Children's home run by Sunfield Children’s Homes Limited in Bromsgrove

Inspection report children's home: SC038435 1 SC038435 Registered provider: Sunfield Children’s Homes Limited

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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 children’s home registered with Ofsted. It is also a residential special school registered by the Department of Education. Since May 2017, it has become a subsidiary of the Ruskin Mill Trust. The home is registered to accommodate 61 children who have severe and/or complex learning difficulties and/or behavioural needs, including seven placements for children who require short breaks. There are 12 houses within the grounds of the school. At the time of this inspection, eight homes were open and accommodating 23 children.

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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 are not protected or their welfare is not promoted or safeguarded, and the care and experiences of children are poor and they are not making progress.

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Inadequate

Date of last inspection: 22 February 2017

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Inadequate

Overall judgement at last inspection: Sustained effectiveness

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Enforcement action since last inspection

None Inspection report children's home: SC038435 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

 Staff have failed to promote the safety and well-being of children in their care.  Staff and managers have not followed procedures when safeguarding incidents have occurred.  Managers have not referred allegations appropriately to ensure children’s safety and well-being.  Staff are ill-informed about children’s behaviour because key documentation is not always up to date.  The support and management of children’s behaviour is poor because staff do not follow children’s behaviour plans.  Staff have failed to ensure that children have the appropriate level of supervision in line with their individual care plans.  Children’s routines are unstructured and not in keeping with advice received from professionals.  Staff can be quick to apply restrictive measures in an attempt to manage children’s behaviour.  Managers and staff do not identify or manage children’s presenting risks effectively. This has left some children vulnerable and at risk of harm.

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Key findings from this inspection

 Risk assessments are not kept up to date and do not identify all known risks.  There is a lack of consistent managerial oversight and review of how safeguarding incidents are managed and in the use of control measures.  The lack of consistent staff means that children do not benefit from continuity of care.  Managers have not made sure that staff are sufficiently skilled and trained to meet the individual needs of children.  Managers give insufficient attention to the safe recruitment of agency staff.  Staff are not following fire regulations.  Managers do not have a sufficient overview of staff practice to bring about effective change.

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Key findings from this inspection

 Children’s families are able to stay in family friendly accommodation on the school site. This enables families to experience their child’s residential and school life.  Arrangements for young people moving into adult provision are well planned to Inspection report children's home: SC038435 3 secure a successful move.  Professionals work together well to promote children’s healthcare needs.  Children have good school attendance and develop essential life skills.

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Inspection date Inspection type Inspection judgement

22/02/2017 Interim Sustained effectiveness 11/05/2016 Full Requires improvement 04/02/2016 Interim Sustained effectiveness 03/08/2015 Full Requires improvement Inspection report children's home: SC038435 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 within the given timescales.

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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, and 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. Staff must provide personalised care that meets each child’s needs, as recorded in the child’s relevant plans, taking account of the child’s background; and make decisions about the day-to-day arrangements for each child, in accordance with the child’s relevant plans, which give the child an appropriate degree of freedom and choice. (Regulation 6(1)(a)(b)(2)(b)(ii)(iv)(ix)) 07/08/2017

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Requirement Due date

The quality and purpose 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, and use this understanding to deliver care that meets children’s needs and supports them to fulfil their potential. In particular, the standard in paragraph (1) requires the registered person to ensure that the premises used for the purposes of the home are designed and furnished so as to meet the needs of each child; and enable each child to participate in the daily life of the home. (Regulation 6(2)(c)(i)(ii)) 07/08/2017

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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. (Regulation 12(1)) 07/08/2017

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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.

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Requirement Due date

In particular, the standard in paragraph (1) requires the registered person to ensure that staff assess whether each child is at risk of harm, taking into account information in the child’s relevant plans. Staff must, if necessary, arrange to reduce the 07/08/2017 Inspection report children's home: SC038435 5 risk of any harm to the child; help each child to understand how to keep safe; and take effective action whenever there is a serious concern about a child’s welfare. (Regulation 12(2)(a)(i)(ii)(vi)) The protection of children standard is that children are protected from harm and enabled to keep themselves safe.

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Requirement Due date

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; and that the effectiveness of the home’s child protection policies is monitored regularly. (Regulation 12(2)(b)(e)) 07/08/2017

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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. To ensure that staff have the experience, qualifications and skills to meet the needs of each child; ensure that the home has sufficient staff to provide care for each child; and ensure that the home’s workforce provides continuity of care to each child. (Regulation 13(1)(a)(b)(2)(a)(c)(d)(e)) 07/08/2017

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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 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. The registered manager must use monitoring and review systems to make continuous improvements in the quality of care provided in the home. (Regulation 13(1)(a)(b)(2)(f)) 07/08/2017

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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 use monitoring and review systems to 07/08/2017 Inspection report children's home: SC038435 6 make continuous improvements in the quality of care provided in the home. (Regulation 13(1)(a)(b)(2)(h)) The registered person must ensure that any restraint in relation to a child must be necessary and proportionate. (Regulation 20(2)) 07/08/2017

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Requirement Due date

The registered person must take adequate precautions against the risk of fire, including the provision of suitable fire equipment in the children’s home. These include regular routine checks of fire equipment and lighting and proper use of fire doors. (Regulation 25(1)(a)) 07/08/2017

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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 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)(5)) 31/08/2017

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Requirement Due date

The registered person must ensure that full and satisfactory information is available in relation to any individual employed to work in the children’s home in respect of each of the matters in Schedule 2. (Regulation 32(3)(d)) 07/08/2017

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Requirement Due date

The registered person must provide for the prompt referral of an allegation about current or ongoing abuse or neglect in relation to a child to the placing authority and, if different, the local authority in whose area the home is located. (Regulation 34(2)(b)) 07/08/2017

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Requirement Due date

A copy of the staff duty roster of persons working at the home, and a record of the actual rosters worked. (Regulation 37(2) Schedule 4(3)) 07/08/2017

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Overall experiences and progress of children and young people: inadequate

The progress and experiences of children are inadequate. Staff are not alert to children’s vulnerabilities and risks, and the lack of management oversight means that children’s vulnerabilities increase. For example, the staff supervision of children is not in line with the children’s care plan. As a result, children do not receive the right level of staff monitoring to keep them safe. Staff fail to ensure that children’s individual care plans stay up to date and are an accurate reflection of the child’s care needs. Staff are ill-informed of children’s behaviour. This is because guidance on how children’s behaviour should be supported is missing or, at best, confusing. Plans are often cumbersome to read and this makes it difficult for staff to follow. For example, staff were not aware that one child should have a pillow placed under her head when she starts to bang her head. There is little Inspection report children's home: SC038435 7

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Overall experiences and progress of children and young people: inadequate

information for staff on the strategies that they need to take to manage children’s behaviour and to prevent incidents from occurring. This leaves children vulnerable to physical injury. Key documentation is not always available or up to date. In one house, sensory plans and plans to help children take their medication were out of date. On one occasion, a plan was followed that was out of date; this resulted in a child becoming distressed due to their usual routine not being followed. As a result, the child refused to then take their medication. Epilepsy plans that help instruct staff on how to respond to a child’s seizures are not comprehensive and not all staff are trained in epilepsy management or the administration of recovery medication. Consequently, children’s healthcare is compromised. Children’s routines are unstructured and do not follow the advice from psychology services. For example, one child should not be left alone with nothing to do for more

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Overall experiences and progress of children and young people: inadequate

than five minutes. Despite staff knowing this fact, there were no structured activities planned for the child. Some children are making very good progress in their development, although this is not consistent in all the houses. Children have good school attendance. This enables them to learn essential skills. Children’s moves to adult services are well structured. This helps children, who are soon to be an adult, to make a smooth move to adult care. Staff recognise the importance of children staying in touch with family and friends to enhance their well-being. Families are made welcome into the home. Those who live far away are able to stay in one of the home’s self-contained family flats. Staff support these visits well and provide follow up support. Consequently, children are helped to stay in contact with the people who are important to them. These opportunities help parents to be able to experience their child’s schooling and residential experiences. The home

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Overall experiences and progress of children and young people: inadequate

also runs events for children’s brothers and sisters to visit and discuss what it is like being the sister or brother of a child living at the home. This also helps sister and brothers to remain close to their other sibling. Some staff develop good relationships with children and have a genuine interest in ensuring that their needs are met. One parent told the inspectors, ‘They are interested in the children and young people. He is liked and loved. They work incredibly hard.’ However, children can experience frequent changes in staff. This means children experience care from staff who are not fully aware of their needs and patterns of behaviour. This has a negative effect on children’s emotionally and physically well-being.

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

Staff are not sufficiently alert to the importance of safeguarding children. Staff and managers have not followed procedures when safeguarding incidents have occurred. Managers have not swiftly referred allegations to the local authority to ensure children’s safety and well-being. This failure has caused delays in external scrutiny of incidents. Children’s risk assessments are not effective. For example, a child can often put things in his mouth and the risk assessment states that staff should seek medical advice when this Inspection report children's home: SC038435 8 happens. This was followed when the child picked up some glass when digging in the garden. However, on another occasion when the same child told the staff he had eaten a small head from an action figure, staff did not seek immediate medical advice and instead gave him water to drink and arranged for him to be seen by a doctor on the next

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

day. Staff do not follow children’s behaviour plans. For example, when a young person started to smash a computer screen, staff retreated from the room. Consequently, the child was injured. This could have been avoided if the child’s behaviour plan had been implemented effectively which explains what staff should have done. Staff are not using agreed restraint techniques consistently. This places children at a potential risk of significant harm. In some instances, staff have responded to children’s challenging behaviour by using restraint before exploring other options to deescalate the situation. Management oversight of the measures of control used by staff is inadequate. When staff use physical intervention to guide a child from one room to another, this practice is not seen as a measure of control. Consequently, managers do not have sufficient overview of staff practice or of the actual level of physical intervention used. There are

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

sometime delays in staff completing checks on children after a restraint has occurred. This creates a delay in staff checking that a child has not received any injuries. Records are sometimes difficult to follow to show at what point medical attention is offered. In one month, one young person had to be restrained on 30 separate occasions. The increase in incidents was discussed in weekly meetings between the home and the psychologist. However, this was not subject to any senior management oversight to determine if the care and management plans for the child remained appropriate. Staff are reactive rather than proactive in their practice. They use restriction measures in an attempt to manage children’s behaviour. For instance, staff lock children’s wardrobes, kitchen doors and doors leading to secure garden areas. Staff do not adhere to agreed supervision arrangements and staffing levels to ensure children’s safety. This practice is was observed by inspectors during the course of the

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

inspection in a number of the houses. For example, inspectors observed children that should have two staff with them with only one member of staff. This puts everyone at risk of harm . Agency staff working in the home are not suitably vetted before they start working at the home. For example, references are not obtained and gaps in employment histories are not explored. This means that there is the potential for unsuitable adults to come into direct contact with children. However, recruitment of permanent staff is safe. Fire safety checks are not regularly conducted in all houses and fire doors are held open with items of furniture or string. As a result, children and others using the building are not adequately protected from the risk of fire. Ofsted contacted the fire service, which has been in contact with managers and will be conducting a fire audit in the near future. More positively, managers ensure that regular fire drills are routinely completed to

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

ensure that children and staff know what to do in case of an emergency. Staff receive training to help keep children safe from the risks of child sexual exploitation, internet safety and radicalisation. This helps staff to stay vigilant about risks to children and ensure that suitable protection is in place. Inspection report children's home: SC038435 9

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The effectiveness of leaders and managers: inadequate

This home has recently been taken over by a new organisation. The new senior managers have quickly identified weaknesses in the residential provision and have already began to take decisive action to improve practice. Senior managers have already started evaluating the service and have brought in additional resources to enable improvement work to be commenced. The statement of purpose has been updated to reflect the change in management. At the time of this inspection, the service was being restructured. The registered manager has resigned from his position and is now serving his notice period. There has been a high staff movement across the school site and this has led to children experiencing inconsistency in their care. One professional told the inspectors, ‘Because of a reduction in experienced workforce, there are often new staff in the houses which does not give consistent input to the children.’ The use of unfamiliar staff affects children

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The effectiveness of leaders and managers: inadequate

emotionally and physically. Staff caring for children do not always have close relationships with them and are not fully aware of their needs and patterns of behaviour. Staffing deficits have prevented children from going out of the home to enjoy their community activities. As a result, children have become anxious and this has resulted in staff having to use physical restraint to manage the children’s challenging behaviour. This is further exacerbated by a roster system that has failed to accurately record the members of staff working in the home at any given time. As a result, managers have not had a clear understanding of who is working in the home at all times. Staff are not always child-focused. For instance, some staff do not sit and eat with children at meal times. Other staff members keep their own crockery in children’s kitchens, which means that kitchen cupboards need to be locked. The combination of

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The effectiveness of leaders and managers: inadequate

these staff practices demonstrates a lack the awareness that this is the children’s home. Staff are not compliant with the requirement to have achieved their level 3 qualification in residential childcare within the set timescale. A total of 34 staff are not qualified within the required timescales. Three members of staff have been working at the home over six years and remain unqualified. Managers have failed to take any meaningful action to make sure staff are qualified to the required standard. This means that there are a number of untrained staff without the necessary skills and knowledge to work with the children in their care. The children’s guide is in an accessible format and clearly displayed in some houses. This helps children to have a basic understanding of the main features of the home and how to make a complaint. Staff are skilled in using children’s communication aids effectively to help children

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The effectiveness of leaders and managers: inadequate

participate in the running of the home. For example, staff have used their skills to engage children in plans to refurbish the houses and have chosen soft furnishings and decor for their homes. Staff support children’s religious and cultural needs by helping them learn about differences in cultures. One young person has a Buddha display in his Inspection report children's home: SC038435 10 room to support his religious needs.

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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: SC038435 11

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Children’s home details

Provision sub-type: Residential special school

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Children’s home details

Registered provider: Sunfield Children’s Homes Limited

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Children’s home details

Registered provider address: Clent Grove, Clent, Stourbridge, Worcestershire DY9 9PB

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Inspector(s)

Sue Young, social care lead inspector Louise Battersby, social care inspector Alison Cooper, social care inspector Inspection report children's home: SC038435 12 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)

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

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