Children's home run by Care Management Group Limited in Mole Valley

Inspection report children’s home: SC037152 1 SC037152 Registered provider: Care Management Group Limited

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Inspected under the social care common inspection framework

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Information about this children’s home

This is a privately run home. It provides care and accommodation for up to five young people who have autistic spectrum disorder and/or special needs and learning difficulties. Because of the complex needs of the four children currently placed at the home, the company does not propose to admit any further children for the immediate future, and this has been the case for the past three years. Currently, two children live at the home full-time and two have shared care between the home and their parents.

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Overall experiences and progress of

children and young people, taking into account

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good

How well children and young people are helped and protected good

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good

The effectiveness of leaders and managers requires improvement to be good

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good

The children’s home provides effective services that meet the requirements for good.

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good

Overall judgement at last inspection: Improved effectiveness

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Enforcement action since last inspection

None Inspection report children’s home: SC037152 2

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Key findings from this inspection

 Children experience stability and continuity of care; some have been living at the home for over four years.

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Key findings from this inspection

 Staffing levels are high, ensuring that children receive one-to-one care.

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Key findings from this inspection

 Children receive high quality care from staff who understand their complex needs.

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Key findings from this inspection

 There is easy access to a number of resources on the home’s site. Children can access a swimming pool, a soft play area, a ball pool and a sensory room.

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Key findings from this inspection

 The home environment has improved greatly in the last six months. New floors have been fitted and the bedrooms are in the process of redecoration.

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Key findings from this inspection

 Senior managers support the registered manager to fulfil her role. She has organised and implemented improved systems to ensure the smooth running of the home.

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Key findings from this inspection

 There are excellent working relationships with children’s schools, parents and social workers.

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Key findings from this inspection

 Despite children’s complex needs, the staff team ensures that they take them away on a holiday during the summer break.

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Key findings from this inspection

The children’s home’s areas for development:

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Key findings from this inspection

 Staff supervision and yearly appraisals require more consistency to ensure that they support staff to do a good job.

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Key findings from this inspection

 Staff would benefit from training on the risks of radicalisation and child sexual exploitation.

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Key findings from this inspection

 Leaders and managers do not chase placing authorities to provide care and pathway plans for children.

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Key findings from this inspection

 The safeguarding policy and procedures should include responses to all risks, including the risk of radicalisation, sexual exploitation, e-safety, self-harm and risk of suicide. Inspection report children’s home: SC037152 3

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Inspection date Inspection type Inspection judgement

27/03/2017 Interim Improved effectiveness 01/11/2016 Full Requires improvement 15/03/2016 Interim Sustained effectiveness 28/10/2015 Full Requires improvement Inspection report children’s home: SC037152 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 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.

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Recommendations

 The registered person should ensure that staff can access appropriate facilities and resources to support their training needs, and should understand the key role they play in the training and development of staff in the home, specifically in relation to the risk of radicalisation and child sexual exploitation. (‘Guide to the children’s homes regulations including the quality standards’, page 53, paragraph 10.11)

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Recommendations

 Ensure the policy on protection of children from abuse and neglect should include arrangements in relation to dealing with e-safety, any form of exploitation and to counter risks of self-harm and suicide. All polices should be reviewed regularly and revised where appropriate. (‘Guide to the children’s homes regulations including the quality standards’, page 44, paragraph 9.19)

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Recommendations

 Ensure the registered manager challenges any placing authority who asks them to accept a child in the absence of a complete and current relevant plan, as the expectation that a placement of a child without the necessary information would go ahead is inadequate in relation to their role. It is essential that homes understand what will be required of them before they accept responsibility for a child’s placement, to avoid disruption and instability for the child in future and for other children in the home. (‘Guide to the children’s homes regulations including the quality standards’, page 56, paragraph 11.5)

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Recommendations

 Ensure the home’s records on each child represent a significant contribution to Inspection report children’s home: SC037152 5 their life history. Staff should understand their important role in encouraging the child to reflect on and understand their history, according to their age and understanding. Staff should keep and encourage children to keep appropriate memorabilia of the time spent living at the home and help them record significant life events. (‘Guide to the children’s homes regulations including the quality standards’, page 62, paragraph 14.5)

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Overall experiences and progress of children and young people: good

Children have well-thought-out and individual placement plans. These provide excellent details of every aspect of the children’s day-to-day care. All children living at the home have high level needs, which require staff to be up to date and aware of any changes. Regular updates on placement plans give staff all necessary information to ensure that they can give the best possible quality care.

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Overall experiences and progress of children and young people: good

The home is very good at understanding children’s needs and updating its placement plans according to changes in their needs. However, it does not yet have copies of all the children’s placing authority care or pathway plans. The placing authority care or pathway plans should inform the home’s placement plans. This would ensure that the staff understand the desired outcomes for the children and help with target-setting and meeting goals. Leaders and managers at the home are not responsible for deciding what the children’s care plans should be, but they do have a responsibility to chase the placing authority to ensure that this information is made available.

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Overall experiences and progress of children and young people: good

All the children living at this home have benefited from stable and consistent placements. Some have been staying or living here for six years and all of them for more than three years. This consistency and stability helps children feel safe and secure in their home. One parent says, ‘It has been a lovely home, a very good and stable placement for him.’

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Overall experiences and progress of children and young people: good

Children can make choices about their home, such as the decoration and personalisation of rooms, choosing clothing items and involvement in deciding where they would go on holiday or what they would like to eat. Staff know the children well; they understand their needs, moods and wishes, despite communication difficulties. This knowledge, and staff’s desire to understand, avoids frustration and resulting negative behaviours. Understanding what children want helps predict likely triggers for behaviours and avoids situations escalating, keeping children calm and happy.

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Overall experiences and progress of children and young people: good

All the children have enjoyed a lovely break this summer holidays. The manager and staff team worked hard to make this happen, organising children going away at different times to ensure that there was enough capacity to care for and keep them safe. On holidays, children enjoyed trips to the beach, arcades, walks, dressing up and going out to sing and dance. Children who preferred to be quieter went separately and were helped to keep routines despite being away. Inspection report children’s home: SC037152 6 Staff take many photographs of children completing day-to-day tasks or when they go out and about on activities or holidays. Although staff keep these records for children, it would be beneficial for children to have these collated into life-story books or memory boxes to ensure that memories, dates and funny anecdotes are remembered and kept for the future.

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Overall experiences and progress of children and young people: good

A strength of this staff team is its capacity to work with parents. Organising shared care for two of the children, who have complex care needs, can be a challenge for both the staff and the parents. This is managed well. An effective communication book helps both parents and staff understand needs and provide continuity of care. The communication books also help inform schools about any important information, dates or events which affect the children. This all helps to ensure smooth transitions between the home, school and parents’ care. One commissioning social worker stated, ‘They work well with parents, they are always well informed.’

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Overall experiences and progress of children and young people: good

Staff have the help of a communication document for each child, which is an excellent document and a great tool for staff. It includes the children’s likes, dislikes, methods of communication, diagnosis and other important information. This allows staff to access information quickly and ensure that children’s needs are met. Working documents are translated for children via picture exchange communication systems (PECS). This enables children to easily access information about their care, choices, targets and other important aspects of their care. Regular sharing of these documents with children in key- work sessions and residents’ meetings helps them to understand.

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Overall experiences and progress of children and young people: good

Children continue to make progress living in this home. For example, some of the children have lost weight through good partnership with the dietician and following a healthy eating and exercise plan. Staff encourage children to make healthy choices and try new foods. Often simple changes are significant for children and their families. For example, having fewer outbursts of behaviours, managing feelings better, doing well in school and making simple choices when out shopping are excellent signs of progress. One parent spoken to said, ‘He has become more independent and his behaviour has stabilised.’ The noticeboard in the entrance hall of the home depicts lovely pictures of the children enjoying recent activities and displays artwork and certificates awarded in school. All these things help children feel a sense of achievement and show them that staff have pride in what they do. One of the children’s social workers spoken to said, ‘He

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Overall experiences and progress of children and young people: good

has made progress in communication and skills in everyday living.’

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Overall experiences and progress of children and young people: good

All the children are on roll in education, and staff encourage them to be organised and in good routines during term-time. There has been an increase in one child’s attendance at school from 81% to 93.2%. This increase has coincided with a carefully managed withdrawal from prescribed medication.

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Overall experiences and progress of children and young people: good

The registered manager ensures that complex health needs are managed well. All staff complete mandatory first-aid training. In addition, more specialist training on how to manage epilepsy and how to administer emergency treatment in the event that a child has an epileptic fit is also available. Only trained staff administer medication, and good records indicate careful management by staff and oversight by the manager via a Inspection report children’s home: SC037152 7 monthly audit. Routine health checks, including dental and optician appointments, take place, and children who require regular blood tests now have these done at the home by a visiting phlebotomist. This has reassured children and made this process routine instead of an appointment attending the hospital.

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Overall experiences and progress of children and young people: good

Children have consistent routines. This helps them to feel safe and settled. Regular mealtimes, activities and school routines all support children to understand the structure of their days. Staff regularly reinforce routines with clear, simple instructions, which they repeat consistently. This helps children keep calm and focused on what to expect. Staff create and use social stories for more complex changes and transitions, such as a change of school or to explain shared care. These social stories, shared via PECS, help children to understand what is going to happen, when and what they can expect.

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

All the children have individual risk management plans, which identify known and potential risks. The organisation shares the relevant parts of the completed risk assessments with their positive behaviour support team (PBS). The PBS then provides positive behaviour support plans for each individual child. These plans provide staff with clear, simple strategies to manage behaviours and help to de-escalate situations. Staff regularly update risk assessments every six months, or sooner if new behaviours or risks appear.

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

Staff understand children’s vulnerability when outside of the home. Some of the children have no sense of danger and require constant supervision by staff. The staff ratio is always a minimum of one-to-one and sometimes higher when out in the community. Individual risk assessments identify restrictive practices. For example, the home has a biometric system on external doors, operated by fingerprints or code. This prevents children from leaving the home without staff knowledge or supervision. Older and more able children have a capacity assessment to test their understanding of risk and restrictive practice. This high level of supervision and monitoring ensures that no children have gone missing from the home or while out on activities in the community.

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

Children benefit from key documents designed to promote safeguarding. Although staff spoken to felt confident to report any safeguarding issues and are aware of the whistleblowing policy, clearer guidance on actual process, including helpful contacts, would support this process. The child protection policy does not yet have sections included about child sexual exploitation, risks of radicalisation, e-safety, self-harm and risk of suicide. Covering these areas in the policy and guidance will support staff to identify such risks and take appropriate action if needed.

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

The registered manager has systems in place to ensure that recording of incidents takes place and that the regulator is notified of incidents if necessary. Staff understand the vulnerability of the young people they work with and are extra vigilant to ensure their safety. For example, body maps are completed when children arrive for shared care and when they go home. This ensures that any injury, however minor, is recorded with its cause. Contact is made immediately with parents and placing authorities if there is any Inspection report children’s home: SC037152 8 accident or illness while children are in shared care.

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

A committed staff team offers clear boundaries for children. They receive training in managing challenging behaviour and work together as a team to ensure that clear and consistent boundaries are given. Restraint is rarely used in this home. However, there is always a staff member on shift who is trained in case this is required.

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

The registered manager regularly undertakes a thorough review of the safety of the home, including the local area surrounding the home and any risks this may present to children. For example, the home is based on a site with other adult service provision, and some of the resources, such as the swimming pool and sensory room, are available to all on the site. Careful risk assessments of the children’s use of such resources helps to keep them safe. The local fire service recently completed an annual risk assessment of fire risks at the home, which helps to keep potential risks to a minimum. All the children have safety evacuation plans in the event of a fire and regular fire drills help them to understand how to leave the home in an emergency.

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

The registered manager has a training log that helps her to ensure that all mandatory training is completed. If bank staff do not complete essential training, the system picks this up and advises the registered manager. The human resources team writes to staff to advise that they will not be offered further shifts until mandatory training is complete. This ensures that all staff have the necessary skills to keep children safe. The staff team would benefit from additional training on the risks of radicalisation and child sexual exploitation. Although these are touched on within the general safeguarding training, further training and guidance will help staff keep children safer from potential risks.

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

The improvements to the home environment have continued since the interim inspection in February 2017. There is new flooring in the hall, downstairs lounge, stairs and the landing. Decorating took place while children went on holiday. Prior to going away, the children chose colours they wanted their rooms painted. This involved the use of social stories and many reminders while they were away about what changes to expect on their return. Staff took photographs of the children’s rooms, so that they could put furniture and ornaments back in exactly the same place to ensure that children did not feel disrupted. This demonstrated staff’s capacity to understand the children’s needs and ensure that the rooms’ decoration caused the least distress possible.

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

Robust staff recruitment processes are in place. This protects children from exposure to unsafe people working in their home.

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

A suitably qualified registered manager has been in post for the past 16 months, but has also worked for the organisation in a variety of care roles over the years. The registered manager is part way through completing the level 5 diploma in leadership and management and is aware of the relevant date for completion.

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

Three recommendations made at the interim inspection have been met, showing the Inspection report children’s home: SC037152 9 capacity of the manager to take on advice and improve the service. These recommendations included improvements to how the leaders and managers record and share information, restraint training for staff and case recordings.

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

Following a year in which the manager was distracted and side-tracked into other parts of the service, it feels as if the home has been back on track to improvement in the last six months. The manager is leading more effectively and has systems put in place to measure and show improvements. For example, a comprehensive action plan has helped leaders and managers to identify areas for improvement more effectively and work through these methodically. The manager has a mentor to support her own personal development and management skills. Staffing levels are increasing and the manager is developing confidence in her role. This is evident in delegating tasks to team members and recruiting a deputy manager to support staff supervision.

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

Staff enjoy working at this home and say that they feel well supported. The personalities at the home are friendly and informal support is present. However, formal systems to ensure regular supervision and yearly appraisal are not yet consistent. Regular appraisals would help staff to develop skills and ensure that poor practice is addressed quickly. Regular supervisions ensure that the managers have an overview of staff practice and help staff to be reflective and take guidance on complex issues. Although there is no direct impact on children at present, without consistent systems to monitor staff practice and development the manager will not have an overview on how well they function as a staff team.

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

Leaders and managers are aware of the shortfalls and this is positive, as they are already creating action plans to continue improvement. The registered manager completes a review into the quality of care at the home, which identifies areas for improvement. This review is a regular six-monthly report, which is helping the home to identify areas for ongoing development.

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

There have been a number of changes to the staff team, with two new members of staff starting recently. These staff told the inspector that they found their induction ‘helpful’ and ‘informative’. Regular team meetings help staff to feel part of the team. Staff regularly discuss children’s needs at staff meetings to ensure that information is shared. This helps new staff to learn about the children they care for and which strategies staff find most effective when dealing with behaviours. It can take new staff some time to learn how to manage children’s individual needs and the manager is careful to ensure that more experienced workers support new staff on shifts.

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

Leaders and managers know the children well and there are obvious positive relationships. They understand the children’s need for constancy and stability. For this reason, no further children will be admitted to this home in the near future. This is because of the complex needs of the current children and the likely negative impact that introducing any other children into the home would have. This decision is child-focused and demonstrates the organisation’s commitment to the existing residents in the home.

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

An independent visitor regularly monitors what goes on in the home and reports directly Inspection report children’s home: SC037152 10 to Ofsted every month. These reports have improved in their analysis and are reflecting an impartial view of the home’s arrangements for safeguarding and promoting the welfare of the children in the home’s care. In what has been traditionally an adult- orientated organisation, this independent view is helping the manager to improve the home.

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

Overall, the home is working within its intended purpose. However, managers must ensure that staff support meets the objectives set out.

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

The leaders and managers have positive relationships with the host borough and the staff team works well with professionals and parents to ensure that children’s needs are met. The registered manager has also developed a good working relationship with the police neighbourhood team, which regularly visits the home and site.

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Information about this inspection

Inspectors have looked closely at the experiences and progress of children and young people. Inspectors considered the quality of work and the difference made to the lives of children and young people. They watched how professional staff work with children and young people and each other and discussed the effectiveness of help and care provided. Wherever possible, they talked to children and young people and their families. In addition, the inspectors have tried to understand what the children’s home knows about how well it is performing, how well it is doing and what difference it is making for the children and young people who it is trying to help, protect and look after.

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Information about this inspection

Using the ‘Social care common inspection framework’, this inspection was carried out under the Care Standards Act 2000 to assess the effectiveness of the service, how it meets the core functions of the service as set out in legislation, and to consider how well it complies with the Children’s Homes (England) Regulations 2015 and the ‘Guide to the children’s homes regulations including the quality standards’. Inspection report children’s home: SC037152 11

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Children’s home details

Registered provider: Care Management Group Limited

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Children’s home details

Registered provider address: The Care House, Randalls Way, Leatherhead, Surrey KT22 7TW

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Inspector

Christine Kennet, social care inspector Inspection report children’s home: SC037152 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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