Children's home run by Holibrook House Limited

Inspection report children’s home: SC377702 1 SC377702 Registered provider: Holibrook House Limited

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Full inspection Inspected under the social care common inspection framework

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Information about this children’s home

This privately owned home provides care and accommodation for up to six young people who have emotional and/or behavioural difficulties. The home aims to provide a therapeutic environment. In addition to having two other children’s homes, the company is a registered education provider.

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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

Date of last inspection: 22 December 2016

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requires improvement to be good

Overall judgement at last inspection: sustained effectiveness

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Key findings from this inspection

This children’s home requires improvement to be good because:

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Key findings from this inspection

 Young people with significant needs are admitted without proper assessment of their risks and the impact this has on the young people already resident. This reduces the home’s capacity to manage the needs of the young people, Inspection report children’s home: SC377702 2 resulting in poor placement outcomes.  Young people do not make good progress in relation to their behaviour and emotional well-being.  A number of incidents have occurred involving young people assaulting staff and/or going missing from the home as well as other serious events that required police intervention.  Risk factors are not robustly assessed. Strategies to mitigate the risks and challenging behaviour exhibited by young people are limited.

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Key findings from this inspection

 Staff keep in regular contact with social workers and other professionals as well as with the family members of the young people.  Young people’s views are sought after and considered when sanctions are applied.  Young people’s cultural identities are respected and celebrated.  The home is warm and welcoming. It is a homely home.

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Inspection date Inspection type Inspection judgement

22/12/2016 Interim Sustained effectiveness 15/06/2016 Full Good 29/02/2016 Interim Improved effectiveness 14/07/2015 Full Requires improvement Inspection report children’s home: SC377702 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 protection of children standard In order to meet the protection of children standard, the registered person must ensure that staff:

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Requirement Due date

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; take effective action whenever there is a serious concern about a child’s welfare.

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Requirement Due date

The care planning standard In order to meet the care planning standard, the registered person must ensure that children:

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Requirement Due date

receive effectively planned care in or through the children’s home; and

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Requirement Due date

have a positive experience of moving on from the home;

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Requirement Due date

that children are admitted to the home only if their needs are within the range of needs of children for whom it is intended that the home is to provide care and accommodation, as set out in the home’s statement of purpose.

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Requirement Due date

In particular, the registered person should only accept placements for children where they are satisfied that the home can respond effectively to the child’s assessed needs as recorded in the child’s relevant plans and where they have fully considered the impact that the placement will have on the existing group of children.

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Requirement Due date

The positive relationship standard In order to meet the positive relationship standard, the registered person must ensure that children are helped to 01/12/2017 Inspection report children’s home: SC377702 4 develop and practise skills to resolve conflicts positively and without harm to anyone and de-escalate potentially violent behaviour by children.

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Requirement Due date

(Regulation 11 (2)(iv)(xi)) Behaviour management policies and records The registered person must keep the behaviour management policy under review and, where appropriate, revise it.

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Requirement Due date

The leadership and management standard In order to meet the leadership and management standard, the registered person should understand the impact that the quality of care provided in the home is having on the progress and experience of each child and use this understanding to inform the development of the quality care provided in the home.

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Recommendations

 The registered person should ensure that the home takes account of information provided by independent return home interviews when assessing risks and putting arrangements in place to protect each child. Evaluation of missing incidents should be undertaken to identify any gaps in training, skills or knowledge for staff or to record and retain evidence of what worked well. This evaluation should inform the review of quality of care. (‘Guide to the children’s homes regulations including the quality standards’, pages 45 and 46, paragraph 9.30 and 9.31)  The registered person should ensure that the home’s safeguarding policy includes arrangements set out to protect children from gangs. (‘Guide to the children’s homes regulations including the quality standards’, page 44, paragraph 9.19)  Review and revise the location risk assessment to include any risks of gangs. (‘Guide to the children’s homes regulations including the quality standards’,

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Recommendations

page 64, paragraph 15.1)  The registered person should work with the placing authority to ensure that each child’s transition is planned and help each child to prepare for leaving, both practically and emotionally. (‘Guide to the children’s homes regulations including the quality standards’, page 57, paragraph 11.9)  Ensure that notifications of serious events include details of the action taken by the home’s staff in response to the event. (‘Guide to the children’s homes regulations including the quality standards’, page 63, paragraph 14.13)  The registered person should have a workforce development plan which can fulfil the workforce-related requirements of regulation 16, schedule 1 Inspection report children’s home: SC377702 5 (paragraphs 19 and 20). (‘Guide to the children’s homes regulations including the quality standards’, page 53, paragraph 10.8)  The registered person should support staff to be ambitious for every child in the

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Recommendations

home and enable them to actively support each child to achieve their potential. (‘Guide to the children’s homes regulations including the quality standards’, page 52, paragraph 10.5)

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improvement to be good

Young people do not benefit from positive experiences or make good progress. A number of young people are admitted without proper assessments and experience placement disruptions. Strategies to manage challenging behaviour are largely ineffective. One young person’s placement was terminated within seven weeks of admission. This young person went missing from his first day of placement and had two further missing episodes. He verbally and physically attacked staff and attempted to cause damage to the premises on almost every day of his placement, some of which required police intervention.

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improvement to be good

Two other young people have had short-term stays in the home since the last full inspection. One young person, who came from a secure unit and was assessed to be at high risk of child sexual exploitation, went missing for a week. This young person was then moved to another secure unit six weeks after admission. Another young person left after nine days due to high levels of care required to keep the young person safe, and the impact that her negative behaviour was having on the home and the local community.

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improvement to be good

Another young person’s placement was terminated after six months for assaulting and threatening to harm staff and the other young people living in the home. He was arrested and moved to another placement from the police station. This young person was also affected negatively by the challenging behaviour of another young person admitted to the home.

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improvement to be good

The experiences of young people placed for a year or longer is mixed. The home has given notice to move one young person due to his association with a gang. He has been in the home for a year with high incidence of missing episodes and increasingly anti- social behaviour. Another young person who has been in the home for almost a year did not return from a weekend contact with her mother. Although the young person liked the home, she wished to be with her family. Another young person who has been in the home for almost a year has breached his youth offending order and is on conditional bail.

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improvement to be good

Young people’s progress in education is varied. A young person’s school attendance is at 44%. The home put in place an incentive for the young person to attend school. However, when he obtained his incentive, he refused to attend. As he cannot manage a Inspection report children’s home: SC377702 6 full-time timetable, he is due to return to school on a part-time basis. This young person has not made the expected progress since his last personal educational review. A professional from the virtual school head team stated that the attendance of two of the young people is around 85% which is a slight improvement from last year. However, one of the two young people has not made the expected level of progress.

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improvement to be good

A young person who has been in the home for over three years will be attending college in the autumn to undertake a course in carpentry. Another young person completed his GCSEs and attended graduation with staff’s support in June and will be attending college next term.

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improvement to be good

One young person was placed in the home for almost a year without an identified school placement, although the home advocated for the young person to be in school. The young person received home tuition and was supported by the staff to apply to college, which the young person showed interest in before she left the home.

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improvement to be good

Individual care plans include the young person’s needs and strengths as well as the necessary actions. However, they lack clarity on what the desired outcomes are and the impact of support provided by the staff. Key-working sessions reflect important issues mentioned by the staff, such as helping young people to keep safe in the community. However, there is a lack of analysis regarding the impact of the sessions on helping young people make progress in the identified key areas.

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improvement to be good

Views from professionals about the efforts made by the home have been largely positive. A youth offender service worker stated that she found the home to be supportive of the young person and impressed with staff members’ efforts to set boundaries with the young person during challenging times. A young person who was on a community-based court order engaged well in the workshops on social communication, anger management and weapons awareness.

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improvement to be good

One social worker stated that he was ‘impressed by how quickly and how well the staff got to know’ the young person. The young person mentioned in his own child looked after reviews that he felt well supported in the home.

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improvement to be good

Young people are also supported by staff to experience positive contact with their family members. One young person has started overnight contact with his mother and attends church with his grandparents, which appears to be a positive influence. A parent stated that her child is well looked after and that when he does not return home after curfew, the staff will try to find him. She notes that staff keep her informed of any issues.

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improvement to be good

Staff teach young people independent living skills to assist them to perform basic tasks such as cleaning, shopping and making snacks. However, most are not emotionally or mentally prepared for semi-independent living. For these young people, the manager has advocated for them to remain in placement and receive more support so that they can benefit from better managed transitions. Despite such advocacy, there is still room for improvement in working with placing authorities for better outcomes for the young people. Inspection report children’s home: SC377702 7 Young people are in good health and receive help to manage their health needs. A young person with diabetes has received support from the staff and health professionals to learn more about, and manage, her condition successfully. Where appropriate, young people are offered specialist support such as through community mental health services. However, the uptake by young people is limited even with the staff’s encouragement.

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improvement to be good

Young people are treated with dignity and sensitivity. A social worker stated that the staff ‘go the extra mile’ to engage the young people in various aspects of their ethnicities and family histories. The home celebrates young people’s cultural identities and helps them learn about others. This helps young people feel valued. In addition, the home creates memories albums for young people with photos taken of special events, outings, activities with their peers and staff and contact visits with family members. This helps to remind them of positive moments they have experienced during their placement.

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improvement to be good

All but one of the young people were away on a holiday trip out of the area during the inspection. The young person who remained engages well with the staff.

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improvement to be good

The manager and staff provide an environment that feels homely and where everyone is given a warm welcome.

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improvement to be good

Young people do not receive good enough help and protection. However, there is no widespread failure in safeguarding young people.

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improvement to be good

Risk factors are identified but not robustly assessed. For example, a young person’s level of risk related to their sexual abuse history was assessed to be low to medium based on the other young people in the home not having such a history. This assessment did not reflect a clear understanding of the risks and how the young person should be supported to become increasingly safe.

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improvement to be good

A young person, who was admitted from a secure unit with a high level of risk from child sexual exploitation, was assessed to be medium at the time of admission with no analysis of how this risk was mitigated. Such a lack of robust risk assessment contributes to ineffective safety planning for the young person when they go missing.

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improvement to be good

The home’s safeguarding policy is comprehensive and includes protecting young people from harm, neglect, abuse, sexual exploitation, self-harm and radicalisation. Staff also receive training on female genital mutilation and e-safety. However, the policy lacks information and the arrangements set out to protect young people from gangs. This is also missing in the home’s location risk assessment, which covers most relevant risk factors. This means that risks have not been properly assessed, which leads to insufficient placement planning.

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improvement to be good

Strategies to manage challenging behaviour are limited to ensuring that the young Inspection report children’s home: SC377702 8 people have a structured, active day to preoccupy them. While this strategy is useful in some ways, it has been ineffective in managing assaultive and frequently going missing behaviour. Some of the behavioural management plans of young people set out additional strategies to manage difficult behaviour. In relation to the young people who are negatively influenced by their peers out in the community, the staff have talked with the young people and spoken to their friends about expectations, keeping safe and taking personal responsibilities for their actions. However, it is not clear what substantive impact these actions have had on helping young people make progress in the identified areas of risks. Moreover, there is limited evidence of young people having input into the completion of their own behavioural management plans.

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improvement to be good

Although staff follow the home’s procedures when young people go missing from the home, there has been a lack of effective action to mitigate the persistent pattern of high-risk behaviour. One young person with frequent missing incidents sustained a knife injury during one episode. In another episode of going missing, the same young person was involved in a fight, sustaining a physical injury. Evidence of independent return home interviews being offered, and having taken place, are not consistent. When return home interviews do take place, the information obtained from these and informal debriefs by staff are not utilised effectively to help reduce missing incidents.

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improvement to be good

Staff have not used physical restraint on young people since the last inspection. The giving of sanctions is proportionate. The systems in place for recording incidents and sanctions are appropriate. Staff seek and consider the young people’s views before applying sanctions.

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improvement to be good

Young people know how to complain. Complaints made since the last inspection have been appropriately handled by the deputy manager in partnership with the local authority designated officer.

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improvement to be good

The home has notified Ofsted of serious incidents that have taken place without delay. However, some notifications lack detail, such as the actions that the staff have taken as a result of the incident. Some of the notifications reflect gaps in practice which impact the quality of care provided to the young people.

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

The characteristics of good leadership and management are not consistently in place, although there have been some recent improvements.

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

The deputy manager has been overseeing the home since the registered manager left at the end of March 2017. A new manager has been appointed and will assume her post in mid-August.

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

The deputy manager has been working as a deputy for five years. Since the registered manager’s departure, the deputy manager has tried to maintain a good standard of practice and work to the ethos set out in the home’s statement of purpose. The deputy manager’s self-assessment of the home is thoughtful and considered, recognising the Inspection report children’s home: SC377702 9 areas that need improvement. For example, the deputy manager acknowledges that they may have been complacent and that risk assessments and behaviour management plans could be more robust. The deputy manager also recognises that placement referrals could be better assessed in terms of the potential impact on the current group of young people. There is evidence that this learning has become more embedded: an impact assessment conducted on the most recently admitted young person contained a clear evaluation of risks, how these may impact the other young people and ways to

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

The deputy manager undertakes regular reviews of medication, health and safety, incidents, risk assessments and written records of formal supervision, among others. However, the review of the effectiveness of the plans and the impact on the young people achieving progress has been limited. The deputy manager utilises formal supervision and team meetings to address practice issues as necessary, although an example of supervision recording, which the manager considered to be good, did not contain any details of the feedback given to the staff member about their practice.

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

A training plan for staff is in place which includes the four-day therapeutic childcare training. This helps to teach staff to put themselves in the young person’s shoes and take the initiative to start to engage the young person. In addition to training sourced internally, staff have access to a variety of training through the local safeguarding board and have benefited from specialist training delivered by a nurse on diabetes. This raised staff awareness of the condition and led to better support for the young person affected by it.

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

Staff are aware of child protection policies and their responsibilities to safeguard the young people. One member of staff said that she would like more training on managing challenging behaviour and conflict management effectively.

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

A workforce development plan, which should detail the processes for managing and improving performance and other workforce-related requirements, is not in place. This limits the review of the professional development needs of staff, including the home’s manager.

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

The deputy manager and the staff have a good understanding of the young people’s needs and are committed to making a difference in their lives. However, there is room to be robust in managing difficult behaviour and be ambitious for the young people and not limit aspirations for them despite their challenging starting points.

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

Staff members are clear about their roles and responsibilities and have stated that they feel supported. They describe the home as a ‘family’.

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

Safe recruitment is in place. The home is adequately staffed, which means that young people receive a sufficient level of supervision.

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

One social worker stated that he found the staff ‘very approachable, accessible and keen to work closely’. Communication was ‘always good and frequent’. Inspection report children’s home: SC377702 10

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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 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: SC377702 11

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Children’s home details

Registered provider: Holibrook House Limited

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Children’s home details

Registered provider address: First Floor, 172 Hoe Street, Walthamstow, London E17 4QH

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Inspector

Linda Kim-Newby, social care inspector Inspection report children’s home: SC377702 12 achieve excellence in the care of children and young people, and in education and skills for learners of all ages. It regulates and inspects childcare and children’s social care, and inspects the Children and Family Court Advisory and Support Service (Cafcass), schools, colleges, initial teacher training, further education and skills, adult and community learning, and education and training in prisons and other secure establishments. It assesses council children’s services, and inspects services for children looked after, safeguarding and child protection.

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Inspector

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Inspector

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Inspector

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