Children's home run by South West Mental Health Ltd in Somerset

Inspection report children's home: 1185768 1 Registered provider: South West Mental Health 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 privately operated children’s home is currently registered to provide care and accommodation for up to five children and young people.

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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 requires improvement to be 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: 2 November 2016

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good

Overall judgement at last inspection: Declined in effectiveness

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Key findings from this inspection

This children’s home is good because: Inspection report children's home: 1185768 2  Effective care planning and risk assessment are completed in consultation with the placing authorities and specialist health agencies. This allows young people with complex mental health needs to live outside of a hospital environment. Young people are encouraged and supported to take some responsibility for their development and progress towards independence.

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Key findings from this inspection

 Young people feel listened to and are consulted about all aspects of the care and therapy provided to them. They are able to make informed choices because they feel safe. They are assured that the adults around them will act in their best interests and take control should risk taking become unacceptable.

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Key findings from this inspection

 Staff work in partnership with education providers. Learning opportunities are offered to young people who have not been engaged in education for long periods. Staff recognise academic ability and potential. Education recourses are in place that are promoting and delivering achievements for the young people.

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Key findings from this inspection

 Young people participate in a range of activities linked to their strengths, interests and development needs. A relaxation specialist and a sports coach are among those providing activities requested by young people.

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Key findings from this inspection

 The home has been without a registered manager in post for more than 12 months. This has had an impact on the leadership and management judgement. A recently appointment manager has continued to develop the home and ensure that the shortfalls noted at the previous inspection have been addressed. Ofsted has received an application for registration from this manager, which is being processed.

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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

 Staff should be aware of the language used in the home. Words such as ‘contact’ and ‘transition’, or describing young people as ‘young ladies’ should be carefully considered.

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Key findings from this inspection

 The use of initials instead of names on formal records has the potential to make them meaningless in years to come and very difficult to interpret should investigation or audit be needed.

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Key findings from this inspection

 There are areas of the home that are institutional in appearance. These are in contrast to the lounges and kitchen area, which appear homely and comfortable. Inspection report children's home: 1185768 3  The organisation should consider effective succession planning to avoid any future gaps in the management of the home.

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Inspection date Inspection type Inspection judgement

02/11/2016 Interim Declined in effectiveness 06/06/2016 Full Requires improvement Inspection report children's home: 1185768 4

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Recommendations

 Staff should be familiar with the home’s policies on record keeping and understand the importance of careful, objective and clear recording. In particular ensure that names are recorded clearly on formal records and ensure that language used is appropriate and does not stigmatise children and young people because they live in a children’s home. (‘Guide to the children’s homes regulations including the quality standards’, page 62, paragraph 14.4)

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Recommendations

 For children’s homes to be nurturing and supportive environments that meet the needs of their children, they will, in most cases, be homely, domestic environments. Children’s homes must comply with relevant health and safety legislations (alarms, food hygiene etc.); however, in doing so, homes should seek as far as possible to maintain a domestic rather than ‘institutional’ impression. (‘Guide to the children’s homes regulations including the quality standards’, page 15, paragraph 3.9)

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Recommendations

 The registered person should agree with their local police force, procedures and guidance on police involvement with the home to reduce unnecessary police involvement in managing behaviour and criminalisation of behaviours. Children should not be charged with offences resulting from behaviour within a children’s home that would not similarly lead to police involvement if it occurred in a family home. (‘Guide to the children’s homes regulations including the quality standards’, page 47, paragraph 9.40)

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Overall experiences and progress of children and young people: good

The staff offer carefully planned and considered placements to young people with complex mental health needs. All have come from a hospital setting where, to varying extents, they have been deprived of their liberty.

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Overall experiences and progress of children and young people: good

This home makes a positive difference to the lives of the young people who live here. Multi-agency working, especially with health care professionals, ensures that young people get the therapy and help they need. A child and adolescent mental health services manager works directly with young people and offers guidance and support to the staff team. He commented positively about the dedication of the staff team, adding, Inspection report children's home: 1185768 5 ‘they have kept young people out of hospital longer than I would have predicted’.

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Overall experiences and progress of children and young people: good

Young people grow in confidence and self-esteem. They are gradually taking responsibility for themselves and make informed choices. The improvements they make are allowing them to re-engage in activities which promote their progress.

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Overall experiences and progress of children and young people: good

The staff are imaginative and flexible in negotiating with providers to educate young people. Mental health problems and hospital admissions have had an impact historically on school attendance. Young people are now benefiting from education services. Both young people have made remarkable headway, after being out of education for many years. One young person is studying to take GCSEs and another has plans to go to college.

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Overall experiences and progress of children and young people: good

The range of activities provided supports young people’s emotional and social development. Many activities are educational and linked to young people’s interests and hobbies. Young people have lots of things going on in the home and also out in the local community. Keeping occupied alongside learning to relax helps young people to reduce both the severity and the frequency of self-harm incidents.

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Overall experiences and progress of children and young people: good

Young people attend routine healthcare appointments and check-ups. One young person now has access to the treatment and resources needed to treat two significant conditions which previously had gone undiagnosed. When young people refuse medication, the staff make sure that they are fully aware of the consequences. This allows them to make informed choices and take increasing responsibility for their actions.

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Overall experiences and progress of children and young people: good

There is an important focus on improving young people’s mental health in developing their independence skills. One young person has recently moved on to more independent living arrangements. They continue to receive the support services needed to make a success of this move.

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Overall experiences and progress of children and young people: good

Young people are able to meet with those important to them where this is of benefit and does not create safeguarding problems. Young people also have mobile phones and use of the internet, which supports their friendships and allows them age-appropriate access to social media and the world wide web.

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

Inspection report children's home: 1185768 6 The home offers placement to young people who self-harm in response to past trauma and mental health problems. The staff working in partnership with health professionals and therapists provide a service to young people which is reducing the severity and frequency of self-harm.

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

The risk of self-harm remains high and is likely to be a continuing feature of the coping strategies used by the young people. Regular contact and consultation with placing authorities and other professionals allows for identification and careful consideration of how to manage these risks. Young people have increasing freedoms and opportunities as a result and are able to make informed choices. This has led to them making increasingly safer choices about medication, self-harm and behaviour.

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

Regular discussion and consultation with young people is supportive of their development. Staff are honest about their concerns for young people. They do not shy away from some very difficult conversations when behavioural and attachment issues are a cause for concern. This approach is building trust and young people’s respect for the staff.

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

Young people say they have adults around them whom they can speak to. Although they have been offered advocacy services, they do not feel this is necessary. Young people know how to make a complaint, and the manager takes any discontent among residents seriously. Grumbles are recorded and dealt with to the satisfaction of young people, who say they feel listened to.

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

Restraint is used to protect young people from serious risk of harm. Staff are trained in the safe use of these techniques. Information about these interventions was held in several different records, making it difficult to get a clear picture and to ensure that all the information needed is available. The manager has recently amended the recording requirement, making records much clearer and easier to analyse. Initials are used in some formal records where full names are required.

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

Reflective practice allows staff to consider behavioural incidents and improve their skills in de-escalating difficult situations. On occasion, the police have been called to manage behaviour. Reflecting on a recent incident has led to additional support and guidance for a member of staff and improved relationships with young people.

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

Young people have not recently gone missing from the home. Protocols are in place and staff work in partnership with the police. The staff understand young people’s fears and flight responses. Staff managed to find and safely return a young person to healthcare staff when they went missing from a stay in hospital.

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

Safer recruitment practice is in place to avoid unsuitable adults working with these vulnerable young people. This practice has improved since the last inspection.

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The effectiveness of leaders and managers: requires improvement to be good

Inspection report children's home: 1185768 7 The home has been without a registered manager for more than 12 months. This shortfall has had an impact on the inspection judgement in this area. A recently appointed manager is now employed and has applied for registration.

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The effectiveness of leaders and managers: requires improvement to be good

Some areas of the home look and feel less than homely. Stairways and corridors are particularly bare and some carpets are badly fitted. This is in contrast to the lounges and other communal areas in the home.

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The effectiveness of leaders and managers: requires improvement to be good

Staff do not fully consider the use of language in the home. This can contribute to young people continuing to use institutional language. This identifies them as different from their peers.

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The effectiveness of leaders and managers: requires improvement to be good

The home, which was registered in 2016, is still developing as a service for young people with mental health problems. Managers and directors have made full use of feedback from previous inspections to address concerns and avoid breaches of regulations.

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The effectiveness of leaders and managers: requires improvement to be good

The home is providing the aims and objectives as described in the statement of purpose. Given the complexities of the young people, managers have agreed with Ofsted and mental health professionals to reduce the maximum number of young people who can be looked after from five to three. The statement of purpose is being updated to reflect these changes.

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The effectiveness of leaders and managers: requires improvement to be good

Recent developments to records are already making a difference to demonstrating attention to safeguarding, and to evidencing the experiences of young people. This is particularly true of records relating to physical intervention and therapy sessions. In contrast, the use of initials in some records instead of full names limits their usefulness.

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The effectiveness of leaders and managers: requires improvement to be good

The new manager has acted quickly and made changes which are having a helpful impact on the young people. He has brought clarity to the varying roles and responsibilities of the different staff working in the home. This has made lines of accountability and decision-making clear. He also moved the office from the third floor and it is now situated next door to the kitchen where he can be fully involved in the care provided and be readily available to both young people and staff.

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The effectiveness of leaders and managers: requires improvement to be good

A recent analysis of the home provided to Ofsted by the manager demonstrates good understanding of the strengths and weaknesses of the home. The report includes plans for improvements which should benefit young people. The plan has distinct timescales and accountability so that things get done.

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The effectiveness of leaders and managers: requires improvement to be good

Staff are receiving supervision and support on a regular basis, with the frequency of formal supervision having improved recently. The home also employs an independent consultant who specialises in the therapeutic residential care of young people. The consultant offers individual and team support sessions to staff. This helps staff to understand behaviour and contributes to them coping with the stresses and anxieties of managing young people who remain a risk to themselves.

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The effectiveness of leaders and managers: requires improvement to be good

The majority of staff have a social care qualification. In addition, several are working Inspection report children's home: 1185768 8 towards foundation degree level courses, to ensure that young people are cared for by an appropriately experienced and qualified team. The staff team also contains qualified nursing staff who have a wealth of experience in caring for young people with mental health problems.

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The effectiveness of leaders and managers: requires improvement to be good

The staff work as a team. They share concerns and consult with one another and with young people on a regular basis. Expectations of young people and staff are clear. This contributes to young people knowing what to expect and helps them to feel safe.

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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. Whenever 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 whom 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 and 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: 1185768 9

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Children’s home details

Registered provider: South West Mental Health Ltd

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Children’s home details

Registered provider address: Victoria Hayward, Crossmoor Meadows House, Spaxton Road, Bridgwater, Somerset TA5 2PB

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Inspector

Janice Hawtin, social care inspector Inspection report children's home: 1185768 10 achieve excellence in the care of children and young people, and in education and skills for learners of all ages. It regulates and inspects childcare and children’s social care, and inspects the Children and Family Court Advisory and Support Service (Cafcass), schools, colleges, initial teacher training, further education and skills, adult and community learning, and education and training in prisons and other secure establishments. It assesses council children’s services, and inspects services for children looked after, safeguarding and child protection.

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Inspector

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Inspector

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Inspector

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