Children's Home, Residential special school run by MacIntyre Care in Buckinghamshire

Inspection report children’s home: SC043994 1 SC043994 Registered provider: MacIntyre Care

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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 service is a residential special school that is registered as a children’s home for young people who have severe learning disabilities. It is run by a large independent organisation. The school accommodates up to 40 young people in seven separate houses, usually on the basis of a 52-week placement.

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Overall experiences and progress of

children and young people, taking into account

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Good

How well children and young people are helped and protected Good

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Good

The effectiveness of leaders and managers Good

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Good

The children’s home provides effective services that meet the requirements for good.

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Good

Date of last inspection: 24 November 2016

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Good

Overall judgement at last inspection: Sustained effectiveness

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Key findings from this inspection

 Strong leadership, and how this informs good care planning, results in young people making very good progress, especially when bearing in mind their starting points. Some of this progress has been life changing, even life-saving, in respect of one young person who, prior to admission, was failing to thrive. Inspection report children’s home: SC043994 2  Obtaining young people’s wishes and feelings is central to the practice of the home. Staff continually promote communication, provide choices and facilitate young people’s contribution to plans.  When particular difficulties arise, or progress stalls, managers pull together professionals working across the provision, including a behavioural support team and, when necessary, people with additional expertise from outside the school. This has been highly effective in improving matters for young people.  Safeguarding is a particularly strong area of work, with clear lines of reporting

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Key findings from this inspection

and monitoring concerns, whether about childcare practice, health or injuries. This leads to prompt and robust action taken by managers, which ensures that young people are safe.

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Key findings from this inspection

The children’s home’s areas for development:

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Key findings from this inspection

 Information on the diverse backgrounds of young people is not readily available or used to inform direct work with them.  There is over-reliance on agency workers due to the difficulty of recruiting and retaining permanent staff.  Managers are not monitoring practice to ensure that all staff, whether permanent or agency, are receiving the level of support appropriate to their demanding roles. This includes insufficient reviewing of supervision and house meeting records to ensure that supervisions are occurring frequently enough and are adequately documented.  Plans are not always updated when circumstances change, such as when actions are allotted in care, health or education plans, or when a risk assessment identifies new needs.

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Inspection date Inspection type Inspection judgement

24/11/2016 Interim Sustained effectiveness 10/05/2016 Full Requires improvement 17/11/2015 Interim Sustained effectiveness 29/06/2015 Full Requires improvement Inspection report children’s home: SC043994 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

In meeting the quality standards, if the registered person considers, or staff consider, a placing authority’s or a relevant person’s performance or response to be inadequate in relation to their role, challenge the placing authority or the relevant person to seek to ensure that each child’s needs are met in accordance with the child’s relevant plans. (Regulation 5 (c)) In particular, escalate concerns promptly if it appears that the placing authority or the relevant person is not responding appropriately. 31/07/2017

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Requirement Due date

In order to meet the leadership and management standard, the registered person is required to: ensure that the home’s workforce provides continuity of care to each child. (Regulation 13 (2)(e)) In particular, ensure that placement plans are reviewed, regularly updated and that records demonstrate that they are followed consistently. 31/07/2017

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Requirement Due date

The registered person must ensure that an individual who works in the home in a care role has the Level 3 Diploma for Residential Childcare (England) or equivalent by the date which falls 2 years after the date on which the individual started working or, in the case of an individual who was working in a home on 1 April 2014, 1 April 2016. (Regulation 32 (4) and (5)) 31/07/2017

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Recommendations

 The importance of understanding who we are and where we come from is recognised in good social work practice, for example through undertaking life story work or other direct work. Staff in children’s homes should play a full role in work of this kind. (‘Guide to the children’s homes regulations including the quality standards’, page 16, paragraph 3.14)  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 Inspection report children’s home: SC043994 4 children. (‘Guide to the children’s homes regulations including the quality standards’, page 24, paragraph 4.24) This should include being supported to make a complaint that is dealt with in accordance with regulation 39.  Each child’s placement plan should set out the permissions that their placing authority has delegated to the registered person. (‘Guide to the children’s homes

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Recommendations

regulations including the quality standards’, page 31, paragraph 6.2) In particular, plans should identify the legal status of young people.  The registered provider must ensure that staff are able to build a positive relationship with each child and help the child develop skills to have positive relationships with others. (‘Guide to children’s homes regulations including the quality standards’, page 38, paragraph 8.6) In particular, ensure sufficient continuity of staff to maintain relationships over time.  Staff should continually and actively assess the risks to each child and the arrangements in place to protect them. Where there are safeguarding concerns for a child, their placement plan, agreed between the home and their placing authority, must include details of the steps the home will take to manage any assessed risks on a day-to-day basis. (‘Guide to the children’s homes regulations including the quality standards’, page 42, paragraph 9.5) In particular, ensure

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Recommendations

that identified risks are addressed in support plans.  The registered person must have systems in place so that all staff receive supervision of their practice from an appropriately qualified and experienced professional, which allows them to reflect on their practice and the needs of the children assigned to their care. (‘Guide to the children’s homes regulations including the quality standards’, page 61, paragraph 13.2)  All children’s case records must be kept up to date, and signed and dated by the author of each entry. (‘Guide to the children’s homes regulations including the quality standards’, page 62, paragraph 14.3)  The registered person should support staff to be ambitious for every child in the home and to gain skills and experience that enable them to actively support each child to achieve their potential. (‘Guide to the children’s homes regulations including the quality standards’, page 52, paragraph 10.5) Specifically, create

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Recommendations

opportunities for young people to practise skills to attain targets set for them.

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Overall experiences and progress of children and young people: good

The manager and staff are providing a service that meets the aims of their statement of purpose. As a result, children and young people are enjoying living in the home and they make good progress. Improvements include gaining skills, learning greater toleration of others, and gaining enjoyment of new experiences. In some instances, children are thriving, when they may otherwise have failed to do so. Links to education are very positive, both in terms of communication and overlap of personnel. This helps young people to transition between home and school. As a result, Inspection report children’s home: SC043994 5 attendance is very high, particularly for those children and young people who, prior to admission, have been extremely resistant to any formal education. Targets are set across the education and residential provision. However, in some houses, these targets have not been worked on effectively, may be largely ignored, or not

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Overall experiences and progress of children and young people: good

achieved for long periods. This limits the potential for young people to practise and achieve new skills. To some degree, this is a consequence of staff turnover, as new staff are not familiar with the process. New workers shadow experienced staff before engaging in young people’s personal care to ensure that those young people are familiar with them. Managers attempt to use the same agency staff to provide continuity of care, but numbers can still be high and key workers change frequently. It is clear that each young person’s individuality is acknowledged and promoted. The complex needs of the young people means that each care plan is the result of a carefully thought through and bespoke process. Staff get to know each young person’s personality and preferences. They are attentive and patient, taking care to explain situations to young people and reinforcing boundaries. When necessary, they divert or

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Overall experiences and progress of children and young people: good

distract young people to promote positive behaviour and avoid potentially difficult events. Members of staff show appropriate affection, which young people reciprocate. Young people contribute to the running of the home to whatever level that they are capable of, such as putting their plates in the sink after lunch. When parents request that young people attend a place of worship, or provide the home with a particular diet, managers and staff ensure that these requests are complied with. However, they are not proactive in helping young people to explore their cultural heritage. Placement plans do not always state what a young person’s ethnicity is, and the section that covers how culture and religion will be supported is restricted to stating whether they attend a place of worship or not. Placement plans are otherwise highly personalised; young people contribute to these by adding a description of their likes,

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Overall experiences and progress of children and young people: good

dislikes, interests and other things that are important to them. Managers and staff regard young people’s views as central to the running of the home. They take every opportunity to gain the young people’s wishes and feelings in whichever manner a young person prefers to use. These are then followed wherever possible, meaning that young people have a greater influence on their own day-to-day lives. Houses are generally well maintained, with rolling repairs and maintenance that, together with decorative features, promote a homely atmosphere. Safety gates at the top of the stairs in two houses detract from this. Although the gates provide an effective barrier in the event of a young person falling, or establish a demarcation between young people’s living areas, they are not made to blend in with their surroundings. Another house had the personal profiles of young people on display, meaning that they could be

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Overall experiences and progress of children and young people: good

read by visitors, including contractors undertaking work there. Residential staff, ably supported by the nurse, promote young people’s health and well- being. They assist young people to lose weight through healthy eating and exercise. A letter from a doctor on a case file noted that one young person’s seizures had reduced and described the home’s documentation as ‘excellent’. Indeed, records are detailed and Inspection report children’s home: SC043994 6 clear. Transition planning and practice is thorough and much appreciated by families. This work is begun well in advance of young people moving on. A transition worker supports social workers and parents to identify suitable next placements and to prepare young people for the change in environment and care. Staff share information and facilitate visits from, and to, the new provider, contributing significantly to young people settling successfully.

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

Since the last inspection, the home has reviewed the quality of recruitment practice and has improved the process. Consequently, all recruitment records examined showed that the correct procedure has been followed and that all necessary checks on staff are carried out. This ensures that only adults with appropriate backgrounds work at the home. Behaviour management is excellent and managers have implemented a successful programme to reduce the numbers of physical interventions young people experience and the numbers of accidents and staff injuries. This enhances the safety of all in the home. Plans help staff respond appropriately when a young person is having ‘a good day’, when there are signs that they are unsettled, when they are distressed and after any incident. The emphasis is on helping young people remain as calm and as engaged as possible. This means that they are helped to manage anxieties and to experience life

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

as fully as possible. Staff are fully aware of how to respond if they have concerns. An ethos has developed in which any unease can be raised with managers with responsibility for safeguarding, no matter how small, which ensures that no issue is missed. Effective decision-making and monitoring processes back this up, so that the whole system provides a robust safety net for young people. Relationships built up between staff and young people are trusting and meaningful. Inspectors observed a genuine fondness for the young people by adults, which was evident in how the young people were spoken about and to. Some young people displayed aggressive, even violent, behaviour towards staff; but, even here, tolerance, acceptance and empathy were clearly demonstrated. Excellent team working maintained staff resilience so that each member was able to meet the challenges posed and assisted young people to make significant, and sometimes unexpected, progress. Examples

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

include young people attending school and allowing staff to wash and brush their hair, when neither had been possible for some years prior to admission. Staff promote positive relationships between peers and address potential bullying or targeting well. For example, a social story was developed to help a young person appreciate how friends should be treated, and a house meeting was used to address the same issue, particularly helping young people understand how their actions influence how others feel. This means that young people are likely to have more enjoyable social interactions. Individual risk assessments address those activities or situations that are pertinent to Inspection report children’s home: SC043994 7 each young person, and actions to reduce their likelihood or severity are included to ensure that staff are aware of how to avoid difficulties. These assessment are leading to a less risk-averse culture in the home, with some young people allowed to be in the

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

secure site without the supervision of an adult, such as when making their way to and from school. In some houses, some assessments and other documentation are generic to the point of names not always being changed when entries are ‘cut and pasted’. This undermines the purpose and effectiveness of these records. One risk assessment identified the potential for a young person to fall downstairs if he had a seizure on the landing. An action to put this in his support plan and epilepsy protocol had not been followed up. Such oversights could lead to effective action not being taken to reduce the risks young people are exposed to. The approach to fire safety has become more systematic and rigorous since the last inspection. A new assessment for the whole site has been carried out and work is being completed to address all deficiencies, including the replacement of defective fire doors. Fire checks and emergency evacuation drills are being carried out in line with, or

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

exceeding, regulatory requirements and they are recorded well. However, managers do not always scrutinise these records to ensure that information is used to inform future action. For example, managers had not checked that all staff and young people regularly participate in a fire drill; indeed, it was found that one young person had not done so for eight months. In another house, the fire risk assessment had not been signed by either the fire officer or the compliance officer.

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The effectiveness of leaders and managers: good

A strong senior management team provides clear leadership and good support. Very good multi-disciplinary working ensures cohesive and well-structured care planning for the young people, especially with regards to such areas as managing transition and behaviour management. Such combined expertise assists and informs members of staff to provide sensitive support. Close working relationships, especially with health professionals and parents, ensure that there is a strong sense of collaboration and a feeling that everyone is working together for the young people’s benefit. There has been one incident where the manager was not sufficiently rigorous in challenge the placing authority, when an action from a looked after child’s review was not completed. This has left staff uncertain as to how they should respond if events take a particular course. Members of staff receive an induction which prepares them to work with the young

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The effectiveness of leaders and managers: good

people. They also receive regular training in areas such as safeguarding, first aid, epilepsy and administration of first aid. However, almost half of permanent staff who have been employed for two years or more have not yet attained their level 3 qualification. The manager has not been able to ensure that all agency workers employed have the level of mandatory training required by regulation, either. Although managers oversee the practice of agency staff during shifts, these workers do not Inspection report children’s home: SC043994 8 receive formal supervision. Supervision of staff is not consistent across the team. For some members of staff, there are instances of significant gaps between formal supervision sessions. This does not ensure that all staff have the opportunity to reflect on practice, or have their performance discussed and assessed on a regular basis. Members of staff do have regular informal supervision sessions, which are opportunities for them to be supported,

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The effectiveness of leaders and managers: good

but these are not an appropriate alternative to structured and thoroughly recorded sessions. Senior managers are aware of the relatively high turnover of staff and the impact this has on continuity of care. Local managers have taken the steps they can to improve retention and recruitment, but it remains a problem that the provider is looking at addressing more widely. There are some shortfalls in recording and documents that have not been noticed or rectified by management monitoring systems. For example, members of staff involved in the young people’s care have not signed some plans, supervisors and supervisees have not signed all supervision sessions, some details in care plans are wrong, such as the recording of ethnic origins, and paperwork was found to be in files that were for the wrong young person. These shortfalls have not had an impact on young people’s welfare, but show that monitoring is not always effective.

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The effectiveness of leaders and managers: good

Staff have gone to considerable lengths to include young people’s contribution to placement plans through a personal profile, describing their personal preferences and views of care. Plans do not identify young people’s legal status, leading to some confusion, such as regarding the detail of restricted contact with parents, and consequent implications for delegated authority. Reviews of young people’s progress ensure that any crises can be reflected on and strategies developed to enable the young people to move on. All requirements and recommendations made at the last inspection have been effectively addressed. Parents speak highly of managers and staff. For example, one parent commented, ‘We’re getting our boy back; we are really pleased he’s here. The staff are great.’ Professionals spoken to consider the school to be a service that has improved consistently over recent years, a view with which inspectors concur.

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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 Inspection report children’s home: SC043994 9 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: SC043994 10

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Children’s home details

Provision sub-type: Residential special school

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Children’s home details

Registered provider address: MacIntyre Care, 602 South Seventh Street, Milton Keynes, Buckinghamshire MK9 2JA

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Inspector(s)

Chris Peel, social care inspector Paul Taylor, social care inspector Rosie Dancer, social care inspector Inspection report children’s home: SC043994 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(s)

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Inspector(s)

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Inspector(s)

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