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 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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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: 5 September 2017

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requires improvement to be good

Overall judgement at last inspection: inadequate Inspection report children’s home: SC438756 2

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Enforcement action since last inspection:

Two compliance notices were issued after the last inspection. These notices were in relation to leadership and management and the administration of medication. The compliance notices were reviewed at this inspection visit and the outcomes are included in this report.

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Key findings from this inspection

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

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Key findings from this inspection

 The local authority plans in each of the children’s files are significantly out of date. The staff do not regularly request updated plans from the placing authorities.  The health plans for the children are not consistently dated. This does not evidence that regular reviews of these plans are taking place.  Direct work with the children is not taking place regularly enough.  Communication with the parents requires improvement. Parents say that the staff and the managers do not readily share information with them about the home.  The behaviour management processes are unclear and do not provide consistency for all of the children.  Information in recruitment files is difficult to locate and understand.  External monitoring and internal monitoring does not consistently include the views of parents and the placing authorities.  There has been a further medication error since the last inspection.

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Key findings from this inspection

 The children’s information leaflet has been suitably revised since the last inspection. This is now accessible to the children.  The staff listen to and communicate with the children. The staff are aware of and responsive to the children’s individual ways of communicating through sounds and expressions.

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Inspection date Inspection type Inspection judgement

05/09/2017 Full Inadequate 31/08/2016 Full Requires improvement Inspection report children’s home: SC438756 3 06/07/2016 Full Inadequate 14/03/2016 Interim Declined in effectiveness 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 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 and understand the child’s health and well- being needs and the options that are available in relation to the child’s health and well-being, in a way that is appropriate to the child’s age and understanding. (Regulation 10(1)(a)(2)(a)(i)(ii)) 20/11/2017

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Requirement Due date

The positive relationships standard is that children are helped to develop, and to benefit from, relationships based on mutual respect and trust, an understanding about acceptable behaviour and positive responses to other children and adults.

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Requirement Due date

In particular, the standard in paragraph (1) requires the registered person to ensure that staff strive to gain each child’s respect and trust. (Regulation 11(1)(a)(b)(c)(2)(viii)) 20/11/2017

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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 that each child’s relevant plans are followed. (Regulation 14(1)(a)(b)(2)(b)(ii)(c)) 20/11/2017

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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)) 20/11/2017

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Requirement Due date

The registered person must prepare and implement a policy (‘the behaviour management policy’) which sets out how Inspection report children’s home: SC438756 5 appropriate behaviour is to be promoted in the children’s home. The registered person must keep the behaviour management policy under review and, where appropriate, revise it. (Regulation 35(1)(a)(2)) When the independent person is carrying out a visit, the registered person must help the independent person, if they consent, to interview in private such of the children, their parents and relatives. (Regulation 44(2)(a)) 20/11/2017

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Requirement Due date

The registered person must complete a review of the quality of care provided for children (‘a quality of care review’) at least once every 6 months.

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Requirement Due date

In particular, the registered person must provide for ascertaining and considering the opinions of children, their parents, placing authorities and staff. (Regulation 45(1)(5)) 20/11/2017

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Recommendations

 Ensure that recruitment, supervision and performance management of staff safeguards children and minimises potential risks to them (‘Guide to the children’s homes regulations including the quality standards’, page 61, paragraph 13.1). In particular, ensure that relevant recruitment information is included in the recruitment files.

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improvement to be good

This full inspection follows an inspection in September 2017 that resulted in a judgement of inadequate overall. Two compliance notices were issued, in respect of medication and leadership and management, following the last full inspection.

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improvement to be good

This inspection identified some strengths. The children are stable and settled and making progress. However, there are several areas of weak practice. These include administration of medication, health plans, placing authorities’ plans and recruitment records. Behaviour management procedures require further development.

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improvement to be good

The acting manager has made improvements to the medication procedures. These improvements include photographs of the children on the medication charts and weekly contact between the staff and parents to clarify the medication arrangements for each child. Despite these changes, there has been an additional medication error since the last inspection. The child did not suffer adverse side effects. The acting manager is undertaking an investigation into the error and actions are in place to prevent a recurrence. This further error is of concern because there have been previous errors, Inspection report children’s home: SC438756 6 which resulted in a compliance notice. The administration of medication is not effective. The children have complex needs and require medication on a daily basis. This further error places the children at risk and does not sufficiently protect them or meet their long-term health needs. The compliance notice is therefore not met. However, changes

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improvement to be good

to the medication processes are in their infancy and there has been some progress. This aspect of care will continue to be closely monitored by Ofsted.

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improvement to be good

The staff have revised the health plans for the children. However, the plans are not consistently dated and it is not clear if the plans are reviewed regularly. Some of the children have complex health needs that regularly change. In one of the plans, information regarding the child’s nut allergy is vague and insufficient. The plan does not adequately inform the staff of the severity of the allergy or how it should be managed.

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improvement to be good

Each of the children’s local authority care plans are significantly out of date. There is minimal evidence that the staff regularly request updated plans. This results in a lack of consistency in the statutory plans and the home’s care plans. Despite this, there is a current person-centred plan in place for each child. The staff outline the children’s individual needs, daily routines and communication. The views of the children are evident throughout, as the information includes their likes and dislikes and preferred activities.

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improvement to be good

Direct work with the children is not taking place regularly enough. There are no records to show the reasons for missed sessions or when further work is to take place with the children. This does not provide the children with the dedicated time and space that they need to build relationships with the adults who are looking after them.

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improvement to be good

Communication has, at times, been lacking, particularly in relation to the management changes in the home. This has left parents feeling anxious. Although this is an area that requires improvement, the staff have adopted a more regular approach to communication. There are now weekly contacts with parents to clarify medication plans and meetings are taking place with managers at the request of parents.

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improvement to be good

The children’s information leaflet has been revised since the last inspection. The leaflet now includes information about trusted adults with whom the children can talk. The format is accessible for the children as it contains signs and symbols. In addition, there is visual information on the advocate’s board on a wall in the home. This information includes photographs of the children and the staff, helping the children to visually identify who they would like to talk to. An independent advocate visits the home on a regular basis.

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improvement to be good

The staff listen to and communicate with the children well. The staff are aware of the children’s individual sounds and expressions and what they mean. Symbols, cards and signing are used to communicate. There is a written rota and photographs of the staff so it is clear who is on shift. During the inspection, the staff were observed to be attentive to the children’s needs, immediately recognising when a child wanted some paper to write down his views. This enabled the child to express his views, to which the staff listened. The staff have a good understanding of the children’s personalities and Inspection report children’s home: SC438756 7 empower them to make their own decisions and choices as much as possible.

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improvement to be good

The staff at the home liaise with school staff regularly. Each child has an education plan. Communication books are well utilised and the staff make contact with the school staff to inform them of behaviours or issues for each child before school begins. This ensures that the school staff are well prepared with relevant information, and can act quickly to de-escalate incidents and behaviours or provide additional support to that child on arrival if needed.

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improvement to be good

Children are happy and settled and children’s placements rarely break down. The staff are committed to making sure that the children are able to take part in activities in the community. This builds the children’s self-confidence and social skills. One parent said, ‘My child seems happier at home; he is more relaxed and wants to spend more time with his family when he is at home now. They [staff] have been really good with him and he seems very happy.’

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improvement to be good

The behaviour management processes are unclear and do not provide consistency for all of the children. One child has a very detailed behaviour plan, while another does not have a plan because the staff have identified no challenging behaviours. This does not recognise the need to promote good behaviour for the children. There is a sanction book in place, but the use of it is not consistent or effective. The children are not clear about why consequences are imposed.

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improvement to be good

Although the home follows safe recruitment procedures, information on all of the recruitment files seen during the inspection was difficult to locate and understand. There were gaps in the information held on the files. This does not provide a clear audit trail of information or indicate that there is good management oversight. The current recording practices do not demonstrate that safeguarding the vulnerable children at the home is a priority.

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improvement to be good

Individual risk assessments and general risk assessments are comprehensive. These help to identify and reduce the risks for the children. Revised impact risk assessments are in place in readiness for any new admissions. These include assessment of children’s individual behaviours and their potential impact on others.

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improvement to be good

All of the children have up-to-date fire evacuation plans. Fire drills take place for new children and staff. This protects the staff and the children at the home, making sure that they know how to escape in the event of a fire.

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improvement to be good

There are very few incidents at the home. The children’s behaviour is generally settled and calm. When there are incidents, the staff use de-escalation techniques effectively. The recording of incidents is good and management oversight of these records is provided. Inspection report children’s home: SC438756 8 The staff carefully consider and analyse the use of physical interventions. The records help the manager to have clear oversight of the use of physical interventions. There is transparency in the staff member’s actions and reflection on practice. There are no concerns regarding bullying at the home. A bullying-incident book and procedure are in place to help the staff to record and recognise bullying incidents.

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

Since the full inspection in September 2017, the registered manager has given notice of his intention to resign from his post. An experienced manager from another of the organisation’s homes is managing this home as an interim measure. She is currently undertaking the level 5 diploma in leadership and management for residential childcare. She has significant experience of managing a similar home within the organisation. Recruitment is underway so that a permanent manager can be appointed. The organisation has taken action to put in additional management support to bring about the improvement required following the judgement of inadequate at the last full inspection.

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

The acting manager has met the compliance notice in relation to leadership and management. Changes implemented since the last inspection address the shortfalls, making sure that the home has an effective management structure.

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

The current staff team is consistent and several of the core staff have been in post for many years. One staff member said, ‘We are a very tight team. We work well together. I think we are really good.’ The children benefit from consistent care from staff who know their individual needs and behaviours.

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

The manager has formulated a new rota to ensure that a good mix of suitably skilled and experienced staff are on each shift. The staff are in a period of adjustment. One staff member said, ‘We are in a state of flux as it is early days.’

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

The staff training is up to date and recorded clearly. The training is relevant to the needs of the children and includes training in complex medication, physical intervention and first aid. The staff are well equipped to respond to the complex needs of all the children. The staff either hold a relevant level 3 qualification or they are working towards it.

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

The staff receive regular supervision. The acting manager supports and guides the staff, making sure that relevant issues are explored, including areas of personal development and performance management.

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

Regular staff meetings provide the staff with opportunities to discuss their work as well as any issues within their roles. The manager utilises this time effectively to improve the knowledge of the staff in relation to safeguarding matters.

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

External monitoring and internal monitoring do not consistently include the views of Inspection report children’s home: SC438756 9 parents and the placing authorities. These important views therefore do not inform areas of future development and change at the home.

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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: SC438756 10

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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 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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