Children's home run by Thoughts of Others Limited in Birmingham

Inspection report children‟s home: SC484716 1 SC484716 Registered provider: Thoughts of Others 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 private children‟s home is registered to provide care and accommodation for up to six children who have emotional and/or behavioural difficulties.

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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.

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inadequate

Date of last inspection: 9 November 2016

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inadequate

Overall judgement at last inspection: requires improvement

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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

 This home has not had a registered manager since September 2016.  The registered person has failed to make any significant or sustained Inspection report children‟s home: SC484716 2 improvement in the provision of care since the home opened in 2015.  The registered person does not ensure that staff maintain an accurate record of the use of restriction or restraint to help show that such use is necessary or proportionate.  Children are at risk because staff do not ensure that safe arrangements are put in place when preparing children for time out of the home on their own.  Managers and staff do not take adequate protective measures when illegal drugs are suspected to be in the home.  The vetting of new staff does not include all the required checks that are set under regulation.  Not all staff have the necessary knowledge, skills and qualifications to meet the needs of children accommodated.  Children often experience inconsistency in who the staff are caring for them.

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Key findings from this inspection

 Medication arrangements are not safe.  Complaints made by children and their families are not properly investigated.  The accommodation is not well maintained to help ensure that children have a welcoming and nurturing environment in which to live.  A new extension for staff has no evidence to show whether planning approval was or was not required.  Staff do not help children to discuss matters that affect them through regular key-work sessions.  Managers and staff often work separately rather than in partnership with parents, police and the designated officer.  Information in the statement of purpose does not describe accurately the service operated at the home.

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Key findings from this inspection

 Children do well at the organisation‟s school and individual achievements are good.  Placing authorities value the progress children make, especially through close staff supervision.  Children benefit from prompt access to the organisation‟s psychological service and creative therapies and assessment. Inspection report children‟s home: SC484716 3

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Inspection date Inspection type Inspection judgement

09/11/2016 Full Requires improvement 26/07/2016 Full Inadequate 25/02/2016 Interim Declined in effectiveness 10/08/2015 Full Good Inspection report children‟s home: SC484716 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

In meeting the quality standards, the registered person must ensure that staff 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. (Regulation 5(d)) 16/08/2017

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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 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 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 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.

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Requirement Due date

In particular, carry out direct work to meet children‟s needs and ensure a welcoming, nurturing environment. (Regulation 6 (1)(a)(b) and (2)(c)(i)(ii)) 16/08/2017

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Requirement Due date

The health and well-being standard is that the health and well- being needs of children are met.

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Requirement Due date

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. (Regulation 10(1)(a) and (2)(a)(i)) 16/08/2017

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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. 16/08/2017 Inspection report children‟s home: SC484716 5 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, and, if necessary, make arrangements to reduce the risk of any harm to the child. (Regulation 12(1) and (2)(a)(i))*

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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 take effective action whenever there is a serious concern about a child‟s welfare. (Regulation 12(1) and (2)((a)(vi))* 16/08/2017

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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. (Regulation 13(1)(a)(b) and (2)(a))* 16/08/2017

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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 ensure that staff have the experience, qualifications and skills to meet the needs of each child. (Regulation 13(1)(a)(b) and (2)(c))* 16/08/2017

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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 ensure that the home‟s workforce provides continuity of care to each child. (Regulation 13(1)(a)(b) and (2)(e))* 16/08/2017

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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. In particular, the standard in paragraph (1) requires the 16/08/2017 Inspection report children‟s home: SC484716 6 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. (Regulation 13(1) and (2)(f))*

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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 make continuous improvements in the quality of care provided in the home. (Regulation 13(1)(a)(b) and (2)(h))* 16/08/2017

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Requirement Due date

The care planning standard is that children have a positive experience of arriving at or moving on from the home.

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Requirement Due date

In particular, the standard in paragraph (1) requires the registered person to ensure that arrangements are in place to ensure the effective induction of each child into the home. (Regulation 14(1)(b) and (2)(b)(i))* 16/08/2017

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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. (Regulation 16(1))* 16/08/2017

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Requirement Due date

The registered person must ensure that the home is at all times conducted in a manner which is consistent with its statement of purpose. (Regulation 16(5))* 16/08/2017

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Requirement Due date

The registered person must ensure that restraint in relation to a child must be necessary and proportionate. (Regulation 20(2))* 16/08/2017

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Requirement Due date

The registered person must make arrangements for the handling, recording, safekeeping, safe administration and disposal of medicines received into the children‟s home. (Regulation 23(1))* 16/08/2017

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Requirement Due date

The registered person must recruit staff using recruitment procedures that are designed to ensure children‟s safety. (Regulation 32(1))* 16/08/2017

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Requirement Due date

The registered person must ensure that all employees receive practice-related supervision by a person with appropriate experience. (Regulation 33(4)(b))* 16/08/2017

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Requirement Due date

The registered person must prepare and implement a policy (“the behaviour management policy”) which sets out the measures of control, discipline and restraint, which may be used in relation to children in the home. In particular, ensure that behavioural policy, procedure, practice and records evidentially promote children‟s rights and safety. (Regulation 35(1)(b))* 16/08/2017

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Requirement Due date

The registered person must ensure that within 24 hours of the 16/08/2017 Inspection report children‟s home: SC484716 7 use of a measure of control, discipline or restraint in relation to a child in the home, a record is made which includes all elements of (3)(a)(i-viii) and within 48 hours of the use of the measure, the registered person, or a person who is authorised by the registered person to do so (“the authorised person”)— has spoken to the user about the measure; and has signed the record to confirm it is accurate; and within 5 days of the use of the measure, the registered person or the authorised person adds to the record confirmation that they have spoken to the child about the measure. (Regulation 35(3)(a)(i-viii)(b)(c))* The registered person must maintain records (“case records”) for each child which include the information and documents listed in Schedule 3 in relation to each child; are kept up to

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Requirement Due date

date; and are signed and dated by the author of each entry. In particular, ensure that there are records of incidents when children go missing and records of immunisations. (Regulation 36(1)(a)(b)(c))* 16/08/2017

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Requirement Due date

The registered person must ensure that case records must be kept securely in the children‟s home during the period when the child to whom the case records relate is accommodated there. (Regulation 36(2)(c)) 16/08/2017

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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))* 16/08/2017

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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(4)(c)) 16/08/2017

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Requirement Due date

The registered person must give notice in writing to HMCI, as soon as it is reasonably practicable to do so, if any of the following events take place or are expected by the registered person to take place — any change in the identity of the responsible individual, or the premises of the home are significantly altered or extended. (Regulation 49(e)(iii)(g))

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Requirement Due date

* These requirements are subject of a compliance notice.

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Recommendations

 Ensure that the design of the home provides staff that sleep in the home overnight with appropriate accommodation and facilities to do so. („Guide to the children‟s homes regulations including the quality standards‟, page 17, paragraph 3.26)

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Recommendations

 Ensure arrangements that reflect the importance of safeguarding and promoting the welfare of children, including: clear policies in line with those from the Local Safeguarding Children Board for dealing with allegations against people who work Inspection report children‟s home: SC484716 8 with children. Such policies should make a clear distinction between an allegation, a concern about the quality of care or practice or a complaint. („Working together‟, page 54, paragraph 4)

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Recommendations

 Ensure that all staff learn from serious case reviews which have repeatedly shown the dangers of failing to take effective action in relation to poor practice that includes poor record keeping. („Keeping children safe in education. Statutory guidance for schools and colleges, September 2016‟, page 9, paragraph 30)

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Recommendations

 Identify and provide appropriate opportunities for children to develop themselves in accordance with their wishes and feelings and as part of the home‟s plan for their care. Each child‟s talents and interests should be understood and nurtured, with children selecting activities based on their personal preferences and abilities, so far as is reasonable. Staff should also support children to try activities that are „new‟ for them, where appropriate, such as other clubs, volunteering and leisure activities that will promote their independence. Specifically, promote positive independent friendships, enjoyment and fun. („Guide to the children‟s homes regulations including the quality standards‟, page 31, paragraph 6.4)

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Recommendations

 Children must be consulted regularly on their views about the home‟s care, to inform and support continued improvement in the quality of care provided. Due consideration should be given to the child‟s cognitive ability in the development and implementation of any consultation processes. Children should be able to see the results of their views being listened to and acted upon. („Guide to the children‟s homes regulations including the quality standards‟, page 22, paragraph 4.11)

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Overall experiences and progress of children and young people: inadequate

Staff often care for children in isolation from each other, apart from group activities or for planned joint social visits. Children have their own sitting room and are under continual staff supervision. Children report that there are frequent changes in the staff caring for them. For example, one child told the inspectors, „I would like to know who staff are more regularly.‟ Another child remarked to the inspectors that they wanted their allocated staff to take them on home visits instead of unfamiliar staff. A third child commented that he wanted to have his favourite staff on duty with him more often, rather than the member of staff having to work at other homes, so he could share his feelings. Consequently, children experience frequent disruption in their care because of staff changes.

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Overall experiences and progress of children and young people: inadequate

Four children, of whom two have a learning disability, are living in this home. Despite a requirement at the previous inspection, staff continue to lack the knowledge for working with children who have a learning disability, autistic spectrum disorder or epilepsy, because training or any assessment of staff competence has not been completed. This leaves staff not sufficiently alert to children‟s vulnerabilities because of their additional Inspection report children‟s home: SC484716 9 needs. Additionally, not all staff understand the impact of these additional needs on children‟s emotional or behavioural difficulties. This lack of insight has contributed to two children being moved from the home when the organisation was unable to continue to meet their behavioural needs. One child moved out after a significant crisis that required police intervention.

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Overall experiences and progress of children and young people: inadequate

Staff fail to ensure that children benefit from direct-work sessions to help address their pressing needs. These include support to understand the risks of illegal drugs, sexuality, developing independence skills and personal hygiene. Children told the inspectors that they want to learn to keep themselves safe inside the house and out in the community. The children commented that they want more help and opportunities to practise safe internet use. This missed opportunity to engage children means that they do not receive staff guidance on matters that affect them. However, children do get some practical and emotional help to make meaningful progress during their time at the home. For example, a child told the inspectors: „This home and the company are outstanding because they have helped me control my anger and voices. If I do get angry, it only takes me one hour to get over it. Before moving here I would be angry for a whole day.‟

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Overall experiences and progress of children and young people: inadequate

Managers and staff disregard concerns and complaints made by children and parents. For example, the registered person has failed to act on concerns raised by children, even when an independent visitor has flagged up shortfalls in children‟s complaints in reports. Staff have also not managed effectively parents‟ complaints about their child‟s care. This weakness in managers‟ and staff understanding of complaints procedures means that children‟s and parents‟ concerns go unresolved.

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Overall experiences and progress of children and young people: inadequate

A lack of staff insight into children‟s health needs leaves some children vulnerable. For example, children‟s health records do not always hold all essential information, such as details of a child‟s immunisation history. This is made more serious due to a lack of partnership working with parents to find out a child‟s medical history. The lack of clear recording and consultation with parents has resulted in a child having their immunisations repeated.

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Overall experiences and progress of children and young people: inadequate

Despite having a quality assurance process for the administration of children‟s medication, errors identified at previous inspections continue to be made by staff. Consequently, poor practice continues, including incomplete medication records that do not show whether staff have given a child their medication in accordance with their prescription.

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Overall experiences and progress of children and young people: inadequate

Parents have complained about the poor state of their child‟s personal hygiene. These concerns have not been dealt with promptly and sensitively to help improve their child‟s physical health.

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Overall experiences and progress of children and young people: inadequate

Staff fail to help children early on in their placement to establish good daily routines through well-planned activities. For example, staff do not establish good daily or bedtime routines. A social worker told the inspectors that sometimes her child got bored because, „Staff lacked imagination and proactivity at organising interesting activities.‟ Despite this shortfall, social workers are generally positive about the care and support their children Inspection report children‟s home: SC484716 10 receive. One social worker told the inspectors that they had seen a „massive reduction‟ in one child going missing and angry, and in his violent incidents since moving to the home. Another social worker said how the exceptional staff team had managed some very challenging, unpleasant behaviours, „but they didn‟t demonise him‟.

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Overall experiences and progress of children and young people: inadequate

Staff are positive in their approach to education and its value for children. One child has taken his GCSE exams early and has been selected for a local university science summer programme. This exciting opportunity is helping to improve his academic potential. One child moved from home education into the organisation‟s school and another child is now in full-time education in the classroom.

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Overall experiences and progress of children and young people: inadequate

Staff make sure that all children do go out in the community, with staff supervision. Children go on a range of exciting, energetic activities, alongside other children and staff from other homes. However, no child has any independent leisure activities or local friendships beyond the organisation.

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Overall experiences and progress of children and young people: inadequate

Children are looking forward to planning their summer holidays. Some children are saving and holding their own cash as part of independence work. Others do their own housework. These help to develop older children‟s life skills that will support their transition from childhood to adulthood.

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Overall experiences and progress of children and young people: inadequate

Children are given every encouragement to keep in contact with their family, and staff give the practical support to make this contact possible. This helps children to stay in touch with people who are important to them.

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Overall experiences and progress of children and young people: inadequate

The registered person seeks out specialist services early in children‟s placements. This has resulted in children benefiting from the external psychology service that provides baseline assessments. Three children have benefited from having a life-skills coach session. One child receives speech and language therapy and another child is able to access music therapy. Consequently, children‟s particular needs, which may affect their future outcomes, are identified at the earliest opportunity and services are secured.

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

One child was placed at serious risk of harm because staff had failed to ensure that he was adequately prepared for time out of the home on his own. Risk management documents and key-work records to support the child‟s independence lacked detail. The weakness in preparation and staff insight into the potential risks resulted in the child becoming missing and involved in a serious incident. Staff did not make an individual record of the period of time when the child was missing. The home‟s logbook, completed by staff, does not show that staff took prompt or effective action when they realised the child had not returned at the expected time. Following the incident, no consideration was given to updating the child‟s risk assessment so that all staff were aware of the child‟s increased vulnerability.

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

Staff have failed to do preventative work with one child who was suspected of having illegal drugs in the house. Once the drugs were found, staff decided to dispose of them Inspection report children‟s home: SC484716 11 without consulting the police for advice and without making a record of their action. These failures reduced any possibility of appropriate support and counselling for the child, or for any restorative work to be completed by the police, to help the child to understand the dangers of drugs.

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

The registered person has not exercised professional curiosity or carried out any review of these events to learn lessons or establish whether staff and the manager acted in accordance with procedures.

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

Children‟s liberty and movements, in spite of being raised at previous inspections, continue to be restricted. One child told inspectors that he did not want to be here because of the „too high security and staff following you around and no privacy‟. Another child said, „The problem is they don‟t understand the social aspect. You can keep me safe but I need to go out.‟

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

Staff have prevented children from leaving the house and from going upstairs to their bedrooms. In such instances, staff have not written a clear record of their actions to show how they met the threshold for restriction. Despite previous inspections having raised requirements about restraint practice in the home, the staff continue to hold children on the floor. Records do not include adequate descriptions of how children get to the floor, the staff positions or the name or full description of the hold used. Consequently, records of sanctions and restraint are unreliable. These records do not show whether the manager has spoken to the child or staff involved to confirm that the record is accurate. The absence of detail means that it is difficult to establish if the voice of the child and debrief of staff are secured within timelines set under regulation.

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

The ongoing shortfalls in managerial scrutiny of behaviour-management and record- keeping means that the registered person does not know if restrictions, sanctions and physical restraints are necessary or proportionate. A practice of updating records by backdating them calls into question the authenticity of records.

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

The organisation‟s lead safeguarding officer‟s knowledge is underdeveloped and results in confusion. For example, she has not implemented the principle of working together with key statutory safeguarding officers to seek advice or guidance about an active investigation. Managers and staff also lack understanding about the difference between a complaint and an allegation. Staff refer to an out-of-date organisational policy for child protection; this creates further confusion and poor decision-making.

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

The registered person did not fulfil their responsibility to share information in a reference about a member of staff who had been dismissed from the organisation. This was only disclosed when the designated officer directed the registered person to share the information.

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

Managers do not ensure that there are careful recruitment procedures to prevent unsuitable people from being recruited to work with children. For example, references do not always demonstrate a person‟s fitness to work with children and the registered person interviews applicants only after they have started their training programme. Inspection report children‟s home: SC484716 12 There have been some improvements in safeguarding. Managers are now making sure that when children make allegations about an injury during restraint, these are referred to the designated officer and concluded in consultation with them. An updated version of the home‟s statement of purpose makes clear that the registered person plans to change from the current system of physical intervention to another, accredited method. However, this change and staff training have not yet started.

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The effectiveness of leaders and managers: inadequate

Leadership and management is characterised by persistent regulatory shortfalls at successive inspections. The registered person has failed to make continuous improvement to meet 16 requirements from the last inspection. Recurrent shortfalls include: poor safeguarding practice, lack of effective leadership, unsafe staff recruitment, poor quality record-keeping, poor healthcare, weaknesses in the safe administration of medication and failure to notify Ofsted of significant events in a child‟s life. Ofsted has found regulatory breaches for inappropriate or unnecessary restraint and inadequate records of restraint at all inspections since Ofsted registered the home in 2015.

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The effectiveness of leaders and managers: inadequate

Accountability has been lacking, both at registered manager and responsible individual levels. There has been no registered manager working at this home since September 2016, following the inadequate judgement at the July 2016 inspection. The current manager had told his employer two weeks before the inspection that he would be stepping down to the deputy position. He had not submitted a complete application to register with Ofsted. Children now face having a third manager in less than 12 months. For several months, the registered person delayed notifying Ofsted of the change of the responsible individual and the managerial arrangements.

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The effectiveness of leaders and managers: inadequate

The registered person has not learned from past inspections, practice and feedback, including the direct testimony of children, complaints, placement breakdowns and serious events. In February 2017, an independent visitor identified issues about children‟s complaints, restriction of liberty and a lack of direct work with children. In May 2017, another independent visitor advised that there was a need for better information about risks of gangs in the home‟s local area. This did not happen. Subsequently, a new child at risk of becoming engaged in gang culture, moved in without a thorough assessment of whether the location of the home protected them from gang involvement. The registered person does not contribute to the report of the review of the quality of care; this demonstrates a lack of senior management oversight to secure improvement.

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The effectiveness of leaders and managers: inadequate

Children are not provided with continuity of care due to managerial and staff turnover. The registered person has not assessed whether the core staff team and model of extra staff deployment is beneficial to meeting the children‟s needs. The manager told the inspectors that 14 staff connected to the house had either left or been dismissed since the last inspection. The manager said that he had inherited a „macho‟ staff culture, which the registered person resolved through disciplinary processes or resignations. The statement of purpose, dated July 2017, lists 21 core staff working at the home. The four Inspection report children‟s home: SC484716 13 children placed in this home need at least six staff on duty with them during the waking day. Five staff are on duty at night. A large number of extra staff from other homes work at this home to maintain these intensive staffing levels. The manager is unsure of

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The effectiveness of leaders and managers: inadequate

how many hours staff work. The inspectors found a 2017 appraisal record for one member of staff that reported he worked, „up to 90 hours a week‟.

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The effectiveness of leaders and managers: inadequate

Despite requirements being raised about the home‟s statement of purpose at previous inspections, there are still shortfalls in the details provided. For example, it still does not describe the service offered and has not been shared with Ofsted. It still does not give details of the qualifications and professional supervision arrangements of the staff providing healthcare or therapy. It does not describe the way the registered person has adapted the accommodation to care for children. It does not describe the sleeping accommodation for staff, or that only five bedrooms are available for children‟s use.

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The effectiveness of leaders and managers: inadequate

The statement of purpose describes how the service requires children‟s commitment to change before admission. Admission documents suggest that the last two children admitted did not want to come to the home or to the area in which this home is located. The statement of purpose requires any local authority placing a child to apply for a Deprivation of Liberty order to restrict that child‟s movements. This information gives a conflicting view of how staff should work with children and how they welcome them into the home. This confusion and lack of detail means that the information available to children, placing authorities and families fails to give clarity about the care provision.

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The effectiveness of leaders and managers: inadequate

While education is provided for some children who are not ready to move into the school environment, there is no classroom with IT facilities to aid children‟s learning.

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The effectiveness of leaders and managers: inadequate

Since the last inspection, some staff working at the home have still not attained appropriate qualifications at level 3 by the relevant date of 1 April 2016. Without this qualification, children are not assured of care by staff who are assessed as being competent to practise in residential care. Regardless of previous inspections raising requirements about training, staff still do not have training or an evaluation of their competence to support children who have epilepsy, a learning disability or autistic spectrum disorder. Only seven of the 21 staff have up-to-date training in administering medication. Only two staff have had training in preventing extremism and radicalisation. There is no record of any specific training after induction about children who go missing from care or who self-harm. This lack of competence manifests in staff errors when they have failed to consult with parents about children‟s health history, when administering

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The effectiveness of leaders and managers: inadequate

medication to children or helping children to keep good standards of personal health and hygiene.

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The effectiveness of leaders and managers: inadequate

Even though previous inspections have raised concerns about infrequent and poor quality supervision, staff continue not to receive effective support and challenge. For example, one staff member has not had supervision for over four months, and other members of staff for over two months. The lack of staff supervision was subject to a compliance notice following the July 2016 inspection. Recurring shortfalls show a lack of capacity to improve staff practice through supervision. The registered person has missed opportunities in supervision to develop or challenge several staff about their practice Inspection report children‟s home: SC484716 14 when children have made allegations about them. Considering his inexperience in the role and the challenges in the home, the manager has not had enough support from his supervisor. Only one of his three supervision sessions since January 2017 covered any of the significant safeguarding issues relating to children or staff at the house. He told the

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The effectiveness of leaders and managers: inadequate

responsible individual that his deployment on shift on the rota was „making [his] role near enough impossible‟.

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The effectiveness of leaders and managers: inadequate

Unreliable, missing or poor records about children continue to negatively affect the quality of care. This is because the registered person, the external visitor and Ofsted cannot rely on them. Because the registered person does not ensure that staff maintain records, children do not experience integrated and well-coordinated care. For example, there is an absence of informed records about children that go missing from home, and about the immunisation history of a child. Additionally, records are not securely or confidentially stored. Staff store sensitive records in an unlocked, often open cupboard in a shared dining room, which is accessible to visitors and other children.

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The effectiveness of leaders and managers: inadequate

The registered person has not always worked in partnership with parents about their children‟s healthcare or kept them informed about their child‟s care plan. Staff have not engaged with the police about illegal drugs found on the premises. Staff have not contacted the designated officer when they have had questions about professional partners‟ actions. Poor communication and isolated working has not helped children to enjoy the additional safeguards that emerge from the professional advice of skilled partners.

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The effectiveness of leaders and managers: inadequate

In spite of previous inspections raising concerns about the requirement to notify the regulator of serious concerns, the registered person still does not exercise enough professional judgement about which events in children‟s lives he considers to be serious and require Ofsted being notified. For example, the registered person did not notify that a child had spent two nights in a police cell. Additionally, the registered person arranged crisis accommodation for a child in unregistered accommodation. Risk assessment documents suggest staff deprived the child of his liberty during that period.

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The effectiveness of leaders and managers: inadequate

The inside and outside of the house are shabby and have been subject to heavy wear and tear. Furnishings are poor, curtains do not fit and are of poor quality, and curtain poles are broken. Children‟s bedrooms and living rooms do not show the individuality of the child. Living rooms are not set up for nurture and creative activity. Children rely on television, electronic games and items they bring from home to occupy themselves. The lack of a welcoming environment does not show children that staff care about and value them.

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The effectiveness of leaders and managers: inadequate

The registered person has extended the premises to provide extra space for staff to work and sleep. However, the registered person is not able to demonstrate whether planning approval was or was not required. The house is overcrowded. The number of staff and children at the house day and night is above the limit set in the home‟s original planning permission granted in 2015. There are not enough rooms to allow six children to sleep at the home because of the way children use the extra bedrooms as sitting rooms. Staff do not have adequate sleeping arrangements and have to use pull-out Inspection report children‟s home: SC484716 15 mattresses on the floor of children‟s lounges to sleep.

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The effectiveness of leaders and managers: inadequate

Despite the various shortfalls highlighted in this report, the service does have the confidence of placing authorities who recognise the work staff do to help some challenging children. Placing authority partners report constructive relationships and helpful partnership working. One told inspectors that staff were, „approachable and helpful‟. Another said they had chosen the registered person‟s service because, „They have a proven track record.‟

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The effectiveness of leaders and managers: inadequate

The registered person has not shown that they have the capacity to improve and Ofsted has issued compliance notices in respect of 18 regulatory breaches. Ofsted will check compliance and improvement at an unannounced visit within eight weeks.

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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: SC484716 16

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Children’s home details

Registered provider: Thoughts of Others Ltd

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Children’s home details

Registered provider address: Thoughts of Others, 99 College Road, Sutton Coldfield, West Midlands B73 5DL

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Inspectors

Christy Wannop, social care inspector Dawn Bennett, social care inspector Inspection report children‟s home: SC484716 17 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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Inspectors

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Inspectors

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Inspectors

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