Children's Home run by Cambian Childcare Limited in Cambridgeshire

Inspection report children‟s home: 1257796 1 Registered provider: Cambian Childcare 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 home is registered for up to 16 children who have mental disorders. It is privately owned and has a separately registered school on site.

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Overall experiences and progress of

children and young people, taking into account

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requires improvement to be good

How well children and young people are helped and protected requires improvement to be good

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requires improvement to be good

The effectiveness of leaders and managers requires improvement to be good

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requires improvement to be good

The children‟s home is not yet delivering good help and care for children and young people. However, there are no serious or widespread failures that result in their welfare not being safeguarded or promoted.

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requires improvement to be good

Overall judgement at last inspection: Not applicable

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Key findings from this inspection

Inspection report children‟s home: 1257796 2 This children‟s home requires improvement to be good because:

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Key findings from this inspection

 Fire safety arrangements have not been effective in identifying and removing risks to children.  Managers are not consistently or effectively monitoring in some key areas of the home.  The supervision of staff remains inconsistent, with gaps of three months between supervision sessions for some staff.  Managers are not undertaking annual appraisals of all staff.  Some children‟s risk assessments do not provide sufficient guidance for staff.  The manager‟s review of the quality of care does not ascertain or consider the opinions of children, their parents, placing authorities or staff.  Not all records of physical intervention and sanctions include the required information.  Following physical interventions, managers are not speaking to staff to review each incident for periods of up to six and a half weeks.  Not all staff who have been working at the home for two years or more have completed their appropriate qualification, although they are working towards

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Key findings from this inspection

 The children feel safe, and the staff help them to reduce their risk-taking behaviour.  Children make progress while living at the home. This progress includes improved health and education.  The children develop positive relationships with the staff who look after them.  There are sensitive introductions to help children settle into the home.  The children take part in a wide range of activities, both with staff and in the local community.  The staff balance the safety of children with helping them to develop independence skills.  The management team has been strengthened by the appointment of a second deputy manager.

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Recent inspection history

Inspection report children‟s home: 1257796 3

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Inspection date Inspection type Inspection judgement

This is the home‟s first inspection. Inspection report children‟s home: 1257796 4

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Statutory requirements

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

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Requirement Due date

The protection of children standard is that children are protected from harm and enabled to keep themselves safe.

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Requirement Due date

In particular, the standard in paragraph (1) requires the registered person to ensure that staff assess whether each child is at risk of harm, taking into account information in the child‟s relevant plans, and, if necessary, make arrangements to reduce the risk of any harm to the child. (Regulation 12 (1)(2)(a)(i))

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Requirement Due date

In particular, ensure that children‟s risk assessments provide sufficiently clear guidance for staff. 15/09/2017

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Requirement Due date

The registered person must ensure that the requirements of that Order and any regulations made under it, except for article 23 (duties of employees), are complied with in respect of the home. (Regulation 25(2)(b))

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Requirement Due date

In particular, the registered person must ensure that the issues identified through the fire risk assessment and any damage to fire safety equipment (such as fire doors) are identified and addressed promptly and that people who complete fire risk assessments are competent to do so. 15/09/2017

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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 duration of the measure. Further, 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 within 5 days they have spoken to the child. (Regulation 35(3)(a)(iv) (b)(i)) 15/09/2017

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Requirement Due date

The registered person must ensure that staff have the appropriate qualifications for the work that the individual is to perform. (Regulation 32(3)(b)) 31/12/2017

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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 to aspire to their full 15/09/2017 Inspection report children‟s home: 1257796 5 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)(2)(h))

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Requirement Due date

In particular, ensure that records are monitored and that errors identified are addressed, and that issues relating to the maintenance of the home are identified and addressed. The registered person must ensure that the system for monitoring, reviewing and evaluating the quality of care provided for children, provides for ascertaining and considering the opinions of children, their parents, placing authorities and staff. (Regulation 45(2)(5)) 31/12/2017

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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 and have their performance and fitness to perform their roles appraised at least once every year. (Regulation 33 (4)(b)(c)) 30/09/2017

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Requirement Due date

The registered person must keep the statement of purpose under review and, where appropriate, revise it. (Regulation 16(3)(a)) 15/09/2017

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improvement to be good

Overall, children, including those who are living a long way from their home area, have positive experiences and make progress while they are living at this home. The judgement for this area takes account of this, but also of the shortfalls recorded later in this report relating to the safety of children, and the management and leadership in the home.

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improvement to be good

The health of children at this home improves because of the work that is done with them. They have their routine health needs met and are registered with dentists, doctors and opticians. Their specialist health needs, including emotional and psychological needs, are met through the work done by the clinical team and the support of the care staff. For most of the children this approach is effective and leads to better health outcomes. In a small minority of cases children‟s health needs have changed for reasons not related to the home. Their placements have become unsustainable for them and the other children in the home. Managers have recognised this and reluctantly made decisions that some children needed to move on to ensure that their needs could be met. Inspection report children‟s home: 1257796 6 Most children make progress in their education, even though some can find even the short journey to the on-site school too difficult to manage. In such cases, teachers from

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improvement to be good

the school or residential staff will try to work with the children in the home. Most of the children increase their school attendance while they are living at this home. This helps them to maintain routines and have experiences similar to those of other children. It will also help them to learn skills and gain qualifications to help them in the future.

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improvement to be good

The staff build positive relationships with the children and are concerned for their welfare. One child said that, „Staff here genuinely care for me.‟ Positive relationships help the children to feel valued and develop a sense of belonging. The staff also build effective relationships with parents, which help to ensure consistent care for the children. Where appropriate, parents are included in the planning and introductions when children move into the home. The home does not take emergency or same-day placements. The home‟s admission process allows the staff to plan placements and offer children sensitive introductions which are tailored to the individual child. The children find this process helpful.

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improvement to be good

While living at this home, the children have opportunities to take part in a range of activities. These include trips out with the staff to go skating, or to go to cinemas and coffee shops. There are regular visits to the home by therapy dogs and other pets, which the children enjoy. Some children can have pets such as rabbits and guinea pigs. One child did not feel able to go out of the home to choose her guinea pig. Staff visited the pet shop and took photos of the guinea pigs to show the child so that she could choose which one she wanted. This helped the child to get the most she could from the experience of choosing her pet. Some children go horse riding or attend local groups such as police cadets and St John Ambulance. This range of experiences and activities help to build the children‟s self-esteem and allow them to enjoy childhood experiences.

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improvement to be good

The staff help children to develop their independence skills as far as they can while keeping them safe. For example, if a child can self-medicate, the administration of medicine is closely supervised by staff to protect the child who is receiving the medicine, and prevent other children from gaining access to it. Some children are able to take the medication themselves under the supervision of staff, which is a step towards independence. Some children are also able to cook and do their washing. Learning these skills will help children to be fully independent later in their lives.

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improvement to be good

The staff write risk assessments to help identify and reduce risks for the children. While these are clear and easy to read, in one case there was not sufficient guidance for the staff. Based on advice from paramedics, the document stated that an ambulance should not be called in response to a child‟s seizures as they were not epileptic. However, the document tells staff to call 999 if the child‟s condition is serious. There is no guidance for staff on what is serious, and consequently this could lead to the staff acting Inspection report children‟s home: 1257796 7 inconsistently and failing to call emergency help when required.

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improvement to be good

The process for assessing the suitability of placements has changed. Residential managers are now more involved in the process and, along with a written assessment, this helps to ensure that children are only admitted to the home when their needs can be met, and they will fit in with the existing group of children. The social workers for some children whose placements ended in unplanned ways said that they felt that the decision for the children to move into the home was the right one at the time.

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improvement to be good

A fire risk assessment was completed by an independent company on 30 November 2015. The registered manager reviewed this on 19 January 2017. She has not had any training to undertake the review, and it did not cover the range of issues that the original risk assessment did. For example, it did not include a review of the premises. The original risk assessment identified a risk due to materials being stored in a particular area, and recommended that this risk should be addressed by 30 March 2016. This shortfall has not been addressed and remains a fire risk. The registered manager said that a shed was to be bought to store the materials in, but this has not yet happened. At the time of the inspection, a fire door was sticking on the carpet and not closing. This issue had not been identified as a fire risk. Failure to address these issues, especially after one had been identified 20 months previously, does not effectively protect children

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improvement to be good

The registered manager has introduced a new physical intervention approach which provides more clarity for staff, and managers feel that it is more suitable for the children who live at the home. The staff keep records of the physical interventions which they use, but these records are not always clear. In one case the physical intervention is recorded to have lasted one hour and 45 minutes. The description of the event indicates that it was much shorter than the recorded time, but this has not been identified through monitoring of the records. The forms for recording physical interventions include space to record that staff have been debriefed following each incident, along with the date and time of the incident and the location of the records of it. None of these are filled in. Records of debriefs are kept on staff files, but some debriefs have not taken place for up to six and a half weeks, rather than the 48 hours required by The Children‟s

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improvement to be good

Homes (England) Regulations 2015. Consequently, staff may be involved in further incidents without having had the opportunity to reflect on and review their practice. Also, managers are signing records of physical intervention without having had these full discussions with staff about the measures taken.

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improvement to be good

There are very few incidents of children going missing from care due to the high levels of staff supervision. When children do go missing the staff respond appropriately, looking for them and reporting them as missing. When the children return, they are spoken with by someone independent of the home, to try and understand the reasons why they went missing. This helps to protect those children who go missing. Due to their individual needs, a number of the children at the home are involved in self-harming behaviour at times, but for most children this decreases over time. The children say that they feel safe in the home, there is no bullying and the staff help them to keep them safe. This contributes to a feeling of security for children. The staff supervise the Inspection report children‟s home: 1257796 8 children‟s use of the internet so that the children can learn about safe internet use.

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improvement to be good

The staff help children to develop positive behaviour. A placing social worker said that the staff put clear boundaries and structures in place for children. Sanctions are used at times, but there is also an emphasis on positive consequences to reinforce the children‟s good behaviour. The records of positive consequences show examples of children learning to manage conflict with each other. There has been one recent incident of a safeguarding concern at the home. This incident was managed quickly and appropriately to help ensure that the matter was dealt with and that children remain safe while living at the home.

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

This home was re-registered on 26 July 2017 following a change in ownership. The responsible individual and registered manager remained the same, as did the home‟s aims and purpose. Although this is a new registration, a number of the shortfalls identified in this inspection had also been identified at the last inspection of the home before it was re-registered. These include:

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

 Supervision and appraisal of staff  Fire risk assessments  Monitoring  Obtaining of stakeholder reviews as part of reviews of the quality of care  Records of physical interventions.

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

Although there are a number of recurring shortfalls, there have also been some significant areas of progress in the leadership and management of the home. Some placing social workers commented on disruption from previous management changes, but spoke positively about the current management team. Staff said that they feel supported by managers.

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

The home has a registered manager who is experienced and appropriately qualified. The management team in the home has been strengthened by the appointment of a second deputy manager. Previously there has been a significant turnover of staff, but this seems to be slowing down. Some agency staff are used, but these are experienced and consistent staff who can build relationships with the children. Some staff who have worked in the home for over two years have not yet obtained a suitable qualification, but they are currently working towards this.

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

Managers have a sound understanding of children and their needs. They have the needs of children at the centre of their practice. Although there is monitoring of records and practice in the home, this is not comprehensive and sometimes it is not effective. The managers have identified shortfalls in some records, such as the inclusion of children‟s comments in records of sanctions, but despite this, the gaps remain. Other records such as room searches, which have spaces for the manager to sign, are not signed by managers. The sticking fire door had not been identified as a fire risk. Improvements have been made in management oversight of the home, but some areas require further Inspection report children‟s home: 1257796 9 work so that the registered manager can have an effective overview of the care of children, and identify areas for improvement. The registered manager has undertaken a review of the quality of care which identifies some areas for improvement. However, the

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

process has not taken account of the views of children, their parents, placing authorities and staff, so some important information may not have been included. There are monthly visits to the home by an independent visitor, which are effective in looking at practice and identifying areas for improvement.

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

There has been an improvement in the frequency of staff supervisions, but some staff are still going three months between supervision sessions, and some have not had an annual appraisal. This reduces management oversight of practice, and limits the ability of managers to identify areas of improvement for staff, particularly at times when staff are under pressure. The training available for staff has improved. The home‟s clinical team provides regular sessions for care staff. A new member of staff described their induction as „extensive‟.

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

Some of the children at the home have needs relating to identity and choice, including sexuality and diet choices. Staff have been trained to help them understand the issues for children. The staff speak with children about how they see the issues, and how they want staff to respond to them. This helps to ensure that staff have an understanding of equality and diversity issues, and that children‟s wishes and views are taken into account.

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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 differences 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 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, 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: 1257796 10

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Children’s home details

Registered provider: Cambian Childcare Ltd

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Children’s home details

Registered provider address: Cambian Group, 4th Floor Waterfront Building, Chancellors Road, Hammersmith Embankment, London W6 9RU

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Inspector(s)

Clive Lucas, social care inspector Michael Mulvaney, social care inspector Inspection report children‟s home: 1257796 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 looked after children, safeguarding and child protection.

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Inspector(s)

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Inspector(s)

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Inspector(s)

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