Children's home run by ROC Northwest Limited in Westmorland and Furness

Inspector Elaine Clare

A full inspection was carried out on 3 November 2016 and the home was judged to be inadequate. Widespread failings were found, including: poor day-to-day care arrangements to ensure young people’s safety and well-being, poor arrangements for medication, and failure to provide a safe, homely, welcoming environment for children. As a result, a restriction of accommodation notice and two compliance notices were issued on 17 November 2016 to address these concerns. An unannounced monitoring visit took place on 14 December 2016 to monitor compliance with the two notices and to assess whether the restriction of accommodation notice was still required.

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Inspector Elaine Clare

There have not been any admissions to the home since the last inspection. As a result the responsible individual is compliant with the restriction of accommodation notice that Ofsted placed on the home.

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Inspector Elaine Clare

The manager of the home has now recruited a registered nurse, with a specialism in learning disabilities, to oversee the healthcare and medication in the home. She has reviewed and improved the healthcare and medication procedures in the home. In addition, staff have received training in communication and understanding the needs of children who have autistic spectrum disorder including the behavioural characteristics of autistic spectrum disorder. Staff said that they found the training and additional support from the nurse to be excellent, and that they feel more confident around detecting signs and symptoms of illness in young people. This was recently demonstrated when a young person’s behaviour altered. The young person was being more vocal than usual and refusing to go to bed, and she also had a high temperature. Staff sought the necessary medical attention without delay and the young person was subsequently prescribed antibiotics for an

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Inspector Elaine Clare

infection. As a result, staff protected the young person’s welfare.

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Inspector Elaine Clare

At the last inspection, a young person who required a high level of medical intervention, including a percutaneous endoscopic gastrostomy tube into their stomach, was accommodated at the home. The inspection identified concerns about the care of this young person, who, following a hospital admission, has not returned to the home. The manager of the home stated that, in future, young people requiring a high level of ‘nursing’ need would not be accepted into the home. She felt that the home is not a suitable environment for this kind of high- dependency care. Any future admissions to the home will be significantly risk- assessed to ensure that the staff and the home environment can satisfactorily meet the needs of young people prior to placement. As a result, staff do not have responsibility for ensuring the safe use of specialist equipment to minimise the risk of infection.

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Inspector Elaine Clare

Levels of communication with outside agencies and family members have improved. Following the inadequate judgement, placing authorities and young people’s social workers were communicated with. A number of social workers and local authority commissioners undertook visits, to ensure that their young person placed was safe. Management and staff worked with these professionals and were completely transparent about the inspection findings and their action plan. A national advocacy worker visited and spoke with staff about communicating with young people. In particular, they offered advice about how to help young people who are non-verbal to raise their concerns. She subsequently visited a week later and reported to the manager: ‘I visited Mountwood yesterday and was very impressed to see that you have put guidance for young people up on each unit explaining how to make a complaint and what to do if you don’t feel safe. I

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Inspector Elaine Clare

understand that staff have already had conversations with young people about this guidance, so it appears to be helping them already.’ This demonstrates that staff are improving their communication skills with young people, and as a result young people are safer.

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Inspector Elaine Clare

On 8 December 2016 the manager received a complaint from a family member about poor communication at a contact visit. A parent was left anxious when her son did not turn up for contact at the agreed time and there had not been any communication from the home to explain the delay. Records, including the handover book, provide scant information around the arrangements for the contact visit. Following the complaint, the manager acknowledged the complaint in writing to the parent and an investigating manager was appointed to review the complaint. While the outcome of the investigation had not been finalised, the manager did acknowledge that there had been a shortfall in communicating with the complainant. A plan to improve communication had been actioned immediately.

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Inspector Elaine Clare

The medication area in the home has been moved to two separate areas of the home. A nurse, recently employed in the home to oversee the medication, has taken steps to address the shortfalls around the administration of medication. This includes only senior trained staff administering medication until all staff have completed their medication training. They must also complete a written workbook and be observed by the nurse administering medication, to ensure that staff are competent in administrating medication. This was still ongoing during the monitoring visit. The nurse had ensured that a full audit of medication had been undertaken and any medication that had passed its expiry date had been disposed of safely with the pharmacist. The nurse was closely monitoring staff practice to ensure that the arrangements for the handling, recording, safekeeping, safe administration and disposal of medicines are safe.

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Inspector Elaine Clare

Syringes used for the administering of medication are now disposed of following their use. This ensures that the equipment used for the administering of liquid medicine is in a clean, hygienic state when used. There is now a clear trail of medication that comes into the home, the quantities held and records of any medication that is disposed of. The manager further explained that a pharmacist company will be introducing a blister pack medication system in January 2017, which she hoped would assist staff further in the managing of medication.

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Inspector Elaine Clare

Despite the above changes, records of medications administered remain poor. The nurse’s own internal audit had found 13 recording errors. This mainly centred on staff not signing the medication administration record (MAR).The nurse also identified during her internal audit that on two occasions staff had signed the MAR but had not administered the medication. The young person required the medication to relieve anxiety and improve concentration while in school. As a result, staff had failed to protect the young person’s welfare. The manager of the home initiated an investigation, which at the time of the monitoring visit had not reached a conclusion. While it is not satisfactory that errors have occurred in the administration of medication, the management of the home had identified the shortfalls themselves prior to this monitoring visit, through their own audit, and have taken immediate steps to address practice with those concerned.

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Inspector Elaine Clare

In line with Ofsted’s framework, a case review has been held following this visit. It concluded that the evidence gathered at this visit evidences that the compliance notices under Regulation 12 and Regulation 23 have been met. A decision was also reached that the restriction of accommodation notice will remain in place until February 2017, and until further improvements are secured.

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Information about this children's home

 The home is registered for up to 15 children from eight to 18 years old.  The home is run by a private company.  A company school is on-site.  The home offers care and accommodation for children who have learning disabilities, physical disabilities and associated medical needs.  An outreach service is registered separately with the Care Quality Commission.

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Statutory requirements

This section sets out the actions that 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 In order to meet the protection of children standard, the registered person must ensure that: (2)(a)(vi) staff take effective action whenever there is a serious concern about a child’s welfare; and (2)(b) the home’s day-to-day care is arranged and delivered so as to keep each child safe and to protect each child effectively from harm. 31/12/2016

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Requirement Due date

13: The leadership and management standard In order to meet the leadership and management standard the registered person must: (2)(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; (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; and (f) understand the impact that the quality of care provided in the 31/12/2016 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. 10: The health and well-being standard In order to meet the health and well-being standard the registered person must ensure that: (1)(a) the health and well-being needs of children are met.

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Requirement Due date

In particular, ensure that suitable dietary management protocols and guidance are in place to support children who have weight management issues. 31/12/2016

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Requirement Due date

6: The quality and purpose of care standard In order to meet the quality and purpose of care standard, with particular reference to providing children with a comfortable, good-quality, homely living environment, the registered provider must: (2)(c) ensure that the premises used for the purposes of the home are designed and furnished so as to— (i) meet the child's needs; and (ii) enable each child to participate in the daily life of the home. 31/12/2016

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Requirement Due date

7: The children's views, wishes and feelings standard (1)(c) ensure that young people receive care from staff who take their views, wishes and feelings into account in relation to matters affecting the children’s care and welfare and their lives. 31/12/2016

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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. In particular, ensure that records of medication are accurate, that the stock held correlates with the record of medication held and that any emergency remedies are not kept beyond their expiry date. (Regulation 23 (1)) 31/12/2016

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Requirement Due date

The registered person must ensure that the requirements of the Regulatory Reform (Fire Safety) Order 2005(1) and any regulations made under it are complied with in respect of the home. In particular, ensure that all staff who work in the home receive suitable instruction and ensure that the fire risk assessment is maintained under review to reflect changes within the home. (Regulation 25 (2)(b)). 31/12/2016

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Requirement Due date

The registered person must ensure that all employees receive appropriate supervision and undertake appropriate continuing 31/12/2016 professional development. (Regulation 33 (4)(a)(b)).

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Recommendations

To improve the quality and standards of care further, the service should take account of the following recommendation(s):  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. In particular, ensure suitable overview of any restraint by a person independent of the incident ('Guide to the children's homes regulations including the quality standards', page 46, paragraph 9.36).

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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

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

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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