Children's home run by The National Autistic Society

Inspection report children‘s home: SC485659 1 SC485659 Registered provider: National Autistic Society

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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 large children‘s home is operated by a national charity and provides care and accommodation for up to 17 children who have a primary diagnosis of autism.

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Information about this children’s home

Inspection dates: 12 to 13 September 2017

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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 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: 30 January 2017

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requires improvement to be good

Overall judgement at last inspection: improved effectiveness

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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

 Difficulties with the recruitment and retention of sufficient staff and a deputy manager have negatively impacted on the service. Inspection report children‘s home: SC485659 2  The interim manager has not applied for registration in the registered manager‘s absence.  Staff supervision of children is not always effective.  A few parents would like communication with staff to improve.  The environment would benefit from further equipment for children, and action to reduce noise levels.  Some staff would like to see improved communication between them and the leaders and managers of the home.

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Key findings from this inspection

 There is a robust staff recruitment process.  Staff meet children‘s individual food preferences well.  Fire safety is well organised.  Staff help children to settle and make some progress.  Staff manage medication safely.  Effective partnership working with other professionals helps children to make progress.

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Inspection date Inspection type Inspection judgement

30/01/2017 Interim Improved effectiveness 21/06/2016 Full Requires improvement 10/03/2016 Interim Sustained effectiveness 13/10/2015 Full Requires improvement Inspection report children‘s home: SC485659 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 registered provider must appoint a person to manage the children‘s home if— (a) there is no registered manager in respect of the home; and (b) the registered provider— (i) is an organisation or a partnership; (ii) does not satisfy regulation 28; or (iii) is not, or does not intend to be, in day-to-day charge of the home. (Regulation 27(1)(a)(b)(i–iii)) 31/10/2017

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Requirement Due date

13. The leadership and management standard

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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— (a) helps children aspire to fulfil their potential; and (b) promotes their welfare. (2) In particular, the standard in paragraph (1) requires the registered person to— (a) lead and manage the home in a way that is consistent with the approach and ethos, and delivers the outcomes, set out in the home‘s statement of purpose; (d) ensure that the home has sufficient staff to provide care for each child. In particular, strengthen the structure of the management team and continue efforts to recruit staff. 31/10/2017

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Requirement Due date

The registered person must ensure that a record is made of any complaint, the action taken in response, and the outcome of any investigation. (Regulation 39(3)) 31/10/2017

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Requirement Due date

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— (i) the name of the child; (ii) details of the child‘s behaviour leading to the use of the measure; (iii) the date, time and location of the use of the measure; (iv) a description of the measure and its duration; (v) details of any methods used or steps taken to avoid the 31/10/2017 Inspection report children‘s home: SC485659 4 need to use the measure; (vi) the name of the person who used the measure (―the user‖), and of any other person present when the measure was used; (vii) the effectiveness and any consequences of the use of the measure; and (viii) a description of any injury to the child or any other person, and any medical treatment administered, as a result of the measure; (b) within 48 hours of the use of the measure, the registered

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Requirement Due date

person, or a person who is authorised by the registered person to do so (―the authorised person‖)— (i) has spoken to the user about the measure; and (ii) has signed the record to confirm it is accurate; and (c) within 5 days of the use of the measure, the registered person or the authorised person adds to the record confirmation that they have spoken to the child about the measure. (Regulation 35(3)(a)(b)(c))

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Recommendations

 Specify the procedures to be followed and the roles and responsibilities of staff when a child is missing from care or away from the home without permission. (‗Guide to the children‘s homes regulations including the quality standards‘, page 45, paragraph 9.28). Specifically, ensure that staff report any suspicion of a child being missing immediately to the police, rather than after a search.  Ensure that for children‘s homes to be nurturing and supportive environments that meet the needs of their children, they will, in most cases, be homely, domestic environments. Children‘s homes must comply with relevant health and safety legislations (alarms, food hygiene etc.); however in doing so, homes should seek as far as possible to maintain a domestic rather than ‗institutional‘ impression. (‗Guide to the children‘s homes regulations including the quality standards‘, page 15, paragraph 3.9). Specifically, review noise levels regarding

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Recommendations

doors banging, the sound of the alarm on the front door and the volume of voices and how these may impact on children.  Ensure that all staff have their performance and fitness to carry out their role formally appraised at least once annually. This appraisal should take into account, where reasonable and practical, the views of other professionals who have worked with the staff member over the year and children in the home‘s care. As part of the performance management process, poor performance should be addressed by a timely plan to bring about improvement. (‗Guide to the children‘s homes regulations including the quality standards‘, page 61, paragraph 13.5). Specifically, make sure that all staff receive an annual appraisal of their performance.  Have systems in place so that all staff, including the manager, receive supervision Inspection report children‘s home: SC485659 5 of their practice from an appropriately qualified and experienced professional,

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Recommendations

which allows them to reflect on their practice and the needs of the children assigned to their care. (‗Guide to the children‘s homes regulations including the quality standards‘, page 61, paragraph 13.2). Specifically, make sure that all staff receive regular supervision.  Ensure that children are offered a wide range of activities inside the home (where appropriate) and are encouraged to participate in those activities (‗Guide to the children‘s homes regulations including the quality standards‘, page 31, paragraph 13.2). Specifically, review if there is sufficient play and sensory equipment in the garden and the home.

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improvement to be good

This home requires improvement because some aspects of leadership and management and the protection of children require improvement, and this impacts on children‘s experiences.

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improvement to be good

Children build positive relationships with the core staff team. Familiar staff, who know children‘s needs very well, are central to providing the children with secure routines. Key workers demonstrate good understanding of children‘s needs, and plan activities to engage them and help them make progress. Use is made of temporary agency staff when there are shortages on a shift. Agency staff supervise those children with lesser needs. However, as children take time to build trust in their relationships with adults, this arrangement is not ideal in helping children make progress and enjoy their experience of the home.

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improvement to be good

Children settle into the residential experience, which for some is considerable progress in itself. One child said they like living in the home ‗a bit‘ and feel safe. Another child said, ‗I‘m happy.‘ Children indicate that they like their rooms, appearing relaxed in their own space. They enjoy warm relationships with some of the staff. A social worker said, ‗The young person has been observed to be happy, confident in his new environment, and has settled in well.‘

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improvement to be good

Children develop confidence and make small but significant steps of progress. Some are more accepting of staff support to carry out their personal care routines, relying less on prompts from staff. Others are more tolerant of changes to their routines and changes in the home. Staff encourage children to make choices and develop independence skills. A member of staff said, ‗It is good to see children develop skills and improve. ‘

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improvement to be good

Staff help children with the often difficult transition when staying away from their families for short breaks, or moving into the home long term. Staff visit other short- break services to learn how to help children with the transition to this service. A social worker said, ‗They sent their staff to work alongside staff in order to have a good Inspection report children‘s home: SC485659 6 understanding of the young person‘s needs, their likes, dislikes, and how to manage their behaviours.‘ Children benefit from attending the school attached to this home, as they are already familiar with some staff and other children. Children also benefit from input from the professionals attached to the school, such as the occupational therapist and a psychologist who helps to plan their care.

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improvement to be good

The quality of communication with parents and professionals varies. For example, one parent said, ‗Communication is improving but things aren‘t always followed up.‘ Another parent said, ‗It would be good to get more feedback about their short breaks.‘ Conversely, a social worker said, ‗They‘ve been excellent in terms of information sharing, putting the needs of the young person first, seeking advice, and providing the young person with a secure and caring home environment.‘

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improvement to be good

The condition of the premises is reasonable. Staff try to make the building appear more homelike. Children like their bedrooms, which suit their individual needs. Staff currently accommodate one child away from others in order to meet their needs, but this precludes others from using that part of the building. Staff would like further rooms where children could go when they choose to be alone for periods.

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improvement to be good

Some play and sensory items are available in children‘s rooms, the library and sensory room. Further toys, or sensory equipment, would enhance children‘s time in the communal areas of the home as well as the garden, which appears quite stark. One safety feature in the home is an alarm on the front door. However, the alarm noise, together with doors banging and some loud adult voices, affects those children who are sensitive to noise and makes the home‘s atmosphere appear institutional.

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improvement to be good

Children are generally safe, but some safety aspects require improvement. The home is a very busy place, with eleven children present at the time of the inspection. Staff-to- child ratios are generally high, partly to help manage the children in such a large building.

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improvement to be good

Incidents of children going missing from the home, or while on trips out, are rare. One child has managed to leave the building a few times, but staff have gone with them to keep them safe, and then returned with them. However, on one occasion, the child went missing unnoticed by staff and, on discovering this, staff did not immediately contact the police. Fortunately, no harm came to this child. The interim manager has taken steps to learn from this incident and prevent any further missing episodes, and to improve children‘s safety.

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improvement to be good

Despite the completion of an impact risk assessment, the impact of one new resident‘s behaviour on two existing residents was of concern. Staff did not inform management of an incident, nor was this incident recorded. Staff did not record their use of low-level physical intervention either. Lack of incident recording prevents management checks to Inspection report children‘s home: SC485659 7 make sure that behaviour management is appropriate.

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improvement to be good

Staff receive regular training and updates on how to keep children safe, and on physical interventions. The interim manager has completed safer recruitment and safeguarding training on current risks to children, and has disseminated key information from the training to staff, to keep them informed. Staff take care to record any marks or injuries and refer any concerns, as they are aware of how vulnerable children are to abuse. Staff have not recorded all physical interventions, and the person in charge has not always recorded that they have followed up incidents within five days, as required by regulation.

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improvement to be good

Adults make very few complaints about the service. In one case, the interim manager responded to concerns raised by a parent but did not record this as a complaint. This prevents scrutiny of all matters affecting the service.

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improvement to be good

Other aspects of safety in the home are strong. Procedures for checking that staff are suitable are good. This helps to ensure that only suitable people are employed to work with vulnerable children. Health and safety checks ensure the safe maintenance of the building, and that fire safety is promoted. Arrangements for the administration of medication are good.

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

The home has continued to struggle to recruit and retain staff, and to appoint a deputy manager. This has affected record-keeping, time for staff training and support, continuity, and the quality of care and information sharing. Not all staff have received regular supervision or annual appraisals during this inspection period. This limits opportunities for all staff to reflect on their practice. This shortfall has been identified at previous inspections.

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

Leaders and managers have tried various means to recruit and retain staff, with only limited success. Staff are of the view that rates of pay do not promote staff recruitment and retention. The long-term use of some agency staff positively supports the permanent team. However, the use of some temporary agency staff does not enhance the quality of children‘s care.

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

The registered manager is on a planned absence for a year. The interim manager has not yet applied to register, as required. She is also frequently working on shifts and providing support to parents, which takes her away from management tasks. The change in management, shortage of staffing and lack of a deputy weaken the leadership and management of the home.

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

Children benefit from a core team of both day and night staff, some of whom have worked in the home for many years. Some show passion for their work with children. One staff member described their colleagues as ‗a really great team – wonderful team to work with‘. A team leader said, ‗I love my job – I‘ve learned so much.‘ A process of Inspection report children‘s home: SC485659 8 induction helps new staff settle into the role. Staff describe the quality of ongoing training as ‗good‘, but finding the time to complete some training has been difficult for some.

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

Some staff feel well supported by management. A few staff feel that communication between management and leaders and the staff team could be improved, and these staff can ‗feel a bit isolated‘ from management.

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

The interim manager has completed a review of the service, and an independent person visits each month to check what goes on. In reports of their visits they make useful suggestions about how to improve the service. The frequency of sharing these reports with Ofsted has recently improved.

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

The statement of purpose was confusing in some areas. The interim manager corrected these at the time of the inspection.

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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: SC485659 9

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Children’s home details

Registered provider: National Autistic Society

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Children’s home details

Registered provider address: 391–393 City Road, London EC1V 1NG

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Inspector

Jacqueline Graves, social care regulatory inspector Inspection report children‘s home: SC485659 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 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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