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

Inspection report children’s home: SC049714 1 SC049714 Registered provider: Thoughts of Others Limited Full inspection Inspected under the social care common inspection framework

p.1

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 past the age of 18 when this is part of a plan to move on. The organisation operates a nearby school and can provide therapeutic services. The organisation operates this setting as a home for girls.

p.1

Information about this children’s home

Inspection dates: 19 to 20 December 2017

p.1

Overall experiences and progress of

children and young people, taking into account

p.1

inadequate

How well children and young people are helped and protected inadequate

p.1

inadequate

The effectiveness of leaders and managers inadequate

p.1

inadequate

There are serious and widespread failures that mean children and young people are not protected or their welfare is not promoted or safeguarded.

p.1

inadequate

Date of last inspection: 6 September 2017

p.1

inadequate

Overall judgement at last inspection: inadequate

p.1

Enforcement action since last inspection:

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

p.1

Enforcement action since last inspection:

Following the inspection, Ofsted raised 10 requirements and issued two compliance notices. These were in respect of: Inspection report children’s home: SC049714 2  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.

p.1

Enforcement action since last inspection:

A monitoring visit was conducted on 31 October 2017. This visit found that the registered person had not met the compliance notices and previous requirements. Following the inspection, Ofsted issued a further compliance notice. This was in respect of:

p.2

Enforcement action since last inspection:

 failure to take action, or put systems in place, to keep children safe.

p.2

Key findings from this inspection

This children’s home is inadequate because:

p.2

Key findings from this inspection

 Management oversight of the home continues to be ineffective.  The regulator has escalated concerns by serving three compliance notices with the intention to improve practice. However, the provider has not taken effective or sufficiently timely action to meet all of the required steps set out in the compliance notices.  Internal monitoring of quality standards remains ineffective. This means that no formal review to evaluate the quality of care has been undertaken within the required period.  Lessons are not learned after safeguarding allegations are raised by children, including when children raise concerns over being physical restrained.  The organisation’s medication policy does not provide staff with the necessary information to help them ensure that medication is safely handled, administered and stored.  Staff do not administer or record children’s medication in line with the prescriber’s advice. The registered person’s monitoring of medication is not

p.2

Key findings from this inspection

effective and fails to ensure that staff follow good practice guidance.  The registered person has not taken sufficient action to meet six requirements set following previous inspections.  Staff still do not have the skills or training to meet the significant needs of the children they care for. This extends to a lack of knowledge around mental health and how to keep children safe who might self-harm.  Children still do not have sufficient opportunity to sustain positive relationships with a core team of staff whom they can come to know well.  Staff still do not have sufficient management support. This includes regular good quality supervision and routine annual appraisals.  Records of physical restraints continue to lack the details required to ensure Inspection report children’s home: SC049714 3 that children are safeguarded.  Senior managers do not provide necessary and required independent scrutiny

p.2

Key findings from this inspection

when the registered manager has been part of a physical restraint, or when staff restrain children where levels of risk are high such as face down on the ground or on the bed. This remains an issue that was identified at the previous inspection.  The registered person continues to delay sending the independent visitor’s monthly report to Ofsted. These reports are of poor quality, failing to detail the home’s inspection and compliance history.  Children’s records, including records of complaints made by children, lack the required information to provide children with an accurate account of their life at the home or to provide an understanding of incidents that they may be involved in.  The views of children, parents, placing authorities and staff are still not being used to help to inform the six-monthly quality of care review.

p.3

Key findings from this inspection

 Children make good educational progress through attending the organisation’s school on a regular basis.  Staff help children to keep and nurture positive family relationships.  Children learn life skills.  Placing authorities and parents are positive about the impact that the service has in comparison to children’s previous experiences in care.

p.3

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 children’s home: SC049714 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 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.

p.4

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 deliver 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), (2)(a)(c)(f)) 09/02/2018

p.4

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.

p.4

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(1),(2)(h))* 09/02/2018

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))* 09/02/2018

p.4

Requirement Due date

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

p.4

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 09/02/2018 Inspection report children’s home: SC049714 5 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),(2)(a)(i))*

p.4

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)) 09/02/2018

p.5

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)) 09/02/2018

p.5

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. (Regulation 36(1)(a)(b)(c)) 09/02/2018

p.5

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), (5))* 09/02/2018

p.5

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 provide a copy of the independent person’s report to HMCI and the placing authorities of children. (Regulation 44(1)(4)(7)(a)(c)) 09/02/2018

p.5

Requirement Due date

* These requirements are subject to a compliance notice.

p.5

inadequate

Inspection report children’s home: SC049714 6 Management oversight of the home and of daily practice continues to be unacceptably poor. Despite the registered manager being a skilled practitioner, he has not been able to exert sufficient influence to ensure that required changes to meet regulatory shortfalls have been made.

p.6

inadequate

Managers do not routinely monitor or review the quality of care provided to children. In addition, they do not regularly review practice or staff development and so required improvements are delayed or absent. As a result, it is not possible to ensure that children have positive experiences in a safe environment while being cared for by a consistent, appropriately qualified staff team.

p.6

inadequate

Children still do not have access to an established and familiar core staff team. Consequently, children receive inconsistent care that falls short of the required standard of quality. For example, not all staff working with the children know about the specific procedure agreed with health professionals when a child self-harms. In the four weeks preceding the inspection, the number of staff caring for children from other homes remained at just over 50% of the cover required. 30 of the 41 staff caring for children in the home between 11 November 2017 and 11 December 2017 were non-core staff. During this same period, three of the 11 named core staff had not worked any shifts at the home.

p.6

inadequate

Despite not having an established staff team, children have managed to form good relationships with a small number of staff. However, children continue to raise their concerns about not having regular access to their named key staff. The registered manager has introduced a system to enable children to send and receive texts, in an attempt to supplement the absence of key staff.

p.6

inadequate

The registered manager has recently introduced consultation processes, alongside house meetings. These forums have been successful in gathering children’s views on things such as activities and the décor of the home.

p.6

inadequate

Children’s school attendance and academic progress continue to improve. For example, staff have supported one child, who had not been to school for some years, to attend school regularly on a flexible timetable.

p.6

inadequate

Children are supported to rebuild positive relationships with their family. For example, children will be seeing their families over Christmas. For one child, this will take place at the home. Both girls are excited at the prospect of Christmas and are involved in making the final plans. They are busy buying and wrapping presents, making decorations for their sitting rooms, baking and planning the Christmas menus.

p.6

inadequate

Daily plans and high staffing levels help to ensure that children access a range of activities in the house and in the local community. Recently, children have started to plan activities together. For example, they planned a trip to a German Christmas market. Children develop life skills, although this is subject to close supervision by staff. Inspection report children’s home: SC049714 7 Placing authorities and parents remain positive about the impact that the service has, in comparison with children’s previous experiences in care.

p.6

inadequate

Children benefit from timely assessments and support from psychologists. Since the last inspection, the registered manager has liaised with and strengthened his partnership working with health professionals.

p.7

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

There continues to be an absence of any effective managerial oversight to monitor, review and develop safeguarding practice and to ensure that the safety and well- being of children and staff are sustained.

p.7

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

In response to a compliance notice, the organisation’s medication policy has been reviewed. However, the policy still fails to help staff to safely handle, administer and store children’s medication. It does not address issues that include the storage and administration of home remedies, ‘as and when required’ (PRN) medication, how staff competency will be assessed and the development of systems needed to ensure that medication is safely audited.

p.7

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

Medication records continue to be chaotic. Some staff do not make a daily record of their administration of medication. Instead, they add their signature days after they have administrated a child’s medication. In addition, staff make their record on the wrong medication records and fail to ensure that children receive prescribed creams. A weekly check aimed at monitoring staff practice had not happened for nine days. The weaknesses in oversight of the safe administration of medication leave children’s health at risk.

p.7

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

There have been no safeguarding concerns since our last inspection on 31 October 2017. All core staff have completed safeguarding training. All managers were booked on designated safeguarding lead training. This was running over the two days of the inspection, and the responsible individual and registered manager had to leave this to be present at the inspection.

p.7

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

Staff supervise children’s internet use, but none of the core staff are trained in protecting children online. The organisation continues to fail to adequately monitor, review or plan improvement in the area of safeguarding practice. Consequently, managers do not have systems in place to identify and manage risk.

p.7

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

No children have been missing from home, and incidents of self-harming have reduced. For example, one child has had an unprecedented period of calm, with no incidents for 41 days. Nevertheless, children have histories of significant self- harming and yet five of the 11 core staff have still not received awareness training to help them to protect children with such a history. Similarly, core staff continue to have gaps in their knowledge of mental health, despite this being a key feature of the health needs of both children. Inspection report children’s home: SC049714 8 Managers have failed to implement an effective system of review, plan and action to ensure that children can be more robustly safeguarded by identifying triggers and learning lessons from previous incidents. For example at the time of the inspection managers were unaware that documents aimed at helping staff to know what to do to reduce risks of self-harm and/or children going missing from home are not up to

p.7

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

date. Furthermore, managers were equally unaware that records do not evidence whether staff followed the correct procedure by contacting medical professionals on the same day that a child self-harmed. Data that has been collated has not been interrogated or analysed to identify patterns and trends of incidents, staff involvement or whether interventions are successful in keeping children safe.

p.8

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

No children at this home have a deprivation of liberty order. Despite this, staff continue to keep children under constant supervision, with high staffing ratios of up to three staff to one child. This includes children not being allowed to go out without staff.

p.8

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

The management oversight of physical restraint within the home is unacceptably poor. Staff restrain children only to prevent self-harm. However, physical restraints that have taken place have resulted in children being restrained in ways that include high levels of risk to the child such as face down on the ground and face down on beds. There is no independent scrutiny from senior management when the registered manager has been involved in physical intervention. The registered manager does not know if pool staff involved in physical interventions have up to date training. Staff do not talk to children in a timely manner following a physical restraint. There is no record of conversations between the registered manager and staff about their restraint practice to show that practice is closely monitored. The registered provider has not used the organisation’s behavioural management trainer to review the appropriateness of face-down ground holds or restraints on beds, to

p.8

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

help to identify alternative strategies.

p.8

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

When children raised concerns about how staff restrain them, the registered person reported their concerns to the organisation’s safeguarding lead but not to the local authority designated officer. One concern about an uncomfortable restraint, raised before the last monitoring inspection of 31 October 2017, resulted in the member of staff being moved to another home. The registered provider has not followed up the issue with that member of staff. At this inspection, Ofsted referred concerns about another restraint to the local authority designated officer. Together this demonstrates a failure to ensure that staff practice is appropriately subject to external scrutiny and that managers follow up on recommendations made by safeguarding professionals.

p.8

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

Arrangements are in place to keep children safe from the risk of fire. The registered person has now implemented the requirements of the fire service.

p.8

The effectiveness of leaders and managers: inadequate

Inspection report children’s home: SC049714 9 Leadership and management have been characterised by persistent regulatory shortfalls at the last two inspections. Ineffective monitoring and poor review systems have resulted in the six requirements and three compliance notices from the last inspection and monitoring visit remaining unmet.

p.9

The effectiveness of leaders and managers: inadequate

 poor safeguarding and behaviour management practice  a lack of effective leadership and management oversight  poor-quality or missing records  poor medication arrangements  poor staff supervision, appraisal and training  ineffective internal and external quality assurance.

p.9

The effectiveness of leaders and managers: inadequate

As a result, leaders and managers do not promptly comply with all of the regulations that apply to children’s homes.

p.9

The effectiveness of leaders and managers: inadequate

The registered manager has been in post since September 2016, and is appropriately qualified and experienced. The organisation told Ofsted in December 2016 that the registered manager would not routinely work on shift but, instead, have more days of managerial time. This has not happened and the manager continuing to work on shifts.

p.9

The effectiveness of leaders and managers: inadequate

The registered provider has now undertaken an analysis of staff working at the home. This analysis has identified some initial short-term actions to allocate staff to the homes at which they work the most hours, to stabilise the core staff team. However, these have not yet been implemented.

p.9

The effectiveness of leaders and managers: inadequate

Staff do not receive regular supervision or annual appraisal to ensure that their practice is reviewed against the needs of the children. This was a previous requirement that remains unmet. Staff do not have any debriefing after significant behavioural incidents such as restraint. The 11 core staff are line managed by the registered manager, yet do not receive regular supervision or appraisals. For example, a core member of staff, who was moved to another home after a child made a complaint after a restraint, has not had supervision since February 2017. Neither has a second member of staff, who moved under similar circumstances in October 2017, received supervision since being moved. The registered manager does not supervise or appraise pool staff who work at the home and does not play a role in their professional development to meet the needs of children at this home. These ongoing shortfalls mean that staff do not have a supportive environment that

p.9

The effectiveness of leaders and managers: inadequate

helps them to reflect on their practice and be able to achieve high standards of care for children.

p.9

The effectiveness of leaders and managers: inadequate

The staffing model does not promote regulation’s definition of ‘positive relationships’: ‘characterised by consistency and unconditional positive regard for the Inspection report children’s home: SC049714 10 child on the part of the carer; and where the carer acknowledges the importance of understanding and responding to the child’s lived experience of care. Positive, stable relationships help the child to feel secure and cared about and for.’ Staff are not trained in attachment theories and, because of the staffing model, are not able to come to know the children well. The manager and deputy try to provide leadership, but cannot sustain this, alongside their regulatory responsibilities, while working on each shift. There are no other senior staff in the team. Consequently, the opportunity to make best use of resources through having a stable and consistent staff team for children is still not realised in practice.

p.9

The effectiveness of leaders and managers: inadequate

The quality of care has still not been reviewed by the registered person as required by regulation. This is an unmet requirement from December 2016. The registered person does not have an effective system for monitoring and reviewing the quality of care. Consequently, there is no improvement. The registered person has still not learned lessons from the 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. There has been no formal consultation with parents and placing authorities. Consultation with children has just started, but has not been analysed as part of a quality review process. The registered person has not submitted a report to Ofsted for over a year about the quality of care at the home. They do not share their analysis and plans for the service with Ofsted, placing authorities, children or parents. This ongoing weakness means that the organisation

p.10

The effectiveness of leaders and managers: inadequate

continues not to have a coordinated self-evaluation process that gives the senior managers and stakeholders a well-analysed and reliable self-evaluation reporting system.

p.10

The effectiveness of leaders and managers: inadequate

The arrangements for independent scrutiny of children’s well-being and safeguarding are now in place, but reports are not sent into Ofsted in a timely manner. The registered person does not make use of these reports as a tool for improvement. The current independent visitor’s reports do not reflect the inadequate status of the service and do not report on the progress made against the six requirements and three compliance notices. This leaves managers without independent insight into how well they are improving the quality of their work with children.

p.10

The effectiveness of leaders and managers: inadequate

Children’s records continue to be unreliable in capturing their experience at the home. Children’s records, including of restraint, medication, safeguarding, complaints and self-harm incidents, lack essential information to help children to make sense of children’s experience, now or later in life. Staff do not use these records to inform their care or record significant events in children’s lives. This leaves staff without a clear understanding of how their work influences positive change in children’s lives.

p.10

The effectiveness of leaders and managers: inadequate

Staff are supported by the registered manager, and state that he is always available to give support and advice. Placing authorities and parents are positive about the service.

p.10

The effectiveness of leaders and managers: inadequate

The statement of purpose has now been updated and shared with Ofsted. It is Inspection report children’s home: SC049714 11 available on the organisation’s website. Parents, placing authorities and advocates now have the information that they need to know how the home operates. Inspection report children’s home: SC049714 12

p.10

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 difference 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.

p.12

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: SC049714 13

p.12

Children’s home details

Registered provider: Thoughts of Others Limited

p.13

Children’s home details

Registered provider address: 99 College Road, Sutton Coldfield, West Midlands B7 5DL

p.13

Inspectors:-

Dawn Bennett, social care inspector Christy Wannop, social care inspector Inspection report children’s home: SC049714 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 looked after children, safeguarding and child protection.

p.13

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 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.14

Inspectors:-

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

p.14

Inspectors:-

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

p.14