Children's home SC063059

children and young people since the most recent full inspection

This home was judged good at the full inspection. At this interim inspection, Ofsted judge that it has declined in effectiveness .

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children and young people since the most recent full inspection

This inspection focused on the effectiveness of the home and the progress and experiences of young people since the last inspection. The inspection identified significant shortfalls in safeguarding practices and procedures have affected the welfare and safety of young people living in the home. Staff and managers spoken to during the inspection all raised significant concerns about safeguarding practices in the home. Staff comments made to inspectors included: ‘Young people are not safe living here’, ‘We cannot keep them safe’, ‘Kids are really at risk here. It’s a surprise nothing has happened already’, and ‘We have been waiting for you to come. It’s worse than last time.’

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children and young people since the most recent full inspection

Contrary to the admissions policy and procedures, not all young people have benefited from a comprehensive referral, compatibility risk assessment or a thorough appraisal of their needs. Managers have offered placements to young people without identifying, assessing and addressing their full range of needs and the potential impact on others who were already living in the home. Consequently, some young people have been inappropriately placed. For example, the manager made a decision on 4 October 2016, to move a child much younger than the other children at the home from another home within the company to this home. This was because she had previously worked with him. However, no consideration was given to the known risks associated with other young people’s specific needs and behaviours that were already living in the home. This has had an impact on the young person’s safety and welfare as he has subsequently experienced significant

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children and young people since the most recent full inspection

bullying. He has told staff he is ‘unhappy’ and that he ‘does not feel safe living in the home’.

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children and young people since the most recent full inspection

Members of staff spoken to during the inspection also confirmed that the young person was being bullied. One staff member said they were, ‘very concerned about his safety’. This was because the older young people were entering into the young person’s bedroom at night and he was reported by staff members to be ‘petrified’. The provider had put in place waking night staff. However, these arrangements were ineffective, as night staff were reported by their colleagues and young people to be, ‘sitting downstairs on the couch, on their mobile phones’. Despite staff and managers being aware of this, no further action was taken. Consequently, this meant that the young person was not helped to feel safer at night.

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children and young people since the most recent full inspection

Young people were reported as requiring and being on a one member of staff to one young person level of support. However, young people were leaving the home unaccompanied on a regular basis. They were known to be visiting a local public house to access the free wi-fi. Concerns were highlighted by an adult member of the public, who contacted the home by telephone to report to staff that he had, ‘bought a young person a drink’ and had enquired, ‘should the young person be there.’ The staff member said to the unknown male ‘[Name of young person] does not have permission to be there, but we know that he sits outside using the wi-fi.’ There was no further evidence of any immediate actions taken by staff to manage the situation effectively or to minimise the risks to young people, including updating any risk management plans. This fails to demonstrate that staff are aware of their roles and responsibilities in protecting and safeguarding young people, nor

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children and young people since the most recent full inspection

are they proactive in responding to worrying concerns that are shared with them. This places young people at risk of significant harm. Social work professionals voiced concerns about the ability of the home to support the safety and progress of some young people. One social worker said, ‘Staff appear to be frightened of young people and seem to put all the blame on them’, and, ‘The home is always in chaos with a poor standard of care and accommodation.’

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children and young people since the most recent full inspection

The home’s rear garden is adjacent to an open prison. Young people were known to be sitting in the garden talking to the prisoners through their garden fence. One young person brought to the attention of the inspectors a seat that they said that they use to, ‘sit and talk to the men from the prison’. When this was discussed with staff, they said, ‘We know they do it, but didn’t know they had actually put a seat there. Anyway it’s an open prison so they must be OK.’ This demonstrated a worrying lack of understanding of the potential risks to young people and the subsequent action needed to safeguard and protect them.

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children and young people since the most recent full inspection

Care plans and risk assessments do not accurately reflect or address the current needs of young people. Furthermore, insufficient action has been taken to ensure that all risk assessments are reviewed and updated. The assessments do not satisfactorily detail how risk is to be reduced or managed. For example, young people have entered the staff office and taken the keys for the company vehicle on more than one occasion. They have then proceeded to enter the vehicle and drive off putting their own lives and that of others at risk. The action identified to address this high risk and potentially criminal behaviour was limited to staff offering verbal encouragement and key working sessions. However, no direct sessions had been completed. Staff members have failed to identify alternative support to educate young people about the significant risks they are placing themselves and others at through their actions, and therefore to understand the

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children and young people since the most recent full inspection

Similarly, young people are known to smoke in their bedrooms and there are scorch marks caused by cigarette lighters evident in the home. In addition, on 9 September 2016, staff had recorded that they could smell cannabis coming from a young person’s bedroom. A room search was completed and an unknown amount of cannabis and a ‘grinder’ (drug paraphernalia) were removed. Staff reported, ‘The drugs were a small amount and they did not know the whereabouts of the grinder.’ Room search documents failed to identify what action had been taken with the drugs or how the young person had been supported to understand the risk he was placing himself at. During the inspection, this was discussed with the managers on site, who also could not provide any evidence about the whereabouts of the drugs or the actions taken by staff to manage the situation effectively. Furthermore, risks associated with fire setting had not been sufficiently addressed. For example, an

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children and young people since the most recent full inspection

incident took place on 25 November 2016, when a young person was alleged to have set fire to a staff member’s scarf. There was no evidence that the home’s fire risk assessment had been updated to reflect this incident or what specific work had been done with the young person about the dangers of such behaviour. This in turn creates an unacceptable level of risk to all who live in the home.

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children and young people since the most recent full inspection

Staff have failed to follow the company’s own medication procedures. During the inspection, staff were observed by inspectors to be snapping controlled drugs in half, then placing them in a paper towel to give to young people. This was discussed with the responsible individual who reported that this was in breach of the home’s own policies and procedures. Furthermore, records indicated that staff had given a young person two doses of a controlled drug. However, the prescription was for only one tablet each evening. Despite these controlled drugs being administered and signed for by two staff members, the error still occurred. This poor practice exposes young people to a significant risk of being given incorrect medication and is contrary to the home’s procedures for the safe administration of controlled drugs.

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children and young people since the most recent full inspection

Poor relationships between staff and some young people were observed throughout the inspection. The lack of mutual respect and trust was evident from young people’s persistent, uncooperative and demanding behaviour and staff’s lack of sufficient challenge and redirection. Young people made comments such as, ‘They [staff] are scared of me,’ and ‘I can do what I want, they [staff] don’t even like me.’ Staff had little impact on young people’s behaviour, allowing continued inappropriate language and other antisocial behaviours, such as kicking doors, to go unchallenged. A staff member said, ‘They [young people] don’t listen to us,’ and ‘They [young people] are allowed to get away with murder.’ The current approach is failing to teach young people to understand what acceptable behaviour is, or to prepare them for managing their emotions and frustrations constructively as they grow older.

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children and young people since the most recent full inspection

The increase in the use of physical intervention further impedes young people’s development of positive relationships with staff. In addition, a significant increase in staff requesting police assistance to manage young people’s behaviours, resulting in instances whereby young people are being inappropriately criminalised, has further reduced their trust and confidence in staff to keep them safe and secure in their home. All young people spoken to as part of the inspection expressed their unhappiness about their experience of living at the home and their relationships with staff. One young person said, ‘The way we get treated is just wrong.’

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children and young people since the most recent full inspection

There is a clear lack of effective monitoring of physical restraints, medication records, complaints made by young people and incident reports. Relevant paperwork has not always been completed and some records lack an accurate, factual reflection of the events. For example, in one incident report it said, ‘[Young person’s name] demanding keys for bedroom.’ No further information was provided. Consequently, limited recording and explanation does not assist in the analysis or evaluation of the interventions. Similarly, the lack of monitoring of the robustness of records has an impact on the assessment as to whether staff practices and behaviour management strategies remain appropriate to safeguard young people adequately.

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children and young people since the most recent full inspection

The home fails to ensure that young people receive the statutory requirements of 25 hours per week of education. Although the responsible individual reported to inspectors that she had raised concerns with placing authorities about the lack of education placements, there was no education planning within the home. Some young people remain on minimal home-tuition timetables, and others have refused school attendance. When young people refuse to attend school there is no clear structure or formal plan around their day. As a result, the opportunity for young people to reach their full educational potential is seriously compromised. This in turn affects their future life chances.

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children and young people since the most recent full inspection

Young people live in a home that is not managed or led effectively. The home does not meet the aims and objectives of the statement of purpose, because staff members do not have sufficient skills, experience and qualifications to create a safe environment. Furthermore, high levels of staff sickness and staff vacancies have affected the team’s ability to provide young people with continuity of care. This is compounded by the use of employees from other homes and agency staff. As a result, young people’s care, progress and safety have been compromised.

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children and young people since the most recent full inspection

Instability within the management team has caused confusion and concern among staff and young people. The home has operated without a registered manager since February 2016. Although a new manager was appointed, she failed to submit her formal application to Ofsted within the required timescales set out in The Children Homes Regulations 2015. She is now off work sick. In the intervening period, the home’s assistant manager has been overseeing the operation of the home, supported by her peers, the operational manager and the responsible individual. Despite the responsible individual implementing a plan for regular monitoring and overview of the home’s records, staffing and the progress of young people, limited action has been taken to complete these action plans. Furthermore, managers have failed to undertake their additional roles and responsibilities. There is a failure to demonstrate that any manager has a clear overview of the home,

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children and young people since the most recent full inspection

and therefore they do not have a clear oversight of the progress and experiences of young people and the quality of care provided. Monitoring of the home is inconsistent. Actions raised by independent visitors are not monitored month to month to secure positive change. For example, visitors have reported on problems with access to education, but the situation for young people has not improved. Monitoring by the home’s managers has failed to identify and address the shortfalls found in records, such as out-of-date risk assessments, records not being signed and dated by the author, incomplete records of young people’s complaints and sanctions and room search records that have not gathered the views of young people.

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children and young people since the most recent full inspection

Insufficient action has been taken to ensure that rotas clearly show which staff are on shift and the hours they have worked. In addition, some staff members have not received regular supervision. When they have highlighted concerning practices within the home directly to managers, including the safety of young people, there was no evidence of any response or of actions having been taken. This fails to demonstrate that all managers clearly understand their roles and responsibilities in protecting young people.

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Information about this children’s home

The home is a privately owned children’s home. It provides care and accommodation for four young people with emotional and/or behavioural difficulties.

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Recent inspection history

Inspection date Inspection type Inspection judgement 29/06/2016 Full Good 29/03/2016 Full Inadequate 11/08/2015 Full Requires improvement 12/03/2015 Interim Sustained effectiveness 23/07/2014 Full Adequate

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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

7: The children’s views, wishes and feelings standard

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Requirement Due date

In order to meet the children’s views, wishes and feelings standard the registered person must ensure:

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Requirement Due date

(1) that children receive care from staff who: (b) engage with them; and (c) take their views, wishes and feelings into account in relation to matters affecting the children’s care and welfare and their lives. 06/01/2017

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Requirement Due date

In order to meet the education standard the registered person must ensure:

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Requirement Due date

(2)(a) that staff: (i) help each child to achieve the child’s education and training targets, as recorded in the child’s relevant plans; (iii) understand the barriers to learning that each child may face and take appropriate action to help the child to overcome any such barriers; (x) help each child to attend education or training in accordance with the expectations in the child’s relevant plans. 06/01/2017

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Requirement Due date

In order to meet the positive relationships standard the registered person must ensure:

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Requirement Due date

(1) that children are helped to develop, and to benefit from, relationships based on: (a) mutual respect and trust; (b) an understanding about acceptable behaviour; and (c) positive responses to other children and adults. 06/01/2017

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Requirement Due date

12: The protection of children standard * 06/01/2017 In order to meet the protection of children standard, the registered person must ensure:

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Requirement Due date

(1) 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; (ii) help each child to understand how to keep safe; (iii) have the skills to identify and act upon signs that a child is at risk of harm; (v) understand the roles and responsibilities in relation to protecting children that are assigned to them by the registered person; (vi) take effective action whenever there is a serious concern about a child’s welfare; and (vii) are familiar with, and act in accordance with, the home’s child protection policies; (b) that the home’s day-to-day care is arranged and delivered so as to keep each child safe and to protect each child effectively

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Requirement Due date

from harm; (d) that the premises used for the purposes of the home are designed, furnished and maintained so as to protect each child from avoidable hazards to the child’s health.

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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, the registered person must ensure:

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Requirement Due date

(1) that the registered person enables, inspires and leads a culture in relation to the children’s home that: (a) helps children aspire to fulfil their potential; and (b) promotes their welfare. (2) In particular, the standard in paragraph (1) requires the registered person to: (a) lead and manage the home in a way that is consistent with the approach and ethos, and delivers the outcomes, set out in the home’s statement of purpose; (b) ensure that staff work as a team where appropriate; 06/01/2017 (c) ensure that staff have the experience, qualifications and skills to meet the needs of each child; (d) ensure that the home has sufficient staff to provide care for 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

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Requirement Due date

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. 14: The care planning standard

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Requirement Due date

In order to meet the care planning standard, the registered person must ensure:

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Requirement Due date

(1) that children: (a) receive effectively planned care in or through the children’s home; and (2) In particular, the standard in paragraph (1) requires the registered person to ensure: (b) that arrangements are in place to ensure (i) ensure the effective induction of each child into the home; (ii) manage and review the placement of each child in the home; (c) that each child’s relevant plans are followed. 06/01/2017

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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)(2)(c)(3)(b)) 06/01/2017

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Requirement Due date

The registered provider must appoint a person to manage the children’s home if there is no registered manager in respect of the home. (Regulation 27(1)(a)) 06/01/2017

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Requirement Due date

The registered person must ensure that, at all times, at least one person on duty at the home has a suitable first aid qualification. (Regulation 31 (2)(a)) 06/01/2017 33: Employment of staff

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Requirement Due date

Ensure that all employees receive practice-related supervision by a person with appropriate experience. (Regulation 33 (4)(b)) 06/01/2017

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Requirement Due date

35: Behaviour management policies and records

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Requirement Due date

(1) The registered person must prepare and implement a policy (‘the behaviour management policy’) which sets out: (a) how appropriate behaviour is to be promoted in the children’s home; and (b) the measures of control, discipline and restraint which may be used in relation to children in the home. (2) The registered person must keep the behaviour management policy under review and, where appropriate, revise it. (3) The registered person must ensure that: (a) within 24 hours of the use of a measure of control, discipline or restraint in relation to a child in the home, a record is made which includes: (i) the name of the child; (ii) details of the child’s behaviour leading to the use of the measure; (iii) the date, time and location of the use of the measure; (iv) a description of the measure and its duration; (v) details of any methods used or steps taken to avoid the need to use the measure; (vi) the name of the person who used the measure (‘the user’),

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Requirement Due date

and of any other person present when the measure was used; (vii) the effectiveness and any consequences of the use of the measure; and (viii) a description of any injury to the child or any other person, and any medical treatment administered, as a result of the measure; (b) within 48 hours of the use of the measure, the registered person, or a person who is authorised by the registered person to do so (‘the authorised person’): (i) has spoken to the user about the measure; and (ii) has signed the record to confirm it is accurate. (c) within 5 days of the use of the measure, the registered person or the authorised person adds to the record confirmation that they have spoken to the child about the measure. (Regulation 35 (1)(a)(b)(2)(3)(a)(b)(c)) 06/01/2017

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Requirement Due date

36: Children’s case records 06/01/2017 (1) The registered person must maintain records (‘case records’) for each child, which: (a) include the information and documents listed in Schedule 3 in relation to each child; (b) are kept up to date; and (c) are signed and dated by the author of each entry. (Regulation 36 (1)(a)(b)(c)) 37: Other records

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Requirement Due date

The registered person must: (a) maintain in the home the records in schedule 4; (b) ensure that the records are kept up to date. In particular this relates to staff rosters. (Regulation 37 (2)(a)(b)) 06/01/2017

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Requirement Due date

(1) The registered person must establish a procedure for considering complaints made by or on behalf of children. (3) 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 (1)(3)) 06/01/2017

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What the inspection judgements mean

At the interim inspection we make a judgement on whether the home has improved in effectiveness, sustained effectiveness, or declined in effectiveness since the previous full inspection. This is in line with the ‘Inspection of children’s homes: framework for inspection’.

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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 focused on the effectiveness of the home and the progress and experiences of children and young people since the most recent full inspection.

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Information about this inspection

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 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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