Children's home run by The Senad Group Limited in Derby

Inspection report children’s home: SC020193 1 SC020193 Registered provider: The SENAD Group Limited

p.1

Full inspection Inspected under the social care common inspection framework

p.1

Information about this children’s home

This home is registered to provide care for up to 25 children and young people with complex communication and learning difficulties, and severe challenging behaviours. It is part of a residential special school and is owned by a private organisation.

p.1

Overall experiences and progress of

children and young people, taking into account

p.1

inadequate

How well children and young people are helped and protected inadequate

p.1

inadequate

The effectiveness of leaders and managers requires improvement to be good

p.1

inadequate

There are serious and widespread failures that mean children and young people are not protected and their welfare is not promoted or safeguarded.

p.1

inadequate

Overall judgement at last inspection: Sustained effectiveness

p.1

Enforcement action since last inspection

None Inspection report children’s home: SC020193 2

p.1

Key findings from this inspection

This children’s home is inadequate because:

p.2

Key findings from this inspection

 There are poor staffing levels due to staff leaving, and a high level of sickness. Furthermore, a high number of staff are new and inexperienced. This means that young people are put at risk of harm due to not being supported by enough staff with the right skills and experience.  Mealtimes are not adequately supervised. This means that young people who eat their meal quickly may be at risk of choking.  Young people are not evacuated from the building, or are delayed in evacuating, when the fire alarm sounds. This is due to a lack of staff and a poorly coordinated response.  Young people are not going out on planned trips in the community due to a lack of staff.  A potential child protection issue was delayed in being reported.  Recruitment checks for agency workers are not robust. This puts young people at risk of harm.

p.2

Key findings from this inspection

 The registered manager and the senior leadership team have a good understanding of the issues identified within this inspection. They have plans to fully address the shortfalls.  Staff are passionate about providing a good level of care for young people but feel hampered and frustrated by the current situation in the home.  Investigations into allegations made against staff and safeguarding concerns are thorough. Learning points are identified and implemented.  The induction for new staff is now longer. This has helped new staff to have a better understanding of the young people, and subsequently is helping with staff retention.

p.2

Inspection date Inspection type Inspection judgement

21/03/2017 Interim Sustained effectiveness 01/08/2016 Full Good 14/01/2016 Interim Sustained effectiveness 11/06/2015 Full Good Inspection report children’s home: SC020193 3

p.2

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.

p.3

Requirement Due date

The enjoyment and achievement standard is that children take part in and benefit from a variety of activities that meet their needs and develop and reflect their creative, cultural, intellectual, physical and social interests and skills.

p.3

Requirement Due date

In particular, the standard in paragraph (1) requires the registered person to ensure— that each child has access to a range of activities that enable the child to pursue the child’s interests and hobbies. (Regulation 9(1)(2)(b))

p.3

Requirement Due date

In particular, ensure that staffing levels enable young people to go on their planned trips. 18/09/2017

p.3

Requirement Due date

The protection of children standard is that children are protected from harm and enabled to keep themselves safe. 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; have the skills to identify and act upon signs that a child is at risk of harm; are familiar with, and act in accordance with, the home’s child protection policies; that the home’s day-to-day care is arranged and delivered so as to keep each child safe and to protect each child effectively from harm. (Regulation 12(1)(2)(a)(i)(iii)(vii)(b))

p.3

Requirement Due date

In particular, ensure that young people’s fire evacuation risk assessments are appropriate, staff do not delay evacuating young people from the building when a fire alarm sounds, staff do not delay in reporting unexplained bruising, staff have confidence to whistle-blow and staff supervise young people appropriately at mealtimes to reduce the risk of choking. 18/09/2017 Inspection report children’s home: SC020193 4 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 aspire to fulfil their potential; and promotes their welfare. In particular, the standard in paragraph (1) requires the registered person to— ensure that staff work as a team where appropriate; ensure that staff have the experience, qualifications and skills to meet the needs of each child; ensure that the home has sufficient staff to provide care for

p.3

Requirement Due date

each child; ensure that the home’s workforce provides continuity of care to each child. (Regulation 13(1)(2)(b)(c)(d)(e)

p.4

Requirement Due date

In particular, improve staff retention, staff morale and ensure that young people have the correct level of staff support at all times. Ensure that staff receive training in each young person’s preferred method of communication. 18/09/2017

p.4

Requirement Due date

The registered person must recruit staff using recruitment procedures that are designed to ensure children’s safety. 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 individual to work at the home, if the individual satisfies the requirements in paragraph (3). The requirements are that— the individual is of integrity and good character; the individual has the appropriate experience, qualification and skills for the work that the individual is to perform; the individual is mentally and physically fit for the purposes of the work that the individual is to perform; and full and satisfactory information is available in relation to the individual in respect of each of the matters in Schedule 2.

p.4

Requirement Due date

(Regulation 32(1)(2)(3)) 18/09/2017 Inspection report children’s home: SC020193 5

p.4

Recommendations

 Ensure that the registered person makes suitable arrangements to manage, administer and dispose of any medication. (‘Guide to the children’s homes regulations including the quality standards’, page 35, paragraph 7.15)

p.5

Overall experiences and progress of children and young people: inadequate

This home has gone through a turbulent period of staff leaving, having a high number of new, inexperienced staff, high levels of sickness and a lack of understanding from some leaders. This has led to some houses being chaotic, noisy environments with a lack of organisation within the staff team and a lack of communication between staff.

p.5

Overall experiences and progress of children and young people: inadequate

Staff sickness and vacancies mean that there is a shortage of skills and experience on some shifts. This has sometimes resulted in young people not being able to go out on planned trips. For example, three out of the four trips planned were cancelled on one day.

p.5

Overall experiences and progress of children and young people: inadequate

The lack of available staff meant that a young person, who had returned from his parents’ home, was left waiting in reception for some time. This did not feel very welcoming for the young person or his parent.

p.5

Overall experiences and progress of children and young people: inadequate

Young people are not always supported as well as they should be because of a lack of communication and coordination between staff. For example, a young person was left to eat his meal by himself, contrary to his care plan, which identifies a risk of choking. Furthermore, staff did not know who was working with a young person until a senior manager intervened part-way through the shift. This meant that the young person stayed in bed until a member of staff was available to support him.

p.5

Overall experiences and progress of children and young people: inadequate

Young people have recently experienced a number of serious medication errors that have meant that they have received more medication than prescribed on a number of occasions. The incidents have been reported to the appropriate agencies, and the leadership team has thoroughly investigated. Learning outcomes have been identified and are being implemented to prevent future errors. Staff say that the new system is much safer.

p.5

Overall experiences and progress of children and young people: inadequate

Young people have access to education on-site and all attend regularly. School and care teams work closely together. However, a lack of continuity in school, particularly regarding staffing, has led to young people experiencing a number of changes to their education. This can be unsettling and confusing for them. Furthermore, the changes in school staff have added extra pressures for the care team. A member of staff said: ‘Young people were not coping with the changes implemented in school. It was just incident after incident that we were dealing with, and we had few skilled staff to deal with them.’ Inspection report children’s home: SC020193 6 Young people like living in this home and say that they like the staff. They like their rooms, which are highly personalised. Pictures of young people, their families and activities they have participated in adorn the walls. This gives the environment a more

p.5

Overall experiences and progress of children and young people: inadequate

homely feel. It is clear that staff have positive, warm and nurturing relationships with young people. Most young people make good progress around their personal care skills, behaviour and independence skills. A contract monitoring visitor said: ‘We were pleased to see the young person looking so happy, healthy and comfortable in his accommodation. His detailed care plan shows that he has made great progress in the time he has been with you.’

p.6

Overall experiences and progress of children and young people: inadequate

Young people are registered with the local doctor, dentist and optician. They also have access to mental health services. They attend their healthcare appointments. Staff use social stories to support them with their appointments. One young person is significantly healthier as a result of a healthy diet and regular exercise. Young people also have access to a range of therapists, ensuring that their unique and complex emotional and physical health needs are fully met. The employment of a health promotions manager has been a positive step, and has been fundamental in devising and implementing a more robust and, therefore, safer medication system.

p.6

Overall experiences and progress of children and young people: inadequate

Young people are prepared well for moving into the home, and when they leave, as well as moves within the service. A social worker said about a child who has recently moved into the home: ‘Before he came, there was a thorough assessment of his needs, which included visits to his school, his parents and his respite placement to gather information. He then had two overnight stays before moving in. His mum has also visited. Staff are keeping mum informed of how he is settling and sending her lots of pictures.’

p.6

Overall experiences and progress of children and young people: inadequate

Life skills are promoted and are helping young people to successfully make the transition into adulthood. A residential manager said: ‘I want to send young people off equipped for adult life.’ Communication aids are individual and creative when used by trained staff. This helps to ensure that young people are able to communicate their thoughts, feelings and choices.

p.6

Overall experiences and progress of children and young people: inadequate

Helping young people to understand themselves and the world around them is important work that staff carry out. For example, a range of techniques are used to help young people better understand how their body works as they move into adolescence. An example of this is a young person who was taught how to shave through modelling and desensitisation.

p.6

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

Staffing levels are not always at the level defined in care plans. For example, two young people, who should have a member of staff each to support them, will regularly have one member of staff caring for them both. This became an issue as they were delayed from evacuating a building when the fire alarm sounded as one of the young people refused to leave his room. A lack of coordinated response from staff meant that the lives of staff and young people were put at risk. Fortunately, the fire alarm was sounded due to maintenance work and not a fire. Inspection report children’s home: SC020193 7 Furthermore, some staff were not going to evacuate one young person. They were heard saying that he would be ‘difficult to get back into the home’. A manager intervened and the young person was evacuated. Again this would have placed him and the staff at significant risk of harm had there been a real fire.

p.6

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

Personal emergency evacuation plans (PEEPs) are brief and do not support staff to keep young people safe in the event of a fire. For example, plans inform staff to use a two- person guide if the young person refuses to leave. The young person should have a member of staff supporting him, but regularly shares a member of staff with another young person. Therefore, there are insufficient staff to implement the plan. Further, there is no contingency plan for young people who refuse to leave the building in the event of a fire alarm sounding. This means that on the three occasions the fire alarm sounded during the inspection, one young person was left in the building with staff trying unsuccessfully to encourage him out. If this had been a real fire, both staff and the young person would have been at serious risk of harm. The registered manager was asked to review the PEEPs for these young people before the end of the inspection. They

p.7

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

Staff are not confident to whistle-blow. They do not feel valued or listened to, and some staff say that nothing gets done anyway when they have reported safeguarding concerns. The leadership team has recognised this and has organised further training. The impact of this is yet to be seen.

p.7

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

On one occasion, staff did not follow safeguarding procedures when they noticed bruising on a young person, for which no explanation was apparent. Although they recorded the concerns at the time, they did not escalate them to the appropriate people. This prevented a prompt investigation of what could have constituted a safeguarding concern.

p.7

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

Vetting procedures for permanent staff protect young people from unsuitable adults working with them. However, the same robustness is not applied to agency workers. This means that unsuitable adults could be working with young people.

p.7

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

Child protection reporting systems are good and help to protect young people when used appropriately by staff. Through this process, allegations against staff and concerns about young people are thoroughly investigated. Learning points are identified and implemented. The safeguarding manager is one of a number of senior leaders trained to fulfil the designated safeguarding role. This means that there is usually someone appropriately trained on duty to manage safeguarding concerns as they are reported. The safeguarding manager works well with other agencies and regularly contacts the designated officer for the local authority for advice and guidance.

p.7

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

Positive behaviour is promoted. Staff have access to pertinent information about young people’s behaviour and how to support them when they are anxious. Some young people learn to self-regulate their behaviour. When young people are feeling anxious or angry, staff remain calm and follow their Inspection report children’s home: SC020193 8 individual plans to help de-escalate the situation. Physical intervention is used regularly, but leaders review patterns and trends and can demonstrate a reduction in the use of physical intervention for most young people over time.

p.7

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

Staff retention is poor. Furthermore, there is a high level of staff sickness. This means that young people do not always have sufficient staff allocated to them to ensure safe care.

p.8

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

A new management structure was implemented earlier in the year. This introduced a new line of management: residential managers. Staff complain that residential managers are not available for them. Residential managers feel that they struggle with their workload, which has included responding to issues within the school. This has put them under a lot of pressure, and on occasions management duties are not completed. This includes the formal supervision of staff, which is not occurring regularly or of a good enough quality. Supervision is critically important due to staff feeling unsupported by managers.

p.8

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

Staff morale is low. This has caused negativity and stress, leading to a high level of sickness. Staff want to provide good care for young people. However, they feel hampered by the leadership team. Staff have resigned their posts across the service, particularly in education, resulting in a lack of continuity for young people.

p.8

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

Staff attend appropriate training in the main. However, some young people communicate by using a signing system that staff are no longer trained to use. This means that new staff currently do not have the skills to communicate effectively with some young people. There are plans to reintroduce this valuable training to improve communication with young people.

p.8

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

Staff are passionate about providing good care for young people but feel frustrated about the current situation. They feel that young people are not receiving the care they deserve. This is due to poor staffing levels and the skills and experience of new staff.

p.8

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

Leaders advocate well on behalf of young people. They challenge placing authorities and other professionals in the interests of young people.

p.8

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

The leadership team is aware of the issues identified during this inspection and has plans to address the significant shortfalls. The leadership team has demonstrated that it can learn lessons from complaints and incidents. Its members have implemented changes to improve service delivery and safety, such as improving the induction of new staff with a real focus on retaining them.

p.8

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

The registered manager is very experienced and suitably qualified. He is reflective and has recognised where things have gone wrong and what he needs to do to improve the service. He uses data effectively to track patterns and trends, and to inform plans to improve the Inspection report children’s home: SC020193 9 service and outcomes for young people. He has a good understanding of the strengths and weaknesses of the home. Improvements are planned, but these have yet to be fully implemented and embedded.

p.8

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.

p.9

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: SC020193 10

p.9

Children’s home details

Provision sub-type: Residential special school

p.10

Children’s home details

Registered provider: The SENAD Group Limited

p.10

Children’s home details

Registered provider address: SENAD Group Ltd, 1 St. Georges House, Vernon Gate, Derby DE1 1UQ

p.10

Inspectors

Joanne Vyas, social care inspector Rachel Griffiths, social care inspector Inspection report children’s home: SC020193 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.

p.10

Inspectors

If you would like a copy of this document in a different format, such as large print or Braille, please telephone 0300 123 1231, or email enquiries@ofsted.gov.uk . You may reuse this information (not including logos) free of charge in any format or medium, under the terms of the Open Government Licence. To view this licence, visit http://www.nationalarchives.gov.uk/doc/open-government-licence , write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: psi@nationalarchives.gsi.gov.uk .

p.11

Inspectors

Interested in our work? You can subscribe to our monthly newsletter for more information and updates: http://eepurl.com/iTrDn .

p.11

Inspectors

T: 0300 123 1231 Textphone: 0161 618 8524 E: enquiries@ofsted.gov.uk W: http://www.gov.uk/ofsted

p.11