Children's home run by Young Foundations Limited in Wirral

This monitoring visit

A monitoring visit was carried out on 29 December 2016 due to concerns about behaviour management policy and physical intervention practice. A lack of planning to reduce high levels of physical intervention leaves children and young people at emotional and physical risk of harm. Physical intervention holds are carried out on children and young people without the benefit of child-focused medical assessments. This leaves children and young people at risk of injury. For those who have additional medical needs, being restrained without their particular medical conditions being taken into account further increases this risk. The lack of child-focused medical assessments leaves staff without the full knowledge of the risks to children and young people of undertaking some types of physical restraint. The physical restraint training manual is of poor quality. It does not include one of the most high-level holds that is regularly used in this setting. This means that

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This monitoring visit

staff do not have the clear instructions that they need to carry out safe physical holds. The physical restraint training manual focuses solely on the use of physical intervention. It does not provide staff with de-escalation techniques that they could use before the threshold for physical intervention is reached. Management oversight of physical restraint is poor. Managers do not monitor the length of time that children and young people are physically restrained. On occasion, children and young people sustain injury during physical restraint, but it is not always clear that they receive medical attention for this. Managers have failed to identify this shortfall in their review of physical intervention. The use of pain relief and behaviour management drugs is not robustly monitored. This means that such medication could be administered inappropriately. The independent visitor has failed to identify the significant issues raised at this

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This monitoring visit

monitoring visit. This means that the safety of children and young people, when they are subject to physical restraint, cannot be fully assured. The recording of physical restraint incidents is not robust. The length of time that children and young people are restrained for is not always correct. The checks that should be carried out on children and young people while they are in higher-risk holds are not evident. This leaves children and young people at risk of injury. The behaviour management policy is not specific to children and young people, or to this particular setting. This means that staff do not have clear information about positive behaviour management. Impact assessments for new residents coming to the home are poorly evaluated. This means that the conflicting needs of children and young people are not properly identified and managed. In addition, children and young people are not always adequately prepared for the

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This monitoring visit

arrival of new residents. This potentially causes high levels of anxiety and challenging behaviour in those children and young people who require consistency and stability.

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Information about this children’s home

This home is run by a private provider. It provides care for children and young people who have autism, complex learning difficulties and/or challenging behaviour. The home can accommodate up to 12 children and young people.

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Statutory requirements

This section sets out the actions that must be taken so that the registered person 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 must comply within the given timescales.

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Requirement Due date

*12. In order to meet the protection of children standard, with particular reference to ensuring that children with specific health needs have these needs medically assessed, in accordance with restraint techniques used, the registered person must ensure: (2)(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. 17/02/2017

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Requirement Due date

13. In order to meet the leadership and management standard, with particular reference to ensuring that robust management oversight of all restraints, the use of prescribed medication and behaviour management strategies, demonstrate that practice in the home is informed and improved by taking into account and acting on (h) the use of monitoring systems to make continuous improvements in the quality of care provided in the home. 17/02/2017

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Requirement Due date

14. In order to meet the care planning standard, with particular reference to individual healthcare plans, the use of pain relief and behaviour management medication, the registered person must ensure that children (1)(a) receive effectively planned care in or through the children’s home. 17/02/2017 The registered person must ensure that (a) within 24 hours of the use of a measure of control, discipline or restrain in relation to a child in the home, a record is made which includes (vi) a description of the measure and its duration; (viii) a description of any injury to the child or any other person, and any medical treatment administered, as a result of the measure. (Regulation 35 (3)(iv)(viii))

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Requirement Due date

The registered person must prepare and implement a policy (‘the behaviour management policy’) which sets out (a) how appropriate behaviour is promoted in the children’s home; and (b) the measures of control, discipline or restraint in relation to children in the home. (Regulation 35(1)(a)(b)) In particular, the registered person must ensure that the behaviour management policy and restraint practice are child focused. 17/02/2017

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Recommendations

 The registered person should only accept placements for children where they are satisfied that the home can respond effectively to the children’s assessed needs as recorded in the child’s relevant plans and where they have fully considered the impact that the placement will have on the existing group of children. (‘Guide to the children’s homes regulations including the quality standards’, page 56, paragraph 11.4) In particular, they should ensure that all children’s needs are taken into account when considering new admissions to the home, and that existing residents receive information of new placements, and that this information is delivered at a level at which they can understand it.  The registered person should ensure that all incidents of control, discipline and restraint are subject to systems of regular scrutiny, to ensure that their use is fair and that the above principles set out in 9.35 are respected.

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Recommendations

(‘Guide to the children’s homes regulations including the quality standards’, page 46, paragraph 9.36) In particular, they should ensure that the independent visitor analyses physical intervention practice and supports the manager to monitor high level holds, such as the ‘tantrum’ and ‘cross arm hold’.

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Information about this inspection

The purpose of this visit was to monitor the action taken and the progress made by the children’s home since its last Ofsted inspection. This inspection was carried out under the Care Standards Act 2000. out in 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 this guidance, please telephone 0300 123 4234 or email enquiries@ofsted.gov.uk .

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Information about this inspection

to 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

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Information about this inspection

Store Street Manchester M1 2WD T: 0300 123 1231 Text phone: 0161 618 8524 E: enquiries@ofsted.gov.uk W: www.gov.uk/government/organisations/ofsted

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