Children's home run by Thoughts of Others Limited in Birmingham

Inspection report for children's home - monitoring visit: SC484716 1 SC484716

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Thoughts of Others Ltd

Monitoring visit Inspected under the social care common inspection framework

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Information about this children’s home

This private children‟s home is registered to provide care and accommodation for up to six children who have emotional and/or behavioural difficulties.

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This monitoring visit

This children‟s home was judged inadequate at the full inspection on 5 and 6 July 2017.

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This monitoring visit

Following the inspection, Ofsted issued 18 compliance notices. These were in respect of:

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This monitoring visit

 Poor risk management of children who may go missing.  Ineffective systems for managerial monitoring, review and improvement.  Weaknesses in staff response to suspected illegal drugs on the premises.  Unsafe staff vetting and recruitment checks.  A lack of staff consistency.  Insufficient staff training and checks on staff competence.  Poor staff supervision.  Unsafe administration of medication.  A lack of response to children‟s and parents‟ complaints  Weaknesses in the statement of purpose.  A lack of clarity in policy, procedure and staff practice about the use of restriction and restraint.

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This monitoring visit

In order to evaluate the progress that the managers and staff have made in Inspection report for children's home - monitoring visit: SC484716 2 addressing these concerns, a monitoring visit was undertaken on 17 August 2017. This home has not had a registered manager since September 2016. A manager has now been appointed and started work on 7 July 2017.

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This monitoring visit

The registered person has taken some action to meet elements of the compliance notices. However, only six of 18 compliance notices are judged to be met at this monitoring inspection.

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This monitoring visit

At the previous inspection in July 2015, Ofsted found that staff had failed to ensure that one child was adequately prepared for time out of the home on his own. Risk management documents and key-work records to support the child‟s independence lacked detail. The weakness in preparation and staff insight into the potential risks resulted in the child becoming missing and getting involved in a serious incident.

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This monitoring visit

The registered person has not improved any of the children‟s risk assessments to ensure that they are up to date and known to the staff team. Some staff have insufficient knowledge about specific locations that may increase risk for one child. For example, one member of staff told the inspectors that, „All staff should know about stuff to keep him safe.‟ The staff member also commented that they were unsure how they should manage children‟s unescorted time out of the home. Consequently, staff still do not have guidance in managing and responding to risks for children who may be subject to sexual exploitation or go missing from care.

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This monitoring visit

The registered person reviewed the incident when the child went missing and identified some areas to improve practice, notably the records. However, the registered person has not taken the action they identified. The manager did share a memo with staff to remind them to report children to the police if they go missing. However, this detail is completely missing from the child‟s individual care plan. There was no evidence of any other action subsequent to the review to improve the staff‟s implementation of the home‟s policy for missing children in relation to individual children. Children‟s individual details have still not been shared with local police. This is an ongoing missed opportunity to share information with partner agencies to help safeguard children.

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This monitoring visit

Some action has been taken to meet five compliance notices in respect of leadership and management. However, the pace of improvement is slow. Since the home‟s registration in May 2015, the registered person has not managed to establish good leadership that delivers improvement.

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This monitoring visit

57 different staff currently work here. Out of the 57 staff, only 20 are classed as core staff. The manager does not have managerial responsibility for the majority of staff, who are described as „pool staff‟. They come from different homes in the organisation. Some staff do not know which colleagues are on their „core staff‟ team. The manager delivers key messages about care practice by memo, because Inspection report for children's home - monitoring visit: SC484716 3 she does not manage, or supervise, the majority of staff. There is an absence of staff meetings at the home to ensure that staff are familiar with the statement of purpose. This means that the manager has very little opportunity to influence staff practice or ensure that all staff are delivering any revisions to children‟s care.

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This monitoring visit

The registered person has not evaluated that the staffing model delivers continuity of care to each child. The responsible individual told inspectors that he now accepted that the staffing model results in too many different staff working with children. On the day of the inspection, the registered person completed a statistical analysis of the numbers and care hours at the home over a 47-day period. This shows that core staff do work the majority of hours needed to staff shifts. However, staff report working between 50-70 hours a week to ensure this. There is not yet a comparator to show whether the picture of continuity is improving, so that the number of pool staff can be reduced.

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This monitoring visit

The registered person told inspectors that they had responded to children‟s requests for more time with their key staff. However, the registered person has not asked children about their experience of the number of people caring for them. The registered person has not yet evaluated patterns and trends of staff turnover, but reports that they plan to.

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This monitoring visit

The registered person has still not delivered staff training relevant to children‟s needs, or assessed staff competence. However, they have devised a new staff- training programme. This includes training on self-harm, epilepsy, and what to do when children go missing from care. So far, 14 of the 20 core staff have completed training in the care of medication, self-harm and an introduction to autism spectrum disorder. Four staff have now done online training in preventing extremism and radicalisation. However, some staff are not familiar with common terms like „CSE‟, and do not know the circumstances when they would administer „as and when required‟ medication for behaviour management. The registered person has not assured or assessed staff competence, because supervision is not regular or good enough. The organisation operates a very long probationary period and the registered person does not make a decision for two years about

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This monitoring visit

whether staff are sufficiently competent to be permanently employed.

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This monitoring visit

Managerial monitoring and review systems are still not effective. The registered person produced an action plan after the last inspection and shared this with the four placing authorities, but has not yet sent this to Ofsted. This plan has not been successful in driving improvement at the pace required by the compliance notices, or in those areas of most significance: risk and behaviour management. Similarly, there is no external scrutiny of children‟s welfare or safety. The previous independent visitor has been appointed as the manager. The registered person described a plan to create a data collection system that they hope will show them the quality of care in the home. However, it is not planned to include the managerial analysis or input. Inspection report for children's home - monitoring visit: SC484716 4 The registered person has not consulted with children about the impact that the quality of care is having on their experience at the home. Ofsted asked the

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This monitoring visit

registered person to review previous placement endings and record lessons to inform future admissions and to learn from placement breakdown. The registered person has not done this.

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This monitoring visit

Key staff talk to children about their issues in regular sessions, as they have always done. However, there have been no house meetings or any focus on children‟s views to inform the development of the home after the inadequate judgement in July 2017. There is no detailed improvement plan that incorporates children‟s views. When reviewing the service, the registered person still does not take heed of children‟s views and their direct testimony.

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This monitoring visit

The registered person has improved the behaviour management policy. This now sets out the measures of control, discipline, and restraint that staff may use in relation to children. However, staff do not implement the policy. This has not been picked up by managerial scrutiny.

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This monitoring visit

Despite a low number of measures of control, restraints and sanctions since the last inspection, the registered person is still not reliably monitoring the practice or the records. The registered person did not review one of the four restraints. They did not follow up on another when they identified an issue about insufficient detail regarding a restraint that took place on a bed. Some reports still do not show which staff held what part of the child‟s body. The registered person does not ensure that staff always have an individual debrief.

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This monitoring visit

Staff impose limitations on children‟s access to the kitchen in the house. Staff do this as a sanction in response to threats or actual violence towards others, even when the incident has not happened in the kitchen. This type of sanction is not part of the new behaviour management policy. It is inconsistent with the description of reparations and a learning, positive approach to sanctions. The manager does not review this limitation on access to ensure that this measure of control is necessary and proportionate. This measure of control does not always relate to an increased level of risk, as all knives and potentially dangerous kitchen implements are locked away. The records of three such sanctions and limitations do not meet regulation. For example, they do not describe the effectiveness or the consequences. Records show that staff do not give children an opportunity to reverse the sanction, or a chance to make reparation. Children object to the

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This monitoring visit

limitation. One told the staff, „I‟m 14. I should be allowed in my kitchen.‟

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This monitoring visit

Despite an increased number of staff trained in administration of medication, errors persist. Staff do not understand when they should administer medication needed on an „as and when required‟ basis to manage children‟s behaviour. Records show that staff have not given children medication on several days. This means that the registered person‟s system to routinely check medication, identify discrepancies and rectify errors is still unsafe. Inspection report for children's home - monitoring visit: SC484716 5 A member of staff from this home is alleged to have sexually abused a child at another home, prior to the last inspection. The local designated safeguarding officer had advised the registered person about their responsibility to share safeguarding information about dismissed staff in the references they give to future employers. The organisation has still not learned from this. Staff responsible for recruitment, although trained, still do not appropriately apply

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This monitoring visit

recruitment procedures or promote the safety of children. They did not verify the reasons for one newly employed member of staff‟s dismissal by their previous employer. This means that unsuitable people may have contact with children.

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This monitoring visit

Ofsted previously issued a compliance notice in July 2016 about infrequent and ineffective staff supervision. The registered person has still not delivered individual supervision at the frequency detailed in the statement of purpose of one supervision every eight weeks. Nine of the 20 core staff have not had supervision for over two months. This issue has been a persistent regulatory failure. This failure does not address the complex and stressful nature of the work staff do with children, and whether staff are fit for it.

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This monitoring visit

The council‟s planning department has advised Ofsted that a condition attached to the original planning consent means that the house can only accommodate six people, including children. The registered provider currently exceeds this, with four children and five or six staff at the home. The registered person has still not provided evidence of planning permission for the recent extension, or that the building is safe. Ofsted had referred this issue to the fire service, to the council‟s planning department and to the building control surveyor. The registered person reports that representatives from the fire authority have recently visited and have no concerns.

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This monitoring visit

The registered person has taken action to meet five compliance notices. Children‟s liberty and movements are not now restricted. From the information available it appeared that restraints have been necessary and proportionate, and were to prevent harm to the child or others, or serious damage to the home. No child has been prevented from leaving the home. One or two staff still closely supervise each child. However, one child, who had previously found this restrictive, told inspectors, „It‟s got better, it‟s cool, I‟m happier.‟

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This monitoring visit

The registered person has recently revised and updated the statement of purpose, and it is available to staff. The statement of purpose now better describes how the available bedrooms are used as living rooms. It is clear about the numbers of staff at the home overnight, that there is no classroom and about restrictions of children‟s movement.

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This monitoring visit

The statement of purpose now better describes the qualifications of therapists available to children at the home. Further detail is required to make clear the arrangements for their professional supervision. A new requirement is made to Inspection report for children's home - monitoring visit: SC484716 6 make clear that the learning disability nurse described in the behaviour management policy is registered as a nurse, and to include the arrangements for her professional supervision.

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This monitoring visit

Staff are now clear about the difference between a complaint and an allegation. Children say they know there is a new system for their complaints, and that they can easily obtain a complaints form. The system is untested, but there is better awareness between staff and children.

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This monitoring visit

Children‟s records are improving. The practice of updating records by backdating them no longer happens. Children‟s records are now securely stored in the staff office and are not left for other children or visitors to see.

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This monitoring visit

The new manager has made contact with local police with the intention of seeking advice about illegal drugs and strengthening partnerships. However, they have not met yet. Some rooms have been improved, curtains are now hung properly and damage has been repaired. Staff now have two bedrooms to sleep in overnight. The third member of staff who sleeps over is still using a pull-out mattress and a sleeping bag in one of lounges. One child told inspectors this did not disturb them.

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This monitoring visit

There have been no more children admitted to the home. There have been no serious incidents since the last inspection. One child told inspectors that they, „get to say their thing‟ at meetings with key staff. Two members of staff told inspectors that they felt things were better at the house, including better arrangements for files and paperwork.

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This monitoring visit

The new manager has begun to make changes to implement the registered person‟s action plan. Improvements to policy and documentation are not yet tested, or embedded into care practice. This is the first time the organisation has not required the manager to work on shift. The registered provider has shared their plan for improvement with placing authorities. The responsible individual and the manager told inspectors of further actions they planned to take.

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This monitoring visit

Despite this, the registered provider has not improved the critical areas of regulatory failure most linked to children‟s safety and staff support. This home is likely to be subject to further enforcement action. A full inspection will take place within 16 weeks of the full inspection on 5 and 6 July 2017.

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Recent inspection history

Inspection report for children's home - monitoring visit: SC484716 7 Inspection date Inspection type Inspection judgement 05/07/2017 Full Inadequate 09/11/2016 Full Requires improvement 26/07/2016 Full Inadequate 25/02/2016 Interim Declined in effectiveness Inspection report for children's home - monitoring visit: SC484716 8

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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

In meeting the quality standards, the registered person must ensure that staff seek to develop and maintain effective professional relationships with such persons, bodies or organisations as the registered person considers appropriate having regard to the range of needs of children for whom it is intended that the children‟s home is to provide care and accommodation. (Regulation 5(d)) 08/10/2017

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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; use this understanding to deliver care that meets children‟s needs and supports them to fulfil their potential. (Regulation 6(1)(a)(b) and (2)(c)(i)(ii))

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Requirement Due date

In particular, the standard in paragraph (1) requires the registered person to provide personalised care that meets each child‟s needs, as recorded in the child‟s relevant plans, taking account of the child‟s background; and ensure that the premises used for the purposes of the home are designed and furnished so as to meet the needs of each child; and enable each child to participate in the daily life of the home.

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Requirement Due date

In particular, carry out direct work to meet children‟s needs and ensure a welcoming, nurturing environment. 08/10/2017

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Requirement Due date

The health and well-being standard is that the health and well-being needs of children are met.

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Requirement Due date

In particular, the standard in paragraph (1) requires the registered person to ensure that staff help each child to achieve the health and well-being outcomes that are recorded in the child‟s relevant plans. (Regulation 10(1)(a) and (2)(a)(i)) 08/10/2017

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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. 08/10/2017 Inspection report for children's home - monitoring visit: SC484716 9 In particular, the standard in paragraph (1) requires the registered person to ensure— (a) that staff— (i) assess whether each child is at risk of harm, taking into account information in the child‟s relevant plans, and, if necessary, make arrangements to reduce the risk of any harm to the child. (Regulation 12(2)(a)(i))* 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.

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Requirement Due date

In particular, the standard in paragraph (1) requires the registered person to— (a) 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. (Regulation 13(2)(a)) * 08/10/2017

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Requirement Due date

The leadership and management standard is that the registered person enables, inspires and leads a culture in relation to the children‟s home that helps children aspire to fulfil their potential and promotes their welfare.

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Requirement Due date

In particular, the standard in paragraph (1) requires the registered person to— (c) ensure that staff have the experience, qualifications and skills to meet the needs of each child. (Regulation 13(2)(c))* 08/10/2017

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Requirement Due date

The leadership and management standard is that the registered person enables, inspires and leads a culture in relation to the children‟s home that helps children aspire to fulfil their potential and promotes their welfare.

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Requirement Due date

In particular, the standard in paragraph (1) requires the registered person to ensure that the home’s workforce provides continuity of care to each child. (Regulation 13(2)(e)) * 08/10/2017

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Requirement Due date

The leadership and management standard is that the registered person enables, inspires and leads a culture in relation to the children‟s home that helps children aspire to fulfil their potential and promotes their welfare.

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Requirement Due date

Understand the impact that the quality of care provided in the home is having on the progress and experiences of each child and use this understanding to inform the development of the quality of care provided in the home. (Regulation 13(2)(f))* 08/10/2017

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Requirement Due date

The leadership and management standard is that the registered person enables, inspires and leads a culture in 08/10/2017 Inspection report for children's home - monitoring visit: SC484716 10 relation to the children‟s home that helps children aspire to fulfil their potential and promotes their welfare.

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Requirement Due date

In particular, the standard in paragraph (1) requires the registered person to— (h) use monitoring and review systems to make continuous improvements in the quality of care provided in the home. (Regulation 13(2)(h))* The care planning standard is that children have a positive experience of arriving at or moving on from the home.

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Requirement Due date

In particular, the standard in paragraph (1) requires the registered person to ensure that arrangements are in place to ensure the effective induction of each child into the home. (Regulation 14(1)(b) and (2)(b)(i))* 08/10/2017

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Requirement Due date

The registered person must make arrangements for the handling, recording, safekeeping, safe administration and disposal of medicines received into the children‟s home. (Regulation 23(1))* 08/10/2017

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Requirement Due date

The registered person must recruit staff using recruitment procedures that are designed to ensure children‟s safety. (Regulation 32(1))* 08/10/2017

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Requirement Due date

The registered person must ensure that all employees receive practice-related supervision by a person with appropriate experience. (Regulation 33(4)(b))* 08/10/2017

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Requirement Due date

The registered person must prepare and implement a policy (“the behaviour management policy”) which sets out the measures of control, discipline and restraint which may be used in relation to children in the home. (Regulation 35(1)(b))* 08/10/2017

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Requirement Due date

The registered person must ensure that— (a) within 24 hours of the use of a measure of control, discipline or restraint in relation to a child in the home, a record is made which includes— (i) the name of the child; (ii) details of the child’s behaviour leading to the use of the measure; (iii) the date, time and location of the use of the measure; (iv) a description of the measure and its duration; (v) details of any methods used or steps taken to avoid the need to use the measure; (vi) the name of the person who used the measure (“the user”), and of any other person present when the measure was used; (vii) the effectiveness and any consequences of the use of the measure; and 08/10/2017 Inspection report for children's home - monitoring visit: SC484716 11 (viii) a description of any injury to the child or any other person, and any medical treatment administered, as a result of the measure; (b) within 48 hours of the use of the measure, the registered

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Requirement Due date

person, or a person who is authorised by the registered person to do so (“the authorised person”)— (i) has spoken to the user about the measure; and (ii) has signed the record to confirm it is accurate; and (c) within 5 days of the use of the measure, the registered person or the authorised person adds to the record confirmation that they have spoken to the child about the measure. (Regulation 35(3)(a)(i,ii,iii,iv,v,vi,vii,viii)(b)(i,ii)(c)) * The registered person must give notice in writing to HMCI, as soon as it is reasonably practicable to do so, if any of the following events take place or are expected by the registered person to take place — the premises of the home are significantly altered or extended. (Regulation 49(g)) 08/10/2017

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Requirement Due date

The registered person must ensure that the privacy of children is appropriately protected; children can access all appropriate areas of the children‟s home‟s premises; and any limitation placed on a child‟s privacy or access to any area of the home‟s premises—is intended to safeguard each child accommodated in the home; is necessary and proportionate; is kept under review and, if necessary, revised; and allows children as much freedom as is possible when balanced against the need to protect them and keep them safe. (Regulation 21(a)(b)(c)(i)(ii)(iii)(iv)) 08/10/2017

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Requirement Due date

The registered person must ensure that any person who works as a nurse at the home is a registered nurse. (Regulation 31(2)(b)) 08/10/2017

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Requirement Due date

*These requirements are subject to a compliance notice.

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Recommendations

 Ensure the design of the home should provide staff that sleep in the home overnight with appropriate accommodation and facilities to do so. („Guide to the children‟s homes regulations including the quality standards‟, page 17, paragraph 3.26)

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Recommendations

 Ensure arrangements that reflect the importance of safeguarding and promoting the welfare of children, including: clear policies in line with those from the LSCB for dealing with allegations against people who work with children. Such policies should make a clear distinction between an allegation, a concern about the quality of care or practice or a complaint. („Working together to safeguard children. A guide to inter-agency working to safeguard Inspection report for children's home - monitoring visit: SC484716 12 and promote the welfare of children‟, March 2015, page 54, paragraph 4)

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Recommendations

 Learn from Serious Case Reviews, which have repeatedly shown the dangers of failing to take effective action. Poor practice includes: failing to act on and refer the early signs of abuse and neglect; poor record keeping; failing to listen to the views of the child; failing to re-assess concerns when situations do not improve; sharing information too slowly; and a lack of challenge to those who appear not to be taking action. („Keeping children safe in education. Statutory guidance for schools and colleges‟, September 2016, page 9, paragraph 30)

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Recommendations

 Identify and provide appropriate opportunities for children to develop themselves in accordance with their wishes and feelings and as part of the home‟s plan for their care. Each child‟s talents and interests should be understood and nurtured, with children selecting activities based on their personal preferences and abilities, so far as is reasonable. Staff should also support children to try activities that are „new‟ for them, where appropriate. („Guide to the children‟s homes regulations including the quality standards‟, page 31, paragraph 6.4). Specifically, promote positive independent friendships, enjoyment and fun.

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Recommendations

 Consult children regularly on their views about the home‟s care, to inform and support continued improvement in the quality of care provided. Due consideration should be given to the child‟s cognitive ability in the development and implementation of any consultation processes. Children should be able to see the results of their views being listened to and acted upon. („Guide to the children‟s homes regulations including the quality standards‟, page 22, paragraph 4.11)

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Information about this inspection

The purpose of this visit was to monitor the action taken and the progress made by the children‟s home since its last Ofsted inspection.

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Information about this inspection

This inspection was carried out under the Care Standards Act 2000. Inspection report for children's home - monitoring visit: SC484716 13

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Children’s home details

Registered provider: Thoughts of Others Ltd

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Children’s home details

Registered provider address: Thoughts of Others, 99 College Road, Sutton Coldfield, West Midlands B73 5DL

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Inspectors

Christy Wannop, social care inspector Andrew Hewston, social care inspector Inspection report for children's home - monitoring visit: SC484716 14 to achieve excellence in the care of children and young people, and in education and skills for learners of all ages. It regulates and inspects childcare and children‟s social care, and inspects the Children and Family Court Advisory and Support Service (Cafcass), schools, colleges, initial teacher training, further education and skills, adult and community learning, and education and training in prisons and other secure establishments. It assesses council children‟s services, and inspects services for looked after children, safeguarding and child protection.

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Inspectors

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Inspectors

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Inspectors

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