Children's home run by Surrey County Council

Inspection report children‘s home: 1230411 1 Registered provider: Surrey County Council

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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 local authority home, registered for two young people, is part of an innovative, jointly commissioned and funded multi-agency service that provides psychiatric and therapeutic support for young people who have complex mental health, education and social care needs that cannot be met by one agency alone. The residential element of this service offers support to young people in mental health crisis who need intensive support, without which they may be admitted to a psychiatric ward or become a child looked after. Places are available to young people for up to 10 days at a time, to enable partner agencies to respond better to young people‘s mental health needs out of hours.

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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

Overall judgement at last inspection: improved effectiveness

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Enforcement action since last inspection

None Inspection report children‘s home: 1230411 2

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Key findings from this inspection

 The passionate and committed acting manager communicates her child-centred vision for the service very well. This has underpinned the development of a strong team which shares the manager‘s vision.

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Key findings from this inspection

 The integrated health and social care staff team works effectively together to achieve the aims and objectives of the statement of purpose. This partnership working is replicated in their good relationships with other stakeholders.

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Key findings from this inspection

 Young people and their families benefit from clear, targeted and time-limited support at a time of crisis, from a staff team which is equipped for and confident in its roles.

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Key findings from this inspection

 Staff develop warm relationships with young people. They provide an environment in which young people feel safe and contained, so they and their families are helped to come through the crisis.

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Key findings from this inspection

 Staff safeguard young people through active risk management and the application of clear protective measures. This has enabled young people to find safer ways of expressing themselves and reduced the number of episodes of going missing.

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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

 The home is not open full time, and some young people‘s moves out of the home have not been determined by their needs but by the closure of the home.

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Key findings from this inspection

 There are some records that are not maintained as required by regulation.

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Key findings from this inspection

 There is insufficient communal space to enable meetings and family contact to take place privately if there are two young people staying in the home.

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Inspection date Inspection type Inspection judgement

01/03/2017 Interim Improved effectiveness 15/09/2016 Full Requires improvement Inspection report children‘s home: 1230411 3

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Statutory requirements

This section sets out the actions that the registered person(s) must take to meet the Care Standards Act 2000, Children‘s Homes (England) Regulations 2015 and the ‗Guide to the children‘s homes regulations including the quality standards‘. The registered person(s) must comply within the given timescales.

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Requirement Due date

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.

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Requirement Due date

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. (Regulation 6(2)(c)(i))

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Requirement Due date

In particular, consider where and how best to manage meetings and family contact when there are two young people staying in the house. 30/9/2017

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Requirement Due date

The registered person must ensure that within 24 hours of the use of a measure of control, discipline or restraint in relation to a child in the home, a record is made which includes the name of the child; details of the child‘s behaviour leading to the use of the measure; the date, time and location of the use of the measure; a description of the measure and its duration; details of any methods used or steps taken to avoid the need to use the measure; the name of the person who used the measure (―the user‖), and of any other person present when the measure was used; the effectiveness and any consequences of the use of the measure; and a description of any injury to the child or any other person, and any medical treatment administered, as a result of the measure. (Regulation 35 (3)(a)(i-viii) 30/09/2017

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Requirement Due date

The registered person may only— employ an individual to work at the children‘s home; or if an individual is employed by a person other than the registered person to work at the home in a position in which the individual may have regular contact with children, allow that 31/03/2018 Inspection report children‘s home: 1230411 4 individual to work at the home– if the individual satisfies the requirements in paragraph (3).

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Requirement Due date

For the purposes of paragraph (3)(b), an individual who works in the home in a care role has the appropriate qualification if, by the relevant date, the individual has attained— the Level 3 Diploma for Residential Childcare (England) (―the Level 3 Diploma‖); or a qualification which the registered person considers to be equivalent to the Level 3 Diploma (Regulation 32(2)(4)(a)(b)) The registered person must recruit staff using recruitment procedures that are designed to ensure children‘s safety. In particular, ensure that full and satisfactory information is available in relation to the individual in respect of each of the matters in Schedule 2. (Regulation 32(1)(3)(d) Schedule 2(1)(6)) 30/09/2017

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Requirement Due date

If the registered provider appoints a person to manage the home, the registered provider must, without delay, give HMCI notice of the name of the person so appointed; and the date on which the appointment takes effect. (Regulation 27(2)(a)(b)) 30/09/2017

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Requirement Due date

The registered person must maintain in the home the records in Schedule 4; a record in the form of a register showing in respect of each child the child‘s address immediately before being accommodated in the home; the child‘s address on leaving the home; the statutory provision (if any) under which the child is accommodated. (Regulation 37(2)(a) Schedule 4(c)(d)(f)) 30/09/2017

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Requirement Due date

The registered person must maintain records (―case records‖) for each child which are signed and dated by the author of each entry. (Regulation 36(1)(c)) 30/09/2017

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Requirement Due date

The independent person must provide a copy of the independent person‘s report to HMCI. (Regulation 44(7)(a)) 30/09/2017

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Recommendations

 When establishing the home, the registered person must ensure that it is suitably located so that children are safeguarded effectively and can access services to meet needs identified in their relevant plans (see regulation 12(2)(c)). Under regulation 46, the registered person should review the appropriateness and suitability of the location and premises of the home at least once a year. The review should include the identification of any risks and opportunities presented Inspection report children‘s home: 1230411 5 by the home‘s location and strategies for managing these. Providers should refer to the non-statutory advice about the location assessment process: Children‘s homes regulation amendments 2014: Advice for children‘s homes providers on new duties under regulations that came into effect in January and April 2014. (‗Guide to the children‘s homes regulations including the quality standards‘, page

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Recommendations

 Children‘s home staff should take reasonable precautions and make informed professional judgements based on the individual child‘s needs and developmental-stage about when to allow a child to take a particular risk or follow a particular course of action. Staff should discuss the decision with the child‘s placing authority where appropriate. If a child makes a choice that would place them or another person at significant risk of harm, staff should assist them to understand the risks and manage their risk-taking behaviour to keep themselves and others safe. (‗Guide to the children‘s homes regulations including the quality standards‘, page 42, paragraph 9.7). In particular, ensure that supporting documentation provides staff with sufficient detail to achieve consistency of practice in their management of assessed risk.

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Overall experiences and progress of children and young people: good

Young people move into this home at a time of crisis, with a maximum length of stay of 10 days; 85 have moved in and out since the last full inspection 10 months ago. The mental health nurses who work for the service plan and risk-assess the admission of young people within a tight timeframe in response to each identified crisis. Some young people need to be the only occupant and this happens, despite the reduction in capacity that this causes. Staff plan for endings on admission. Sometimes the placing authority struggles to identify a move-on placement in a timely way, but through effective staff support, most young people manage the tensions well. One professional was very complimentary about the skill of staff in managing transitions: ‗X was resistant to moving in, reluctant to leave but achieved both well.‘ Some endings are determined by the alternate weekend closure of the service, not the needs of the young people. The

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Overall experiences and progress of children and young people: good

management acknowledge this weakness and is working towards full-time opening from September 2017.

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Overall experiences and progress of children and young people: good

Staff provide sensitive care that meets the needs of each young person with a vigilant awareness of the associated risks. Despite the very short-term nature of the placements, young people develop warm and trusting relationships with staff. Young people benefit from a child-centred, well-structured environment. Staff are consistent in their approach and provide continuity and reassurance to young people who respond positively. A professional commented, ‗For such a small provision they picked X up really quickly.‘

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Overall experiences and progress of children and young people: good

Staff support young people effectively through a time of crisis and provide most with a platform on which to build. One professional observed that a young person had learned the importance of a medication routine to maintain her mental health and has sustained Inspection report children‘s home: 1230411 6 this since moving out. A few young people need longer-term intervention and move on to alternative placements. A small minority are readmitted to the home for a further short stay.

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Overall experiences and progress of children and young people: good

Staff provide young people with good support to engage in education. For the majority this is through the linked day services provision, because most young people have not been attending school. This provides young people with a structure to their day and gives them a new starting point.

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Overall experiences and progress of children and young people: good

Staff encourage young people to choose from a range of activities. There is a wide range of games, arts and crafts, DVDs and similar for in-house entertainment. Young people also enjoy off-site trips to the cinema, local parks, shopping and go-karting.

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Overall experiences and progress of children and young people: good

Young people benefit from very good support for their holistic health needs, with a particular focus on mental health. The staff across the linked residential, day and out-of- hours services work together with young people on this. There is also good liaison with child and adolescent mental health services. A professional said of the residential provision, ‗It is really helpful for many young people. It helps them and their families to come through a crisis.‘

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Overall experiences and progress of children and young people: good

Families too are very appreciative of the difference a stay at the home has made. One relative said, ‗She feels safe when she‘s there, so we have peace of mind. When she came home we had the old X back.‘ Other comments included, ‗Staff are fantastic; communication is absolutely brilliant.‘

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Overall experiences and progress of children and young people: good

One young person wrote, ‗It‘s been amazing and everyone there has helped me so much. They have made a massive difference to me and my life.‘

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

The management team knows that strong risk management is a central element in the running of this service. The staff team demonstrates a very good understanding of risk and risk reduction and applies this knowledge in its work to good effect. As a result, young people moving in at a time of crisis say that they feel safe while they are living in the home. This is seen in the significant reduction of incidents of self-harm and episodes of going missing. Staff use the supporting documentation well. Most records are detailed and cross-reference accurately. In some instances, the records are insufficiently specific. Although staff can outline what they understand by ‗distraction techniques‘ and ‗regular‘, the lack of detail does not ensure staff consistency in their management of assessed risks.

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

Staff manage episodes of young people going missing effectively, with a keen awareness of the range of possible individual risks for each young person, such as child sexual exploitation and self-harm. These are included in the individualised missing person protocols, which the acting manager has introduced since the last inspection. Staff actively strive to keep young people in sight if they leave the house without prior agreement and maintain communication as far as possible. Staff work in partnership Inspection report children‘s home: 1230411 7 with the police to secure the welfare of young people. For example, a missing person coordinator is scheduled to attend a staff meeting as part of the further development of team working. The vast majority of periods of absence are very short in duration. The records of these events are of a very good standard. The acting manager has challenged the placing authority about the lack of return home interviews and steps are being taken

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

to ensure that these happen. One young person was really pleased at the quality of the welcome given by staff on her return. A professional said, ‗X has gone missing from everywhere else, it is a testament to the work that she has not done so here.‘

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

Staff are skilled at providing a supportive environment that enables young people to build relationships with them in a short time. Young people are positive about the staff, one described them as ‗kind‘. Staff engage well with young people, sensitively tuning their interactions on the basis of a young person‘s presentation, without shying away from challenge where this is necessary, for example in young people‘s use of discriminatory language. As a result staff manage young people‘s behaviour effectively. Staff understand young people‘s emotional and mental health difficulties and successfully encourage them to express their feelings safely. Staff have never applied sanctions. Physical intervention has been used only twice in a year; however, staff have not recorded one of these as required by regulations.

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

Staff provide clear verbal and written information, in the statement of purpose and the young people‘s guide, about when they will search belongings and rooms. Young people understand that such searches are to promote their welfare.

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

Recruitment records do not fully demonstrate that all the required checks have been done. For example, in two file samples not all gaps in employment are covered by a written explanation, and in one proof of identity was not found. This fails to securely evidence that only staff deemed suitable are working in the home.

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

Managers and staff are knowledgeable about the action they need to take in the event of a disclosure or allegation by a young person. They apply this knowledge to their practice, managing young people‘s worries and concerns effectively and in accordance with statutory guidance.

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

The very recently appointed assistant manager is in the process of updating the location risk assessment as recommended in the last report. She has sought, and is waiting for, feedback from relevant professionals. The local authority commissioned an external fire risk assessment, and the report is awaited. The team has made some changes to the office in the light of verbal feedback during the visit. The acting manager is chasing a health and safety check of the house which is overdue.

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

As planned at the time of the last inspection in March 2017, the registered manager has not been acting in this capacity since April 2017. However the local authority has not sent a formal notification of the change, neither has a resignation from the previous manager, nor an application form from the acting manager, been received. At the time Inspection report children‘s home: 1230411 8 of this inspection the responsible individual had just arranged temporary line management to cover the social care aspect of the service.

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

The manager‘s plan to operate the service seven days a week has been deferred until September 2017; until then the service remains closed on alternate weekends. This management decision was made in the light of staff turnover. The staff team has recently stabilised and the acting manager is making good use of the opportunities to provide planned induction and training.

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

The manager has identified training as an area for improvement and has taken steps to address this. For example, mental health nurses on the team are scheduled to deliver a presentation to their colleagues on risk and self-harm. There is a significant delay in the enrolment of staff on a course to gain the required qualification and staff may struggle to achieve this within the timescale set by regulation. The acting manager has actively chased this, but it is outside her control.

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

The acting manager successfully promotes and models a learning environment, for example in her encouragement of staff reflection at the end of each shift. The management team provides a good level of support for staff, individually and as a team. Managers are now providing regular formal supervision, alongside continued informal advice and guidance and team meetings. The assistant manager is nearing completion of the workforce development plan.

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

Staff are very confident in the acting manager (a nurse) and the assistant team manager (a social care professional). They describe them as, ‗A really good team, there is nothing you couldn‘t go and speak to them about‘. This confidence underpins the integration of the health and social care elements of the service effectively. As a result, health and social care staff have a good understanding of, and appreciation for, their complementary roles and work effectively together to meet the needs of young people.

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

The acting manager has met two of the three recommendations made in the last report. As previously noted, the location risk assessment remains a work in progress.

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

The statement of purpose and the young people‘s guide have been reviewed and updated. Both clearly outline the ethos of the home and this is reflected in staff practice. A professional commented, ‗They set out what they could do and have done this. They were also very clear about what they couldn‘t do and this was very helpful.‘

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

The small house is well maintained and provides a warm, homely environment. The lack of space can also provide challenges in how visits to young people are managed when there are two staying. Senior managers are looking to see if there are ways to address this.

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

Staff recording in young people‘s notes is generally of a good standard. However, many entries do not identify the author. The admission and discharge register does not contain all the required information. Inspection report children‘s home: 1230411 9 The staff and managers of the home work effectively in partnership with a range of professionals. All are very positive about the good quality of communication and engagement provided by the team. One professional said, ‗They delivered above and beyond expectations.‘ Another described managers as, ‗Amazing; patient, but assertive when they needed to be‘.

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

The management team is developing good systems to support their effective monitoring and oversight of practice. The acting manager has completed a monitoring report and identified that the analysis and evaluation should be stronger to better inform the development plan. The team appreciates the role of the independent visitor and is beginning to make better use of the monthly reports. These reports have not been sent to the regulator as required.

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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: 1230411 10

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Children’s home details

Registered provider address: Quadrant Court, 35 Guildford Road, Woking GU22 7QQ

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Inspector

Maire Atherton, social care inspector Inspection report children‘s home: 1230411 11 achieve excellence in the care of children and young people, and in education and skills for learners of all ages. It regulates and inspects childcare and children‘s social care, and inspects the Children and Family Court Advisory and Support Service (Cafcass), schools, colleges, initial teacher training, further education and skills, adult and community learning, and education and training in prisons and other secure establishments. It assesses council children‘s services, and inspects services for children looked after, safeguarding and child protection.

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Inspector

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Inspector

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Inspector

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