadequate

The arrangements for handling, recording, and storing medication are inadequate. Medicines belonging to a young person who has moved from the home are still in the medication cabinet. Prescription labels do not always match how the medication is being used. It is therefore unclear whether some medication should be used ‘as and when required’ or more regularly. In addition, some staff are unaware of the purpose of some medication or the impact if young people refuse to take it. This places young people at potential risk. The registered manager does not assess or analyse the number of staff working in the home. A manager from another service completes the staff rotas. To make sure of sufficient staffing levels, staff based in other homes are routinely used to cover shifts. This does not allow the registered manager to ensure that the home’s workforce provides continuity of care to each child. In addition, staff who sleep at

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Inadequate

the home do not always have appropriate facilities or accommodation available to them. At times, some staff sleep on a temporary bed in the lounge. This does not afford them adequate privacy.

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Inadequate

Aspects of record keeping are poor. Some records are not kept up to date. Other records lack detail and are unclear. This limits the information available to staff. Young people’s case records are not always stored securely while young people are living in the home or when they leave. This fails to safeguard young people’s confidential information.

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Inadequate

The registered manager does not oversee staff recruitment for the home and fails to check the rigour of these systems. Processes are flawed and are not always followed. For example, managers do not sufficiently explore applicants’ reasons for leaving previous employment with children or vulnerable adults. Nor do managers always investigate discrepancies in references, or sufficiently assess negative references. These issues fail to safeguard young people from potentially unsafe adults gaining employment in the home.

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Inadequate

The staff and registered manager have developed some positive relationships with a number of other agencies, including social care, education and mental health services. This ensures that communication is generally effective.

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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 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, 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,

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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

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

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Information about this inspection

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

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