Children's home run by Care Management Group Limited in Mole Valley

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:

 Essential documents on children and young people’s files need to be updated, and also to be signed by relevant professionals and family members.  Children and young people do not receive enough support to manage their frustrations and behaviours. Staff have not received enough training to help them to feel confident to manage complex behaviours or restrain children and young people if there is a risk to themselves or others.  Changes within the staff team have meant that children and young people have had to meet new workers and cope with more agency staff on shifts. This does not promote consistency or security for children and young people with autistic spectrum disorder and additional complex needs.  Staffing issues in other parts of the company’s service have resulted in the registered manager covering additional duties. This has impacted upon her ability to monitor, manage and improve the home.

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The children’s home provision requires improvement because:

 The registered manager has not always notified the regulator when a child protection enquiry or other serious incident has occurred.  Correct recording of the administration of medication does not always happen. Some records do not have staff signatures added.  The registered manager’s quality of care review is not submitted to the regulator on a regular basis, as required.  The home environment is not always maintained to an acceptable standard.  Recording and passing of information to others are not always consistent.  Not all the care staff in the home hold the level 3 diploma for residential childcare.

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The children’s home strengths

 A consistent group of children and young people live at this home and know one another well. Some have stayed in placement for up to four years.  Updates to policy, procedures and essential documents have taken place since the last inspection.  Children and young people have an accessible children’s guide, hospital passport and communication passport. These documents are pictorial and easy for children and young people to understand.  Staff make good use of booklets for communication between school and the home, and between the home and parents.  Professionals and parents feel that children and young people are safe in this home and make progress from their starting points.  The registered manager has introduced a system of recording any marks, scratches or bruises on body maps to ensure that no injuries, however minor, go unexplained.  Children and young people enjoy a high staff ratio which allows them to

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The children’s home strengths

enjoy activities such as swimming, eating out at a restaurant and going shopping or to the cinema.  The registered manager and senior management team deal with poor practice quickly. They work out clear staff rotas ahead of time and ensure that they request the same agency workers to promote consistency.  Despite recent difficulties and changes, the home is making good efforts to undertake direct work with children and young people to help them to be more independent, and to stay healthy and safe.

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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

12. The protection of children standard:

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Requirement Due date

(2)(a) In order to meet the protection of children standard, with particular reference to the risks that children and young people present to each other, the registered provider must ensure that staff: (iv) manage relationships between children to prevent them from harming each other. 31/01/2017

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Requirement Due date

13. The leadership and management standard:

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Requirement Due date

(2) In order to meet the leadership and management standard, with particular regard to ensuring that staff have relevant skills to manage behaviours to meet children and young people’s needs consistently: (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. 31/01/2017

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Requirement Due date

The registered person must notify HMCI and each other relevant person without delay if a child protection enquiry involving a child is instigated or concludes (in which case, the notification must include the outcome of the child protection enquiry); or there is any other incident relating to a child which the registered person considers to be serious. (Regulation 40(4)(d)(i)(ii)(e)) 30/11/2016

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Requirement Due date

The registered person must ensure that a record is kept of the administration of medicine to each child. (Regulation 23(2)(c)) 30/11/2016

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Requirement Due date

The registered person must maintain records (‘case records’) for each child, which are kept up to date; and are signed and dated by the author of each entry. (Regulation 36(1)(b)(c)) 31/12/2016

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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 and supply to HMCI a copy of the quality of care 28/02/2017 review report within 28 days of the date on which the quality of care review is completed. (Regulation 45(1)(4)(a)) The registered person must ensure that any individual who works in the home in a care role has the level 3 diploma for residential childcare (England). (Regulation 32(4)(a)) 31/07/2017

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Recommendations

To improve the quality and standards of care further, the service should take account of the following recommendation(s):

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Recommendations

 The registered manager must ensure that the home plays a full part in promoting the best interests of the child, proactively advocating for the child to ensure that others play their role and deliver the high-quality support that is needed while the child lives in the home. (‘Guide to the children’s homes regulations including the quality standards’, page 11, paragraph 2.4) This in respect of all staff working consistently with local authority, school and parents.  The registered person must ensure that the home is a nurturing and supportive environment that meets the needs of their children. (‘Guide to the children’s homes regulations including the quality standards’, page 15, paragraph 3.9) This is in relation to replacing the carpet in the lounge and refurbishing the bathrooms.

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Information about this children’s home

This is a privately run home. It provides care and accommodation for up to five young people who have autistic spectrum disorder and/or special needs and learning difficulties.

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Recent inspection history

Inspection date Inspection type Inspection judgement 15/03/2016 Interim Sustained effectiveness 28/10/2015 Full Requires improvement 19/03/2015 Interim Improved effectiveness 05/12/2014 Full Adequate

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Requires improvement

Young people have individualised care plans which provide details about all aspects of their care. All the young people living at the home have limited verbal communication and some have a high level of complex health, mobility and behavioural issues. All the young people have placement plans, risk assessments and behavioural support plans which give staff simple but detailed information about their needs.

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Requires improvement

Some records, including placement plans, risk assessments, hospital passports and emergency evacuation assessments, require updates. This would ensure that new staff or staff coming onto shifts know the most up-to-date information so that they can provide the best-quality care.

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Requires improvement

Information about the care that young people receive is easily accessible to them. For example, the young people’s guide contains pictures and simple language. Although this information is in accessible format, it is unclear how and when it is shared with young people. Communication books, completed by staff, help to inform parents, teachers and other professionals about any important information, issues or events which affect the young people. This helps to ensure smooth transitions between the home, school and parents’ care.

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Requires improvement

Recent staff changes have affected the quality and consistency of care for young people. For example, it takes new staff and young people time to come to know one another and build up trust and relationships. Agency staff cover shifts to ensure appropriate staffing levels. The registered manager seeks to book regular agency workers. This ensures the least disruption to young people.

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Requires improvement

Young people make progress from their starting points. For example, one young person opened a bank account and learned to shop online safely. Others make progress, improving personal care and learning appropriate social behaviour. Some young people have been less consistent, taking a backward step in improving healthy lifestyles or presenting difficult behaviours. Given the level of complex needs that young people present, progress can vary. One school said, ‘It is not unusual to have steps backwards. X presents as more complex than last year.’

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Requires improvement

All young people are on roll in education and staff encourage them to get into consistent routines. This helps them to be organised to go to school on time and with the equipment that they need. The registered manager and the staff team have positive relationships with schools and complete a communication book to ensure that important information is shared. A parent said, ‘The communication book is good. Activities are more consistent. It’s a great thing, as it prompts staff to remember things.’

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Requires improvement

Some delays are evident in achieving partnership working with schools on managing behaviour and healthy eating. Despite this delay, staff work well with schools by observing young people in the education setting and working together to provide consistent strategies for challenging behaviours. One headteacher said, ‘Staff came in to discuss behaviours. They were very keen to take on strategies.’

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Requires improvement

Some young people have complex health needs. Most staff receive first aid training and specialist training in how to manage epilepsy and how to administer emergency treatment in the event that a young person has an epileptic fit. Only trained staff administer medication. On occasion, the administration of medication is from less familiar staff who work at other units on the same site. Appropriate record keeping of the administration of medication takes place. Poor record keeping and a lack of signatures by staff responsible for overseeing this process occurred one day in relation to records of the medication coming in and out of the home. No young people suffered any harm, and revised systems are now in place to ensure clearer recording.

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Requires improvement

Staff listen to and interact with young people. For example, young people asked if they could go swimming when they came back from school and staff arranged to take them. The home has an on-site activity centre where young people can go swimming or use the gym equipment/activity hall. This helps young people to take regular exercise and lead a healthier lifestyle.

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Requires improvement

There is no consistent forum to engage young people in everyday choices such as the menu and organised activities, or to challenge behaviours or discuss important topics. Young people’s meetings and key-work sessions are not happening often enough to have an impact on behaviour, choices, feedback and planning. Young people would benefit from regular sessions to think about these issues.

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Requires improvement

Young people have consistent routines which help them to understand what is expected of them and when. All young people eat at regular times and sit down together with staff to eat their food at the table. This helps young people to establish positive eating routines and relationships. When young people return from school, staff greet them warmly and encourage them to change their clothes, have a snack and drink, and relax before their main evening meal.

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Requires improvement

Two of the young people live at the home on a shared care plan. Staff help them to understand their routine with weekly timetables and pictures of their two homes and their school. This helps them to understand where they are staying and when.

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Requires improvement

A strength of this home is the positive encouragement of and work with young people to gain independence skills. Young people help to load the dishwasher, write shopping lists, help to prepare simple meals and drinks, help to clean their rooms, learn personal care and bring down their laundry. This helps young people to learn new skills and be as independent as possible.

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Requires improvement

Safe recruitment processes are in place, with all necessary checks undertaken to determine staff suitability to work with vulnerable young people. For example, a minimum of two references, as well as checks with the Disclosure and Barring Service are taken up. This helps to ensure that unsuitable adults do not work at the home.

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Requires improvement

The home has appropriate fire safety systems and checks to ensure young people’s safety in the event of a fire. All young people have a fire evacuation plan so that, if an emergency arises, the staff know what to do and how to evacuate safely.

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Requires improvement

Staff know the young people and are aware that some of them do not get on well together. Staff manage this situation well and are vigilant to pre-empt behaviours and observe potential confrontations. Due to young people’s vulnerabilities and potential conflicts, staffing levels are high, allowing good levels of supervision and monitoring to keep young people safe.

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Requires improvement

The home does not use restraint and staff do not receive training in restraint techniques. Staff do receive training in managing challenging behaviour and have advice from a positive behaviour support team (PBS) to think about strategies to manage behaviour. It has been necessary on occasion to evacuate some young people for their own safety, due to another’s behaviour. The PBS advice includes the use of holding and guiding techniques to manage these incidents. However, staff require specialist training to use these holds. Young people’s safety is not at risk, but the current management strategy includes other’s evacuation from their own home. Without having some staff trained in holding/restraint techniques, there is a risk of accidental harm to young people when incidents take place.

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Requires improvement

Staff understand young people’s vulnerability, particularly when out in the community. No young people have gone missing from the home or while out on activities. The staff ratio is a minimum of one-to-one to ensure that one staff member is responsible for one young person and can keep them as safe as possible. There are no restrictions of liberty within the home and young people can access all areas of the home and the garden safely. The external door has a biometric door system, which enhances security at the home and prevents young people from leaving without staff’s knowledge or supervision. All necessary consents and policies surrounding this restriction of liberty are in place. Parents agree to these restrictions and young people over 16 years have capacity assessments completed to consider their needs and views. All key documents designed to promote safeguarding are in place. Staff spoken to feel confident to report any safeguarding issues and are aware of the

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Requires improvement

whistleblowing policy. The registered manager completes a thorough review of the safety of the home, including the immediate local area in which the home is situated and any potential risks arising from this, for example other adult service provision on the same site. This helps placing authorities and parents to understand that the home promotes young people’s safety.

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Requires improvement

Risk assessments identify risks and provide staff with clear, simple strategies to manage them. To be more effective, risk assessments require updating to reflect changes quickly and consistently.

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Requires improvement

The registered manager omitted to notify the regulator of one child protection enquiry and one serious incident in the home, in line with guidance and regulations. Notification to the placing authorities did occur and the registered manager took appropriate action to manage these incidents and safeguard young people. This did not place young people at any significant risk, but did not allow the regulator oversight of what is happening in the home. A social worker raised the concern, ‘Recording and passing of information to others are not always consistent.’

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Requires improvement

Despite some concerns, parents and professionals feel that young people are safe. They were worried about unexplained minor injuries occurring when young people receive one-to-one supervision. The registered manager has brought in a system of recording body maps for the two young people who receive shared care to ensure that no marks, however minor, are unexplained.

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Requires improvement

The home is generally clean, tidy and well maintained. One room has a strong smell of urine from the carpet. Despite regular cleaning of the carpet, the odour is still present, therefore the carpet needs replacing. The upstairs bathrooms are also in need of some refurbishment and this is included in the improvement plan for the home for this financial year. Young people deserve to have a pleasant environment to live in. This helps to raise their self-esteem and confidence.

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Requires improvement

The manager was registered as suitable in April 2016. Prior to this, the service had had no registered manager in place since December 2014. Two interim managers covered the post until the current registered manager took up the post in October 2015. Prior to working as the interim manager, the registered manager had limited experience in children’s settings and was attempting to cover two settings in the early stages of her employment. Since April 2016, she has managed just this home. The registered manager is enrolled on the level 5 diploma in leadership and management and is aware of the date by which she needs to complete this qualification.

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Requires improvement

Initially, the registered manager made good progress in updating the home’s policies and procedures and bringing the service up to date to meet the Children’s Home Regulations (England) 2015 and the quality standards. Since the interim inspection in March 2016, the progress and improvement have slowed and some areas of this inspection show concerns emerging in the consistency of leadership and management. The home is owned by a company and is situated on a geographical site with other homes, which provide services for adults. The registered manager frequently supports the other adult service provision on site, taking her focus and concentration away from improving the children’s provision.

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Requires improvement

Leaders and the manager recently appointed a new deputy manager and a new senior support worker, which will alleviate the duties of the registered manager and allow more focus on improving the service. The new workers both have limited experience in children’s services, although they are experienced and well-qualified workers. This home still has an adult focus, so it must prioritise its work with children and young people if it is to improve. Workers from adult services backgrounds face a challenge to become familiar with the legislation, practice knowledge and training required to run an effective children’s service.

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Requires improvement

Young people’s progress is inconsistent. All the young people have been at the service for some time, and some of them are making good progress. Others have made small steps or backward steps, for example in healthy eating, weight loss and behaviour management. Given the complex needs of young people, backward steps are to be expected. However, the feedback from parents and professionals indicates some concerns about consistency in communication, actions and reporting. One social worker said, ‘On occasions, there is a lack of continuity with care; not consistent, at other times really good.’

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Requires improvement

Staff report that there have been changes in the team, which are difficult, as regular staff have left or are leaving, and agency workers are covering their shifts. Morale is affected by staff moves. Staff say that they do not feel supported above the registered manager level and this has led to some leaving. Staff leaving inevitably impacts on the care provided to young people. One social worker said, ‘They do have quite a bit of turnover of staff and workers don’t always understand needs.’ The registered manager is aware of these issues and tries hard to keep staff rotas as consistent as possible for young people. The registered manager needs support from the senior leaders and managers to focus on this home and do her job effectively.

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Requires improvement

An independent person visits the home once each month and seeks the views of young people, staff, parents and other professionals. Recommendations on how to improve the home are sent to the leaders and managers. Slow progress has been made on fulfilling recommendations, which reflects the feedback from this inspection. There is progress, but actions are slow and improvement is delayed.

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Requires improvement

The manager should complete a review of the quality of care within the home every six months. These reports have not been timely or consistently submitted, which does not allow the regulator to understand what is happening at the home or to intervene to improve progress. The recent report shows that leaders and managers are aware of their shortfalls. However, there is no clear action plan submitted to address these.

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Requires improvement

The home’s statement of purpose is due for revision. Overall, the home is working within its intended purpose. However, the recent staff changes must be reflected in this document.

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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’. 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 looked after children is safeguarded and promoted. Minimum requirements

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What the inspection judgements mean

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 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 0300 123 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 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

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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