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

inspection

A compliance notice was issued on 4 August 2016. A monitoring visit took place on 30 September 2016. The compliance notice had been met.

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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:

 Some young people’s freedom of movement is overly restricted at times.  Staff are trained in physical restraint techniques that cause pain to young people.  Physical restraint records are poor and do not have sufficient oversight from managers. This fails to evidence that restraint is appropriately used.  Admissions are poorly planned. Managers admit young people whose needs are outside of those covered by the home’s statement of purpose.  Young people are not always satisfactorily prepared when they leave the home.  The processes and practices governing medication require improvement.  Managers fail to make sure that all staff are safely vetted.  Management monitoring and review systems are inadequate.  Staff do not always have the training, knowledge, or support that they need.  Managers do not record complaints/allegations appropriately.  Record keeping is not sufficient.  Facilities for staff who sleep at the home are not adequate.

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The children's home strengths

 Young people engage well in education and make good progress in this regard.

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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

In order to meet the health and well-being standard, with particular reference to physical restraint, the registered person must ensure:

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Requirement Due date

(1)(a) the health and well-being needs of children are met. 09/12/2016

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Requirement Due date

In order to meet the protection of children standard, with particular reference to taking action, the registered person must ensure that staff:

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Requirement Due date

(2)(a)(vi) take effective action whenever there is a serious concern about a child's welfare. 09/12/2016

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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:

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Requirement Due date

(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 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. 16/12/2016

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Requirement Due date

In order to meet the care planning standard, with particular 09/12/2016 reference to planning and admissions, the registered person must:

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Requirement Due date

(2)(b)(i) ensure the effective induction of each child into the home. 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)) 16/12/2016

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Requirement Due date

The registered person must ensure that the home is at all times conducted in a manner which is consistent with its statement of purpose. (Regulation 16(5)) 09/12/2016

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Requirement Due date

Restraint in relation to a child must be necessary and proportionate. (Regulation 20(2)) 09/12/2016

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Requirement Due date

These Regulations do not prevent a child from being deprived of liberty where that deprivation is authorised in accordance with a court order. (Regulation 20(3)) 09/12/2016

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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)) 09/12/2016

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Requirement Due date

The registered person must recruit staff using recruitment procedures that are designed to ensure children's safety. (Regulation 32(1)) 09/12/2016

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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)) 09/12/2016

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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 the effectiveness and any consequences of the use of the measure. (Regulation 35(3)(a)(vii)) 09/12/2016

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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)) 16/12/2016

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Requirement Due date

The registered person must maintain records ("case records") for each child which are signed and dated by the author of each entry. (Regulation 36(1)(c)) 16/12/2016

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Requirement Due date

The registered person must ensure that a record is made of any complaint, the action taken in response, and the outcome of any investigation. (Regulation 39(3)) 09/12/2016 The registered person must notify HMCI and each other relevant person without delay if there is an allegation of abuse against the home or a person working there. (Regulation 40(4)(c)) 09/12/2016

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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 design of the home should provide staff who 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 staff help each child to prepare for any moves from the home, whether they are returning home, moving to another placement or adult care, or to live independently. This includes supporting the child to develop emotional and mental resilience to cope without the home's support and, where the child is moving to live independently, practical skills such as cooking, housework, budgeting and personal self-care. ('Guide to the children's homes regulations including the quality standards', page 17, paragraph 3.27)  Ensure that staff have the relevant skills and knowledge to be able to: respond

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Recommendations

to the health needs of children; administer basic first aid and minor illness treatment; help children to manage long-term conditions and where necessary meet specific individual health needs arising from a disability, chronic condition or other complex needs. ('Guide to the children's homes regulations including the quality standards', page 34 and 35, paragraph 7.12)  Ensure that in a restraint situation, staff use their professional judgement, supported by their knowledge of each child's risk assessment, an understanding of the needs of the child (as set out in their relevant plans) and an understanding of the risks the child faces. Professional judgements may need to be taken quickly, and staff training and supervision of practice should support this. ('Guide to the children's homes regulations including the quality standards', page 48, paragraph 9.53)  Ensure that those commissioning training in restraint for children's homes’ staff

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Recommendations

should be satisfied that the training fits with their approach to restraint or existing 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 any child who has been restrained is given the opportunity to express their feelings about their experience of the restraint as soon as is practicable, ideally within 24 hours of the restraint incident, taking the age of the

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Recommendations

child and the circumstances of the restraint into account. In some cases, children may need longer to work through their feelings, so a record that the child has talked about their feelings should be made no longer than five days after the incident of restraint. Children should be encouraged to add their views and comments to the record of restraint. Children should be offered the opportunity to access an advocacy support to help them with this. ('Guide to the children's homes regulations including the quality standards', pages 49 and 50, paragraph 9.60)

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Information about this children's home

The home provides care and accommodation for up to six young people with emotional and/or behavioural difficulties. The home is owned and operated by a private company.

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Recent inspection history

Inspection date Inspection type Inspection judgement 26/07/2016 Full Inadequate 25/02/2016 Interim Declined effectiveness 10/08/2015 Full Good

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Requires improvement

Staff restrict some young people’s movements in and around the home. For some young people this is overly oppressive. For example, staff do not allow young people to leave the home without two or three members of staff accompanying them. In some instances, these staff remain within arm’s length at all times. One young person’s movements are also restricted within the home. He is constantly supervised and is not allowed time alone in his bedroom during the day. In addition, he does not have access to essential personal hygiene products without reference to staff. These restrictions on young people are not authorised by a court order and they affect their day-to-day experiences and their relationships with staff. Furthermore, the restrictions do not allow young people to develop the skills and emotional resilience they will need when they move from the home. Some young people voiced their frustration about this and were unsure how they can

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Requires improvement

‘progress’ to greater independence. However, managers consulted placing authorities and parents about the use of these measures, to which they have given their consent.

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Requires improvement

Managers do not adequately assess or plan when young people move into the home. ‘Placement proposal’ documents do not effectively explore ‘matching’ with other young people. Nor do managers consider staff skills or identify when extra training is required. As a result, managers do not help to prepare staff prior to the admission of a young person. In addition, some young people have needs that are outside the remit described in the home’s statement of purpose. For example, young people with learning disabilities have been moved into the home with insufficient consideration of their needs. This has the potential to limit young people’s progress.

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Requires improvement

Staff support young people to meet some of their physical health needs, such as attending routine appointments. However, some staff do not have enough knowledge of other specific, long-term health issues. This limits the staff’s ability to support young people.

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Requires improvement

Managers have taken action to update all young people’s risk assessments and placement plans. This helps to provide some guidance for staff and improves their ability to offer personalised care to young people. In addition, managers have been more proactive in identifying when young people may require additional clinical assessment. This has started to identify their learning/communication needs and abilities. This information is yet to be fully embedded in or influence staff practice.

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Requires improvement

Young people make progress in some areas of their life. Most notably in their education attendance, which has significantly improved. Because of this, they achieve more academically from their starting points. All young people are educated in the school owned by the provider. The head teacher talked positively about the progress young people have made. She highlighted that some young people, who had previously not engaged in education, were now sitting exams.

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Requires improvement

Staff support young people to see their families and friends when it is safe to do so. This is very important to young people, some of whom now live a considerable distance away from where they were born.

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Requires improvement

Staff understand and identify some areas of risk. This includes the risks that young people could face when away from the home. Young people no longer go missing. This reduces other concerns, including the likelihood of exploitation and the misuse of drugs and alcohol. This is in large part due to the high staffing levels and the restrictions placed on young people. Nevertheless, this provides some young people with a sense of safety. One social worker stated, ‘The best thing that could have happened to the young person was coming to the home. He feels safe.’

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Requires improvement

Young people’s behaviour generally improves and social workers talk positively about this. Staff frequently use physical restraint in response to some young people’s behaviour. Staff all receive training in this area. This training teaches two techniques that cause pain to young people. While there is no evidence that staff have used these, the fact that they are trained in such techniques means that they could. These techniques are neither proportionate nor appropriate for use in a children’s home.

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Requires improvement

Records of restraint are poor. For example, staff do not suitably describe the intervention used. The effectiveness and consequence of the restraint used is not considered. Because of this, it is impossible to ascertain whether the restraint is necessary and proportionate. A lack of management oversight means that managers have failed to tackle these issues. In addition, on one occasion, they failed to take effective action after staff identified an area for improvement. Specifically, staff felt that the addition of a clear bedtime routine for one young person might reduce the likelihood of physical restraint being required. The delay in exploring this could have been detrimental to the young person.

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Requires improvement

Managers do not seek evidence that the restraint system used by staff is appropriate. Specifically, they have not ascertained whether it has been medically assessed for use with young people who are still developing physically and emotionally. Managers do not adequately consider any medical conditions that young people may have, or the impact of these, if a young person is restrained. In addition, records do not show that young people receive suitable medical support following a physical intervention. This includes instances when they may have harmed themselves during a restraint. These shortfalls have the potential to place young people’s health and well-being at risk.

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Requires improvement

Staff talk to young people after any restraint has taken place. However, these conversations sometimes focus on whether young people understand why they were held and whether they apologise for their behaviour. As such, these conversations do not always give the young person the opportunity to express their feelings about their experience of restraint.

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Requires improvement

Staff do not always receive the support they need following a physical restraint. For example, on one occasion, managers identified that a member of staff had been involved in a high number of incidents. However, they did not raise the subject in the member of staff’s formal supervision session. This does not help staff to develop their professional judgement, their understanding of young people’s needs or the risks associated with restraint.

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Inadequate

The registered manager has not managed the home since the last inspection. In his absence, two other managers have taken day-to-day charge of the home. Neither of these managers are registered with Ofsted in relation to this home.

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Inadequate

Management monitoring and review systems are ineffective. As a result, managers are not sufficiently aware of the home’s strengths and weaknesses. Consequently, managers do not make enough progress to improve the home. For example, they have failed to identify a number of the shortfalls raised in this inspection. In addition, they have not rectified a number of deficits identified at the home’s previous inspection. Managers do not always understand the impact that these shortfalls have on the progress and experiences of young people. This affects the quality of care that young people receive and the speed with which the service can improve.

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Inadequate

The home’s statement of purpose lacks important detail. Specifically, it does not give details of the qualifications and professional supervision arrangements of the staff involved in providing healthcare or therapy. This limits the information available to young people, placing authorities and families.

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Inadequate

A significant number of staff have worked at the home since the last inspection. Managers were not able to provide an exact number. This lack of awareness and oversight of staffing arrangements does not make sure that young people receive adequate continuity of care.

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Inadequate

Staff are not always well supported. For example, not all staff receive training in a number of areas. These include areas directly linked to young people’s physical well-being, such as first aid and epilepsy. In addition, there is no formalised training covering subjects such as learning disability and autistic spectrum disorder. This prevents staff from adequately understanding some young people’s needs and behaviour. Some staff hold the required level 3 diploma in residential childcare or a suitable equivalent. Others are working towards this. There are plans in place to make sure that they complete this within the required timescales.

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Inadequate

The arrangements for the handling, recording, safekeeping, and safe administration of medication are weak. Records are sometimes confusing. This means it is not always clear whether young people have been given their medication in line with the prescriber’s instructions. This has the potential to place young people’s health at risk.

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Inadequate

Managers do not always make sure that staff are thoroughly vetted prior to starting their employment. Since the last inspection, risk assessments for staff who do not have ‘clear’ disclosure and barring service certificates have been kept in the recruitment file. However, these documents lack detail or analysis. As a result, they do not accurately determine the level of risk posed by applicants. This continues to place young people at risk from potentially unsafe adults.

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Inadequate

Managers seek young people’s feedback at times. However, managers do not always record complaints sufficiently. This includes allegations made by young people about staff. Managers make sure that the appropriate safeguarding agencies are informed about these allegations. However, written records do not always detail the complaint, the action taken, and the outcome of any investigation. In addition, on one occasion, managers failed to notify HMCI of an allegation of abuse against a person working at the home. These shortfalls prevent effective oversight.

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Inadequate

Staff who sleep in the home overnight continue to have poor facilities and have to use mattresses placed in lounge areas. This does not provide them with enough privacy. This is a shortfall from the last inspection.

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Inadequate

Managers do not make sure that record keeping is of an adequate quality. Some records are not kept up to date. Others are not signed and dated by the author of each entry. These shortfalls reduce the accuracy of the information available to managers and staff to care for young people. Furthermore, young people who may wish to view their own files in the future do not get an accurate record of their time living in the home. Managers have developed good working relationships with some other agencies, including social care services. This helps them to offer useful challenge on some occasions, for example, around issues of contact for one young person, which resulted in safer and better-planned contact.

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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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