Children's home run by Andover And District Mencap in Test Valley

Inspection report children‟s home: SC011976 1 SC011976 Registered provider: Andover and District Mencap

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Full inspection Inspected under the social care common inspection framework

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Information about this children’s home

The home provides short-break residential care for a maximum of four children and young people who have learning difficulties and/or associated physical disabilities. It is a four-bed unit owned and managed by a local branch of a charitable organisation.

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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 widespread failures that mean children and young people are not protected or their welfare is not promoted or safeguarded.

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inadequate

Date of last inspection: 15 February 2017

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inadequate

Overall judgement at last inspection: Inadequate

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Enforcement action since last inspection

Compliance notices were issued in regards to regulation 13 (2)(a)(c)(f) and (h) and regulation 25 (1)(a)(b)(c) and (d), (2)(a)(b) and (3). Ofsted judged these notices as met at the monitoring visited conducted on 4 April 2017. Inspection report children‟s home: SC011976 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

 The unsafe practice in relation to the administration of medication places children at severe risk of harm.  A lack of monitoring and oversight from leaders and managers has resulted in serious and widespread failings across the service.  Leaders and managers have failed to ensure that staff have received the training they need to provide competent care to children.  Parents describe communication from the service as poor.  This service has failed to sustain the improvements noted at the interim inspection.  The majority of requirements made at the previous inspection have been found to be breached at this inspection.

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Key findings from this inspection

 The majority of younger children enjoy their stays at the service.  Children have opportunities to go on trips out.  Care plans are personalised.

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Inspection date Inspection type Inspection judgement

15/02/2017 Full Inadequate 13/07/2016 Interim Declined in effectiveness 17/12/2015 Interim Sustained effectiveness 23/07/2015 Full Good Inspection report children‟s home: SC011976 3

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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 within the given timescales.

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Requirement Due date

5: Engaging with the wider system to ensure children‟s needs are met In meeting the quality standards, the registered person must, and must ensure that staff— (d) seek to develop and maintain effective professional relationships with such persons, bodies or organisations as the registered person considers appropriate, having regard to the range of needs of children for whom it is intended that the children‟s home is to provide care and accommodation. 13/07/2017

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Requirement Due date

12: The protection of children standard In order to meet the protection of children standard, the registered person must ensure that staff— (2)(a) (iii) have the skills to identify and act upon signs that a child is at risk of harm; (vii) are familiar with, and act in accordance with, the home‟s child protection policies; (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 from harm; (e) that the effectiveness of the home‟s child protection policies is monitored regularly. 13: The leadership and management standard In order to meet the leadership and management standard, the registered person must: (2)(a) lead and manage the home in a way that is consistent with the approach and ethos, and delivers the outcomes set out in the home‟s statement of purpose; (c) ensure that staff have the experience, qualifications and skills to meet the needs of each child;

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Requirement Due date

(f) understand the impact that the quality of care provided in 13/07/2017 Inspection report children‟s home: SC011976 4 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; (h) use monitoring and review systems to make continuous improvements in the quality of care provided in the home. 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. (Regulation 16 (1)) 13/07/2017

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Requirement Due date

For the purposes of paragraph (3)(b), an individual who works in the home in a care role has the appropriate qualification if, by the relevant date, the individual has attained the level 3 diploma for residential childcare (England) („the level 3 diploma‟); or a qualification which the registered person considers to be equivalent to the level 3 diploma. (Regulation 32 (4)(a)(b)) 13/07/2017

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Requirement Due date

The registered person must ensure that a record is made of any complaint, the action taken in response, and the outcome of any investigation. (Regulation 39 (3)) 13/07/2017

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Requirement Due date

The registered person must complete a review of the quality of care provided for children („a quality of care review‟) at least once every six months. In order to complete a quality of care review the registered person must establish and maintain a system for monitoring, reviewing and evaluating: (a) the quality of care provided for children; (b) the feedback and opinions of children about the children‟s home, its facilities and the quality of care they receive in it; and (c) any actions that the registered person considers necessary in order to improve or maintain the quality of care provided for children. (Regulation 45 (1)(2)(a)(b)(c)) 13/07/2017

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Recommendations

 Children who cannot or choose not to verbalise, have the right to have their views, wishes and feelings heard and respected in the same way as other children. („Guide to the children‟s homes regulations including the quality standards‟, page 24, paragraph 4.24) In particular, ensuring that children‟s care plans identify how children communicate how they are feeling.  The registered person must ensure that appropriate opportunities are available for each child to have fun, form friendships and enjoy life, relative to their stage of development and individual needs. („Guide to the children‟s homes regulations Inspection report children‟s home: SC011976 5 including the quality standards‟, page 31, paragraph 6.10)  Restraint also includes restricting a child‟s liberty of movement. The registered person must ensure that restrictions such as these, and all other restrictions of liberty of movement, should be recorded as restraint. („Guide to the children‟s

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Recommendations

homes regulations including the quality standards‟, page 47, paragraph 9.42)  The registered person must ensure that a child‟s EHC plan or statement of special educational needs contains details about planned and agreed approaches to restraint or restraint techniques to be applied in the day-to-day routine of the child. („Guide to the children‟s homes regulations including the quality standards‟, page 47, paragraph 9.43) In particular, plans provide details on young people‟s capacity and ability to keep themselves safe.  The registered person must ensure that there is a workforce plan in place and contains the information required by guidance. („Guide to the children‟s homes regulations including the quality standards‟, page 54, paragraph 10.8)  When considering new placements, the registered manager should fully consider the impact that the placement will have on the existing group of children. („Guide

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Recommendations

to the children‟s homes regulations including the quality standards‟, page 56, paragraph 11.4) In particular, the registered manager should evidence their judgement of compatibility between the young people.  The registered person must ensure that supervision and performance management of staff safeguards children and minimises potential risks to them. („Guide to the children‟s homes regulations including the quality standards‟, page 61, paragraph 13.1)  The registered persons must further develop and consolidate the assessment of the suitability of the location of the home. („Guide to the children‟s homes regulations including the quality standards‟, page 64, paragraph 15.1)

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Overall experiences and progress of children and young people: inadequate

Leaders and managers have failed to respond to requirements set previously about the protection of children, and the leadership and management of the setting. Children‟s safety and well-being is compromised and they do not receive an improving service. Managers‟ weak monitoring systems fail to identify poor practice. Concerns regarding medication practice were identified at the previous inspection. The administration of medication remains unsafe. Poor practice by staff has resulted in serious medication errors, compromising children‟s health and welfare. Insufficient training compromises the safety and the quality of the care that children receive. Examples include a member of staff administering medication using a nebuliser without having the training to do so. Staff are not trained to safely support children who are distressed and displaying challenging behaviour. Inspection report children‟s home: SC011976 6

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Overall experiences and progress of children and young people: inadequate

Communication with parents is poor. Parents said that they are not informed of when their child has been booked in for a stay. They are not told about what their child has been doing while at the service. All parents spoken to told the inspector that they had not been asked to review their child‟s plan of care for over a year. Parents‟ confidence in the members of staff varies. Parents said that some staff have a good knowledge of their children and that they do not worry when children are in the care of those staff. Parents described other staff as „complacent‟ and „lazy‟. Some parents raised concerns about staff training, with one parent stating, „I do not feel they provide care to a high standard.‟ Evidence of decision-making on the compatibility of the children placed together remains incomplete. The current process does not provide specific guidance to staff or inform them of strategies to reduce the likelihood of children‟s behaviours adversely affecting

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Overall experiences and progress of children and young people: inadequate

other children. Young people‟s mental capacity is not explored within their plans. As a result, it is not evident if the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards have been considered. This could result in young people‟s rights not being promoted. Parents of teenagers using the service advised that activities inside and outside of the home are aimed at younger children and do not promote the interests of young people. As a result, young people are not stimulated or fulfilled during their time at the service. The majority of children do enjoy their stays. Staff provide opportunities for children and young people to go to the beach, a local farm and the park. One child using the service at the time of inspection was seen to be relaxed and comfortable in staff‟s presence. Insufficient progress has been made to improve children‟s individual communication plans. They do not provide adequate information on how staff can best encourage and

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Overall experiences and progress of children and young people: inadequate

promote a child‟s ability to communicate, for example, when they are happy, sad, uncomfortable or in pain. This shortfall undermines the quality of the personalised information within plans and other positive aspects, such as staff routinely obtaining children‟s views on the things they would like to do during their stays.

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

A combination of inadequate training and poor process has created an environment in which children are at severe risk. Medication has been given in excess of prescribed dosages, which could have severe consequences. Leaders and managers have failed to carry out robust investigations into medication administration errors and near misses. As a result, administration practices have not been evaluated and areas of concern have not been identified. Managers and leaders have not ensured that the service‟s policy on the administration of medication informs staff on how to administer medication safely. Consequently, staff have failed to administer medication correctly resulting in at least two incidents of children receiving a higher dose of medication than prescribed, putting them at serious risk of harm. Furthermore, staff have not received sufficient training in delegated healthcare tasks to ensure that they provide safe and competent care.

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

Inspection report children‟s home: SC011976 7 Staff‟s inaccurate recording of the doses given has resulted in significant delays in errors being identified and has prevented managers from detecting when errors took place. As a result, staff could not provide a medical professional with accurate information when an overdose was suspected. This undermined the medical professional‟s ability to provide appropriate guidance and support, seriously jeopardising the children‟s health. Since the previous inspection, leaders and managers have failed to monitor or oversee safeguarding concerns, incidents and near misses. As a result, there has not been sufficient investigation of incidents or concerns. This includes incidences of unexplained bruising and marks on children. Records do not evidence that managers and staff took appropriate action to respond to concerns and safeguard children. The improvements noted at the interim inspection have not been maintained. Partner agencies cannot be

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

assured that actions have been taken to protect the children and prevent further incidents. Staff are not provided with the knowledge or skills that they need to identify risks and take appropriate safeguarding action. It was identified at the previous inspection that training did not sufficiently cover topics such as radicalisation, child sexual exploitation, self-harm or online safety. Leaders and managers have not taken action to ensure that staff receive training on these significant risk factors. This is reflected in children‟s risk assessments, in which strategies to protect children who access the internet are limited. As a result, staff are not adequately informed of preventative strategies that should be implemented to keep children safe. There has been one complaint since the previous inspection. There is no evidence of the complaint being investigated or an outcome being reached. As a result, children, parents

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

and others cannot be assured that their complaint will be listened to or used to improve the quality of service or practice. A lack of suitable training in supporting children who display behaviour that is harmful to themselves or others fails to provide suitable protection for the children. The majority of staff have not received training, or have not undertaken refresher training, in the required timescales. This means that staff do not have the skills or up-to-date knowledge to intervene safely when necessary. This shortfall undermines other positive aspects, such as the staff‟s ability to distract children and de-escalate situations, preventing the need for the use of a physical intervention. There have been no sanctions since the previous inspection. Staff have correctly recorded three restrictions of liberty placed on children when they were unable to access the upstairs of the home due to building work. However, staff failed to recognise that

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

preventing a young person from leaving the home, when he wanted to, is also a restriction. Records did not evidence why the young person was not supported safely to leave the home. As a result, young people cannot be assured that their wishes and rights will be promoted and respected. The service‟s location assessment has been improved to demonstrate consideration of the immediate neighbourhood and its risk factors. However, there is no evidence of consultation with relevant professionals, such as the police or local authority, to inform the assessment as required by regulation. Inspection report children‟s home: SC011976 8 No children have gone missing since the previous inspection. Staff demonstrated their awareness of the service‟s policies and procedures if a child was to go missing and the action they would take to find the child quickly. No new staff members have joined the service since the previous inspection. As a result,

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

we could not appraise the quality and safety of the service‟s recruitment processes.

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The effectiveness of leaders and managers: inadequate

The service has not had a registered manager since April 2017. At the time of this inspection, the new manager had been in post for a week and has yet to submit an application for registration with Ofsted. The responsible individual also left the organisation at the beginning of June 2017. The appointed responsible individual is yet to submit a complete application to Ofsted. In the absence of a manager and responsible individual, the organisation failed to put in place suitable interim management arrangements. Consequently, there has been a significant lack of oversight resulting in serious and widespread failings across the service. This service has failed to sustain improvement and has continued to breach the majority of requirements made at the previous inspection. The inaction of leaders continues to raise concerns about their knowledge and ability to fulfil their roles and responsibilities. Leaders and managers remain unaware of the service‟s shortfalls. Monitoring systems

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The effectiveness of leaders and managers: inadequate

are ineffective. Consequently, leaders and managers have an extremely poor oversight of the service and limited understanding of its weaknesses. A development plan was implemented after the previous inspection; however, it has not been reviewed since May 2017 and actions for improvement have not been met. A quality monitoring report completed by staff and the independent visitor showed a lack of understanding of the regulations, quality standards and good practice. This does not challenge or support the staff and the service to develop. There are no systems in place to drive improvements. Such failings continue to question the competence of the provider. Leaders and managers lack insight into how the service and the experiences of the children can be improved. There is a limited understanding of the experiences of children and the impact that their time at the service has. Documents completed during a child‟s

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The effectiveness of leaders and managers: inadequate

stay are repetitive and do not provide a sufficient or accurate reflection of their time. Recordings against children‟s targets is sporadic. Staff have begun to obtain feedback from children about their stays, but there is no evidence that this information is evaluated or used to inform service development. Leaders and managers do not have effective relationships with professionals. Records do not evidence staff‟s conversations with parents or professionals. As a result, children and their parents cannot be assured the service is working with others to promote children‟s safety and well-being. The statement of purpose provides inaccurate information on the qualifications that staff have obtained. In particular, it suggests that many of the staff have completed the required level 3 diploma when they have not. Currently, leaders and managers are unsure about who has completed the diploma or who holds an equivalent qualification.

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The effectiveness of leaders and managers: inadequate

Therefore, leaders and managers cannot be certain that all staff have the required skills Inspection report children‟s home: SC011976 9 and knowledge to fulfil their role. The organisation‟s workforce training strategy has been reviewed, but it still does not cover the information required by guidance and provides a limited overview of the expectations for staff‟s training and supervision. Staff still do not receive supervision within the timescales stated in the service‟s statement of purpose. The continued absence of sufficient training and support seriously restricts the staff‟s ability to safeguard the children and promote their well-being. Leaders and managers have not taken action to ensure that staff have undertaken the required training to provide them with the necessary up-to-date knowledge and skills to care for the children. Children who use the service have varying and, in some cases, very complex,

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The effectiveness of leaders and managers: inadequate

healthcare needs. Managers were unable to demonstrate that staff have received sufficient training in the administration of medication or in delegated healthcare tasks to ensure that they can provide safe and competent care. Staff have still not undertaken training that sufficiently informs them to be able to identify safeguarding concerns and about how to manage risk factors, such as online safety and child exploitation. Managers have failed to ensure that staff have completed initial or refresher training, as outlined in the service‟s statement of purpose.

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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: SC011976 10

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Children’s home details

Registered provider: Andover and District Mencap

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Children’s home details

Registered provider address: Andover and District Mencap, The Wellington Centre, Winchester Road, Andover, Hampshire SP10 2EG

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Children’s home details

Responsible individual: Andrea Knight-Down

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Inspector

Melissa McMillan, social care inspector Inspection report children‟s home: SC011976 11 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 children looked after, safeguarding and child protection.

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Inspector

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Inspector

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Inspector

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