Children's home run by Crossways Care Ltd in Tewkesbury

Inspection report children's home: SC443079 1 SC443079 Registered provider: Crossways Care Ltd

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Full inspection Inspected under the social care common inspection framework

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Information about this children's home

This children's home was registered in March 2012 to provide care and accommodation for up to three young people of either gender who may have emotional and/or behavioural difficulties. The home is run by a care company that runs several other children's homes and a small, specialised school in the area. In 2013, the company was purchased by a larger national organisation, but it retains its local corporate identity.

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Overall experiences and progress of

children and young people, taking into account

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Inadequate

How well children and young people are helped and protected Inadequate

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Inadequate

The effectiveness of leaders and managers Inadequate

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Inadequate

There are serious and/or widespread failures that mean children and young people are not protected or their welfare is not promoted or safeguarded and the care and experiences of children and young people are poor and they are not making progress.

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Inadequate

Date of last inspection: 15 November 2016

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Inadequate

Overall judgement at last inspection: Declined in effectiveness

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Enforcement action since last inspection

None Inspection report children's home: SC443079 2

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Key findings from this inspection

This children's home is inadequate because

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Key findings from this inspection

 Young people who have lived in the home for over two years do not make sufficient progress, and they continue to behave in such a way that they place themselves at significant risk.

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Key findings from this inspection

 Poor practice by some staff, including errors in recording and responses to young people, continues as leaders and managers do not monitor the practice of the staff team effectively.

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Key findings from this inspection

 The majority of the workforce are very new to the role and insufficiently skilled to support the young people’s complex emotional and behavioural needs. There are inadequate levels of expert advice to support the mental and psychological needs of the young people.

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Key findings from this inspection

 The leaders, managers and staff do not always respond in a positive and nurturing way to the young people when they are in crisis. This is not in line with their statement of purpose, ethos and philosophy.

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Key findings from this inspection

 The complex needs of both young people living in the home, coupled with poor behaviour management by the staff, have resulted in extensive damage to the property and repeated assaults on staff. Although the use of physical intervention has decreased, it remains high. The staff do not provide the young people with a well-kept, homely environment to live in.

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Key findings from this inspection

 The manager and staff fail to provide the young people with consistently healthy and nutritious meals. Young people consume a diet that consists mainly of processed foods and high-sugar snacks.

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Key findings from this inspection

 Young people have good attendance at school, and, when necessary, receive sufficient home tuition. A social worker reports that they are making good progress and are on track to achieve good grades.

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Key findings from this inspection

 The manager is qualified and has a full staff team. Some staff demonstrate a keenness to improve the outcomes of young people.

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Key findings from this inspection

 Young people are, in the main, supported to take part in a range of activities by a number of enthusiastic, committed and well-meaning staff. Inspection report children's home: SC443079 3

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Inspection date Inspection type Inspection judgement

15/11/2016 Interim Declined in effectiveness 13/05/2016 Full Good 11/02/2016 Interim Sustained effectiveness 21/10/2015 Full Good Inspection report children's home: SC443079 4

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Statutory requirements

This section sets out the actions that the registered person(s) must take to meet 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 with the given timescales.

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Requirement Due date

The leadership and management standard is that the registered person enables, inspires and leads a culture in relation to the children's home that helps children aspire to fulfil their potential; and promotes their welfare.

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Requirement Due date

In particular, the standard in paragraph (1) requires the registered person to 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;

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Requirement Due date

ensure that staff work as a team where appropriate;

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Requirement Due date

ensure that staff have the experience, qualifications and skills to meet the needs of each child;

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Requirement Due date

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;

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Requirement Due date

demonstrate that practice in the home is informed and improved by taking into account and acting on research and developments in relation to the ways in which the needs of children are best met; and feedback on the experiences of children, including complaints received; and use monitoring and review systems to make continuous improvements in the quality of care provided in the home.

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Requirement Due date

In particular, leaders and managers must provide training and learning opportunities, both internally and externally, that are bespoke to the needs of the young people.

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Requirement Due date

(Regulation 13(1)(a)(b)(2)(1)(a)(b)(c)(f)(g)(i)(ii)(h)) 07/07/2017 Inspection report children's home: SC443079 5 Children's case records

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Requirement Due date

The registered person must maintain records ("case records") for each child which are kept up to date; and are signed and dated by the author of each entry. (Regulation 36(1)(a)(c)) 07/07/2017

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Requirement Due date

The registered person must notify HMCI and each other relevant person without delay if there is any other incident relating to a child which the registered person considers to be serious. (Regulation 40(e)) 07/07/2017

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Requirement Due date

The quality and purpose of care standard

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Requirement Due date

The quality and purpose of care standard is that children receive care from staff who understand the children's home's overall aims and the outcomes it seeks to achieve for children; use this understanding to deliver care that meets children's needs and supports them to fulfil their potential.

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Requirement Due date

In particular, the standard in paragraph (1) requires the registered person to ensure that staff protect and promote each child's welfare;

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Requirement Due date

treat each child with dignity and respect;

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Requirement Due date

provide personalised care that meets each child's needs, as recorded in the child's relevant plans, taking account of the child's background;

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Requirement Due date

help each child to understand and manage the impact of any experience of abuse or neglect;

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Requirement Due date

help each child to develop resilience and skills that prepare the child to return home, to live in a new placement or to live independently as an adult;

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Requirement Due date

provide to children living in the home the physical necessities they need in order to live there comfortably;

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Requirement Due date

ensure that the premises used for the purposes of the home are designed and furnished so as to –

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Requirement Due date

meet the needs of the child; and enable each child to participate in the daily life of the home.

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Requirement Due date

In particular, all staff must provide an environment that is nurturing, and young people must be equipped with all they 07/07/2017 Inspection report children's home: SC443079 6 need to feel valued and respected. Staff responses to young people’s emotions and behaviour must be consistent. They must ensure that young people feel cared for and supported.

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Requirement Due date

(Regulation 6(1)(a)(b)(2)(b)(ii)(iii)(iv)(v)(vi)(vii)(c)(i)(ii)) The health and well-being standard

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Requirement Due date

The health and well-being standard is that children are helped to lead healthy lifestyles. In particular, the standard in paragraph (1) requires the registered person to ensure that staff help each child to achieve the health and well-being outcomes that are recorded in the child's relevant plans.

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Requirement Due date

In particular, ensure that young people receive a diet that is healthy, balanced and nutritious without a reliance on processed foods. (Regulation 10(1)(c)(2)(a)(i)) 07/07/2017

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Requirement Due date

The positive relationships standard is that children are helped to develop, and to benefit from, relationships based on an understanding about acceptable behaviour. In particular, the standard in paragraph (1) requires the registered person to ensure that staff meet each child's behavioural and emotional needs, as set out in the child's relevant plans; help each child to develop and practise skills to resolve conflicts positively and without harm to anyone.

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Requirement Due date

In particular, ensure that all staff are helped to develop positive relationships with each young person, and that young people have a choice of who they are supported by and in accordance with their needs. (Regulation 11(1)(b)(2)(a)(iv)) 07/07/2017

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Requirement Due date

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. The registered person must keep the statement of purpose under review and, where appropriate, revise it; and notify HMCI of any revisions and send HMCI a copy of the revised statement within 28 days of the revision. (Regulation 16(1)(3)(a)(b)) 07/07/2017

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Requirement Due date

The protection of children standard is that children are protected from harm and enabled to keep themselves safe. 07/07/2017 Inspection report children's home: SC443079 7 In particular, the standard in paragraph (1) requires the registered person to ensure 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 from harm.

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Requirement Due date

In particular, staff must learn to help young people understand how to live with uncertainty, upset and change without becoming unduly anxious, stressed or worried. There must not be an over-reliance on physical intervention, and staff must be skilled in de-escalating situations. (Regulation 12(1)(2)(b))

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Overall experiences and progress of children and young people: inadequate

The manager and staff do not meet the emotional, psychological and physical needs of the young people. The majority of staff do not understand how the young people’s previous experiences are communicated through their behaviour and responses. Further to this, young people who have complex behavioural and mental health needs do not receive adequate levels of expert therapeutic support. Consequently, young people who are not able to regulate their feelings and behaviours continue to self- harm and engage in extremely risky behaviours. Requirements are made to ensure that young people receive the correct level of therapeutic support, and that staff receive guidance and training to support the young people’s complex mental, emotional, physical and psychological needs.

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Overall experiences and progress of children and young people: inadequate

Young people live in a home in a rural setting which has lots of space to play and relax. Unfortunately, as a result of some staff not having the skills to support young people when they are upset, anxious and worried, the home is damaged extensively. As a result, the home is stark and unhomely, and bedrooms have little evidence of personalisation. Requirements have been made to ensure that leaders and managers provide an environment that is homely and that all staff are skilled in understanding the behaviour of the young people.

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Overall experiences and progress of children and young people: inadequate

Some staff members have established and maintained positive relationships with the young people. This means that they are able to sensitively and confidently support the young people when they are most challenging. However, some staff do not have this skill, and this has resulted in some staff members choosing which young person to support. Young people are aware of this. It leaves them without choice; for example, one young girl is mostly supported by males. This is not in line with her care plan, her needs, or the ethos of the home. Inspection report children's home: SC443079 8 Young people are receiving education either by home tuition or by attending the company’s school. For one young person this has been a positive experience, through which behaviours are managed more successfully and learning is taking place.

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Overall experiences and progress of children and young people: inadequate

Young people attend all necessary health appointments, including therapeutic services provided by the company’s play therapist and consultant psychologist. However, there is insufficient evidence of the impact of these services. Young people are not receiving sufficient support from external therapeutic services, for example child and adult mental health services (CAMHS), and plans to introduce such services remain unclear and not sufficiently strategic.

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Overall experiences and progress of children and young people: inadequate

Some staff work hard to encourage young people to maintain a healthy lifestyle. However, records scrutinised during the course of the inspection confirm that young people consume a high proportion of processed and fatty foods. In addition, as alternatives to wholesome nutritious meals, young people eat takeaways, crisps, biscuits, ice cream and fizzy drinks on a daily basis, which are all very high in sugar and salt. The manager and some staff have failed to recognise the impact on young people of routinely eating a poor diet. A requirement is made to ensure that young people’s health outcomes are improved, that they access a healthy, balanced diet and that staff do not use unhealthy food as treats and rewards.

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Overall experiences and progress of children and young people: inadequate

Young people enjoy time with their families and are supported by staff during visits. A social worker reports that good progress has been made because staff have worked hard when supervising visits and recording and sharing information. This has resulted in one young person returning to the care of their family and one young person enjoying increased levels of time with their family.

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How well children and young people are helped and protected: inadequate

Young people are not always protected from harm because not all of the staff are knowledgeable, trained, sufficiently experienced or supported and guided by experts to understand the young people’s emotions and behaviours. As a direct result, young people continue to self-harm, cause damage to the home, assault members of staff and police officers, and have heightened levels of anxiety resulting in one young person being sectioned under the Mental Health Act 1983.

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How well children and young people are helped and protected: inadequate

Some staff are able to calm young people and de-escalate situations, and relationships between these staff and young people are positive and warm. Records scrutinised during the course of the inspection show that physical intervention continues to take place but has reduced since the last inspection. However, some staff are not sufficiently skilled in supporting young people and are not using de-escalation techniques effectively. As a result, physical intervention remains high, and some staff overly rely on the use of physical intervention as a means of behaviour management. A requirement is made to ensure that all staff develop a greater understanding of behaviour management and that their response to young people is in line with the young person’s behaviour management plan. Inspection report children's home: SC443079 9 Leaders, managers and staff do not demonstrate sufficient understanding of why young people can cause damage to themselves and the home. Sanctions are

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How well children and young people are helped and protected: inadequate

inappropriately used as a consequence for these behaviours. They are repetitive and ineffective. For example, one young person’s bedroom was stripped bare, with the exception of a bed and television, as a response to their behaviours. This response was disproportionate to the incident, not in line with the care plan and risk assessment of the young person, and against the philosophy and ethos contained in the home’s statement of purpose. This action only served to lessen the young person’s sense of self-worth and self-esteem, and discussion with the young person showed the inspector that they remained confused about the purpose of the action. Furthermore, the recording of these and other incidents is poor. They do not routinely include an analysis of effectiveness of the measure used, and it is unclear if young people understand their purpose. A requirement is made to ensure that young people’s welfare and dignity is promoted and that they receive personalised care in

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How well children and young people are helped and protected: inadequate

line with their risk assessments and care plan.

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How well children and young people are helped and protected: inadequate

Since the last inspection, young people’s behaviours have not been supported effectively and, as a result, the home has been subjected to extensive damage. The usual items found within a home, such as pictures, curtains, ornaments and soft furnishings, have been damaged leaving areas of the home sparse. In particular, most of the contents of the kitchen are stored in the office and not accessible to the young people. The removal of objects that could be used to cause damage or thrown has become the default response by some staff. There is insufficient evidence of staff understanding and addressing the underlying causes of the young people’s behaviours. A requirement is made to ensure that the home is returned to a place where young people can enjoy living, develop a sense of pride and learn to respect and value their home.

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The effectiveness of leaders and managers: inadequate

Leadership and management are inadequate, as the registered manager has failed to deal with ineffective and poor practice of some of the staff, and, as a result, young people have not received adequate levels of care for all of their time living in the home.

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The effectiveness of leaders and managers: inadequate

Staff understand the procedures to follow when they are concerned about poor practice and, on a number of occasions, they have escalated their worries. Unfortunately, the senior management team has not dealt with these concerns about poor practice in a timely manner. A requirement is made to ensure that the leaders and managers address poor practice and operate in line with their statement of purpose.

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The effectiveness of leaders and managers: inadequate

Staff stated that they receive supervision and training that in part meets their needs. New staff praised the induction programme, and the programme does provide staff with a basic entry level of training. However, some staff feel strongly that leaders and Inspection report children's home: SC443079 10 managers do not provide them with learning opportunities or clinical reflective supervision that equips them with strategies to support the young people’s most challenging behaviours; for example, self-harm and mental health. A requirement is made to ensure that training specific to the needs of the young people who live in the house is delivered to all staff.

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The effectiveness of leaders and managers: inadequate

The home is sufficiently staffed. Those spoken with during the course of the inspection demonstrate an enthusiasm, commitment and passion to improving the outcomes of the young people. Unfortunately, the staff team is, in the main, new to the home, and staff members remain on, or have just finished, probation. They have not yet formed a strong relationship with the young people or an understanding of the young people’s complex needs. The manager has failed to ensure that a sufficient number of adequately experienced and skilled staff are scheduled to work each day. As a consequence of this, young people are not receiving support from staff who know and understand them, and records indicate that it is during serious incidents that young people present in a heightened state of anxiousness, stress and worry. A requirement is made that the manager ensures that young people are cared for by a staff team that is skilled in how to help, care and support them. In addition to this, a

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The effectiveness of leaders and managers: inadequate

further requirement is made to ensure that the statement of purpose reflects the current staffing structure and is submitted to Ofsted.

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The effectiveness of leaders and managers: inadequate

Insufficient planning takes place prior to a young person moving into the home. As a consequence, young people who have extremely complex and challenging behaviours are not matched appropriately. Leaders and managers fail to ensure that the required documentation is in place; for example, a local authority review, care plan, and pathway plan. Staff spoken with during the inspection reported that they are unclear on how to support young people as they move into adulthood, and a lack of up-to- date records makes this more difficult. Risk assessments are completed for all activities, ensuring that young people are as safe as they can be when out in the community, and most are up to date.

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The effectiveness of leaders and managers: inadequate

The manager has a range of auditing tools, including feedback from the Regulation 44 visitor. Serious incidents are appropriately shared in a timely manner with all professionals involved in the care of the young people, and this includes notifiable events. The manager, when necessary, seeks advice from the designated officer and members of the senior management team. Social workers reported that they receive regular updates from the manager and that communication is good. However, the manager has failed to sufficiently review and evaluate the practice of staff, some of the records kept, and the progress of young people. In addition, the manager has failed to identify the underlying causes of the young people’s self-harming behaviours, damage and trauma. The manager has also failed to put in place sufficiently clear programmes that support young people living safely without the supervision of staff,

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The effectiveness of leaders and managers: inadequate

and identify patterns of behaviour as young people move into the home. A requirement is made to ensure that the manager reviews all systems to make continuous improvements in the quality of care provided in the home. Inspection report children's home: SC443079 11

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Information about this inspection

Inspectors have looked closely at the experiences and progress of children and young people. Inspectors considered the quality of work and the difference made to the lives of children and young people. They watched how professional staff work with children and young people and each other and discussed the effectiveness of help and care provided. Wherever possible, they talked to children and 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.

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Information about this inspection

Using the 'Social care common inspection framework', this inspection was carried out under the Care Standards Act 2000 to assess the effectiveness of the service, how it meets the core functions of the service as set out in legislation, 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'. Inspection report children's home: SC443079 12

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Children's home details

Registered provider address: Unit B2, Elmbridge Court, Cheltenham Road East, Gloucester, Gloucestershire GL3 1JZ

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Children's home details

Responsible individual: Christine Cameron

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Inspector(s)

Linda Bond, social care inspector Inspection report children's home: SC443079 13 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, further education and skills, adult and community learning, and education and training in prisons and other secure establishments. It assesses council children's services, and inspects services for looked after children, safeguarding and child protection.

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Inspector(s)

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Inspector(s)

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Inspector(s)

T: 0300 123 1231 Textphone: 0161 618 8524 E: enquiries@ofsted.gov.uk W: http://www.gov.uk/ofsted

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