Children's home run by RNIB Charity in Camden

Inspection report children‟s home: SC485607 1 SC485607 Registered provider: RNIB Charity

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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 large children‟s home that provides care and accommodation for up to 30 children and young people in five purpose-built bungalows. The children and young people have a visual impairment, a learning and/or physical disability and/or sensory impairment. One of the bungalows is also registered by the Care Quality Commission and provides a specialist service to children and young people with high health and medical needs who require long-term ventilation, or who have life-threatening or life- limiting conditions. The establishment is owned by a large national charity. The majority of the children and young people attend a registered school on the same site. Some young people remain at the home until the age of 19 to complete their education.

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Overall experiences and progress of

children and young people, taking into account

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requires improvement to be good

How well children and young people are helped and protected requires improvement to be good

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requires improvement to be good

The effectiveness of leaders and managers inadequate

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requires improvement to be good

The children‟s home is not yet delivering good help and care for children and young people. However, there are no serious or widespread failures that result in their welfare not being safeguarded or promoted.

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requires improvement to be good

Overall judgement at last inspection: declined in effectiveness

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Enforcement action since last inspection

Inspection report children‟s home: SC485607 2 None

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Key findings from this inspection

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

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Key findings from this inspection

 The registered manager does not make sure that young people‟s case files include all of the necessary information and documentation.

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Key findings from this inspection

 Staff do not seek young people‟s views or opinions in relation to the quality of care they receive.

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Key findings from this inspection

 Young people are not provided with a variety of activities to meet their needs.

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Key findings from this inspection

 Some staff use some restrictive practices that are not proportionate.

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Key findings from this inspection

 Staff do not receive regular supervision to help them develop their practice.

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Key findings from this inspection

 Some young people are provided with equipment and aids that have not been prescribed or reviewed properly by a professional.

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Key findings from this inspection

 Staff make sure that young people maintain regular and positive contact with their families. They provide young people with practical and emotional support to further these relationships.

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Key findings from this inspection

 Young people have access to a range of specialist facilities and equipment at the home. This helps staff to meet their wide range of needs.

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Inspection date Inspection type Inspection judgement

29/03/2017 Interim Declined in effectiveness 14/11/2016 Full Good 18/03/2016 Interim Declined in effectiveness 11/08/2015 Full Good Inspection report children‟s home: SC485607 3

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Statutory requirements

This section sets out the actions that the registered person(s) must take to meet the Care Standards Act 2000, Children‟s Homes (England) Regulations 2015 and the „Guide to the children‟s homes regulations including the quality standards‟. The registered person(s) must comply within the given timescales.

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Requirement Due date

The quality and purpose of care standard conditions are that the care is approved, and kept under review throughout its duration, by the placing authority; that the care meets the child‟s needs; that the care is delivered by a person who has the experience, knowledge and skills to deliver that care and is under the supervision of a person who is appropriately skilled and qualified to supervise that care. (Regulation 6 (3) (a) (b) (c) (i) (ii))

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Requirement Due date

In particular, make sure that equipment used by young people is suitably assessed and meets their needs. 29/09/2017

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Requirement Due date

The children‟s views, wishes and feelings standard requires the registered person to ensure that staff ascertain and consider each child‟s views, wishes and feelings, and balance these against what they judge to be in the child‟s best interests when making decisions about the child‟s care and welfare; help each child to express views, wishes and feelings; regularly consult children, and seek their feedback, about the quality of the home‟s care. (Regulation 7 (2) (a) (i) (ii) (iv)) 27/10/2017

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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. (Regulation 9 (1)) 27/10/2017

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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-

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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. 27/10/2017 Inspection report children‟s home: SC485607 4 (Regulation 13 (1) (a) (b) and (2) (f)) The care planning standard requires the registered person to ensure that the child‟s placing authority is contacted, and a review of that child‟s relevant plans is requested, if the registered person considers that the child is at risk of harm or has concerns that the care provided for the child is inadequate to meet the child‟s needs. (Regulation 14 (e) (i)) 29/09/2017

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Requirement Due date

The registered person must ensure that restraint in relation to a child must be necessary and proportionate. (Regulation 20 (2))

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Requirement Due date

In particular staff should not hold doors to restrict young people‟s freedom of movement or liberty. 29/09/2017

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Requirement Due date

The registered person must recruit staff using recruitment procedures that are designed to ensure children‟s safety. The registered person may only employ an individual to work at the children‟s home if full and satisfactory information is available in relation to the individual in respect of each of the matters in Schedule 2. (Regulation 32 (1) (2) (a) and (3) (d)) 27/10/2017

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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) 27/10/2017

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Requirement Due date

The registered person must keep the behaviour management policy under review and, where appropriate, revise it. (Regulation 35 (2)) 24/11/2017

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Requirement Due date

The registered person must maintain records (“case records”) for each child which include the information and documents listed in Schedule 3 in relation to each child; are kept up to date; and are signed and dated by the author of each entry. (Regulation 36 (1) (a) (b) (c)) 24/11/2017

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Requirement Due date

The independent person must produce a report about a visit (“the independent person‟s report”) which sets out, in particular, the independent person‟s opinion as to whether children are effectively safeguarded; and the conduct of the home promotes children‟s well-being. (Regulation 44 (4) (a) (b)). 27/10/2017

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Requirement Due date

The registered person must establish and maintain a system for monitoring, reviewing and evaluating the quality of care provided for children; the feedback and opinions of children about the children‟s home, its facilities and the quality of care they receive in it; and any actions that the registered person considers necessary in order to improve or maintain the quality of care provided for children. (Regulation 45 (2) (a) (b) (c)) 27/10/2017 Inspection report children‟s home: SC485607 5

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improvement to be good

At the last inspection, three requirements and one recommendation were made. Young people benefit from living in a bright, well-decorated and personalised home. The home is very clean and welcoming. There are photographs of young people throughout the home. During the inspection, young people were happy about having new portraits taken. This helps young people to feel settled and part of their home.

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improvement to be good

Managers and staff do not make sure that young people‟s case files include all necessary information and documentation. For example, up-to-date placing authority care plans, detailing the aims and objectives of the placement, are not available on some young people‟s files. Up-to-date statutory health and education documents are also missing. This means that internal care plans do not reflect the longer term objectives of the placing authority. Furthermore, missing documents mean that staff do not have a sufficient overview of some young people‟s holistic needs. This potentially limits young people‟s progress and development and is detrimental to their day-to-day experiences.

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improvement to be good

The organisation provides in-house and external therapy services as and when young people need this support. For example, some young people receive input from the specialist behavioural nurse, physiotherapists, occupational therapists and speech and language therapists. This helps to meet the complex needs of some young people. Young person‟s routines are well detailed and provide clear guidance for staff to ensure consistency of approach. However, some young people are receiving personalised care that is not properly reviewed. For example, some young people are provided with boxing head guards that have not been properly recommended and reviewed by a professional. Staff were unsure about who agreed that these items could be used. There was no evidence of the use of this equipment within behaviour support plans or within assessments on young people‟s files. This could mean that some young people‟s needs

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improvement to be good

are not being promoted. As a consequence some young people are potentially being harmed by ill-fitting equipment that is being incorrectly used.

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improvement to be good

Young people have close and warm relationships with staff. Some young people were observed laughing and seeking affection from staff during the inspection. Most staff have a good understanding about the needs of young people. This positive interaction means that staff support the needs of young people well. However, staff do not routinely seek young people‟s views about the quality of care provided by the service. This means that the wishes and feelings of young people are potentially being ignored. Young people are not part of the ongoing development of their home. Inspection report children‟s home: SC485607 6 The home has a variety of specialist equipment and resources to assist young people in their day-to-day life. There are accessible swings and a new hydro-pool within the home that young people can use. There is also a range of interactive and sensory toys. However, not all young people are benefiting from a variety of activities to meet their

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improvement to be good

needs. This means that some young people are not helped by staff to develop their physical and social interests. Activities for some young people are not varied. This lack of creativity means that some young people are not afforded the same opportunities as other young people. This could hinder their progress and limit their enjoyment.

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improvement to be good

Staff have access to a behavioural nurse specialist and work closely with child and adolescent mental health services to help improve some young people‟s behaviours. However, the behaviour management policy is vague and does not clearly identify the overall approach used for managing behaviour. It is not supported by any evidence- base. As a result, staff do not use a consistent approach. Behaviour support plans do not clearly identify the individual needs of young people. This means that not all young people are consistently receiving the help that they need to make progress and develop their skills.

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improvement to be good

Young people currently living in the home are safe. This is because staff make sure that child protection processes are followed. Staff share concerns with social workers and the local authority designated officer. Staff receive mandatory safeguarding training. During this inspection, staff did not raise any safeguarding concerns in relation to the quality of care that young people receive. Several staff members shared knowledge about dealing with safeguarding concerns professionally. As a result, staff are able to prioritise the safety of young people.

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improvement to be good

There have been no recorded incidents of bullying between young people since the last inspection. There have been no episodes of missing from home since the last inspection. This is because young people are closely monitored by staff and some external doors are locked. Staff complete training in the use of physical restraint and de-escalation techniques. Incidents of physical restraint are generally low. Incidents are generally well recorded and young people are spoken to after significant incidents. This helps young people to understand why an incident occurred and assists them in talking about their feelings afterwards.

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improvement to be good

However, not all forms of restraint are proportionate. For example, when one young person becomes very distressed he is taken to his bedroom to calm. On two occasions since the last inspection and for short periods staff will hold the door to keep him in his bedroom. Staff observe the young person from non-recording CCTV. This practice is restrictive and not proportionate. It is not an effective approach. It has caused the young person some further distress. Consequently, the young person is not being helped to develop more positive behaviours or to reduce their anxiety.

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improvement to be good

Staff ensure that they communicate well with young people‟s families. Young people are Inspection report children‟s home: SC485607 7 encouraged and supported to maintain contact with family members and people who matter to them. For example, staff help young people to send birthday cards. As a result, young people maintain their family links, which adds to their sense of emotional stability and sense of identity.

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improvement to be good

The effectiveness of leaders and managers: inadequate.

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improvement to be good

At the time of this inspection, one shortfall is not fully met. This is because the manager has allowed unnecessary restraint for one young person to continue. The manager has not supported staff to consider other behaviour management strategies. The registered manager has extensive experience and the necessary qualifications for the role, including a level 4 diploma in leadership and management for residential childcare. She is supported by a dedicated deputy manager.

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improvement to be good

The registered manager does not make sure that staff receive regular supervision. For example the deputy manager has not had formal supervision from the registered manager for four months. There was no record available of her supervision notes during this inspection. In addition, other staff members are not consistently receiving regular supervision. The deputy manager has a plan in place to monitor and record the supervision of staff but improvements are yet to happen. This shortfall means that staff are not able to consistently review their practice. As a result, the quality of care provided to young people is hindered.

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improvement to be good

Quality assurance processes are ineffective. Although some shortfalls are identified by the independent visitor, safeguarding incidents and allegations against staff are not referred to. This lack of analysis and evaluation potentially places young people at risk of harm and does not promote their well-being. As a result, the actions of managers and staff do not receive independent overview. The registered manager is not using effective monitoring systems to assess and review the quality of care provided by the service. There is not enough evaluation of the weaknesses within the service. As a consequence, there are a number of missed opportunities following significant incidents to review staff practice and to learn from these incidents. This also means that the registered manager does not gain feedback from young people about their experiences.

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improvement to be good

Since the last inspection there have been further allegations of poor staff conduct. The managers have taken necessary and effective action to investigate these incidents, resulting in final written warnings and dismissal in some cases. As a result (and because of staff sickness) there is some use of staff employed by an agency. The registered manager has recognised that this is a shortfall and is taking steps to resolve this issue. However, managers fail to apply safe recruitment practices when they employ agency staff at the home. For example, one agency staff member had not had their identity or references verified. This shortfall could allow unsafe adults to gain employment in the home.

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improvement to be good

Since the last inspection, one young person‟s anxiety appears to have escalated. This has resulted in him assaulting staff. The young person also has high levels of self- harming behaviours. There have been a number of concerns and issues relating to the Inspection report children‟s home: SC485607 8 young person and his complex needs. Despite this, the registered manager has not requested a further review of the young person‟s needs with the local authority. As a result, staff are failing to manage the young person‟s behaviour or meet his needs.

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improvement to be good

The progress and development of young people is variable. Staff do not document the progress and experiences of young people adequately. There is no written evidence of young people‟s starting points and progression. During this inspection there were no written records of one-to-one sessions with young people. Consequently, young people are not being provided with the opportunity to improve their behaviours or express their feelings. This does not enable managers and staff to properly review young people‟s development.

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improvement to be good

The statement of purpose details the underlying therapeutic ethos of the service. This is to ensure that young people receive the specialist care and attention that they require. However, the registered manager is not making sure that this practice is embedded within the culture of the home. There is no effective scrutiny and monitoring of staff practice by the registered manager. This shortfall means that young people do not always receive the individual care needed to reach their full potential.

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

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Information about this inspection

Using the „Social care common inspection framework‟, this inspection was carried out under the Care Standards Act 2000 to assess the effectiveness of the service, how it meets the core functions of the service as set out in legislation, and to consider how well it complies with the Children‟s Homes (England) Regulations 2015 and the „Guide to the children‟s homes regulations including the quality standards‟. Inspection report children‟s home: SC485607 9

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Children’s home details

Registered provider address: c/o RNIB, 105 Judd Street, Camden, London WC1H 9NE

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Children’s home details

Responsible individual: Teresa Stephenson

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Inspectors

Anna Gravelle, social care inspector Lisa Walsh, social care inspector Inspection report children‟s home: SC485607 10 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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