Setting in Islington

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:

 The children‟s individual risk assessments, behaviour support plans and care plans are not sufficiently detailed.  Medication arrangements are not sufficiently robust. Personal emergency evacuation plans which reflect the children‟s individual needs are not in place for all children.  Staff deployment is not consistently arranged to facilitate the best levels of care and supervision for children. The staff are not always provided with suitable supervision and training.  Internal reporting and response systems are not always effectively implemented. Quality monitoring and assurance systems in the home are not sufficiently robust.  Case file management and recording does not contain the required information or detail the level of care and support required to meet the children‟s needs. There are limited opportunities for activities outside of the home.  The aspirations for care and outcomes for the children, as set out in the

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The children's home provision requires improvement because:

home‟s statement of purpose, are not being achieved.

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The children's home strengths

 There is a caring ethos in the home. The staff are committed to the care of the children.

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The children's home strengths

 The children feel safe and look forward to their stay, and demonstrate their excitement to their families.  The majority of families and professionals have absolute confidence in the quality of care that the service provides, describing it as excellent.  The children benefit from staff who know them well and ensure that the children‟s preferences for daily routines and a calm and ordered environment are fulfilled.

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The children's home strengths

 Each child makes progress and grows in confidence at a pace that is suitable to them.

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The children's home strengths

 Good partnership working means that children and their families are able to access the support they need.

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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

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, the registered person must ensure suitable epilepsy management protocols and guidance are in place to support children who have epilepsy. 20/02/2017

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Requirement Due date

In order to meet the protection of children standard with particular reference to effectively assessing and managing risk the registered person must 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; (iv) manage relationships between children to prevent them from harming each other; (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 (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. 27/02/2017 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; (d) ensure that the home has sufficient staff to provide care for 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. and (h) use monitoring and review systems to make continuous improvements in the quality of care provided in the home. 27/03/2017

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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))

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Requirement Due date

In particular, the registered person must ensure that clear and accurate records are maintained of medication which has been received into and discharged from the home and that which has been administered to a child. 27/02/2017

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Requirement Due date

The registered person must ensure that the requirements of the Fire Safety Reform (Fire safety) Order 2005 and any regulations made under it are complied with in respect of the home. (Regulation 25(2)(b))

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Requirement Due date

In particular, the registered person must ensure easily accessible suitable personal evacuation plans are in place for each child. Furthermore, ensure that where bedroom doors are propped open at night that a suitable risk assessment is in place. 27/02/2017

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Requirement Due date

The registered person must maintain records (“case records”) for each child which include the information and documents listed in Schedule 3 in relation to each child. (Regulation 36(1)(a))

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Requirement Due date

In particular, the registered person must ensure a copy of any Education, Health and Care plan prepared in relation to the child 27/03/2017 is and held and details of the statutory provision (if any) under which the child is provided with accommodation are documented.

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Recommendations

To improve the quality and standards of care further, the service should take account of the following recommendation(s):  Consult children regularly on their views about the home's care, to inform and support continued improvement in the quality of care provided. Due consideration should be given to the child's cognitive ability in the development and implementation of any consultation processes. Children should be able to see the results of their views being listened to and acted upon. („Guide to the children‟s homes regulations including the quality standards‟, page 22, paragraph 4.11)

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Recommendations

 Provide a wide range of activities both inside and outside of the home and support and encourage children to participate in those activities. („Guide to the children‟s homes regulations including the quality standards‟, page 31, paragraph 6.5)

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Recommendations

 Provide staff with appropriate facilities and resources to support their training needs. („Guide to the children‟s homes regulations including the quality standards‟, page 53, paragraph 10.8)

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Recommendations

In particular, ensure that all staff receive suitable training in identifying, preventing and responding to child sexual exploitation and that staff who find e- learning packages hard to access, are provided with suitable support.

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Recommendations

 Provide all staff with sufficiently frequent supervision of their practice from an appropriately qualified and experienced professional, which allows them to reflect on their practice and the needs of the children assigned to their care. („Guide to the children‟s homes regulations including the quality standards‟, page 61, paragraph 13.2)

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Recommendations

In particular, ensure that clear support and guidance are in place through regular practice based supervision and team meetings.

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Recommendations

 Ensure staff understand the importance of careful objective and clear recording ensuring information regarding the child is recorded in a way that will be helpful to the child. („Guide to the children‟s homes regulations including the quality standards‟, page 62, paragraph 14.4) In particular, ensure that records are maintained that provide a clear and accurate record of events.

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Information about this children's home

A national organisation runs this service. A maximum of six children receive short breaks in the home. Placements are for children who have complex physical disabilities and/or learning disabilities. The length of stay varies for each child, reflecting their assessed family circumstances.

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Recent inspection history

Inspection date Inspection type Inspection judgement 29/07/2016 Interim Improved effectiveness 02/02/2016 Full Good 10/06/2015 Interim Sustained effectiveness 28/01/2015 Full Good

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Requires improvement

Although the majority of the children receive good, individualised, child-focused care and support, a number of aspects of the service require improvement to get to good. The home is not yet delivering the good quality of support that it aspires to. However, there are no serious or widespread failures that indicate that the children are at risk of harm.

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Requires improvement

The setting provides short breaks for children who have learning disabilities and associated complex needs. Prior to using the service for the first time, an assessment of need is completed and planned transitions take place. A number of the children use the on-site afterschool and holiday clubs. This familiarity of environment helps reduce the children‟s anxieties. The level of progress made by the children is hard to measure due to their particularly complex needs, but people who know them well identify small but personally significant steps for individual children. The staff work together with the parents and professionals to help the children achieve small but individually significant goals, such as not throwing their cup.

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Requires improvement

The parents say that the levels of support are „fabulous‟, and their guidance on how their children should be cared for is generally followed. The consistency of approach helps the children feel safe and settled in their environment and supported by staff who know them well. This is particularly important for children who are often unable to verbally articulate their emotions and anxieties.

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Requires improvement

The parents remain responsible for organising and maintaining their child‟s health and education in accordance with short-break arrangements, although the staff competence to deliver complex care tasks and medication administration is regularly assessed. The individual care plans, however, do not always clearly detail the children‟s needs. For example, children with epilepsy do not have an epilepsy protocol or management plan in place. This means that there is potential for some staff to be unaware of specific aspects of a child‟s care. As a result, they may not receive consistently high-quality care that meets their specific needs. The potential impact is reduced as the children receive support from staff who know them well, and who have received training in supporting people with epilepsy.

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Requires improvement

Arrangements for the administration of medication are not consistently sufficiently robust. Due to the nature of the short-break service and the health needs of many children, medication arrangements are complex, and the risk of error is increased. While otherwise good systems are in place to manage medication, the recording of the medication administered and the medication received, into and returned from the home, is lacking. For example, on one occasion the record of medication received by the home and returned to the parents after the short break did not correlate with the record of medication administered. Furthermore, staff did not identify the discrepancy at the time. The home‟s medication auditing systems failed to identify this error. This means that it is not clear whether the child potentially received too much, or too little, anticonvulsant medication during their stay.

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Requires improvement

Inclusion is central to the organisation‟s philosophy of care. The staff attempt to seek the children‟s thoughts, wishes and feelings through direct discussion and observation of their non-verbal communication. Many of the children use sign language, pictorial symbols and information technology to support their communication. The new manager has aspirations to „up skill‟ the staff team to more effectively promote the use of these systems. The residents‟ meetings take place periodically. However, when suggestions are made, there is no system to provide feedback about what actions have been taken. This means that the children are unable to see the results of their views being listened to and acted on.

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Requires improvement

Those children who enjoy sensory activities are well catered for, with a variety of physical and sensory activities. This promotes a better understanding of the world around them. There are limited opportunities for the children who are more mobile and require greater physical and more varied stimulation. One staff member commented how the boys really like some new staff who go out with them in the garden and play football. Some parents and social workers said the availability of activities outside the home has reduced, and they believe that the children may display some behaviours due to frustration and boredom.

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Requires improvement

The home is a spacious, purpose-built setting with large, individually decorated bedrooms and suitable living space. The children benefit from an environment which is suitably adapted and equipped to meet their needs. Any specialist equipment which would benefit them is provided.

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Requires improvement

Although areas for improvement have been identified, the vast majority of the children, placing authorities and families rate the home as good to excellent. The children enjoy their short break stays. One parent said, „As soon as she gets out of the car she‟s jumping and bouncing with joy.‟ A social worker said, „The boys love it so much. They now go to clubs and have the chance to be more sociable‟. One child described how they have nicknames for their favourite members of staff. Judgement grade

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Requires improvement

The children are helped to feel safe and secure. This is through the familiarity and consistency of the staff team, which they trust. However, specific areas require improvement to ensure that the service consistently and robustly safeguards children.

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Requires improvement

The vast majority of families and professionals have absolute confidence in the service to safeguard their children effectively. One parent described how the excellent support from staff had helped them to build trust, allowing their child to enjoy stays away from the family home for the first time. Another parent said that they were confident that their child enjoyed their short break and communicated that they feel safe. A parent said, „She starts clapping and jumping with excitement as soon as she sees the place.‟ Another said, „I can‟t praise them highly enough. They do a fabulous job and I‟m more than happy to leave my child there, which I wouldn‟t if I had any concerns.‟

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Requires improvement

In discussion with the staff, professionals and the parents it is evident that the children receive supportive, caring responses from individual staff. Most of the staff are familiar with the children‟s needs, personalities and the challenges that they may present. However, not all of the children with epilepsy have a clear epilepsy management plan, which means that staff may not be aware of any particular issues that may affect the children‟s safety and well-being. Nor do behaviour support plans always reflect the children‟s challenging behaviours and the strategies in place to address these. For example, staff described particular aspects of behaviour, such as pinching other children, targeting particular members of staff or becoming excited when receiving personal care. They described how this affected the staff who supported the child during their short break. However, none of this was detailed in the individual behaviour support plans. One child‟s records

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Requires improvement

stated that they had been „sat down‟ by the member of staff and given „time out‟ as a result of their behaviour. The behaviour strategy utilised is not detailed in the child‟s individual behaviour support plan. There is no evidence that agreement on this approach has been reached in consultation with the parent, contrary to the home‟s behaviour policy. Not all of the records of incidents are sufficiently detailed and transparent to aid an effective review. For example, in this incident, it is unclear whether the actions taken constituted a sanction or an environmental or physical intervention. Furthermore, there is no system in place where the manager reviews such incidents to identify any potential areas of concern.

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Requires improvement

The manager ensures that any safeguarding concerns are well managed with partner agencies in an open and transparent manner. However, the manager‟s ability to do so was undermined on one occasion. A member of staff failed to share significant information appropriately and in a timely manner. It is imperative that all staff understand and follow the home‟s safeguarding policies in order to protect the children effectively. The staff do not receive training in preventing, identifying and responding to child sexual exploitation. Therefore, while in a unique position to assist in identifying such potential issues, they may not have the skills and knowledge to do so.

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Requires improvement

Suitable security measures, which have been agreed with parents, ensure that the vulnerable children do not leave the home without staff awareness. As a result, there have been no incidents of children missing from the home. Staff vetting practices are completed in accordance with regulatory requirements, and best practice. This ensures that vulnerable children are safeguarded from unsuitable people gaining employment in the home.

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Requires improvement

The building is suitable to meet the needs of the children. Health and safety arrangements are well managed. There is regular servicing of the equipment and suitable building-based fire prevention measures are in place.

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Requires improvement

One child prefers to have their bedroom door propped open at night, which is contrary to fire prevention guidance. While a note of this has been made on the child‟s case file, there is no risk assessment regarding how this can most safely be managed. Personal emergency evacuation plans are in place for all of the children. However, these are not easily available in the case of an emergency for the particular children receiving a short break at any given time. Furthermore, they do not reflect the guidance given by the fire authority on the best way to keep everyone safe, such as evacuation processes for non-ambulant children in the event of a fire at night. It is essential that staff have clear guidance on how to support each child to evacuate the home effectively in the event of an emergency.

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Requires improvement

The previous manager left the service in November 2016. The new acting manager has submitted an application for registration, and the assessment of suitability has yet to be completed.

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Requires improvement

The management of the home is not yet good. The home is not currently delivering the quality of care that it aspires to within its statement of purpose. Quality monitoring arrangements have not been sufficiently robust to identify and begin to address the shortfalls, and thus drive improvement within the service. For example, the manager does not overview all of the significant events records in the home, and is therefore unable to identify any issues of concern or patterns and trends emerging.

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Requires improvement

Staff deployment arrangements do not always reflect the needs of the service. For example, the busiest time in the short-break service is during weekends, however, the home‟s management team works mainly during the week. Of the weekend shifts sampled on the duty rota, only three detailed a team leader on duty. The management team is therefore limited in its availability to lead and guide the staff group as a whole. Staffing levels are not always arranged to meet the individual needs of the children. On most of those shifts sampled there were three staff on duty irrespective of the number or needs of the children. The parents report that on occasion they have not been aware of the staffing levels agreed to supervise their child. Records indicate that there is a lack of clarity around supervision arrangements. For example, some children have on occasion allegedly been hurt by other children or have not received suitable supervision to help prevent and

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Requires improvement

respond to seizure-related falls. In order to safeguard the children effectively, it is essential that staffing arrangements are planned to meet the needs both of individual children and the group as a whole.

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Requires improvement

The children are making variable progress from their starting points and in accordance with their particular complex needs. The home works well with the parents and the partner agencies to ensure that the children‟s needs are met. The children benefit from a stable and experienced staff team that has the knowledge and understanding of the individual children and their particular likes, dislikes, needs and communication. The staff are well thought of by the children, families and professionals. It is clear that everyone is individually committed to delivering good individualised care, and to building positive relationships with the children. Professionals and families say:

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Requires improvement

 The staff „have a good understanding of [their child‟s] needs‟.  „I am really impressed with the staff.‟  „The staff are lovely. I haven‟t come across any who are not. They‟re all very positive and welcoming.‟

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Requires improvement

Records within the home are not always of sufficient quality or detail. This undermines effective understanding of events, including the levels of supervision, and the actions staff have taken. The children‟s case records are on occasion missing essential documentation, such as details of the legal arrangements under which the child is placed, a copy of the education health and care plan devised by the placing authority. This means that some records do not provide the required information, or that the information is not easily accessible.

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Requires improvement

There is no sense that individual staff feel unsupported by each other or the management team. However, formal systems in place to aid communication and support are not implemented consistently or effectively. For example, the team meetings are infrequent. The staff do not receive regular practice-based supervision. Significant events have not always been appropriately shared by staff with the manager and the parents. As a result, some of the parents‟ confidence in the home has been shaken. The manager has not been able to have appropriate oversight.

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Requires improvement

All full-time staff who have been working with the children in a children‟s home for over two years have completed their level 3 diploma. The majority of remaining staff have been enrolled in courses to study towards the diploma. The staff benefit from a variety of relevant core training. They have received suitable training in areas such as safeguarding, first-aid, fire awareness, medication management and epilepsy management. However, training in preventing, identifying and responding to child sexual exploitation has not taken place. This potentially undermines the staff‟s professional awareness and competence to meet the needs of the children effectively.

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Requires improvement

The manager does have aspirations for the home. She has demonstrated a commitment to address any issues raised by families and from their monthly independent visitor‟s reports. However, no consideration has been given as to how they intend to address the recommendations from the previous inspection, or implement effective internal monitoring systems. This means that the manager does not have a full insight into the strengths of the home and areas for improvement. While improvement is required to get to good, and a number of requirements and recommendations have been set at this inspection, for most children and families the direct delivery of care does meet their individual needs. Therefore, the children and their family members, and the professionals supporting them, remain in the majority of cases highly positive about their experiences at the home, referring to an „excellent‟ service. One foster carer said „it‟s fabulous. The

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Requires improvement

boys are happy to go, they have a good relationship with staff and they really do enjoy it.‟

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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 that 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

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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