Children's Home run by Quality Protects Children Ltd in Knowsley

Inspection report children’s home: SC356929 1 SC356929 Registered provider: Quality Protects Children Limited

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Full inspection Inspected under the social care common inspection framework

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Information about this children’s home

A private company owns this home. It is registered to provide care and accommodation for up to three young people who have emotional and/or behavioural difficulties.

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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 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: Good

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inadequate

Enforcement action since last inspection: None

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Key findings from this inspection

This children’s home is inadequate because:

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Key findings from this inspection

 The registered manager and staff have failed to safely identify, understand and manage individual risks to children and young people.  The administration and recording of medication is not robust. On occasions, records do not accurately state the dose of medication given to children. As Inspection report children’s home: SC356929 2 well as this, the amount of medication left in storage is not correct.  Behaviour management in relation to restraint is not carried out safely, and managers do not monitor and evaluate measures of discipline and control effectively.  Staff are not sufficiently supervised, skilled or competent to meet the needs of the children and young people living at the home.  Parts of the home environment are poorly maintained, with the communal toilet facilities presenting as unclean.  Managers and staff have failed to complete accident records when children have sustained an injury. Furthermore, incident reports lack clarity and detail

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Key findings from this inspection

regarding all of the actions taken by staff to safeguard children and young people.  Managers and staff do not review and update placement plans and risk assessments so that they reflect the needs of all children and young people.  There is insufficient management review and evaluation of all records and events in the home to inform staff practice.  The home has not maintained accurate staff rosters so that it is clear who is on duty and when.  When serious events occur, managers do not always share information with Ofsted.

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Key findings from this inspection

 Staff manage children’s and young people’s complex contact arrangements sensitively.  For some children and young people, attendance at education and their attainment have improved.  Some children and young people’s health outcomes have improved with support from staff.

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Inspection date Inspection type Inspection judgement

25/07/2017 Full Good 15/03/2017 Interim Declined in effectiveness 22/11/2016 Full Good 25/02/2016 Interim Sustained effectiveness Inspection report children’s home: SC356929 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

6: The quality and purpose of care standard

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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 and that they use this understanding to deliver care that meets children’s needs and supports them to fulfil their potential.

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Requirement Due date

In particular, the standard in paragraph (1) requires the registered person to ensure that the premises used for the purposes of the home are designed and furnished so as to meet the needs of each child. (Regulation (6)(2)(c)(i))

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Requirement Due date

In particular, ensure that doors to the living room and activity room are accessible to all children and young people. 02/10/2017

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10: The health and well-being standard

The health and well-being standard is that the health and well- being needs of children are met; children receive advice, services and support in relation to their health and well-being; and children are helped to lead healthy lifestyles. (Regulation 10 (1)(a)(b))

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10: The health and well-being standard

In particular, staff should seek appropriate medical advice when children and young people appear to be under the influence of a substance. 02/10/2017

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12: The protection of children standard

The protection of children standard is that children are protected from harm and enabled to keep themselves safe.

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12: The protection of children standard

In particular, the standard in paragraph (1) requires the registered person to ensure:

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12: The protection of children standard

that staff assess whether each child is at risk of harm, taking 02/10/2017 Inspection report children’s home: SC356929 4 into account information in the child’s relevant plans, and, if necessary, make arrangements to reduce the risk of any harm to the child; help each child to understand how to keep safe; have the skills to identify and act upon signs that a child is at risk of harm; manage relationships between children to prevent them from harming each other; understand the roles and responsibilities in relation to protecting children that are assigned to them by the registered person; take effective action whenever there is a serious concern about a child’s welfare; are familiar with, and act in accordance with, the home’s child protection policies;

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12: The protection of children standard

that the home’s day-to-day care is arranged and delivered so as to keep each child safe and to protect each child effectively from harm;

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12: The protection of children standard

that the premises used for the purposes of the home are designed, furnished and maintained so as to protect each child from avoidable hazards to the child’s health;

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12: The protection of children standard

and that the effectiveness of the home’s child protection policies is monitored regularly. (Regulation 12(1) and (2)(a)(i)(ii)(iii)(v)(vi)(vii)(b(c)(d)(e))

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13: The leadership and management standard

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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13: The leadership and management standard

In particular, the standard in paragraph (1) requires the registered person to:

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13: The leadership and management standard

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;

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13: The leadership and management standard

ensure that staff have the experience, qualifications and skills to meet the needs of each child;

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13: The leadership and management standard

ensure that the home’s workforce provides continuity of care to each child;

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13: The leadership and management standard

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; 02/10/2017 Inspection report children’s home: SC356929 5 use monitoring and review systems to make continuous improvements in the quality of care provided in the home. (Regulation 13(1)(a)(b) and (2)(a)(b)(c)(e)(f)(h)) 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. (Regulation 14(1)(a)(b)) 02/10/2017

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13: The leadership and management standard

The registered person must make arrangements for the handling, recording, safekeeping, safe administration and disposal of medicines received into the children’s home. In particular, the registered person must ensure that a record is kept of the administration of medicine to each child. (Regulation 23(1)and(2)(c)) 02/10/2017

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13: The leadership and management standard

The registered person must ensure that all employees receive practice-related supervision by a person with appropriate experience. (Regulation 33(4)(b)) 02/10/2017

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13: The leadership and management standard

Regulation 35: * The registered person must ensure that 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:

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13: The leadership and management standard

the name of the child; details of the child’s behaviour leading to the use of the measure; the date, time and location of the use of the measure; a description of the measure and its duration; details of any methods used or steps taken to avoid the need to use the measure; the name of the person who used the measure (‘the user’), and of any other person present when the measure was used; the effectiveness and any consequences of the use of the measure; and a description of any injury to the child or any other person, and any medical treatment administered, as a result of the measure;

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13: The leadership and management standard

and within 48 hours of the use of the measure, the registered person, or a person who is authorised by the registered person to do so (‘the authorised person’) has spoken to the user about the measure; has signed the record to confirm it is accurate;

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13: The leadership and management standard

and 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)(b) and (c)) 02/10/2017

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13: The leadership and management standard

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)) 02/10/2017 Inspection report children’s home: SC356929 6 The registered person must maintain in the home the records in Schedule 4; and ensure that the records are kept up to date. (Regulation 37 (2)(a)(b))

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13: The leadership and management standard

In particular, maintain accurate staff rosters that show who is working at the home. 02/10/2017

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13: The leadership and management standard

The registered person must notify HMCI and each other relevant person without delay if—

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13: The leadership and management standard

a child is involved in or subject to, or is suspected of being involved in or subject to, sexual exploitation; an incident requiring police involvement occurs in relation to a child which the registered person considers to be serious; there is an allegation of abuse against the home or a person working there; a child protection enquiry involving a child is instigated; or concludes (in which case, the notification must include the outcome of the child protection enquiry); or there is any other incident relating to a child which the registered person considers to be serious. (Regulation 40 (4)(a)(b)(c)(d)(i)(ii)(e)) 02/10/2017

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13: The leadership and management standard

* This requirement is subject to a compliance notice.

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Recommendations

 Ensure that the children’s guide is made available to all children when their placement in the home is agreed, and it is age appropriate, provided in an accessible format and explained to each child to make sure they understand it. (‘Guide to the children’s homes regulations including the quality standards’, page 24, paragraph 4.21)

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Overall experiences and progress of children and young people: inadequate

Placement plans do not contain enough information about all children and young people’s care arrangements. Consequently, staff do not fully understand all aspects of young people’s care needs, for example how to respond to challenging and risk-taking behaviours effectively.

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Overall experiences and progress of children and young people: inadequate

Parts of the accommodation are poorly decorated, maintained and furnished. In particular, the bathroom was unclean and there were no cleaning materials or towels in place. In addition, one child’s bedroom was in an exceptionally poor state. Staff had removed all of his personal items, including clothing, toys and furniture, as part of an ongoing risk assessment. Throughout the inspection, the child was observed continually asking for his personal possessions, including his shoes. However, as items had been left in a disorganised state in the downstairs activity room, staff were unable to locate items Inspection report children’s home: SC356929 7 easily. This caused undue upset to the child involved. Furthermore, staff had locked doors to the living room and activity room. This restricted access to communal rooms for all the children and young people living in the home. This is not conducive to a warm,

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Overall experiences and progress of children and young people: inadequate

For some children and young people, their health is improving, having received helpful support from staff to make better decisions about their emotional and physical health and well-being. Some young people reported that they are able to talk about things that are worrying them. They know that some staff will listen to them and that staff will help them to resolve any concerns they may have. However, when there have been incidents involving young people misusing alcohol and/or drugs, it is unclear from the records what support strategies are in place to address these incidents and how staff are working to reduce the risk to young people of potential harm.

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Overall experiences and progress of children and young people: inadequate

For some children and young people, education attendance and attainment has improved. Creative morning routines support each child or young person to be up and ready to go to school. One young person recently achieved 100% attendance at the organisation’s school on a full timetable. This is a big achievement for him. As a result, he has secured a place at a music school and, in the short time that he has be there, he has achieved 77% attendance. His social worker and independent reviewing officer are very proud of his achievements. They said, ‘There has been a massive turnaround in his education. It is not yet perfect, but he is getting there.’ This young person has requested a tutor to help him to improve his grades. This is currently being facilitated. The registered manager is working hard to secure a school place for the most recently-placed young person. In the meantime, tutors from the organisation’s school are providing

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Overall experiences and progress of children and young people: inadequate

support over the summer holidays. This is to assess the young person’s needs and to help him to prepare for a new school.

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Overall experiences and progress of children and young people: inadequate

Staff manage children’s and young people’s complex contact arrangements sensitively. Staff ensure that children and young people can see those people who are important to them. One child has asked that staff do not tell him in advance about the family visits. This is because he wants the visits to be a surprise and has said that he gets very excited to see his family. This will also help to reduce his anxieties should a family member be late for a visit. Other young people are making positive friendships at school and in the local area.

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Overall experiences and progress of children and young people: inadequate

While there are aspects of the provision that result in some positive outcomes for some children and young people, the shortfalls in leadership and management and in how young people are safeguarded have resulted in an overall judgement of inadequate.

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

Children and young people do not always benefit from clear and consistent boundaries or effective behaviour management strategies. On occasions, staff have not recorded the disciplinary measures used to manage young people’s behaviours. The home has a ‘bound book’ system in place for recording all incidents and physical interventions. Staff are able to cross-reference the information recorded. However, information within the Inspection report children’s home: SC356929 8 incident book, which stated that staff had used physical intervention on more than one occasion, had not been included in the physical intervention log. The registered manager identified this as a breach in the home’s own policies and procedures. In addition, appropriate action was not taken when a child sustained an injury during a physical restraint. Additionally, when children have been restrained not all records provide a clear overview of the behaviour that led to the measure, the time-frame involved or evidence

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

of any individual debrief with either the child or any staff members. The registered manager had not evaluated the appropriateness or effectiveness of the measures used. Consequently, staff continue to use ineffective behaviour management strategies, and young people are not learning to reflect upon and improve their behaviour.

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

Accident books in the home did not include information about injuries children had sustained. The registered manager acknowledged that the correct documentation had not been completed and that this failed to demonstrate that appropriate action had been taken to ensure the safety and well-being of all children in the home.

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

Behaviour management plans and risk assessments do not accurately identify or address the current needs of the children and young people living at the home. For example, a behaviour management plan that the registered manager had compiled when the child had first moved to the home had not been updated with all of the current risk factors. This included recent incidents involving self-harming behaviour, and aggression towards members of the public in the community. It was also not dated, and failed to show that staffing had been increased to a level of 2 to 1 at all times. Importantly, the plans also failed to identify strategies to work with the child so that the child learns to understand the risks posed to themselves and others because of their actions. Risk assessments do not always state clearly the risks in relation to drug and alcohol use. Nor do they include the action to take should a young person come home under the influence of these

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

substances. Because of this shortfall, there have been two occasions when extra advice was not sought. This fails to ensure the children and young people’s safety and well- being.

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

There are significant shortfalls in the administration of medication. Medication is managed unsafely and fails to comply with the provider’s own policies and procedures. A number of significant errors were evident, including in the recording of the administration of controlled drugs. Some recordings had been written over and it was difficult to ascertain the dates on which children had received their medication. There were also errors in the amounts administered to children and the amounts left in stock. The time that medication had been administered was not recorded. Furthermore, records are not clear on why controlled drugs are missing. For example, the medication records stated that drugs were disposed of. However, there was no further information to explain why tablets had been disposed of and where the tablets had gone. This is a serious failure that potentially places children at risk. The failure to follow the home’s

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

own policies and procedures for the handling, recording, safe keeping and safe administration of medicines is also a significant area of concern. Staff duty rosters fail to accurately reflect the actual staff on duty, and lack transparency. This prevents a clear audit trail of who is working within the setting, when they are working and where. For example, some staff were recorded as having worked Inspection report children’s home: SC356929 9 in excess of six days, including waking nights and day shifts, without a day off. The lack of transparency of who is on duty potentially places children and young people at risk and compromises the continuity of care.

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

Some staff do not have up-to-date safeguarding and first aid training. This means that staff are not equipped with the skills and knowledge required to support and safeguard children and young people in their care.

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The effectiveness of leaders and managers: inadequate

This inspection was completed over the following dates: 24 July, 25 July and 21 August 2017. The third day was necessary in order to gather additional information so that a judgement could be finalised.

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The effectiveness of leaders and managers: inadequate

The registered manager has been in charge of the home since December 2016. Although the manager holds a relevant qualification, children and young people are living in a home that is not being managed effectively. There have been failings in the management oversight and monitoring of the home to identify areas of weakness and to take decisive action to resolve these. As a result, young people’s progress and safety is compromised.

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The effectiveness of leaders and managers: inadequate

Furthermore, although the registered manager had signed off incident sheets, he had failed to identify and report all safeguarding concerns to the relevant safeguarding professionals, including allegations made by a child about staff causing injuries to them. In addition, he did not take action when a young person had been restrained, and no documentation was completed. This fails to demonstrate that the registered manager is fully aware of his roles and responsibilities in protecting young people, and shows a failure to follow the company’s own policies and procedures for safeguarding young people.

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The effectiveness of leaders and managers: inadequate

Some staff have not received supervision with a suitably qualified person. One staff member, who was on a development plan that stipulated the need for close management supervision, had only received two ‘informal supervisions’. This means that not all staff have adequate opportunities to reflect on their practice and performance.

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The effectiveness of leaders and managers: inadequate

Internal placement plans and risk management plans are not reviewed effectively to identify the changing needs of the young people. The plans also fail to address the issues of risk, including how risks are to be managed safely to in order to promote consistency of care. For example, risk assessments are not updated following significant incidents that require the use of physical restraint. In addition, some records are not signed or dated by the author of the record. Therefore, the manager cannot be assured that all staff have a full understanding and knowledge of each young person’s needs.

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The effectiveness of leaders and managers: inadequate

Internal monitoring is ineffective and does not take place regularly. As a result, the quality and standard of care has fallen to an unacceptable level. The manager has not reviewed records in the home or evaluated incidents that have occurred, in order to be able to identify shortfalls and highlight patterns and trends. Subsequently, areas for Inspection report children’s home: SC356929 10 development are not clearly highlighted. This means that leaders and managers are not taking sufficient action to improve the experiences, care and safety of young people.

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The effectiveness of leaders and managers: inadequate

Significant events involving young people who live in the home have not been reported to Ofsted. A failure to share information with all relevant people potentially compromises the safety and welfare of young people. Furthermore, the regulator is unable to carry out its monitoring function to ensure that all appropriate action is taken by the provider to safeguard young people. This lack of rigour has not helped the home to sufficiently protect young people and maintain good enough standards of care. Systems that are more robust are needed to ensure that the safety and well-being of the young person is promoted at all times.

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The effectiveness of leaders and managers: inadequate

There are serious deficits in the home’s external monitoring and auditing systems. This process has failed to identify the shortfalls highlighted in this inspection. For example, one shortfall is the failure to ensure that records of restraint are fully recorded. This lack of rigour has not helped the home to sufficiently protect young people and maintain good enough standards of care.

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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: SC356929 11

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Children’s home details

Registered provider: Quality Protects Children Limited

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Children’s home details

Registered provider address: Quality Protects Children Limited, Hill House, Archway Road, Huyton, Liverpool L36 9XB

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Inspectors

Michelle Edge, social care inspector manager Elaine Allison, social care inspector Christine Scully, social care inspector Inspection report children’s home: SC356929 12 achieve excellence in the care of children and young people, and in education and skills for learners of all ages. It regulates and inspects childcare and children’s social care, and inspects the Children and Family Court Advisory and Support Service (Cafcass), schools, colleges, initial teacher training, further education and skills, adult and community learning, and education and training in prisons and other secure establishments. It assesses council children’s services, and inspects services for children looked after, safeguarding and child protection.

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Inspectors

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Inspectors

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Inspectors

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