Children's home run by Thoughts of Others Limited in Birmingham

Inspection report for children’s home - monitoring visit: SC049714 1 SC049714

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Thoughts of Others Limited

Monitoring visit Inspected under the social care common inspection framework

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Information about this children’s home

This private children’s home is registered to provide care and accommodation for two children who have emotional and/or behavioural difficulties. They may stay over the age of 18 where this is part of a plan to move on. The organisation operates a school nearby and can provide therapeutic services. The organisation operates this setting as a home for girls.

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This monitoring visit

This children’s home was judged inadequate at the full inspection on 6 and 7 September 2017.

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This monitoring visit

Following the inspection, Ofsted issued two compliance notices. These were in respect of:

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This monitoring visit

 failure to put in place safe arrangements for the administration of children’s medication  failure to use monitoring and review systems to make continuous improvements in the quality of care.

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This monitoring visit

In order to evaluate the progress the home had made to address these concerns, a monitoring visit was completed on 31 October 2017. This visit found that the registered person had not met the compliance notices and 10 previous requirements.

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This monitoring visit

The responsible individual and the registered manager have not written an action plan after the inadequate judgement made in September. At this visit it was found that the registered manager was not familiar with the compliance notices or their contents.

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This monitoring visit

Arrangements for the safe administration of medication have not improved. Staff practice relating to administering and auditing medication is still failing to ensure Inspection report for children’s home - monitoring visit: SC049714 2 that children get their prescribed medication as required. Staff competence and training are still not good enough. The home’s policy and procedure for medicines are now out of date. Managerial monitoring of the implementation of the policy is ineffective because managers are not competent. Consequently, errors in administration continue. Staff have failed to obtain prescription medication on time. This meant that a child went without her prescription inhaler for over two weeks. Children’s health is at risk because of the continuous chaotic arrangements for the management of children’s medication. As a consequence of these ongoing failures, the compliance notice remains unmet.

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This monitoring visit

The registered person still does not use monitoring and review systems to help make continuous improvements to the quality of care provided in the home. This is because there is no effective system of monitoring or review. For example, there is no analysis of safeguarding concerns or issues about staff restraint practice, medication errors, patterns of children’s behaviour, and self-harm or when they go missing from care. The registered person has not carried out any review or submitted any report or consulted with parents, children or placing authorities about the quality of care at the home for over a year.

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This monitoring visit

The registered person has not consulted with children about their quality of care. The registered person has not made any analysis of the staffing model relating to continuity of care. The rota shows days when no core staff are on duty. The balance of staff on shift does not guarantee more core than pool staff. The manager still does not directly manage and supervise the majority of staff working with children. One new member of staff who started a month ago is yet to receive supervision from the registered manager. Part of the delay is because she has been working at other homes. This has hindered the manager in being able to complete supervision and track her induction. The manager does not meet with the core staff as a team. Neither staff nor children experience continuity in these arrangements. There is no plan to indicate how the registered person intends to improve staff continuity and consistency and reduce turnover. This compliance notice is not met.

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This monitoring visit

The arrangements to protect children are still not good enough. The registered manager has made no record of a child’s recent concern about staff during a restraint, or of his decision to move the member of staff to another of the organisation’s homes. This concern has not been referred to the local authority safeguarding officer or notified to Ofsted. This is the third concern about ‘heavy’ or unauthorised restraint raised by children and health professionals since May 2017. There has been no review to learn lessons, to improve practice or to protect children.

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This monitoring visit

Children’s risk assessments still do not take account of the impact that unfamiliar staff have on children’s likelihood to self-harm or go missing. Safeguarding arrangements are not yet effective because there is still no managerial review after three allegations or concerns about staff when they restrain children, or when children go missing from care. Managerial decision-making about safeguarding Inspection report for children’s home - monitoring visit: SC049714 3 thresholds or complaints is absent.

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This monitoring visit

Staff still lack the skills, experience and qualifications to meet children’s needs. No staff have had any training in mental health awareness; this is despite having one child who has a significant clinical diagnosis. Consequently, some staff lack insight into what this means for the child. Only the most recent recruit to the core team has been trained in the organisation’s new restraint scheme. Fourteen other core staff continue to use the previous techniques. Two staff require a refresher in restraint, but one has carried out restraint despite this. Only one in 15 core staff has been trained to respond when children go missing from care. No staff have any training about internet safety. There is no sign of planning to improve this profile of staff skill.

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This monitoring visit

The registered person does not send information to Ofsted as required by regulation. The statement of purpose is still out of date and does not show the correct core staffing team or how long its members have worked at the home. The statement of purpose is now on the website, but the registered person has not sent a copy to Ofsted. Monthly visits by an independent visitor began in August, but these lack rigour. For example, the visitor noted that one child had gone missing, but did not follow this up. The report has not been sent to Ofsted in a timely way. This prevents the regulator from fulfilling its responsibility to ensure children’s safety.

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This monitoring visit

The registered person has still not implemented the recommendations of their own fire safety risk assessment from April 2017 and of the fire service after its visit in May 2017. The registered person still does not ensure that there is at least one member of staff on each shift who is trained and competent in the use of fire extinguishers. The registered person has made plans to train the manager and the deputy as fire marshals but has no plan to extend this to other staff. This means that staff may not know what to do in the event of a fire. However, the home is safer from the risk of fire because fire doors and firefighting equipment are now fit for purpose.

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This monitoring visit

Supervision is still not good enough. Three of the 15 core staff have not had supervision at the organisation’s required frequency of once every eight weeks. Two staff, previously subject to concerns about their restraint practice in August, had not had any subsequent supervision to ensure improvement. The manager has no record of supervision with his manager who is the responsible individual. The registered person does not help staff to improve their practice, to understand and manage their own feelings and responses to the behaviour and emotions of children, in order to help children do the same.

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This monitoring visit

Records of restraint still do not clearly show what happened during any incident or that senior staff have spoken to children and staff afterwards. When children raise concerns, these concerns are not recorded. These records omit important information and still do not give children an accurate account of incidents and their Inspection report for children’s home - monitoring visit: SC049714 4 life in the home.

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This monitoring visit

Staff still do not have sufficient facilities when they sleep overnight. Two staff sleep in children’s lounges on mattresses. The assigned staff bedroom is full of mattresses and items that are considered too dangerous for children to keep themselves, such as toiletries and clothing.

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This monitoring visit

The registered manager has now established partnerships with the local police and health services and so no longer works in isolation from services that can help children. Effective coordination between the manager and local mental health services has resulted in a calmer approach to hospital treatment after children self- harm, to avoid mental health crises. The registered manager is no longer required to work on shift. He is hopeful that this will give him time to make further improvements. He talks regularly to each child and knows the detail of their emotional and practical daily lives. He is a significant figure in their lives.

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This monitoring visit

Some staff have undertaken online training in Prevent duty responsibilities, self- harm and medication administration. One child’s bedroom is being refurbished, with a chalk board wall and a new carpet. Both children are now attending the organisation’s school on a full- and part-time basis. Children have met up with their families and this has been positive. Children have successfully raised money in their own planned charity event. No child goes out alone or has any social life independent of the organisation. The registered manager is keen to move one child towards independence and is talking to their placing authority about this.

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This monitoring visit

This visit has raised serious concerns about the capacity of the registered person, including the responsible individual and the registered manager, to improve care and practice in the home. They have not been successful in driving improvement even when directed to do so by legal requirements and higher compliance action. A full inspection will take place within 16 weeks of the full inspection that took place on 6 and 7 September 2017.

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Recent inspection history

Inspection date Inspection type Inspection judgement 06/09/2017 Full Inadequate 30/03/2017 Interim Declined in effectiveness 20/12/2016 Full Good 17/02/2016 Interim Declined in effectiveness Inspection report for children’s home - monitoring visit: SC049714 5

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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, the 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 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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Requirement Due date

In particular, the standard in paragraph (1) requires the registered person to use monitoring and review systems to make continuous improvements in the quality of care provided in the home. (Regulation 13(2)(h))* 17/12/2017

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Requirement Due date

The leadership and management standard is that the registered person enables, inspires and leads a culture in relation to the children’s home that helps children aspire to fulfil their potential and promotes their welfare.

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Requirement Due date

In particular, the standard in paragraph (1) requires the registered person: to 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; to ensure that staff have the experience, qualifications and skills to meet the needs of each child; to ensure that the home’s workforce provides continuity of care to each child; to 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. (Regulation 13(1)(a)(b) and (2)(a)(c)(e)(f)) 17/12/2017

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Requirement Due date

The registered person must keep the statement of purpose under review and, where appropriate, revise it; and notify HMCI of any revisions and send HMCI a copy of the revised statement within 28 days of the revision. (Regulation 16(3)(a)(b)) 17/12/2017

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Requirement Due date

The registered person must ensure that an independent person visits the children’s home at least once a month. The independent person must produce a report, and they must 17/12/2017 Inspection report for children’s home - monitoring visit: SC049714 6 provide a copy of the independent person’s report to HMCI and the placing authorities of children. (Regulation 44(1)(4)(7)(a)(c))

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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 into the children’s home. (Regulation 23(1))* 17/12/2017

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Requirement Due date

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

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Requirement Due date

In particular, the standard in paragraph (1) requires the registered person to ensure: that staff assess whether each child is at risk of harm, taking into account information in the child’s relevant plans, and, if necessary, make arrangements to reduce the risk of any harm to the child; 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; and are familiar with, and act in accordance with, the home’s child protection policies; and that the effectiveness of the home’s child protection policies is monitored regularly. (Regulation 12(1) and (2)(a)(i)(v)(vi)(vii)(e)) 17/12/2017

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Requirement Due date

The registered person must ensure that the requirements of that Order (Regulatory Reform (Fire Safety) Order 2005(a)) and any regulations made under it, except for article 23 (duties of employees), are complied with in respect of the home. (Regulation 25(2)(b)) 17/12/2017

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Requirement Due date

The registered person must ensure that all employees receive practice-related supervision by a person with appropriate experience; and have their performance and fitness to perform their roles appraised at least once every year. (Regulation 33(4)) 17/12/2017

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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 all elements of this regulation. (Regulation 35(3)(a)) 17/12/2017

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Requirement Due date

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. 17/12/2017 Inspection report for children’s home - monitoring visit: SC049714 7 (Regulation 36(1)(a)(b)(c))

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Requirement Due date

The registered person must notify HMCI if a child protection enquiry involving a child is instigated, or there is any other incident relating to a child, which the registered person considers to be serious. (Regulation 40(4)(d)(e)) 30/11/2017

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Requirement Due date

The registered person must establish and maintain a system for monitoring, reviewing and evaluating the feedback and opinions of children about the children’s home, its facilities and the quality of care they receive in it. The system referred to in paragraph (2) must provide for ascertaining and considering the opinions of children, their parents, placing authorities and staff. (Regulation 45(2)(b) and (5)) 30/11/2017

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Requirement Due date

*These requirements are subject to a compliance notice.

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Recommendations

 The design of the home should provide staff that sleep in the home overnight with appropriate accommodation and facilities to do so. (‘Guide to the children’s homes regulations including the quality standards’, page 17, paragraph 3.26)

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Information about this inspection

The purpose of this visit was to monitor the action taken and the progress made by the children’s home since its last Ofsted inspection.

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Information about this inspection

This inspection was carried out under the Care Standards Act 2000.

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Children’s home details

Registered provider: Thoughts of Others Limited

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Children’s home details

Registered provider address: 99 College Road, Sutton Coldfield, West Midlands B73 5DL

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Inspectors

Inspection report for children’s home - monitoring visit: SC049714 8 Christy Wannop, social care inspector Dawn Bennett, social care inspector Inspection report for children’s home - monitoring visit: SC049714 9 to 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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