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

Inspection report for children’s home - monitoring visit: SC484716 1 SC484716

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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 children’s home is registered to provide care and accommodation for up to six young people who have emotional and/or behavioural difficulties. The organisation operates a school nearby and can provide therapeutic services.

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This monitoring visit

This children’s home was judged inadequate at the full inspection on 5 and 6 July 2017. Following the inspection, Ofsted issued 18 compliance notices. A monitoring visit took place on 17 August 2017. The registered person had taken some action to meet six of the 18 compliance notices. Ofsted then issued 12 compliance notices for the unmet regulations.

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This monitoring visit

A second full inspection judged the home inadequate on 11 and 12 October 2017. The home had taken some action to meet the 12 compliance notices, but not all. Ofsted judged the home to be inadequate and issued four compliance notices and four requirements for the unmet regulations. These were in respect of:  Systems for managerial monitoring, review and improvement were ineffective.  Young people did not experience continuity and consistency of care.  The responsible individual did not supervise the manager of the home or drive improvement.  Managers lacked a focus on safeguarding during supervision.  Leaders and managers missed opportunities to learn lessons from the experience of children whose placements broke down and after significant incidents.  Risk management of young people was poor. Inspection report for children’s home - monitoring visit: SC484716 2  Records about young people were unreliable.

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This monitoring visit

 There has been no registered manager at the home for over 12 months.

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This monitoring visit

In order to evaluate the progress that the managers and staff have made in addressing these concerns, a monitoring visit was undertaken on 7 December 2017. The registered person has taken some action to meet elements of the compliance notices and unmet requirements. However, only one of the four compliance notices is judged to be met at this monitoring inspection.

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This monitoring visit

The responsible individual has now recorded basic ‘lessons learned’ from previous placement breakdowns.

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This monitoring visit

This home has not had a registered manager since September 2016. A manager was appointed and started work on 7 July 2017. She has not submitted an application to register with Ofsted.

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This monitoring visit

The registered person has not developed or implemented a system that effectively monitors or reviews the standard of care in the home. The system currently in use has failed to identify shortfalls in respect of managing allegations about staff, risk to children and errors in medication records. Ineffective monitoring does not promote children’s welfare and safety.

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This monitoring visit

The registered person has not devised an effective action plan to support improvement, based on their own monitoring activity, or identified any weakness or strengths in the quality of care. The registered person does not acknowledge the level of inadequacy in leadership and management or safeguarding practice at the home. They do not take rigorous action to address issues of concern. The manager and registered person do not sufficiently follow up safeguarding or behavioural issues, and this does not protect young people from harm.

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This monitoring visit

The manager and registered person have taken some steps to bring about more consistency for young people. For example, each day there is now usually a good balance of core staff working in the home. The number of staff working in the home has reduced slightly from 42 to 37. Young people spend some good-quality time with their keyworkers. However, these improvements do not go far enough. The number of different staff working in the home remains high. Between 29 October and 30 November, 37 different staff worked in the home, including 17 core staff and 20 staff from elsewhere within the organisation (pool staff). Pool staff work mostly at night. This means that, although core staff are available to young people during the day and evening, there are fewer core staff available to young people at night- time. Furthermore, too many pool staff still work here, while core staff work at other homes. Children do not want this. This month, all the children told the manager that

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This monitoring visit

the home would improve if all the core staff worked at the home more.

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This monitoring visit

One core staff member told their supervisor that they want to work more at this Inspection report for children’s home - monitoring visit: SC484716 3 home, rather than at other homes, but that they are not ‘heard’ by the external manager who organises the rotas. Some staff work high levels of overtime. Until inspectors asked for specific information, the manager was not fully aware of how many hours her core staff worked elsewhere. Consequently, the manager cannot ensure that the staff are sufficiently rested and ready to meet the needs of the children.

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This monitoring visit

The manager acknowledges high numbers of staffing. The manager acknowledges that a more consistent core team would help children. Senior leaders have not sufficiently evaluated whether their staff deployment model meets children’s needs. Furthermore, the registered person has not monitored, reviewed or demonstrated that they understand the high trend of staff turnover between March and October 2017. As a result, managers have not yet achieved a stable staff team to effectively meet children’s needs.

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This monitoring visit

There are few opportunities for staff to discuss the work they do with children and to ensure a consistent approach. A core staff member told his supervisor that he was not familiar with the risk assessments for the children. The core staff team members do not meet together regularly with the manager and she does not supervise the majority of staff working at the home. The manager did not know which of the staff working at the home had attended the recent whole-organisation staff meeting. She did not attend. Although the manager told inspectors that she communicates with staff by memo and that staff communicate with each other at daily handovers, there is little recorded evidence to support this. As a result, it is not clear how the manager ensures that staff receive up-to-date information and advice about how to care for young people safely.

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This monitoring visit

Most staff do now receive practice-related supervision by a person who has the relevant experience. Core staff supervision notes show some that staff have some follow-up discussions with their supervisor after a significant incident involving children. However, the manager’s supervision by the responsible individual only covered the one of two safeguarding incidents at the home since the last inspection. This was a missed opportunity for the responsible individual to ensure that both incidents were rigorously investigated and that both reached a satisfactory conclusion.

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This monitoring visit

Safeguarding practice remains poor. For example, staff subject to an allegation of bruising a child during restraint were redeployed to work at other homes without a risk management plan. Records of safeguarding do not show the local designated safeguarding officer’s advice to the registered person about this matter. The registered person did not enquire how the bruise occurred or seek the accounts of the staff involved in the restraint. There was no outcome of the issue for the child who made the allegation to a professional outside the home. Records of a second safeguarding concern about a different member of staff were better. However, the local designated safeguarding officer gave advice about improving the quality of information in the home’s initial referral. Inconsistent safeguarding practice does not protect young people from harm. Inspection report for children’s home - monitoring visit: SC484716 4

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This monitoring visit

Children are at risk because staff do not implement risk management plans. One child with a history of accessing extreme pornography online obtained a new mobile phone with internet access. Staff did not ensure that he handed his phone in each night as directed in his plans. When he did not hand in his phone, it is not clear what action staff took. The daily records do not give any useful information about how staff kept him safe over a period of 12 days until the phone was removed. When the phone was removed, staff found that the young person had used the phone to access ‘extreme inappropriate adult material’. These safeguarding matters were also missed by the responsible individual in his supervision of the management of the home.

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This monitoring visit

The responsible individual told Ofsted that he had now replied to the request for information about his capacity, skills and experience to hold the position. Inspectors verified the information on his file to show whether the organisation had been assured of his fitness for the role. He has not delivered improvement to the service.

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This monitoring visit

There is still no confirmation of building control or planning approval for the most recent extension to the house. This matter remains outstanding.

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This monitoring visit

The responsible individual does now have a system to ensure that electronic and hard copy records and documents created by staff are evidentially reliable in terms of the author, date of creation and any updates. This means that professionals can be assured of their authenticity and children know that they accurately describe their lives in the home.

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This monitoring visit

A regulation 45 formal report of the review of the quality of care is required for the period to November 2017, and the manager showed inspectors that a draft report is under way.

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This monitoring visit

Children are moving on with their lives. Education and access to therapies outside the home continue to be consistent factors in children’s progress. Placing authorities are positive about the security that the home provides to young people. One professional described how different one child’s path in life could have been had he not moved to the home. They are particularly pleased with the positive staff influence on the young person’s identity. One child is looking forward to moving to foster care in the new year. Another now has a pathway plan to lead him into adulthood.

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This monitoring visit

Despite this, the registered provider has not improved the critical areas of regulatory failure in leadership and management, staffing and children’s safety. Repeated failure to safely govern and lead the home leaves young people vulnerable to the risk of harm.

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Recent inspection history

Inspection report for children’s home - monitoring visit: SC484716 5 Inspection date 10/10/2017 17/08/2017 05/07/2017 09/11/2016 26/07/2016 Inspection type Full Monitoring Full Full Full Inspection judgement Inadequate N/A Inadequate Requires improvement Inadequate Inspection report for children’s home - monitoring visit: SC484716 6

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Statutory requirements

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

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Requirement Due date

The 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 take effective action whenever there is a serious concern about a child’s welfare. (Regulation 12(1)(2)(a)(i)(vi)) 30/01/2018

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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. In particular, the standard in paragraph (1) requires the registered person to ensure that the home’s workforce provides continuity of care to each child. (Regulation 13(2)(e)) 30/01/2018

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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. 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)) 30/01/2018

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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. (Regulation 33(4)(b)) 30/01/2018 Inspection report for children’s home - monitoring visit: SC484716 7

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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: Thoughts of Others, 99 College Road, Sutton Coldfield, West Midlands B73 5DL

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Inspectors

Jackie Line, regulatory inspection manager Christy Wannop, social care inspector Inspection report for children’s home - monitoring visit: SC484716 8 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 looked after children, safeguarding and child protection.

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Inspectors

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Inspectors

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Inspectors

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