Children's home run by Aspirations Care Limited

children and young people since the most recent full inspection

This home was judged good at the full inspection in May 2016. At this interim inspection, Ofsted judges that it has declined in effectiveness. The home has declined in effectiveness, because:  The combination of the two young people is no longer workable, resulting in variable or deteriorating outcomes.  Serious incidents have placed the young people and staff at risk of harm.  Medical attention has not always been sought promptly when young people have injured themselves.  Some serious incidents have not been notified to Ofsted.  One physical intervention has not been recorded appropriately.  The home has made some progress against the requirement and recommendations made at the previous inspection, but this work is not yet complete.  Five requirements, including one repeated from the previous inspection, have been made in response to breaches of regulation. When the full inspection took place, there was only one young person in the home.

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children and young people since the most recent full inspection

He thrived on the nurturing and dedicated care provided and, consequently, made good progress. As he approached independence, it was good practice to introduce this young man to the realities of living with another young person. The company’s managers considered the potential dynamics between the existing young person and the proposed new resident carefully. A risk assessment was undertaken and the home’s managers tried to ensure a harmonious match.

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children and young people since the most recent full inspection

When the second resident was admitted in June, the dynamics in the home changed. The young people said that initially they got along reasonably well, but then the relationship between them deteriorated. This is now having a negative impact on their lives. This is not due to either young person’s individual needs or behaviour, but to their interactions.

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children and young people since the most recent full inspection

Specifically, there have been a large number of serious incidents since there have been two residents in the home. The concerns arising from this inspection are mainly related to these incidents and the staff’s response to them. For example, one young person, in an attempt to relief distress and anxiety, harms herself by repeatedly banging her head on hard surfaces. This has the potential to lead to serious medical problems. Despite this, there is no evidence that any attempt has been made to encourage her to use alternative strategies for self-expression.

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children and young people since the most recent full inspection

The manager’s and staff’s understanding is that the child and adolescent mental health service (CAMHS) has advised that the young person should be allowed to bang her head in order to help to defuse the situation. This perception consequently informs their practice and is documented in incident reports. It is possible that the perceived message from health professionals is a misunderstanding and therefore, it requires urgent written clarification.

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children and young people since the most recent full inspection

There have been several occasions when the young person has injured herself to the point at which she has lost consciousness. Loss of consciousness can be a sign of possible brain injury, which could be potentially serious. Only a medical professional is qualified to make this judgement. Therefore, any person who loses consciousness should have prompt access to medical assessment.

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children and young people since the most recent full inspection

Initially, the staff correctly sought medical advice when the young person harmed herself. When the inspector asked why this had discontinued, the explanation given was that the young person has an intense dislike of medical services. This change in response is unacceptable, because adults caring for a vulnerable child must take responsibility for making these decisions.

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children and young people since the most recent full inspection

On one occasion, staff records show that a young person passed out for 10 minutes after inserting a nail into her arm. There is no evidence of any medical advice being sought, despite the fact that there was a clear infection risk and the young person had apparently lost consciousness.

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children and young people since the most recent full inspection

In an incident on 3 August 2016, a young person obtained a sharp knife while the sharps cupboard was unlocked for staff to access equipment. The young person then used this knife to injure herself. This incident could easily have been a great deal more serious.

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children and young people since the most recent full inspection

On 7 September 2016, a young person apparently lost consciousness for two minutes after head banging repeatedly and attempting self-strangulation. On 20 September 2016, the same young person cut her neck with a broken plate. Again, there is no evidence that medical advice was sought. A requirement has been made.

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children and young people since the most recent full inspection

The incidents cited above have not been notified to Ofsted. The decision about whether to notify to Ofsted lies with the provider, who has to decide whether each situation is deemed to be serious. However, these incidents are all serious enough to warrant reporting to the regulatory body. Failure to notify these incidents means that the regulator was not in a position to evaluate the staff’s practice and intervene if necessary. A requirement has been made.

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children and young people since the most recent full inspection

A serious incident, which took place on 16 December 2016, involved an adult-sized young person allegedly assaulting a male member of staff. The staff member had to struggle free from the young person and extricate himself from a potentially dangerous situation. In this instance, when personal safety is under threat, it is accepted that physical interventions cannot always be managed in a controlled way, but they should still be recorded as a restraint. The shortfall in this instance is that the recording does not make it clear which member of staff on duty was assaulted, and there is no description of the breakaway techniques used. Management monitoring had not identified these areas for improvement. A requirement has been made.

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children and young people since the most recent full inspection

There is another example of management monitoring not identifying an incident that should have been notified to Ofsted. In this case, the staff deemed it unnecessary, as they did not call the police, who were summoned instead by concerned neighbours. The manager took action to ensure that this was escalated to the regulator after this omission had been pointed out. In addition to these serious incidents, in recent weeks there has been some bullying in the home. The staff intervened swiftly to put a stop to this. The relationship between the young people is complex and both are, at times, fearful of the other’s outbursts. One notification reports a young person being advised by staff to retreat to their room and lock the door during an incident with their peer. During this inspection, there was a further incident, during which the other young person was, in the staff’s words, ‘cowering in the kitchen’. This young

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children and young people since the most recent full inspection

person told the inspector that they hate living in a house where the windows are constantly being smashed. For some young people, frequent incidents can re-traumatise them by reminding them of situations in their pasts. Both young people said, independently, that they feel that they would be happier living away from each other. Although staff try hard to persuade the young people not to become involved in their peer’s issues, this is difficult to achieve in a small house because there is limited indoor space to create distance between the young people. The physical environment in the home is of a good standard, but the emotional climate is not healthy. The current mix of young people requires urgent review. A requirement has been made. There has been some degree of sexual activity between the young people on an unknown number of occasions. When the young people first reported this in July, the staff were instructed to be vigilant. Over a period of about three weeks, in

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children and young people since the most recent full inspection

October 2016, there was further inappropriate contact between them. The staff only became aware of this when the young people very sensibly reported it and not because of increased vigilance. Waking night staff and door alarms have now been put in place, but it is unclear why the staff were not more vigilant after the first incident. This lack of supervision resulted in a repetition. The manager has been rigorous in investigating these incidents, but it has not so far been possible to clarify specific dates and shifts when these oversights occurred. One young person, despite being excluded from college, continues to make progress in his education. He still benefits from a college environment, but with individual support from an external company to enable him to further his studies in mathematics and English. It is less positive that the other young person has not been in education from the beginning of the autumn term in early September, until the present time. The

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children and young people since the most recent full inspection

manager and staff have tried to make progress with this young person’s education provision, and the senior practice manager was attending a meeting with other professionals during this inspection. As a result of this meeting, a plan was made to seek an educational resource out of county. This has led to an improvement in the young person’s situation. The manager and staff manage transitions into and out of the home well. The latest young person to arrive was provided with a planned introduction and was able to visit before moving in. One young person is now starting to prepare for independence. Staff are very well aware of the potential challenges that he faces and are keen to support him for his remaining time in the home.

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children and young people since the most recent full inspection

There have been some concerns about individual staff practice since the previous inspection. These have been swiftly identified and responded to in a robust manner. When required, the manager escalates any concerns to the designated officer.

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children and young people since the most recent full inspection

It is very positive that the young people have not gone missing. There have been a few incidents when staff had to follow a young person briefly, because they ran outside to calm down.

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children and young people since the most recent full inspection

One young person has been restrained on 26 occasions since her arrival. All interventions have been of short duration and appropriate in terms of the rationale and the technique used. There was initially a period of improvement: a long gap of 17 weeks between July and early November, when there was only one restraint.

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children and young people since the most recent full inspection

During this time, the home was having a positive impact on the young person’s life. However, this did not last and in November, when the dynamics between the two young people became more challenging, restraints increased in line with incidents. There have been 12 restraints in the past 12 weeks, as many as there were in the early stages of the young person’s placement. This suggests that early progress made may not be sustainable in her present circumstances. At the full inspection, one requirement was made under the leadership and management quality standard. This related to the home’s records, which have improved. Generally, recording is clear and detailed. The inspector found one restraint record in which it was not clear which member of staff had been subjected to an assault, and the record was not dated. As part of this requirement, the company was asked to ensure that managers and staff have access to reliable

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children and young people since the most recent full inspection

computer equipment. This has been partially actioned, but insufficient progress has been made in the seven months since the full inspection. The requirement has been repeated.

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children and young people since the most recent full inspection

Two recommendations were made at the full inspection. The recommendation regarding the need to repair the lounge ceiling has been actioned. The other recommendation, about updating the home’s statement of purpose that is posted on the company’s web site, has not been actioned. Although the statement of purpose has apparently been updated, this is not reflected in the company’s public presentation on the web site. A new requirement has been made.

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children and young people since the most recent full inspection

Management monitoring is generally effective, and there is clear evidence of scrutiny in the home’s documents and logs. For example, managers correctly identified that not all restorative measures are effective, particularly financial consequences for the older young person. It is good to see that staff have been urged to think more creatively. For some young people, it has been difficult to find a restorative measure that matters sufficiently to them to have an impact on their behaviour. Over the past year, the registered manager has worked hard to improve standards in the home. This resulted in the home improving from a judgement of inadequate in 2015, to one of good at the full inspection in May 2016. Although this home has declined in effectiveness on this occasion, these previous improvements have held. The challenge on this occasion has been in responding to the young people’s competing complex needs.

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children and young people since the most recent full inspection

The manager continues to lead and support his staff very well. All are now enrolled on their level 3 award and receive regular, effective supervision. Staff have received relevant advanced-level training to help them to meet these young people’s needs. The home now has access to a consultant in residential services who visits the staff team regularly, to provide advice and support. The manager has also made good use of mentoring and support from senior colleagues and the regulation 44 independent visitor. There were staff shortages during October, due to a number of staff leaving the home. This necessitated the manager working 10 shifts in that month, which made it difficult to for him to manage the home as effectively as he would have wished at that time. The independent visitor identified some paperwork shortfalls. By the time when this inspection took place, the manager had already actioned these matters. This shows

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children and young people since the most recent full inspection

that the home’s system of internal and external monitoring generally works effectively. The registered manager and his senior colleagues also work collaboratively with the police, education providers, local authority departments and the local CAMHS to promote good outcomes for the young people.

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Information about this children’s home

The children’s home is part of a national organisation which operates a number of services for young people and adults. It is registered for up to two young people under the age of 18 years, who may have emotional and behavioural difficulties.

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Recent inspection history

Inspection date Inspection type Inspection judgement

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Recent inspection history

19/03/2015 Interim Sustained effectiveness

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Statutory requirements

This section sets out the actions which must be taken so that the registered person(s) meet(s) 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 12.—(1) The protection of children standard is 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; and (iv) manage relationships between children to prevent them from harming each other. This is with particular reference to ensuring that young people are encouraged to manage self-harm safely, that medical attention is sought appropriately when young people may be injured and that staff prevent sexual contact between residents of the home.

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Requirement Due date

13: The leadership and management standard 13.—(1) The leadership and management standard is 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 28/02/2017 the approach and ethos, and delivers the outcomes, set out in the home’s statement of purpose; and (h) use monitoring and review systems to make continuous improvements in the quality of care provided in the home. This is with particular reference to ensuring that:  the mix of young people in the home is appropriate to their respective needs; and  the staff and managers are effectively supported in their work by fully functioning IT systems and reliable internet access.

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Requirement Due date

16: Statement of purpose 16.—(1) The registered person must compile in relation to the children’s home a statement (‘the statement of purpose’) which covers the matters listed in Schedule 1. (3) The registered person must— (a) keep the statement of purpose under review and, where appropriate, revise it; and (b) notify HMCI of any revisions and send HMCI a copy of the revised statement within 28 days of the revision. (4) If a home has a website, the registered person must ensure that a copy of the statement of purpose is published on that website unless the registered person considers that such publication would prejudice the welfare of children in the home. In particular, they must ensure that the home’s statement of purpose is updated regularly and that the latest version is posted on the company’s website and sent to Ofsted. (Regulation 16(2)(3)(4)) 28/02/2017

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Requirement Due date

35: Behaviour management policies and records 35(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— (viii) a description of any injury to the child or any other person, and any medical treatment administered, as a result of the 28/02/2017 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; and (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. In particular, they must ensure that all physical interventions to manage a young person’s behaviour are recorded as restraints,

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Requirement Due date

that the staff and young people are debriefed and that this interview is recorded. (Regulation 35(3)(a) to (c)).

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Requirement Due date

40. Notification of a serious event (4) The registered person must notify HMCI and each other relevant person without delay if— (a) a child is involved in or subject to, or is suspected of being involved in or subject to, sexual exploitation; (b) an incident requiring police involvement occurs in relation to a child which the registered person considers to be serious; or (e) there is any other incident relating to a child which the registered person considers to be serious. In particular, review the level of incident, which the registered person considers to be serious, and notify Ofsted of any matters that fall into that category. (Regulation 40(4)) 28/02/2017

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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 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 whom 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, 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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