Children's home run by Advising Health And Social-Care Limited

Inspection report children‟s home: 1254109 1 Registered provider: Advising Health And Social-Care 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 privately owned children‟s home provides care and accommodation for up to 15 children and young people who have emotional and/or behavioural difficulties. The young people are aged between 11 and 18. A team of therapists, led by a registered mental health nurse, is employed to undertake direct work with children and young people. An in-house consultant child and adolescent psychiatrist provides consultation and assessment services.

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Overall experiences and progress of

children and young people, taking into account

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good

How well children and young people are helped and protected good

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good

The effectiveness of leaders and managers good

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good

The children‟s home provides effective services that meet the requirements for good.

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good

Date of last inspection: This is the home‟s first inspection.

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good

Overall judgement at last inspection: Not applicable

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Key findings from this inspection

This children‟s home is good because: Inspection report children‟s home: 1254109 2  Young people are making good progress in many aspects of their lives.  Young people‟s emotional and mental health needs are understood early in placement. A holistic approach ensures that these needs are met well. The therapy team provides innovative advice and guidance to staff around behaviour management and positive interventions.  Young people have trusting relationships with staff who provide consistent and nurturing care.  Young people speak positively about their experiences of living in the home.  Young people are at the centre of practice. There are opportunities for young people‟s views to contribute to the running of the home and their own care plans. The registered manager makes himself available to each young person. Young people are confident to raise issues directly with him.  Staff manage challenging behaviour effectively. Over time, incidents of harmful

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Key findings from this inspection

behaviour reduce.  The home environment is nurturing and well equipped. The grounds are used well to provide excellent activities for young people.  Staff support young people well to have contact with their family.  There is a large staff team. This ensures that there are sufficient staff on duty to keep young people safe.

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Key findings from this inspection

The children‟s home‟s areas for development:

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Key findings from this inspection

 The home is a large, new service. Some administrative, recording and management systems are not yet operating smoothly. Some aspects of staff support are not yet formalised. The management team acknowledges that this is a key area for development and is committed to working on this. Inspection report children‟s home: 1254109 3

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Statutory requirements

This section sets out the actions that the registered person(s) must take to meet the Care Standards Act 2000, Children‟s Homes (England) Regulations 2015 and the „Guide to the children‟s homes regulations including the quality standards‟. The registered person(s) must comply within the given timescales.

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Requirement Due date

Engaging with the wider system to ensure children‟s needs are met

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Requirement Due date

In meeting the quality standards, the registered person must, and must ensure that staff—

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Requirement Due date

(a) seek to involve each child‟s placing authority effectively in the child‟s care, in accordance with the child‟s relevant plans;

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Requirement Due date

(c) if the registered person considers, or staff consider, a placing authority‟s or a relevant person‟s performance or response to be inadequate in relation to their role, challenge the placing authority or the relevant person to seek to ensure that each child‟s needs are met in accordance with the child‟s relevant plans. (Regulation 5 (a) and (c)) 06/02/2018

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Requirement Due date

16: Statement of purpose The registered person must compile in relation to the children‟s home a statement (“the statement of purpose”) which covers the matters listed in Schedule 1. (Regulation 16 (1)) 06/02/2018

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Requirement Due date

33: Employment of staff The registered person must ensure that all employees—

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Requirement Due date

(a) undertake appropriate continuing professional development;

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Requirement Due date

(b) receive practice-related supervision by a person with appropriate experience; and

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Requirement Due date

(c) have their performance and fitness to perform their roles appraised at least once every year.(Regulation 33 (4) (a) (b) and (c)) 06/02/2018 Inspection report children‟s home: 1254109 4

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Recommendations

 All children‟s case records (regulation 36) must be kept up to date and stored securely whilst they remain in the home. Case records must be kept up to date and signed and dated by the author of each entry. („Guide to the children‟s homes regulations including the quality standards‟, page 62, paragraph 14.3). This is a large service with various departments and managers. The registered manager needs to ensure that young people‟s records are coordinated and that all staff are aware of central recording systems.

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Recommendations

 When a child returns to the home after being missing from care or away from the home without permission, the responsible local authority must provide an opportunity for the child to have an independent return home interview. Homes should take account of information provided by such interviews when assessing risks and putting arrangements in place to protect each child. („Guide to the children‟s homes regulations including the quality standards‟, page 45, paragraph 9.30).

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Recommendations

 As well as longer-term support for children to move on from the home effectively (regulation 6(2)(b)(vi)), the home has an important role in supporting each child leaving the home in the period immediately before their departure. The registered person should work with the placing authority to ensure that each child‟s transition is planned and help each child to prepare for leaving both practically and emotionally. („Guide to children‟s homes regulations including the quality standards‟, page 57, paragraph 11.9)

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Overall experiences and progress of children and young people: good

Young people are making good progress in many aspects of their lives. Young people have individualised care plans that are understood and implemented by a cohesive staff team. One young person commented: „Most staff know me well and know how to help me in situations.‟ A social worker said that this young person has made „huge progress‟. She went on to say: „I really like the home as it offers a service that meets the holistic needs of children.‟

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Overall experiences and progress of children and young people: good

Planning and preparation for new placements is good. Staff work with placing authorities, parents and young people so that they fully understand the young people‟s starting points. The management team confidently provides care to young people who have extremely complex needs and a history of previous placement breakdown, but only after very careful consideration. This reduces the risk of further placement disruption.

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Overall experiences and progress of children and young people: good

Young people‟s emotional health and well-being is significantly improved. As they become more emotionally resilient and stable, there is a significant decrease in self-harm and disruptive behaviours. Young people also run away much less frequently. One young person, who initially presented as highly dysregulated and at considerable risk, has Inspection report children‟s home: 1254109 5 demonstrated significant progress. An independent visitor noted that the young person is now connecting emotionally with staff and sharing eye contact. The young person has also made marked progress in his physical growth.

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Overall experiences and progress of children and young people: good

Staff are supported by the organisation‟s own consultant child and adolescent psychiatrist who provides guidance to staff and supports the assessment of young people. Therapeutic services are delivered by qualified staff who work full time in the home. A reflective staff supervision session facilitated by the home‟s art therapist was observed. This supported staff to understand and reflect positively on the care needs of a particular young person. All aspects of care are considered from a therapeutic perspective. For example, because one young person becomes very anxious when staff start and finish their shifts, the head of therapy leads a staff handover that involves the young person. This innovative approach has resulted in significantly reduced anxiety and less disruptive behaviours. The young person has benefited greatly from the open approach to his daily care planning.

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Overall experiences and progress of children and young people: good

Young people report being happier at this home than they have been before. All young people report that they have positive and trusting relationships with staff. The consistent staff team shows empathy and a good understanding of young people‟s starting points. They are becoming increasingly resilient and confident as they grow in experience. One young person reported that „everyone here is nice‟.

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Overall experiences and progress of children and young people: good

The majority of young people are making good educational progress from their starting points. Most young people had not engaged with education for some time prior to living at the home. They are now receiving education on a daily basis. One young person is attending college full time, is doing well and has high aspirations. Creative solutions are found to engage young people who are very resistant to formal education. These include working with horses and music workshops. However, some personal education plans are not up to date or realistic. Managers have not raised this issue with the placing authority.

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Overall experiences and progress of children and young people: good

The home environment is welcoming and safe. Young people have personalised their own living areas so that they reflect their own tastes and preferences. Some young people are currently living in their own staffed apartments and say that they prefer the personal space to larger group living accommodation. Outdoor facilities include a wooded area that is used for camping and outdoor activities. A large climbing wall is also available.

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Overall experiences and progress of children and young people: good

Young people have a say in the running of the home. There are weekly consultation meetings and young people report feeling listened to. Where appropriate, staff promote and facilitate regular, good-quality family contact. For example, a family visit for one young person on Christmas Day has been carefully planned.

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Overall experiences and progress of children and young people: good

Staff think carefully about future transitions for young people. They are prepared to invest in alternative community placements if young people would benefit from a less structured environment. One young person successfully transitioned from the home to a foster care placement. However, more robust challenge to placing authorities is Inspection report children‟s home: 1254109 6 necessary in instances when pathway plans are unclear or incomplete.

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

Young people are safe and, over time, become increasingly safe as they stabilise and settle in to the routines of the home. One young person said, „I am ten out of ten safe here.‟ The manager ensures that staff ratios are high. This enables staff to spend quality time with young people and develop positive, nurturing relationships.

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

Some young people having a significant history of going missing and are particularly vulnerable while away from the home. The positive relationships that staff have with young people, combined with staff‟s understanding of individual risks and triggers, have resulted in a significant reduction of running away. Incidents of young people going missing have become rare. However, when young people do go missing there is no record of whether missing from care return interviews have been offered.

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

Staff work well and collaboratively to address the needs of young people who self-harm. This is underpinned by a sound understanding of a young person‟s background and history. One young person with a significant history of self-harm has been supported reduce this behaviour and is now fully engaging with education.

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

Individual risk assessments are thorough and well understood by staff. Effective recording of incidents enables managers to carry out effective review and analysis. Each young person has a log where it can be clearly seen that incidents have reduced. However, the coordination of information could be improved by ensuring that records are easily accessible to all relevant staff.

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

Staff use positive behaviour management strategies. The relationship-based approach supports young people to make safe choices. Challenging or aggressive behaviours reduce because staff are skilled in using de-escalation techniques. One young person is placed at the home with a deprivation of liberty safeguards (DOLS) order. Staff are working hard to stabilise the young person, build up positive relationships and reduce risk taking behaviours so that the DOLS order is no longer required. Current arrangements are effective in safeguarding the young person but staff are very aware that the restriction of liberty must be a short term arrangement.

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

Managers and staff understand and fully adhere to local safeguarding procedures. The manager has completed a detailed locality risk assessment. He liaises with the police and other agencies, gathering relevant information and using this to promote young people‟s safety. The manager ensures that all staff are subject to appropriate pre-employment checks.

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The effectiveness of leaders and managers: good

The manager is experienced and knowledgeable. He is available to young people and staff because he is actively involved in the day-to-day routines of the home. He enjoys generally warm and positive relationships with young people. The responsible individual Inspection report children‟s home: 1254109 7 is also highly experienced and has a proven track record of providing high quality care services. The home‟s two directors have previously operated residential mental health provisions. They are passionate about offering care and therapy within a community social care setting. This high calibre management team also makes use of consultants and independent visitors who have a broad range of social care experience. One young person said that the manager „won‟t do something unless it‟s in my best interests‟.

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The effectiveness of leaders and managers: good

One director is a consultant child and adolescent psychiatrist. However, he works at the home for as much as three days per week. He liaises with local health services, including GPs and the child and adolescent mental health services (CAMHS) to ensure that the mental health needs, and treatment regime, of each young person is carefully reviewed. Managers have a comprehensive understanding of the mental and emotional health needs of each young person, as well as the progress they are making towards good mental health.

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The effectiveness of leaders and managers: good

The independent visitor is a key asset of this service. She provides a clear, monthly report to directors that outlines areas of weakness and areas where improvements can be made. It is notable that all shortfalls identified through this inspection had previously been identified by the independent visitor so that improvement plans were in place prior to the inspection.

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The effectiveness of leaders and managers: good

In some cases, care plans, education plans, and health plans provided by placing authorities are lacking in detail and contain targets that are not set out clearly. There is insufficient evidence that managers have worked constructively with placing authorities to improve these plans. Disorganised systems mean that the registered manager is not always able to easily access plans.

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The effectiveness of leaders and managers: good

Staff say that they feel very well supported. They have daily contact with therapists and managers and feel very confident to seek advice and support. Care staff feel empowered by the range of management and specialist support available to them. For example, they have worked closely with the highly skilled psychotherapist to develop innovative strategies and therapeutic approaches to support a particular child. However, formal supervision is not yet embedded into the home‟s practice. A number of staff do not receive regular supervision from their line manager. All staff in supervisory positions have recently attended training on how to deliver supervision and a programme of supervision is in place.

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The effectiveness of leaders and managers: good

Staff receive a range of training. Each member of staff is given an induction before working directly with young people, and then completes shadow shifts so that they can understand the needs of children and observe experienced staff. However, this induction is not well organised and induction records are sparse. Specialist trainers are commissioned so that staff have access to good learning opportunities that reflect the needs of young people. For example, staff have attended training in relation to self- harm, mental health and deprivation of liberty, as well as mandatory training in safeguarding, food hygiene and first aid. Managers acknowledge that the training programme can be better organised and have recently updated their training plan. Inspection report children‟s home: 1254109 8 The home‟s statement of purpose is informative and presents accurate information to parents and placing authorities about the care, support and services that the home

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The effectiveness of leaders and managers: good

offers. However, the statement of purpose currently lacks an up-to-date list of staffing and qualifications.

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The effectiveness of leaders and managers: good

Managers understand their obligations and responsibilities when caring for children who are subject to DOLS orders. They ensure that each member of staff knows how to adhere to the DOLS order, and take care to ensure that staff do not abuse their power to restrict the liberty of a young person. For example, they make sure that any keys are carried discretely so that the home does not have an institutional feel. Staff allow young people to build up trust and freedom while taking part in activities on site. Young people who are subject to DOLS orders have daily opportunities to access the local community and take part in a range of community activities. Managers work closely with social workers to make sure that clear and realistic plans are in place to enable young people to have DOLS orders removed at the earliest opportunity.

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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: 1254109 9

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Children’s home details

Registered provider: Advising Health And Social-Care Limited

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Children’s home details

Registered provider address: 231 Vauxhall Bridge Road, London SW1V 1AD

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Inspectors

Bev Allison, social care inspector Philip Cass, social care regulatory inspection manager Inspection report children‟s home: 1254109 10 achieve excellence in the care of children and young people, and in education and skills for learners of all ages. It regulates and inspects childcare and children‟s social care, and inspects the Children and Family Court Advisory and Support Service (Cafcass), schools, colleges, initial teacher training, further education and skills, adult and community learning, and education and training in prisons and other secure establishments. It assesses council children‟s services, and inspects services for 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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