Children's home run by Action for Children in Watford

Inspection report children's home: SC013402 1 SC013402 Registered provider: Action for Children

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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 is run by a registered charity in partnership with a local authority. Care and accommodation are provided in two separate and distinct houses. The home may provide care and accommodation for no more than four children under short-break arrangements, and for two to live permanently in one house and no more than five children to live permanently in the other house. Children may have a learning disabilities and/or physical disabilities. The long-stay residential house specialises in work with children who have autistic spectrum disorder.

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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 good

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requires improvement to be good

The effectiveness of leaders and managers requires improvement to be good

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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

Date of last inspection: 15 February 2017

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requires improvement to be good

Overall judgement at last inspection: Sustained effectiveness Inspection report children's home: SC013402 2

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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

 There are a high number of vacant staffing positions in this home and this is having an adverse impact on the quality of care provided to young people.  Staff vacancies are covered by a variety of agency workers. These workers do not have the detailed knowledge of young people that they need to offer both a consistent response and a high quality of care.  Agency workers do not have the necessary skills and experience to work independently with young people. This places more tasks on the permanent staff on shift, and takes them away from direct work with young people.  The ratios of agency workers to permanent staff on duty are sometimes balanced in favour of agency staff.  Some young people are less able to access leisure activities in the community.  Night-time checks on young people are insufficiently individualised.  The system for recording restraint measures lacks sufficient clarity.

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Key findings from this inspection

 Permanent staff know young people well, understand their needs and take pride in their achievements.  They encourage young people to make choices about their daily living.  The home environment is child friendly, homely and safe.  Admissions to the home are carefully considered, and matching of young people coming for short breaks is effective.  There is a new registered manager in post who has appropriate ambitions to achieve excellent standards, and has energy and vision.

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Inspection date Inspection type Inspection judgement

15/02/2017 Interim Sustained effectiveness 01/11/2016 Full Good 16/03/2016 Interim Sustained effectiveness Inspection report children's home: SC013402 3 23/06/2015 Full Good Inspection report children's home: SC013402 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

6: The quality and purpose of care standard Ensure that children receive care from staff who understand the home’s overall aims and the outcomes it seeks to achieve for children, and use this understanding to deliver care that meets children’s needs and supports them to fulfil their potential. (Regulation 6(1)(a)(b)) 22/11/2017

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Requirement Due date

13: The leadership and management standard Ensure that staff have the experience, qualifications and skills to meet the needs of each child, and that the home’s workforce provides continuity of care to each child. (Regulation 13(1)(c)(e)) 22/11/2017

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Recommendations

 Ensure that appropriate opportunities are available to enable children with physical disabilities to participate in leisure activities in the community. (‘Guide to the children’s homes regulations including the quality standards’, page 31, paragraph 6.10)  Ensure that limits on children’s night-time privacy are informed by a rigorous assessment of the child’s needs, properly recorded and kept under regular review. This relates to the routine, night-time observations of all children every thirty minutes. (‘Guide to the children’s homes regulations including the quality standards’, page 15, paragraph 3.10)  Ensure that records made of restraint incidents are kept separately from other incident forms so that areas of concern and effective practice can be quickly identified. (‘Guide to the children’s homes regulations including the quality standards’, page 49, paragraph 9.59)  Ensure that the level of skill, qualifications and the necessity for an appropriate

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Recommendations

induction are considered before agency staff commence work in the home. (‘Guide to the children’s homes regulations including the quality standards’, page 54, paragraph 10.16)  Ensure that no more than half the staff on duty at any one time, by day or night, at the home should be from an external agency. (‘Guide to the children’s homes Inspection report children's home: SC013402 5 regulations including the quality standards’, page 54, paragraph 10.17)

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improvement to be good

Young people receive a high quality of individualised care some of the time. Much care is delivered by committed, permanent staff who know young people well. They understand the young people’s complex individual needs, and give them good quality care. However, young people do not consistently have good experiences or progress well, because the care provided does not fully support their needs, and is variable. Their care is compromised by staffing shortages. The long-stay unit is particularly affected, and currently has a 40% staff vacancy rate. This means that on most shifts there are agency workers and on occasional shifts more than half of the staff on duty are from an agency. These vacancies are filled by agency staff who may be new to the young person and/or the unit. This does not promote an appropriate sense of attachment in young people.

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improvement to be good

Relationships between permanent staff and young people are strong and trusting. This means that staff can reliably interpret the views and wishes of young people with complex communication needs. For example, staff successfully use objects of reference to enable young people to choose food and drinks. They also take pride in young people’s achievements, and are able to cite progress that young people have made, for example becoming more independent in toileting. However, staff and some parents believe that some young people are not making the progress that they should because of the variety of agency staff that look after young people. For example, in one recent week 13 different agency staff worked in the home. These staff clearly do not have the same quality and depth of relationship with young people as permanent staff. This does not promote young people developing appropriate skills.

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improvement to be good

The staff group will try to work effectively with any parent or professional who is involved with the young person. For example, staff will usually routinely visit the school where the young person attends and will plan, together with staff, to help the young person meet appropriate targets. In addition they will work with family members and keep them in touch with their child’s progress. This helps to maintain what may be fragile relationships.

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improvement to be good

Over the last few months, an appropriate, formalised system for identifying and tracking young people’s progression has been introduced. This breaks down desired outcomes into small, monitored steps, for example helping a young person move from wearing pads to wearing underwear. Some young people have been successfully supported by staff to make significant progress, which would help them to be as independent as possible in adult life. However, other young people are not yet benefiting from this system. The staff group feels that this will be a positive initiative for all young people once more permanent staff are in place to deliver it.

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improvement to be good

There was good planning for the recent school holidays, with imaginative on-site activities in Inspection report children's home: SC013402 6 place plus some trips out. However, some off-site activities were limited by staffing shortages and the lack of transport for conveying young people who have physical disabilities. During term time, young people generally follow a set routine before and after school. They receive a warm welcome on their return from school, have any physical needs met and then enjoy a snack or relaxing activity. Young people are strongly encouraged to choose activities and, where appropriate, are given a range to pick from. This helps develop their skills and their self-confidence.

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improvement to be good

Young people have suitably individualised rooms: some have minimal furnishings and others contain more stimulating objects. These variations strongly reflect the young people’s personal needs and wishes. However, in one unit all young people are checked every 30 minutes through the night. This does not appropriately reflect their individual needs; the young people may be to be checked more, or less, often.

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improvement to be good

Transitions into the home are well managed. Careful assessments are done on each referral, and thorough consideration is given to matching young people to an existing group. This is usually a successful strategy and, if not, arrangements are quickly changed. Transitions from the home are less well developed, but appropriate links are made with adult services. The registered manager has a plan for further work in this area in the next year.

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

All young people in this home have disabilities, and consequently they all have significant issues affecting their daily living. But each of them has different challenges to face, and their highly personalised risk assessments reflect this well. For example, some young people may become agitated by noisy environments, while others thrive in a background of ceaseless chatter. The staff’s careful observations of young people’s preferences and regular updating of their risk assessments help keep young people safe.

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

This good knowledge of young people helps staff maintain a pleasant home environment. Positive behaviour is consistently promoted. Restraint and sanctions are rarely used. There is an isolated example of the recording of a restrictive intervention not being entered in the right book. But the intervention was appropriately used, and recorded in the necessary detail and the shortfall was noted by the registered manager. As a result, it did not have an adverse impact on the safety of young people.

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

Staff know the triggers that upset young people, and use strategies to minimise these events. For example, some young people crave food and become distressed if this is not allowed. Staff adeptly use a picture exchange communication system (PECS) to allow a young person to choose small, prepared quantities for herself. This strategy avoids an episode of challenging behaviour and a possible restrictive intervention.

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

Young people do not go missing from this home. Both units are adjacent to each other on a secure campus and young people do not go out without appropriate staffing. However, there is an appropriate missing-from-the-home policy in place and some young people have this risk reflected in their particular risk assessments. Inspection report children's home: SC013402 7 There is good knowledge of safeguarding in this home. Appropriate staff are familiar with the designated officer’s role, and are confident about contacting her for advice and support. The threshold for this contact is appropriately judged and any advice given is followed. Immediate concerns about young people’s safety are promptly and persistently followed up and any necessary actions are taken.

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

Although the home is often unsuccessful in recruiting new staff, its recruitment process is thoroughly carried out. The scrutiny given to new applications from would-be staff remains thorough, appropriate checks are completed and references are validated. New permanent staff positively comment on the rigour of the interviewing process and the comprehensive safeguarding input of their inductions.

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

The home is very well maintained. All young people have appropriate, individualised fire risk assessments and routine maintenance is promptly and effectively completed. For example, a young person caused a degree of damage to his room that presented a significant safety risk to himself. This was immediately remedied, a new assessment of risk was made and the local authority and family members were contacted. The young person was actively involved in future arrangements for his safety and this resulted in a significant reduction in his risk of harm.

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

There is a new registered manager in place who is currently undertaking the appropriate qualification. Her positive impact on the home environment is already apparent. A recommendation at the last inspection was to make the home more ‘homely’. This has been successfully met with good input from young people. There are also more pictures of young people and staff on display, and eye-catching, fun objects in the grounds.

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

The registered manager also knows young people well. She is knowledgeable and experienced in working with young people who have disabilities, and is proactive in initiating specialist assistance if required. For example, she has arranged for staff to be briefed by a mental health specialist to assist them in working with a young person who has complex needs who is a new admission. The registered manager is confident about challenging other services, for example challenging the local authority over significant communication shortfalls. External colleagues note that she ‘enjoys working with the wider team’ and this is a positive approach for young people.

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

However, the major issue in this home is that leaders and managers have not succeeded in attracting and retaining sufficient skilled staff. In the two previous inspections of this home, a requirement was made each time to ensure that there were sufficient skilled staff working in the home. This requirement has again not been met. This means that young people have lacked the support of a sufficient cohort of consistent staff over the last year.

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

Leaders and managers have tried hard to remedy this. They have repeatedly initiated recruitment drives, and tweaked processes to increase the desirability of working in this Inspection report children's home: SC013402 8 home. This has produced some new permanent staff, notably at the team-leader level; however, care staff numbers are still insufficient, especially in the long-stay unit. Managers are aware of some of the reasons for this recruitment difficulty. For example, the timeliness of the whole recruitment process is an issue, as is the particular nature of local market conditions. Significantly changing these major factors is not within the gift of local management, but the wider organisation is trialling some new initiatives. These have not yet come to fruition.

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

The registered manager has tried to improve the situation where she can. For example, she has had some success in persuading identified agency workers to move onto a permanent contract and this is encouraging. In addition, there has been focused work to establish a pool of ‘regular’ agency workers. This has had limited success in that numbers are small, and such staff are still free to choose to work elsewhere. This means that young people can still not rely on consistent staff delivering consistent care. In addition, the skill level of the agency staff being used is variable. Some may have transferable skills from working in other care settings with older people or in nurseries, but others may have no experience of working with young people or indeed in a care setting. On arrival at their unit, agency workers are briefed by staff and there is now an induction booklet for them. This is an improvement on previous practice, but the booklet is basic and does not ensure that such

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

staff have a sound level of knowledge of the young people they are working with.

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

Staff are very concerned about the shortfall in permanent staff, and the numbers and quality of agency staff used. They are concerned about the extra burden this places on them in terms of covering extra shifts, explaining what to do to agency staff, always having to administer medication and not being able to go out with young people as much. They worry that this gives them less direct time with young people. In addition, they are concerned that, ‘Young people don’t get the right input, some take different faces okay, but some really struggle.’ However, overall, morale among staff is good. They have confidence in their new manager and feel supported. Routine, recorded supervision and appraisal practice helps reinforce this. Most staff remain optimistic that the staffing issues will be resolved.

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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 Inspection report children's home: SC013402 9 homes regulations including the quality standards’. Inspection report children's home: SC013402 10

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Children’s home details

Registered provider: Action for Children

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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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Children’s home details

Responsible individual: Shelagh Frankcom

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Inspector

Bridget Goddard: social care inspector Inspection report children's home: SC013402 11 achieve excellence in the care of children and young people, and in education and skills for learners of all ages. It regulates and inspects childcare and children’s social care, and inspects the Children and Family Court Advisory and Support Service (Cafcass), schools, colleges, initial teacher training, further education and skills, adult and community learning, and education and training in prisons and other secure establishments. It assesses council children’s services, and inspects services for children looked after, safeguarding and child protection.

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Inspector

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Inspector

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Inspector

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