Children's home run by Aspris Children’s Service in Hammersmith and Fulham

Inspection report children’s home: 1234621 1 Registered provider: Priory Education Services Limited Interim inspection Inspected under the social care common inspection framework

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Information about this children’s home

This home is one of five homes owned by a national organisation. The home provides care, accommodation and education for up to five children who have emotional and/or behavioural difficulties. The home specialises in offering care and support to children who display sexually harmful behaviours.

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and young people since the most recent full inspection

This home was judged good at the last full inspection. At the interim inspection, Ofsted judges that it has declined in effectiveness.

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and young people since the most recent full inspection

No shortfalls were raised at the full inspection in May 2017. At that time, the home benefited from an established manager and a stable staff team; the home was settled. Since the last inspection, there has been a concerning increase in the number of notifications of significant incidents, and external monitoring reports indicate poor practice issues and safety concerns. Ofsted conducted this interim inspection with specific lines of enquiry about the children’s safety and the management of the home.

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and young people since the most recent full inspection

The manager and two other staff members are currently absent from the home. Inspection report children’s home: 1234621 2 A serious incident has placed children at risk of potential abuse and in physical danger. One child displayed behaviours that the staff were unable to contain, and the placement ended abruptly. Risk assessments have not been updated after incidents. Staffing shortages have led to shifts during which 50% of the staffing has been made up of agency staff, and no qualified staff member has been on duty for a period of seven hours. The home has not been managed effectively. Incidents have not been monitored and some incidents have not been recorded. This does not provide transparent practice that safeguards the children’s welfare.

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and young people since the most recent full inspection

A serious incident occurred during which two children were taken to the beach by a member of staff whom they did not know. The children were left with the member of staff at the beach without transport. A second member of staff returned to the home to prepare the dinner. The children failed to follow instructions and went into the water in an area without lifeguards, and the children were in close proximity to one another. This contravened all of their risk assessments and placed both of the children in danger. The supervising member of staff called for assistance, and the children were quickly collected and returned to the home. The staff failed to record this incident or to add the information to any of the daily records. The operations manager and the home’s deputy manager were made aware of the incident the following day; however, the incident has not been investigated or reviewed, despite taking place a month ago.

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and young people since the most recent full inspection

The individual risk assessments, generic activity risk assessment and location risk assessment all fail to include a review of recent incidents. The children’s individual risk assessments are not updated in a timely manner. An incident of a physical altercation during family contact, which led to the police being called to the home, was not added to the child’s risk assessment until seven weeks after the incident. Another risk assessment relating to children accessing unsafe heights was updated 14 days after an incident occurred. The generic activity risk assessments have not been updated following incidents. An incident during which a child jumped from a flat roof onto a trampoline in the garden has not been added to the risk assessment for the trampoline. In addition, the beach activity risk assessment does not include any guidance about swimming, and makes reference to a swimming pool. The location risk assessment was not updated

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and young people since the most recent full inspection

following children accessing the flat roof. This shortfall was picked up during the June 2017 external monitoring visit, and staff were asked to amend the location risk assessment to reflect the risk. The risk assessments all fail to identify and reduce the risks to the children effectively.

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and young people since the most recent full inspection

A sample of the rotas shows that there are shifts when there are up to three agency staff on duty, making up 50% of the staff on the shift. One shift had no qualified staff on duty until 4.00pm, when a member of staff from another home came to provide support. There was no designated shift leader. This does not provide effective management of the home and has resulted in poor decision-making that placed the children at potential risk.

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and young people since the most recent full inspection

The fire safety prevention checks have lapsed. The member of staff who is designated to ensure that these checks are undertaken is not working at the home. Since the member Inspection report children’s home: 1234621 3 of staff has been absent, the weekly checks for the emergency lighting, the fire alarms and the fire extinguishers have not been completed. There is a period of two months during which the checks have not been carried out. This shortfall, which has the potential to affect children’s physical safety, had not been picked up during the managerial monitoring checks.

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and young people since the most recent full inspection

Refurbishment work has radically improved the ground floor. The environment has been freshly decorated and personalised, and there are photographs of the children displayed throughout. This gives the children a sense that it is their home and provides positive memory prompts. In contrast, the first floor has a bedroom with flaking paintwork and a shower that leaks. This leak has caused a stain on the ceiling below that has been poorly repaired. One bedroom window has extensive cracking to the large pane of glass and awaits replacement. The cracked pane occurred three weeks ago. The landing carpet is stained, and the walls are marked. This does not provide a well-maintained environment and does not encourage the children to respect their home.

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and young people since the most recent full inspection

The admissions and discharges record of the children placed at the home is incomplete and does not include the date on which one of the children was discharged. The record of one child’s admission date states the wrong year, which fails the requirement to provide an accurate record. This demonstrates poor monitoring and does not meet the regulatory requirements.

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and young people since the most recent full inspection

The required internal managerial monitoring is not taking place. The absence of the manager means that records have not been signed off and that incidents have not been reported. The lack of managerial oversight, until the acting manager was appointed, led to the children being placed in a number of unsuitable and unsafe situations. External monitoring is comprehensive and raises a number of safeguarding concerns. These concerns were identified on 10 July 2017, and actions have been taken to address these.

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and young people since the most recent full inspection

Children spoken to appear happy and relaxed. There is a warm rapport with staff who have built good relationships with the children. The children are positive about the staff and their experiences. The children enjoy good-quality time and shared interests with the staff. However, three of the staff are currently absent from the home and a further two are about to leave. This does not provide continuity of care for the children and has left them with insecurities about the current staff team.

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and young people since the most recent full inspection

The home provides on-site and alternative education provision. Two of the children have made good progress in their education. They enjoy attending the alternative provision two days a week, which enables them to gain experience in mechanical and agricultural work. Staff have been proactive in ensuring that one of the children, who had a limited education package on arrival, will be attending full-time education after the summer holidays.

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and young people since the most recent full inspection

The children’s medical appointments are being maintained. The home benefits from visits from a trained therapist once a week, with whom the majority of the children continue to engage well. Access to regular therapy enables the children to reflect on their past experiences and helps them to develop healthy behaviour patterns. Inspection report children’s home: 1234621 4 Generally, relationships between the children appear amicable. There are minor irritations and altercations that reflect rivalrous siblings. The children spoken to said that they feel relaxed and safe at the home, that they know how to take turns in sharing resources and that they use the communal areas in a relaxed way.

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and young people since the most recent full inspection

A number of changes have been made to improve the environment and implement new systems. The children actively participate in meetings. The acting manager has changed the format of these meetings to encourage better involvement. There is evidence around the home that demonstrates that the children have been involved in choosing new items. The children’s views are sought, and the children are open and communicative with the staff.

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and young people since the most recent full inspection

Staff are trained in the use of restrictive physical intervention, although this is rarely used. The last physical intervention was seven months ago, and the number of restraints overall has significantly reduced.

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and young people since the most recent full inspection

The home has declined rapidly in the last two months following a catalogue of poor practice, poor decision-making and poor managerial oversight. However, the organisation’s external monitoring systems have identified the safeguarding concerns. The responsible individual and operations manager were made aware of all of the concerns in a swift manner and have responded appropriately to the majority of these. The appointed acting manager is aware of the shortfalls and is working well with the senior management team to address these. The support systems, and the actions being taken, are starting to improve the quality of the care provided. Inspection report children’s home: 1234621 5

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Statutory requirements

This section sets out the actions which must be taken so that the registered person(s) meet(s) 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 and use this understanding to deliver care that meets children’s needs and supports them to fulfil their potential. 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(1)(a)(b)(2)(c)(i))

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Requirement Due date

This is with particular regard to ensuring that repairs are carried out within reasonable timescales, and that the first-floor decor is maintained to provide a well-kept environment. 30/09/2017

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Requirement Due date

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

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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, and have the skills to identify and act upon signs that a child is at risk of harm (Regulation 12(1)(2)(a)(i)(iii)) This is with particular regard to ensuring that individual and generic activity risk assessments include up-to-date and relevant information. 11/09/2017

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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 promotes their welfare.

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Requirement Due date

In particular, the standard in paragraph (1) requires the registered person to: lead and manage the home in a way that is consistent with the approach and ethos, and delivers the outcomes, set out in the home’s statement of purpose; ensure 11/09/2017 Inspection report children’s home: 1234621 6 that staff work as a team where appropriate; ensure that staff have the experience, qualifications and skills to meet the needs of each child; and use monitoring and review systems to make continuous improvements in the quality of the care provided in the home. (Regulation 13(1)(b)(2)(a)(b)(c)(h)) The registered person must ensure that the requirements of the Regulatory Reform (Fire Safety) Order 2005(a) 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, ensure that regular checks of fire alarm systems, emergency lighting and fire extinguishers are carried out. 11/09/2017

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Requirement Due date

The registered person must maintain in the home the records in Schedule 4. In particular, this refers to a record in the form of a register showing, in respect of each child, the date of the child’s admission to the home and the date on which the child ceased to be accommodated in the home. (Regulation 37(2)(a) Schedule 4 (1)(a)(b)) 11/09/2017

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Requirement Due date

The registered person must notify HMCI and each other relevant person without delay if there is any other incident relating to a child which the registered person considers to be serious. (Regulation 40(4)(e)) 11/09/2017 Inspection report children’s home: 1234621 7

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Inspection date Inspection type Inspection judgement

31/05/2017 Full Good 23/11/2016 Full Good Inspection report children’s home: 1234621 8

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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

This inspection focused on the effectiveness of the home and the progress and experiences of children and young people since the most recent full inspection.

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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’.

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Children’s home details

Registered provider: Priory Education Services Limited

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Children’s home details

Registered provider address: Priory Group, 80 Hammersmith Road, London W14 8UD

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Inspectors

Lynne Drage, social care inspector Deirdra Keating, social care inspector Inspection report children’s home: 1234621 9 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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Inspectors

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Inspectors

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Inspectors

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