Children's home run by Action for Children in Watford

Inspection report children's home: SC438756 1 SC438756 Registered provider: Action for Children 04764232 1097940

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Full inspection Inspected under the social care common inspection framework

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Information about this children’s home

This children’s home provides shared care and long-term care for up to five children, aged eight to 18 years, who have physical disabilities and associated medical needs. A charitable organisation runs the home.

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Overall experiences and progress of

children and young people, taking into account

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inadequate

How well children and young people are helped and protected inadequate

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inadequate

The effectiveness of leaders and managers inadequate

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inadequate

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

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inadequate

Overall judgement at last inspection: Requires improvement

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Key findings from this inspection

This children’s home is inadequate because: Inspection report children's home: SC438756 2  One child does not have a personal emergency evacuation plan that is relevant to this home, nor has he had the opportunity to take part in a fire drill. Although he has a plan that has been used at his previous home, it is not tailored to his current environment. Failure to ensure that children and staff know and understand emergency evacuation procedures puts children who have complex needs at risk of harm.  There have been three errors in the administration of medication since February 2017. One of these errors resulted in the child being distressed and physically unwell.  The absence of effective management has had a significant impact on the experiences of the children. There is no nominated leader to drive forward progress and ensure that the standard of care for the children is good.  The provider has failed to address four of the nine requirements that were

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Key findings from this inspection

raised at the last inspection.  The format of the children’s guide means that it is not accessible to all of the children.  Some children do not have health plans in their records; health plans are not consistently reviewed in line with the organisation’s policy. This is particularly significant as the home providers care for children who have complex medical needs.  One of the children recently transferred from a sister home. His file is not complete and does not contain crucial information outlining his health, education and behaviour plans.  The children’s records are not of a good enough standard. Some of the records are not dated and are not always signed by the staff.  Direct work with the children is not regular enough. One child has only had three direct-work sessions with the staff since January 2017.  Residents’ meetings do not take place, despite the statement of purpose stating that these meetings will be used to gather children’s views.

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Key findings from this inspection

 There is a lack of good-quality communication with parents and carers.  Ineffective management monitoring means that records of physical interventions are not being reviewed in a timely manner.  The registered manager does not consistently provide Ofsted with all of the necessary details of safeguarding notifications.  Impact risk assessments are completed but are not adequate.  Lack of management oversight of the rota means that on occasion, suitably experienced senior staff are not on shift when required.  Staff do not receive regular and effective supervision.

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Key findings from this inspection

The children’s home’s strengths: Inspection report children's home: SC438756 3  The children are attending school regularly. The staff support this by liaising with the school and participating in education meetings.  The staff have worked creatively with one child, helping her to manage her emotions and remain calm.

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Inspection date Inspection type Inspection judgement

31/08/2016 Full Requires improvement 06/07/2016 Full Inadequate 14/03/2016 Interim Declined in effectiveness 25/11/2015 Full Good Inspection report children's home: SC438756 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 children’s views, wishes and feelings standard is that children receive care from staff who develop positive relationships with them, engage with them and take their views, wishes and feelings into account in relation to matters affecting the children’s care and welfare and their lives.

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Requirement Due date

In particular, the standard in paragraph (1) requires the registered person to keep the children’s guide and the home’s complaints procedure under review and seek children’s comments before revising either document. (Regulation 7(1)(a)(b)(c)(2)()) 09/10/2017

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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)(2)(a)(i)) 09/10/2017

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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.

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Requirement Due date

In particular, the standard in paragraph (1) requires the registered person to ensure that staff assess whether each child is at risk of harm, taking into account information in the child's relevant plans, and, if necessary, make arrangements to reduce the risk of any harm to the child. (Regulation 12(1)(2)(a)(i))

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Requirement Due date

This is with particular regard to introducing an impact risk assessment which considers the potential impact of new arrivals and a review system to track progress and evaluate improvements. 09/10/2017

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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 to aspire to their full potential and promotes their welfare. *09/10/2017 Inspection report children's home: SC438756 5 In particular, the standard in paragraph (1) requires the registered person to ensure that: staff have the experiences, qualifications, and skills to meet the needs of each child; the home’s workforce provides continuity of care to each child; the home has sufficient staff to care for each child. In addition, use monitoring and review systems to make continuous improvements in the quality of care provided in the home. (Regulation 13(1)(a)(b)(2)(c)(e)(f)(h))

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Requirement Due date

The care planning standard is that children receive effectively planned care in or through the children’s home and 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 manage and review the placement of each child in the home, and ensure that each child’s relevant plans are followed. (Regulation 14(1)(a)(b)(2)(b)(ii)(c))

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Requirement Due date

This is with particular regard to ensuring that children’s care plans, including records of leisure pursuits and activities, are reviewed to assess outcomes and opportunities for learning. 09/10/2017

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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 in the home. In particular, the registered person must ensure that medicine which is prescribed for a child is administered as prescribed to the child for whom it is prescribed and to no other child. (Regulation 23(1)(2)(b)) *09/10/2017

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Requirement Due date

The registered person must ensure that the requirements of the Regulatory Reform (Fire Safety) Order 2005 (a) and any regulations made under it, except for article 23 (duties of employees), are complied with in respect of the home. (Regulation 25(2)(b)) 22/09/2017

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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))

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Requirement Due date

In addition, supervision should reflect discussion about performance issues and actions identified as part of investigations. 9/10/2017

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Requirement Due date

The registered person must ensure that within 48 hours of the use of a measure of control, discipline or restraint in relation to a child in the home, the registered person has spoken to the user about the measure and has signed the record to confirm it 09/10/2017 Inspection report children's home: SC438756 6 is accurate. (Regulation 35(3)(b)(i)(ii))

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Requirement Due date

* These requirements are subject to a compliance notice.

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Recommendations

To improve the quality and standards of care further, the service should take account of the following recommendations:

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Recommendations

 The development of safe, stable and secure relationships with staff in the home should be central to the ethos of the home and support the development of secure attachments. (‘Guide to the children’s homes regulations including the quality standards’, page 39, paragraph 8.11

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Recommendations

This is with particular regard to consistent recording of direct work (key working) with each child.

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Overall experiences and progress of children and young people: inadequate

This home has failed to provide safe and effective care for children. There have been three errors in the administration of medication since February 2017. One of these errors resulted in the child being distressed, physically unwell and in pain as a direct result. This error occurred on 21 July 2017. At the time of this inspection, 6 September 2017, the investigation into the error by the organisation had not been finalised. This is not good enough. Failure to respond swiftly, to identify and implement actions from lessons learned and to communicate risk-reduction measures to the staff team does not promote children’s health and welfare. Lack of effective management oversight means that there is a failure to provide a comprehensive and quick response to the errors.

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Overall experiences and progress of children and young people: inadequate

The registered manager and the organisation have failed to address four of the nine requirements that were raised at the last inspection. The registered manager has failed to update the children’s guide to make it fit for purpose, despite this shortfall being raised at the last inspection. Consequently, the guide is not accessible for all of the children. It does not include appropriate symbols and the children are not consulted about any proposed changes.

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Overall experiences and progress of children and young people: inadequate

One of the children recently transferred from a sister home. His file is not complete and does not contain crucial information outlining his health, education and behaviour management plans. His care plans were not prepared in readiness for his arrival at the home, despite the statement of purpose stating that, ‘ The allocated key worker completes a person-centred plan, health plan and behaviour plan which will be used by the staff team to work consistently with the child or young person.’ Failure to implement individualised plans that are relevant to this home means that staff do not have the clear and accessible guidance required to enable them to meet the child’s needs effectively.

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Overall experiences and progress of children and young people: inadequate

Health plans are not evident on all of the children’s files, and staff do not complete regular reviews of the plans in line with the organisation’s policy. Many of the children have complex health needs. Failure to ensure that children have relevant and current Inspection report children's home: SC438756 7 plans means that the staff are not guided properly to meet their health-care needs.

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Overall experiences and progress of children and young people: inadequate

There is a lack of good-quality communication with all parents and carers. One parent said, ‘I have had three years of problems with the home. It has been awful, just dreadful. I do not think the service is good; it is inadequate. It is getting better but it has a long way to go. The acting manager is trying to make changes and it has been much better with her there.’ Another parent said, ‘The communication is not very good; it fluctuates. The response from the home is very poor.’ This does not give parents who entrusted the care of their children to this home confidence. For children who have such complex needs, good communication with parents is vital to their care.

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Overall experiences and progress of children and young people: inadequate

The children’s records are not of a good enough standard. The staff do not sign and date the records consistently. There is a lack of clear information on records and body maps, and staff are not consistently reviewing the children’s goals in their daily logs. Records are not clear or concise and do not reflect a clear line of reasoning and analysis about why actions have been taken, or the outcome of the staff’s contact with social workers and professionals. The records do not describe the children’s progress.

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Overall experiences and progress of children and young people: inadequate

Children have access to their own key workers, but direct work with the children is not regular enough, with one child only having three direct work sessions with the staff since January 2017. Regular key work has been recommended in assessments, but this is not happening. This means that opportunities to build nurturing relationships are missed and children do not benefit from a regular space to develop their knowledge or understanding of issues that are important to them.

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Overall experiences and progress of children and young people: inadequate

An advocate visits the home regularly. The statement of purpose identifies that residents’ meetings will take place as part of the consultation process with the children; these meetings are not happening. This does not meet the ethos of the service or help the children to share their views in a group environment.

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Overall experiences and progress of children and young people: inadequate

The children are attending school regularly. The staff support this by liaising with school staff and participating in education meetings. An education professional said, ‘They [the staff] have a good grasp of the child’s needs and know her well. They communicate with us if there is a specific issue.’

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

There are very few physical interventions at the home. However, ineffective management monitoring means that the records of these interventions are not being reviewed in a timely manner. The manager has failed to ensure that the records describe debriefings with the staff. Failure to provide timely management oversight of restraint records means that the intended additional safeguards that having such oversight would mean are missing. This is particularly significant given the children’s vulnerabilities and limited communication.

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

The designated officer reports that there is consultation and contact from the home and Inspection report children's home: SC438756 8 this is appropriate. However, the registered manager did not communicate the outcome of a recent safeguarding matter to Ofsted. In addition, actions identified as part of this process, such as discussion with the staff about reporting concerns, remain outstanding. This does not adequately safeguard and protect the children from further incidents.

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

Impact assessments are carried out but are not adequate. They do not include the individual behaviours of the other children or consider the impact of these behaviours on each child. This shortfall was identified at the last inspection and is not addressed. This means that the matching process is not sufficiently robust as it does not account for the complex needs of the all of the children.

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

One child who is new to the home does not have a personal emergency evacuation plan that is relevant to this home. Although he has a plan that has been used at his previous home, it is not tailored to his current environment. The failure to write and implement a plan that is specific to the child and the home puts the child at risk of harm in the event of a fire or emergency evacuation.

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

Although risk assessments are in place, identified work as outlined in these assessments is not taking place with the children as specified. For one child, this means that there is minimal oversight and no continued work in relation to his use of the internet. This does not sufficiently safeguard him from the risks or provide him with the valuable information needed to protect himself.

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

The staff and the manager work creatively with one child, helping her to manage her emotions and remain calm. The staff seek guidance from health specialists to ensure that the approach used is in the child’s best interests and is working well. She is happy at the home and gets on well with the staff. Although this child receives a cohesive response from the staff and has good experiences at the home, this is not the case for all of the children.

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

Children do not go missing from the home. There is a missing-from-home protocol and clear instructions for the staff. The staff take the time to get to know the children and their individual personalities. They are able to respond appropriately to take effective action when the children are heightened and avert risky situations.

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The effectiveness of leaders and managers: inadequate

At the time of this inspection, the registered manager had been absent for a significant period. Although an acting manager is now in post, this has been a recent development. The lack of effective management has had a significant impact on the children’s experiences, safety and well-being. There has been a lack of leadership to drive forward progress and ensure that the standard of care for the children is good.

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The effectiveness of leaders and managers: inadequate

One parent removed her child from the home on two occasions because she was not confident that the staff on duty could meet his needs. She was concerned that the staff did not know him well enough and could not provide safe care to her son. Failure to Inspection report children's home: SC438756 9 ensure that trained staff are meeting the children’s needs causes disruption and distress to the child and the parent. This parent said, ‘My child has complex special needs and I need someone who knows him and knows his needs.’ She added, ‘I have not been happy with the carers on duty and I have picked him up. This has happened twice at the weekends. They were not experienced night staff and could not manage him. I was worried so brought him home.’ This does not support the child’s regular routine or provide the stability that he needs.

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The effectiveness of leaders and managers: inadequate

The registered manager does not consistently provide Ofsted with all of the necessary details of safeguarding notifications. This does not provide transparency and means that Ofsted does not have the opportunity to review investigations and the outcome.

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The effectiveness of leaders and managers: inadequate

Staff do not receive regular and effective supervision. There are significant gaps in supervision records. This is despite a safeguarding concern being identified and several medication errors. Staff do not receive the support and guidance that they need to oversee their practice or have them formalised and documented opportunities to raise their own concerns.

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The effectiveness of leaders and managers: inadequate

The staff members have good relationships with each other, but are concerned about the impact of annual leave and the use of agency staff. They state that at times it has been ‘very stressful on shift’. Lack of management oversight of the rota means that on occasion, suitably experienced senior staff are not on shift when required.

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The effectiveness of leaders and managers: inadequate

Team meetings are not taking place regularly. This means that staff are unable to share knowledge and skills easily. They do not have the opportunity to communicate with each other within a group environment. The lack of team meetings means that there is a failure to provide strong links with the management team to hear about and deal with any staffing issues or practice concerns.

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The effectiveness of leaders and managers: inadequate

Although the external monitoring identifies clear recommendations, including the need for clear oversight from the registered manager, the internal monitoring is not effective. Some of the shortfalls found at this inspection were raised at the last inspection. Concerns such as those relating to the failure to conclude the investigation into medication errors and the insufficient supervision have not been acted on. The internal monitoring does not include the views of placing authorities, children or parents. This does not sufficiently take account of these views to progress and develop the service.

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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 Inspection report children's home: SC438756 10 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: SC438756 11

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Children’s home details

Registered provider: Action for Children 04764232 1097940

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Children’s home details

Registered provider address: Action for Children, 3 The Boulevard, Ascot Road, Watford WD18 8AG

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Inspector

Debbie Young, social care inspector Inspection report children's home: SC438756 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 looked after children, safeguarding and child protection.

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Inspector

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Inspector

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Inspector

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