Children's home run by RNIB Charity in Camden

Inspection report for children’s home - monitoring visit: SC485607 1 SC485607

p.1

RNIB Charity

Monitoring visit Inspected under the social care common inspection framework

p.1

Information about this children’s home

This is a large children’s home that provides care and accommodation for up to 30 children and young people in five purpose-built bungalows. The children and young people have a visual impairment, a learning and/or physical disability and/or sensory impairment. One of the bungalows is also registered by the Care Quality Commission and provides a specialist service to children and young people who have high health and medical needs who require long-term ventilation, or who have life-threatening or life-limiting conditions. The establishment is owned by a large national charity. The majority of the children and young people attend a registered school on the same site. Some young people remain at the home until the age of 19 to complete their education.

p.1

This monitoring visit

Ofsted completed a full inspection in August 2017 and judged that the home required improvement to be good. The judgment in ‘the effectiveness of leaders and managers’ area was inadequate. The home was then inspected in November 2017 and judged to have sustained effectiveness. Five requirements were made. These related to poor staff knowledge of safeguarding referral procedures, a lack of clarity in internal referral processes, and gaps in safeguarding training. In addition, there were significant concerns with regards to the administration of medication and using the wrong equipment for a young person. There was also no record of the regulation 44 visitor talking to children, parents or staff at the home. This monitoring visit took place after Ofsted received a number of concerning notifications. The concerns related to safeguarding practices and the quality of healthcare that young people receive. In order to explore these incidents further,

p.1

This monitoring visit

Ofsted conducted an unannounced monitoring visit on 13 December 2017. The following shortfalls were identified as a consequence of the visit. Inspection report for children’s home - monitoring visit: SC485607 2 Progress has not been made since the last inspection. There has been a decline in the quality of care provided in the home. The previous requirements made have not been met. There remain considerable and further shortfalls in the areas of safe administration, handling and recording of medication. For example, one young person did not receive their epilepsy medication as per their prescription due to staff error. During another incident for the same young person, paracetamol was found to be out of date. Staff did not seek appropriate advice or source replacement medication in a timely manner. Staff state that the young person did not have a temperature at this time. However, staff did not record the young person’s

p.1

This monitoring visit

temperature appropriately. He was later admitted to hospital. It is possible that this failure had an impact on the young person’s health. During this monitoring inspection, it was discovered that another young person was not given the correct dose of his antibiotic. Managers did not make sure that one young person’s advanced epilepsy care plan was available to staff and paramedics. Staff took 12 hours to find this after the young person was taken to hospital experiencing uncontrollable seizures. This was because the care plan had been archived. It is not known who did this. Managers are not providing effective oversight of young people’s care plans in line with local authority aims and objectives. Consequently, young people’s health needs are not being met. Staff did not make sure that the same young person’s equipment to monitor his oxygen saturation levels and heart rate was set correctly. His oxygen

p.2

This monitoring visit

saturation levels were set too low for an alarm to sound. It is unknown how or why this error occurred. Staff cannot be sure how long it was set like this as there are no records to show this. This error could have been fatal for the young person. Staff do not record children’s vital observations and managers do not ensure the proper monitoring of equipment. The registered manager delegates considerable responsibilities to team leaders for training, overseeing young people’s care plans and ensuring staff competence. Three of the five team leaders do not hold an up-to-date management qualification. This means that team leaders do not have the qualifications and skills that they need to make sure that the needs of young people are met. There is no plan to invest in this training for staff. Senior managers and the registered manager have failed to ensure that care is delivered in line with the service’s statement of purpose. The manager does not

p.2

This monitoring visit

monitor or review the quality of care provided in each of the houses. Monitoring systems are ineffective, shortfalls are not analysed or resolved and poor practice continues. Supervision of managers and staff is not good enough. Sessions are infrequent and of poor quality. For example, the nurse manager has not been supervised by the registered manager since August. The registered manager has no formal record of supervision from the responsible individual. This means that there is a lack of managerial oversight and accountability for the home. Inconsistent and absent supervision is an issue across the service. Staff with supervisory responsibilities are not experienced in this role and not trained in this task. As a consequence, staff are Inspection report for children’s home - monitoring visit: SC485607 3 not given the opportunity to discuss concerns and share practice issues. In addition, managers do not challenge shortfalls in staff practice. Consequently, the quality of

p.2

This monitoring visit

care that young people are receiving is not good enough. Safeguarding procedures in the home have worsened. A designated safeguarding lead caused considerable delay in referring an allegation of emotional abuse by a staff member to the multi-agency safeguarding hub. The registered manager did not follow safeguarding processes properly when managing this incident. The registered manager has not challenged the designated officer in the local authority in regards to a lack of response or advice. The registered manager was directed to do so in October 2017 by the organisation’s safeguarding board. The registered manager lacks the necessary skills and training to manage the home safely. The registered manager does not work within the local authority’s safeguarding procedures to protect children. She has completed investigations into staff conduct in isolation. The registered manager does not have a good understanding of

p.3

This monitoring visit

safeguarding processes and does not provide the necessary scrutiny and oversight to support staff in this area. As a result, young people are at risk. This visit has raised serious concerns about the care and practice in the home.

p.3

Recent inspection history

Inspection date Inspection type Inspection judgement 20/11/2017 Interim Sustained effectiveness 22/08/2017 Full Requires improvement to be good 29/03/2017 Interim Declined in effectiveness 14/11/2016 Full Good Inspection report for children’s home - monitoring visit: SC485607 4

p.3

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.

p.4

Requirement Due date

The protection of children standard is that children are protected from harm and enabled to keep themselves safe. In particular, the standard in paragraph (1) requires the registered person to ensure— that staff understand the roles and responsibilities in relation to protecting children that are assigned to them by the registered person that staff take effective action whenever there is a serious concern about a child’s welfare that staff are familiar with, and act in accordance with, the home’s child protection policies that the premises used for the purposes of the home are designed, furnished and maintained so as to protect each child from avoidable hazards to the child’s health. This is with specific reference to making sure that lifesaving equipment is monitored properly. (Regulation 12(1) and (2)(a)(v)(vi)(vii)(d)) 26/01/18

p.4

Requirement Due date

The leadership and management standard is that the registered person must 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 and use monitoring and review systems to make continuous improvements in the quality of care provided in the home. (Regulation 13(1) and (2)(a)(h)) 23/02/18

p.4

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))* 16/02/18

p.4

Requirement Due date

A responsible individual must have the capacity, experience and skills to supervise the management of the home, or the homes, in respect of which the responsible individual is nominated. (Regulation 26(7)(b)) 26/01/18

p.4

Requirement Due date

The registered manager must undertake such continuing 23/02/18 Inspection report for children’s home - monitoring visit: SC485607 5 professional development as is necessary to ensure that the registered manager has the skills needed for managing the home. (Regulation 29(4)) The registered person must ensure that all employees undertake appropriate continuing professional development; 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)(a)(b)(c)) 26/01/18

p.4

Requirement Due date

*This requirement is subject to a compliance notice.

p.5

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.

p.5

Information about this inspection

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

p.5

Children’s home details

Registered provider address: c/o RNIB, 105 Judd Street, Camden, London WC1H 9NE

p.5

Children’s home details

Responsible individual: Teresa Stephenson

p.5

Inspectors

Anna Gravelle, social care inspector Christy Wannop, social care inspector Inspection report for children’s home - monitoring visit: SC485607 6 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.

p.5

Inspectors

If you would like a copy of this document in a different format, such as large print or Braille, please telephone 0300 123 1231, or email enquiries@ofsted.gov.uk . You may reuse this information (not including logos) free of charge in any format or medium, under the terms of the Open Government Licence. To view this licence, visit http://www.nationalarchives.gov.uk/doc/open-government-licence , write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: psi@nationalarchives.gsi.gov.uk .

p.6

Inspectors

Interested in our work? You can subscribe to our monthly newsletter for more information and updates: http://eepurl.com/iTrDn .

p.6

Inspectors

T: 0300 123 1231 Textphone: 0161 618 8524 E: enquiries@ofsted.gov.uk W: http://www.gov.uk/ofsted

p.6