Children's home run by PCT Care Services Limited in South Norfolk

Inspection report children’s home: SC479645 1 SC479645 Registered provider: PCT Care Services 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

This children’s home provides care and accommodation for up to six children who have emotional and/or behavioural difficulties. The home is owned by a private company

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Information about this children’s home

Inspection dates: 12 to 14 December 2017

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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 are not protected or safeguarded and the care and experiences of children are poor.

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inadequate

Date of last inspection: 27 September 2016

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inadequate

Overall judgement at last inspection: declined in effectiveness

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Enforcement action since last inspection:

At the interim inspection, the home was judged as having declined in effectiveness. A compliance notice was served and 11 requirements made. The compliance notice was issued in relation to Regulation 12. A monitoring visit was carried out on 15 October 2016, following which the compliance notice was reissued as it had not been met. A second monitoring visit was carried out on 18 November 2016, when the notice was found to have been met. Inspection report children’s home: SC479645 2

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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 leadership and management of the home are ineffective and disorganised.  The children are not safeguarded and are at serious risk of harm.  Actions from the fire risk assessment have not all been implemented.  Widespread shortfalls throughout the home have had a significant impact on the care provided.  The staff have not been able to prevent the children regularly leaving the home late at night without permission. This poses risks in terms of child sexual exploitation, peer influence, substance misuse and road safety.  The staff have failed to recognise the signs of child sexual exploitation and take the necessary steps to reduce these risks.  Managers and staff are not updating risk assessments and care planning documents with essential information.  The home’s approach to matching and assessment of new placements fails to include an evaluation of known risks.  Managers ask inexperienced staff who are new to childcare to lead shifts

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Key findings from this inspection

comprised of other new staff.  There are a number of practice and performance issues in the staff team.  The staff lack the skills to de-escalate situations or recognise bullying incidents.  The recruitment checks for new staff are not good enough.  There are errors in the medication administration records.  The children do not have an active voice in the home.  Some areas of the home need work to bring them up to a reasonable standard, and the children cannot access all areas of the home.  Children are not discouraged from smoking at the home.  The statement of purpose has a number of inaccurate claims.

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Key findings from this inspection

 Attendance in education has improved for the majority of the children.  The children are supported by the staff to become independent. Inspection report children’s home: SC479645 3

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Inspection date Inspection type Inspection judgement

27/09/2016 Interim Declined in effectiveness 02/06/2016 Full Requires improvement Inspection report children’s home: SC479645 4

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Statutory requirements

This section sets out the actions that the registered person 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 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 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 and enable the child to participate in the daily life of the home. (Regulation 6(1)(a)(b)(2)(c)(i)(ii)) 15/01/2018

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Requirement Due date

The children’s views, wishes and feelings standard is that children receive care from staff who develop positive relationships with them, engage with them and take their views, wishes and feelings into account in relation to matters affecting the children’s care and welfare and their lives.

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Requirement Due date

In particular, the standard in paragraph (1) requires the registered person to ensure that staff ascertain and consider each child’s views, wishes and feelings, and balance these against what they judge to be in the child’s best interests when making decisions about the child’s care and welfare, and help each child to express views, wishes and feelings. (Regulation 7(1)(a)(b)(c)(2)(a)(i)(ii)) 15/01/2018

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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 understand the child’s health and well-being needs and the options that are available in relation to the child’s health and wellbeing in a way that is appropriate to the child’s age and understanding. (Regulation 10(1)(a)(2)(a)(ii))

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Requirement Due date

This is with particular regard to supporting the children with smoking cessation. 15/01/2018 Inspection report children’s home: SC479645 5 The positive relationships standard is that children are helped to develop, and to benefit from, relationships based on mutual respect and trust and an understanding about acceptable behaviour.

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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 develop and practise skills to resolve conflicts positively and without harm to anyone and de-escalate confrontations with or between children, or potentially violent behaviour by children. (Regulation 11(1)(a)(b)(2)(a)(iv)(xi)) 15/01/2018

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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, and have the skills to identify and act upon signs that a child is at risk of harm. (Regulation 12(1)(2)(a)(i)(iii))* 15/01/2018*

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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; ensure that staff work as a team where appropriate; ensure that the staff have the experience, qualifications and skills to meet the needs of each child; use monitoring and review systems to make continuous improvements in the quality of care provided in the home. (Regulation 13(1)(a)(b)(2)(a)(b)(c)(f)(h))* 15/01/2018*

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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 children are admitted to the home only if their needs are within the range of needs of children for whom it is intended that the home is to provide care and accommodation, as set out in the home’s statement of purpose. (Regulation 14(1)(a)(b)(2)(a)) 15/01/2018

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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 15/01/2018 Inspection report children’s home: SC479645 6 within 28 days of the revision. (Regulation 16(3)(a)(b)) The registered person must make arrangements for the handling, recording, safekeeping, safe administration and disposal of medicines received into the children’s home.

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Requirement Due date

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, and a record is kept of the administration of medicine to each child. (Regulation 23(1)(2)(b)(c)) 15/01/2018

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Requirement Due date

The registered person must ensure that the requirements of the Regulatory Reform (Fire Safety) Order 2005 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))

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Requirement Due date

In particular, ensure that fire risk assessments are adhered to and that fire doors close. 15/01/2018

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Requirement Due date

The registered person must recruit staff using recruitment procedures that are designed to ensure children’s safety and that full and satisfactory information is available in relation to the individual in respect of each of the matters in Schedule 2. (Regulation 32(1)(3)(d)) 15/01/2018

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Requirement Due date

* These requirements are subject to a compliance notice.

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Overall experiences and progress of children and young people: inadequate

The overall experiences and progress and the quality of the care provided are inadequate. The children’s safety is not assured, and there are significant risks to them that are increasing. Managers have failed to ensure that the staff have the experience and skills to identify or reduce these risks. The staff provide an inconsistent approach to the children’s care. This inconsistency has had a significant impact on the quality of relationships. The approach taken to providing care is not based on individual children’s needs, or guided by care-planning documents. The children’s behaviour support plans, 24-hour management plans and risk assessments do not give the staff the guidance that they need to provide safe and effective care. The lack of information and guidance, coupled with the manager’s failure to provide clear direction, result in ineffective behaviour management, which gives the children inconsistent messages.

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Overall experiences and progress of children and young people: inadequate

A lack of adequate training and guidance has meant that some of the staff use physical intervention to make children comply. An example is moving a child physically from areas in the home when the child has refused to move or has prevented staff from leaving an area. The staff use sanctions that are punitive and lack any meaning for the children. Inspection report children’s home: SC479645 7 Some of the records of incidents indicate that confrontation from the children is met with confrontation from the staff. This practice has resulted in incidents escalating and the staff exacerbating the children’s behaviour. One record shows an incident in which a member of staff debates an unnecessary and hypothetical argument with a child. This member of staff shows a lack of skill in de-escalation. The manager commented on the incident record that she is, ‘Really disappointed to read that the child has disengaged

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Overall experiences and progress of children and young people: inadequate

with the team.’ This incident has not been reviewed proportionately, and the staff member was therefore not encouraged to reflect on their own attitudes. This resulted in the child being blamed for the incident, rather than the staff member learning from it. The staff member’s attitudes and approach to the children has resulted in volatile relationships between some of the staff and the children. The children’s views are not heard properly. A child’s concerns about staff practice have not been explored properly despite being raised on several occasions. Residents’ meetings are held. However, one child who did not want to attend was reminded that a consequence of not attending would be loss of snack money. This response is inappropriate. Following this threat, the child did not engage with the meeting. This practice does not encourage the children to share their views.

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Overall experiences and progress of children and young people: inadequate

The staff use an accredited medication administration system for which they are trained. A sample of the medication records shows that, on occasions, significant medication was not recorded as being administered, so inspectors could not be certain that the medication was given to the child. There is no evidence of explanation or follow-up, and this potential omission to administer medication has not been detected through monitoring. The child concerned has complex health needs and missing medication doses could cause her health to deteriorate. The house is large and covers two floors. There are some homely areas, although the quality of decor is poor in places. The kitchen requires new cupboards and the paintwork and wallpaper are dated and torn. The children cannot access the first floor of the building without a member of staff. This is because the door has an electronic key code unknown to the children. The presentation of some areas of the home is neither homely

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Overall experiences and progress of children and young people: inadequate

nor pleasant for the children. The entrance hall has an odour of tobacco and there is evidence of smoke in the games room where the children had recently been. The hardcourt outdoor area is institutional and unsightly. There is a discarded sandpit filled with water and a weathered picnic bench.

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Overall experiences and progress of children and young people: inadequate

The car park area has been designated as a smoking area for the staff. Close circuit television in the manager’s office shows the staff going in and out of the building in small groups to the car park for smoking breaks. They are visible from the interior of the building and several of the staff carry a strong odour of tobacco smoke. Team meeting minutes allude to the staff members’ lack of discretion in regard to smoking. All three of the children at the home smoke. There is little evidence of smoking cessation work or active discouragement. Failure to provide cessation support and positive role-modelling does not support the children to consider the health risks associated with smoking.

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Overall experiences and progress of children and young people: inadequate

Some of the staff have positive relationships with the children and have created good memories for them. A social worker said that one child had a positive relationship with Inspection report children’s home: SC479645 8 the manager. Photographs depict a number of happy occasions during which the children visited theme parks and enjoyed a variety of outdoor summer activities with the staff. However, the number of staff changes, the extensive use of new and inexperienced staff and some staff who have practice and performance issues have a negative impact on the children’s experiences.

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Overall experiences and progress of children and young people: inadequate

The children have made some positive progress, particularly in education. One child has been reintroduced to mainstream school and she has consistently attended. The other children attend an education provision on site. This provision is not registered as a school; however, it provides the children with a daily structure and a routine. The manager is knowledgeable about the children and the progress that they have made. Despite this, there is a lack of data analysis. Staff do not obtain up-to-date information about children’s education attendance and levels of attainment. One child’s file had a school report with the last attendance figures recorded in February 2017; another child’s attendance was not known. This lack of data makes the children’s progress hard to monitor. A social worker said that progress reports are not provided regularly. The staff and manager have knowledge of the children’s day-to-day routines but have no systems

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Overall experiences and progress of children and young people: inadequate

to measure the impact that the home has in respect of the children’s progress.

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Overall experiences and progress of children and young people: inadequate

The children are supported to use public transport with the staff in the first instance and then alone. This has developed one child’s confidence and enabled her to get to school independently.

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

The children are not adequately protected from harm, child sexual exploitation, bullying or fire risks. The risks to individual children are not assessed well enough, and preventive action taken is inadequate.

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

The home’s fire risk assessment fails to include information about children who smoke in their bedrooms and one child who had used an aerosol as a ‘flame thrower’. One child’s bedroom door does not close unaided, making the fire door ineffective. At the time of inspection, the door closure had been faulty for a number of weeks. The front door is kept locked by a key, and therefore a member of staff is required to open it. The fire risk assessment lacks all of the above information, placing the children and the staff at potential risk. The staff have not amended individual risk assessments to ensure that preventative actions are taken to reduce the risk of fire. In addition, the fire risk assessment states that to prevent accidents the metal external fire escape should be gritted during cold weather to prevent slippage. This had not been done, despite icy conditions and a child using the fire escape to leave the building.

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

The manager and staff have failed to update one risk assessment with information, disclosed to the staff by a child, that indicated a significant risk of child sexual exploitation. The child made a significant disclosure to staff. The assessment fails to identify the risks to the child in terms of being vulnerable to child sexual exploitation. Additionally, the child has been missing alone on four occasions in six weeks. Although two recorded conversations clearly indicate a risk of sexual exploitation, this risk has not Inspection report children’s home: SC479645 9 been considered by the staff or linked to her going missing from the home. This failure to recognise the signs and risks of child sexual exploitation shows a lack of understanding and a lack of professional curiosity. The staff have failed to recognise the vulnerability of the child.

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

Another child’s risk assessment is not up to date following an incident in which the child set fire to aerosols and paper in another child’s bedroom. The manager agreed that these risks were wrongly categorised by staff who did not understand the new risk assessment format. The inability to recognise these risks exposes the children to potentially significant harm.

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

The children regularly go missing from this home. Managers have failed to ensure the staff consistently know what to do in these circumstances. The children have left the home late at night in extreme weather conditions. On one occasion, the staff failed to take immediate action to follow the children, despite there being ample staff on duty. The shift leader on this occasion was a new and inexperienced member of staff. Given the potential risks known to these children, failure to act places them in potentially dangerous situations.

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

The staff fail to record all bullying incidents. A concern that a younger child was kicked by an older child have not been identified as bullying. One child influencing and inciting another child into risk-taking behaviours and using threats of violence have not been addressed. This lack of recognition and action fails to protect children. A failure to record such incidents does not enable the manager to identify patterns and help the children to resolve conflicts.

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

Some staff are trained in physical intervention. However, physical intervention records show that the staff have failed to implement their training when physically holding the children. New members of staff, who have physically intervened, have not received any training. The staff have failed to implement strategies to de-escalate incidents and, on occasion, have forcibly moved a child. The staff use physical interventions outside of the organisation’s own guidelines and training. One child is known, when upset, to prevent the staff from leaving or entering areas by standing in their way. The manager said that she has asked the staff to walk away and find an alternative route. The records show that the staff have not adhered to this directive. There are repeated incidents in which the staff forcibly moved the child when this was not necessary, cornered him against a wall, moved him to one side or pushed him away from blocking their path. The staff are

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

unclear about the agreed behaviour management strategies. This confusion leads to escalation of behaviour and unnecessary physical interventions. This has led to children having prolonged incidents that could have been avoided.

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

The approach to behaviour management is unclear, ad hoc and dependent on who is on duty. The manager has reviewed a physical intervention record and asked for the child’s behaviour support plan to be updated. This has not been done and the 24-hour plan has no further detail. A lack of approach and strategy to behavioural incidents results in practice that escalates some children’s behaviours. This failure does not provide the child with consistent behaviour management strategies and is detrimental to the children’s Inspection report children’s home: SC479645 10 welfare.

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

There have been several allegations about staff members’ practice. One allegation resulted in an immediate dismissal, and a second person is currently under provider investigation. These were serious incidents that have been reported and managed appropriately. However, children’s views and concerns about staff practice have not been followed up or explored. Records indicate that a child is unhappy with the staff member’s practice and alleges that he was held in a room by a member of staff, pushed during a physical intervention and that he doesn’t trust another member of staff. There is no evidence of these concerns being followed up by the manager or any of the staff. This failure leaves the children ineffectively safeguarded and without a voice at the home.

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

The pre-employment checks for new staff are not always completed prior to the staff working at the home. One member of staff started working at the home prior to his Disclosure and Barring Service checks being obtained. Other staff members’ files show omissions such as gaps in employment history and a lack of references. Failure to ensure safe recruitment of staff puts children at risk.

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The effectiveness of leaders and managers: inadequate

The management of the home is ineffective and fails to ensure that the children’s welfare is safeguarded. Widespread shortfalls throughout the home have a significant impact on the care provided. The management team has failed to address these shortfalls properly, resulting in a decline in the care provided, which is detrimental to the children’s well-being.

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The effectiveness of leaders and managers: inadequate

The manager has been in post since February 2017 and was registered by Ofsted in September 2017. She is qualified to level 3. The inspection identified concerns in regard to her professionalism and her competence as a manager. There is a lack of accountability and a culture of blame in the management of this home.

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The effectiveness of leaders and managers: inadequate

A number of the shortfalls identified at this inspection are repeats of previous shortfalls. This shows an inability to sustain improvement, ineffective management oversight and inadequate managerial monitoring.

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The effectiveness of leaders and managers: inadequate

The home has become unsettled and volatile after a relatively settled period. The last external monitoring report carried out in September 2017 identified a reduction in incidents and that the children were in school. A new independent visitor has since been appointed and has carried out one visit. This report has not yet been made available to Ofsted. Therefore, the quality and depth of this report are unknown.

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The effectiveness of leaders and managers: inadequate

Managers have failed to ensure that the staffing of the home is adequate to meet the children’s needs. There are several vacancies. A high number of the staff are in their probationary periods and there is regular use of agency staff. The lack of experienced staff makes the deployment of staff difficult. Many staff are unqualified and several have little experience of working in residential childcare. The intention of the staff is generally Inspection report children’s home: SC479645 11 good; they show commitment and enthusiasm. However, their lack of knowledge, experience and skills restricts the quality of care that they are able to provide. On occasion, children are cared for by staff who have little experience of working at the home. The combination of staff does not provide adequate or safe staffing levels for vulnerable children. In addition, it does not promote the children’s emotional security or

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The effectiveness of leaders and managers: inadequate

The staff do not work collaboratively. There is confusion among the staff about behaviour management strategies. The staff and the manager have conflicting ideas. The care plans fail to guide the staff because there are crucial elements that are not included or updated. The team meeting minutes are contradictory. There are several written entries that, when discussed with the staff, were disputed. These include some highly pertinent information in regard to notice being given in respect of two of the children’s placements. The team meeting minutes show that there are disquiet and pockets of negativity in the team. There are a number of practice issues that the manager is aware of; she has recorded that practice is not good enough. These issues include record-keeping, behaviour management and housekeeping not being of a good enough standard. Meeting minutes also allude to the staff being bad tempered. The staff

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The effectiveness of leaders and managers: inadequate

spoken to say that morale is improving; they acknowledge that things have been difficult. However, a lack of clear managerial direction makes for inconsistencies and allows practice that escalates some of the children’s behaviours. This is detrimental to the children’s welfare.

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The effectiveness of leaders and managers: inadequate

Children’s records indicate that there are staff who have a negative outlook on the children. The records show that several of the staff are writing with an emotive and angry slant. The children are blamed. Terms such as ‘disgraceful’ and ‘smugness’ are used. The records show inequality and favouritism. This has not been addressed effectively by the manager.

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The effectiveness of leaders and managers: inadequate

The approach and assessment of new admissions are unrealistic. A manager’s assessment of an emergency admission to the home failed to evaluate the impact of the known risks. The assessment failed to mention a considerable age gap between this child and the other children at the home, a wide range of diagnosed complexities and associated behaviours, significant health needs and sexualised behaviours towards adults. The assessment states that the existing children at the home were spoken to and said that they would like a younger child at the home. This is overly simplistic, presenting a positive match that omits essential information. Failure to assess the impact of the new admission robustly placed the children and the staff in the home in an extremely difficult situation. Following this admission, an experienced member of staff assaulted the new child by hitting her around the back of the head during an incident.

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The effectiveness of leaders and managers: inadequate

The member of staff was described as being quiet and patient. The incident was reported and managed appropriately, and the member of staff no longer works at the home. However, the extreme behaviours detailed in the incident record question the suitability and matching of the placement.

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The effectiveness of leaders and managers: inadequate

The statement of purpose states that there is an in-house therapist, a school on site and that the home caters for children who have learning difficulties. In fact, the home caters Inspection report children’s home: SC479645 12 for children who have emotional and/or behavioural difficulties. There is no registered school on site and no in-house therapist. This document is misleading for commissioners, parents and social workers.

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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: SC479645 13

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Children’s home details

Registered provider: PCT Care Services Limited

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Children’s home details

Registered provider address: Old Hall Farm, Silfield Road, Silfield, Wymondham, Norfolk NR18 9NH

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Inspectors

Clive Lucas, social care inspector Deirdra Keating, social care inspector Inspection report children’s home: SC479645 14 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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