Children's home run by The National Centre for Young People with Epilepsy in Tandridge

This monitoring visit

This monitoring inspection was undertaken following the interim inspection of the home that took place on 5 December 2016, when it was judged as having declined in effectiveness. A restriction of accommodation notice was served with immediate effect on 16 December 2016 until 10 March 2017 inclusively. A monitoring visit was undertaken on 25 January 2017, at which inspectors judged that the children’s home was still struggling to consistently deliver a safe level of care to young people. Therefore, a decision was made that the notice to restrict accommodation would remain in place until 10 March 2017. The purpose of this visit was to ensure compliance with the notice and to monitor progress following the previous monitoring visit. The manager is now registered with Ofsted. The whole senior leadership team has continued to focus strongly on moving the service forward. The leadership team has been successful in supporting the staff team and they have been able to

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This monitoring visit

reflect on practice and to fully identify the development needs of the service. Action plans are comprehensive and evidence an awareness of areas still requiring improvement, and there are clear strategies in place to achieve this. There is an evident commitment from both the staff and senior leadership team to ensure that young people are provided with a good level of care. This has resulted in a positive atmosphere in the houses, which parents also recognise. The progress that has been made in recent weeks is significant. Inspectors were aware during this visit that child protection allegations pertaining to the setting continue to be investigated by the appropriate authorities. Actions taken by the setting in response to past incidents were considered, alongside other evidence available at the time of the visit. There have been no further child protection allegations reported since the last visit on 25 January 2017. The

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This monitoring visit

safeguarding policy has been amended, and new staff sign an updated reporting agreement. These now explicitly state that staff are to intervene to keep young people safe if they are concerned for the young person’s welfare. Safeguarding briefings have been circulated to staff to highlight these changes in policy and the expectation of staff. It is not possible to fully evaluate the implementation of these procedures because there have been no further incidents. However, staff demonstrate a sound knowledge of their safeguarding responsibilities. Risk assessments following staff suspensions have now been reviewed. The templates have been amended to include action taken and strategies to eliminate risk when and if the decision has been made not to suspend a staff member following allegation. Since the last visit on 25 January, staff report a notable increase in staffing levels. The encouraging impact that this has on the staff morale was also evident. Newly

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This monitoring visit

recruited staff are now in post, and the recruitment drive continues with the aim to have a full complement of staff. The vacancy rate has now reduced to 13.9%. Further staff are due to start in the next week, and this will reduce the vacancy rate further to 11.39%. These figures do not take into account the staff members who are unavailable because of suspension or maternity leave. Without the new staff about to commence work, the rate is then 22.78%. However, the organisation has employed a higher number of fixed-term agency staff to ensure consistency for the young people, and the use of these staff reduces the figure to 6%. Although it is recognised that there has been a vast improvement since the last visit, vacancies remain. Although there is now a safe level of staff, there is still a lack of sufficient staff to ensure that the desired outcomes for young people are always fully achieved. The staff retention strategy continues to be reviewed. Shifts

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This monitoring visit

are now ‘RAG’ (red/amber/green) rated by senior staff to determine whether there is safe cover on each shift. This oversight now enables future planning and changes to be made, if any forthcoming shift is deemed to be unsafe. Since February, all shifts except one have been deemed as safe, and a higher number have had the full quota of staff. The skills and quality of the staff are also taken into account in this process. Staff are now more creative in planning the running of shifts and the movement of staff between houses. New staff, including fixed- term agency staff, are given a more comprehensive induction, and staff shadow before working on shift. This enables relationships to start to be formed with the young people and staff to be fully aware of young people’s care plans. Some houses are piloting an online system to ensure that rosters detail the actual hours worked by staff. The recording in other houses remains inconsistent. Further

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This monitoring visit

work is required to establish who was working at certain times and in which house. In addition, rosters do not ensure dedicated time for handovers between shifts. There is a reliance on staff completing this in their own time. This lack of a formal handover process inhibits staff in meeting the specific support required for each young person and, therefore, does not enable consistency of care. Formal supervision arrangements for staff have improved significantly. Staff report that they now feel supported and motivated in their roles. This includes the fixed- term agency staff. The supervision processes are child focused and reflective. The increase in the level of supervision enables staff to feel that they are being listened to. Service group meetings are now in place for all the house managers and their assistants. This is a new development, which needs to embed fully into practice. The staff involved feel that this is a valuable opportunity and use this

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This monitoring visit

time to share information, to think creatively and to motivate each other. The organisation’s action plan is also discussed, which ensures that all staff are involved in its implementation. This is supporting these staff to be given more autonomy and responsibility. This is then disseminated to the rest of the staff in team meetings. Staff are fully aware of and involved in the developments of the service. Improved systems are in place to demonstrate when routine medical examinations and checks have taken place for young people. Information is now collated to ensure that health appointments are made in a timely manner for the young people in full-time residential care. Health plans are more easily available to staff and encompass specific plans for each aspect of a young person’s health and well- being. However, these plans are updated by the healthcare staff, and the communication between all the teams remains poor. When plans are updated, this

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This monitoring visit

is not routinely communicated to the care staff, leaving the potential for them to be following out-of-date guidance. In addition, occupational therapy assessments have been removed from young people’s files due to their requiring review. Care staff are responsible for their implementation and do not yet have updated information to refer to. There is no indication of the timescales of when new plans will be in operation. Communication needs to improve to ensure that the individual support needs of the young people can be fully met. During the visit, young people were seen to be happy and relaxed in the presence of staff. Staff are positive about the changes that have happened in recent weeks and are able to reflect on the progress that young people are making. Following a case review on 8 March 2017, Ofsted has decided to let the notice to restrict accommodation lapse at the time specified in the notice served on 16

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This monitoring visit

December 2016. The time specified is 10 March 2017. No further action is being taken by Ofsted. The level of progress made is satisfactory.

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Information about this children’s home

The service provides education and residential care for up to 60 young people, aged from eight to 18 years, across eight separate houses. Young people attend the organisation’s special school, which is approved by the Department for Education. Young people who have a variety of disabilities, primarily learning difficulties, autistic spectrum disorder, complex health needs and physical disabilities, are accommodated. Young people who stay at the home do not necessarily have a diagnosis of epilepsy. Four houses operate during term time only, and the others for 52 weeks of the year.

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Information about this children’s home

An adult college and some houses, which are exclusively for 18- to 25-year-old young people, are on the same site. These are separately regulated by the Care Quality Commission. The provider organisation is a registered charity.

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Statutory requirements

This section sets out the actions that 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

10: The health and well-being standard In order to meet the health and well-being standard, the registered person is required to ensure: (2)(a) that staff help each child to: (ii) understand the child’s health and well-being needs and the options that are available in relation to the child’s health and well- being. (Regulation 10(2)(a)(ii)) This specifically relates to ensuring that occupational therapy plans are available to staff and there is clear communication between all teams. 30/04/2017

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Requirement Due date

13: The leadership and management standard In order to meet the leadership and management standard, 30/04/2017 (2) the registered person is required to: (d) ensure that the home has sufficient staff to provide care for each child, and (e) ensure that the home’s workforce provides continuity of care for each child. This specifically refers to ensuring that there are dedicated handover times in operation. (Regulation 13(2)(d)(e))

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Requirement Due date

The registered person must maintain records kept in schedule 4. (Regulation 37(2)(a)) This specifically relates to a record of the rosters of actual hours worked. 30/04/2017

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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 Textphone: 0161 618 8524 E: enquiries@ofsted.gov.uk W: www.gov.uk/government/organisations/ofsted

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