Children's home run by Kisimul Group Limited in North Kesteven

Inspection report children's home: SC367623 1 SC367623 Registered provider: Kisimul Group Ltd

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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 service provides education, care and accommodation for up to 66 children and young people who have learning disabilities and challenging behaviours associated with autistic spectrum disorder. For some children this is their home, others have term time only placements and a small number of day pupils come for short breaks.

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Overall experiences and progress of

children and young people, taking into account

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requires improvement to be good

How well children and young people are helped and protected requires improvement to be good

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requires improvement to be good

The effectiveness of leaders and managers requires improvement to be good

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requires improvement to be good

The children's home is not yet delivering good help and care for children and young people. However, there are no serious or widespread failures that result in their welfare not being safeguarded or promoted.

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requires improvement to be good

Overall judgement at last inspection: Good

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Enforcement action since last inspection:

None Inspection report children's home: SC367623 2

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Key findings from this inspection

This children's home requires improvement to be good because:

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Key findings from this inspection

 Not all staff are child focused in their interactions and responses. Some do not make use of the communication systems outlined in young people‟s placement plans.

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Key findings from this inspection

 Some aspects of safeguarding, in particular risk management strategies and one instance of recording and explanation of unexplained injuries, do not provide the necessary level of detail.

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Key findings from this inspection

 Management systems to monitor and evaluate the full range of matters in respect of quality of care and drive improvement are not fully embedded.

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Key findings from this inspection

 The last two inspection reports have made recommendations about behaviour management records. This visit highlighted further shortfalls in this area, in particular the lack of detail in supine restraint records.

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Key findings from this inspection

 There are some weaknesses and inconsistencies in the supporting documentation for the administration of medication.

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Key findings from this inspection

 Staff who know the young people well have supported them effectively to make changes that make a positive difference to them and their families.

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Key findings from this inspection

 Young people enjoy a range of activities, both on and off site, that reflect their interests and abilities.

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Key findings from this inspection

 Young people live in safe, well maintained homes.

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Inspection date Inspection type Inspection judgement

02/03/2017 Interim Sustained effectiveness 05/10/2016 Full Good 02/03/2016 Interim Improved effectiveness 28/07/2015 Full Requires improvement Inspection report children's home: SC367623 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

Make arrangements for the handling, recording, safekeeping, safe administration and disposal of medicines received into the children‟s home. (Regulation 23 (1)) In particular ensure that all the supporting documentation is available and consistent. 15/02/2018

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Requirement Due date

Prepare and implement a behaviour management policy which sets out the measures of control, discipline and restraint which may be used in relation to children in the home. The policy should include detail as to how senior managers will ensure adherence to the policy through their monitoring and analysis of incidents requiring restraint. (Regulation 35 (1)(b)) 15/02/2018

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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— the name of the child; details of the child‟s behaviour leading to the use of the measure; the date, time and location of the use of the measure; a description of the measure and its duration; details of any methods used or steps taken to avoid the need to use the measure; the name of the person who used the measure (“the user”), and of any other person present when the measure was used; the effectiveness and any consequences of the use of the measure; and a description of any injury to the child or any other person, and any medical treatment administered, as a result of the measure. (Regulation 35 (3)(a)(i-viii)) In particular ensure that records of supine restraints include how and by whom the breathing, circulation and communication

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Requirement Due date

of a young person is monitored during and after a supine restraint and the number of people involved. 15/02/2018

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Requirement Due date

The protection of children standard is that children are 15/02/2018 Inspection report children's home: SC367623 4 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; 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. (Regulation 12 (2)(a)(i)(vi)(vii))

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Requirement Due date

In order to complete a quality of care review the registered person must establish and maintain a system for monitoring, reviewing and evaluating— the quality of care provided for children; the feedback and opinions of children about the children‟s home, its facilities and the quality of care they receive in it; and any actions that the registered person considers necessary in order to improve or maintain the quality of care provided for children. (Regulation 45 (2)(a)(b)(c)) 15/02/2018

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Requirement Due date

In meeting the quality standards, the registered person must, and must ensure that staff, seek to develop and maintain effective professional relationships with such persons, bodies or organisations as the registered person considers appropriate having regard to the range of needs of children for whom it is intended that the children‟s home is to provide care and accommodation. (Regulation 5 (d)) 15/02/2018

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Recommendations

 Staff should understand factors that affect children‟s motivation to behave in a socially acceptable way. Staff should encourage an enthusiasm for positive behaviour through the use of positive behaviour strategies in line with the child‟s relevant plans. ('Guide to the children's homes regulations including the quality standards', page 39 paragraph 8.13) In particular review the lunch time waiting arrangements.

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Recommendations

 Any home using CCTV or other monitoring equipment should have a written policy describing how this will support the safeguarding and well-being of those living and working in the home in accordance with regulation 24. Homes must gain consent to any monitoring or surveillance by the placing authority in writing at the time of placement. The use of CCTV is regulated by the Protection of Freedoms Act 2012 and the Surveillance Camera Code of Conduct (Home Office Inspection report children's home: SC367623 5 2013). ('Guide to the children's homes regulations including the quality standards', page 16 paragraph 3.16) In particular gain written consent for the use of door sensors.

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Recommendations

 Those commissioning training in restraint for children‟s homes staff should be satisfied that the training fits with their approach to restraint or existing restraint system, and is appropriate to the needs of the children the home is set up to care for. They should see evidence that any restraint techniques the training advocates for have been medically assessed to demonstrate their safety for use in a context of caring for children who are still developing, physically and emotionally. The registered person should routinely review the effectiveness of any restraint system commissioned. In particular, they should check the medical assessment of the system remains up to date. ('Guide to the children's homes regulations including the quality standards', page 49 paragraph 9.58)

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Recommendations

 Regulations 35-39 detail the records that must be kept in children‟s homes. 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. Children‟s case records must be kept for 75 years from the date of birth of the child, or if the child dies before the age of 18, for 15 years from the date of his or her death. 'Guide to the children's homes regulations including the quality standards', page 62 paragraph 14.3)

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Recommendations

 The registered person should only accept placements for children where they are satisfied that the home can respond effectively to the child‟s assessed needs as recorded in the child‟s relevant plans and where they have fully considered the impact that the placement will have on the existing group of children. The Statement of Purpose is an important document in the process of care planning as it sets out the needs of children the home is set up and equipped to care for. ('Guide to the children's homes regulations including the quality standards', page 56 paragraph 11.4)

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improvement to be good

Most young people benefit from positive engagement with staff. The majority of staff respond to young people‟s approaches with warmth and a sense of fun that they enjoy and appreciate. However, it was observed that a small minority of staff were not attentive enough, for example, not encouraging young people to put their shoes on again when outside in the playground on a cold day.

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improvement to be good

Care and education staff work together to provide young people with a 24 hour curriculum. After lunch young people have about 20 minutes of waiting time before Inspection report children's home: SC367623 6 going back to school. In one particular house the main lounge is crowded, the numbers increased by day pupils and staff. This increases the potential for negative interactions between young people and some staff respond abruptly. Others are creative in their approach and distract and divert young people effectively, using a ball game for example.

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improvement to be good

Some young people have made changes to their behaviour and presentation that has enabled them to access community activities, both with staff and with their families. At the end of a school day young people enjoy a range of activities, both on and off site, that reflect their interests. One young person is particularly proud of his music and DJ skills; others enjoyed their Christmas art work which is used to decorate their respective houses. Staff and parents report that activities may, on occasion, be hampered by the lack of a driver.

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improvement to be good

Some placement plans do not comprehensively address all the needs of the young people; for example known behaviours such as spitting are not included in the placement plan, the support they need for meal times is not defined, neither is what is meant by two to one staffing. Not all staff use the young people‟s individual communication systems described in the placement plans, such as the use of now and next and symbols. In some young people‟s plans their necessary routines are not defined and the activities that they enjoy are not scheduled. Some important documents, such as communication profiles, placement plans and physiotherapy instructions, have no author and/or date.

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improvement to be good

Staff know about young people‟s health needs. There is a strong focus on supporting and encouraging young people to achieve a healthy weight and this is successful. Arrangements for the storage and administration of medication are effective. However, there are some weaknesses in the documentation. These include a lack of consistency between guidance from a health professional, placement plans and health plans; the absence of protocols for prescribed medication to be given as required; a lack of assessment of homely remedies brought in and administered; and poor risk assessment planning around the use of an EpiPen. Also the covert administration of medication is not fully addressed and key tasks such as exploring how pre-menstrual pain may be reduced are not always followed up promptly.

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improvement to be good

Staff understand the importance of transitions tailored to the needs and abilities of each young person. One parent said „They have really gone out of their way to make X feel welcome and fit in.‟ Staff encourage and support young people in the development of self-care and other skills they will need as adults, in line with their abilities. Although moves between houses are agreed with professionals and parents, the information sharing about how and when this will happen is not good enough. These moves are not supported by meaningful assessments. These do not provide a clear picture of how a young person‟s needs will be met in a particular house or their compatibility with others living there.

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improvement to be good

Young people have allocated key workers. Key workers may focus on specific areas with young people. Some achieve this well, for example through consistent use of a good Inspection report children's home: SC367623 7 social story. There is variability and limited follow up, for example, in respect of fire drills.

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improvement to be good

The young people living in this home have wide ranging and complex needs. The quality of staff interactions with and responses to a minority of young people are not child focused. In four out of five houses there is a calm, orderly atmosphere. Young people are settled and staff respond to their expressed anxiety and excitement appropriately, effectively reducing arousal levels. In the fifth house the atmosphere is heightened, particularly at lunchtime. Young people are in close proximity in the busy lounges and staff intervene to keep them impinging on each other. This is often done by touch alone without any supporting verbal or alternative communication systems. Some of the touch is insufficiently gentle, tugging clothing or an arm for example. This does not support the learning of young people in how to interact positively with others.

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improvement to be good

The training programme ensures that staff receive timely training in the accredited behaviour management approach used in the home. This includes the use of restraint techniques, including supine restraint. Records show that in the past year there has been a reduction in the number of restraints and in the number of young people held. The recording of these incidents remains insufficiently detailed. The last two inspection reports have recommended improvements to recording, however shortfalls remain. Although managers have signed the incidents reports as being suitable there is no indication who was the lead on the restraint and who monitored the breathing, circulation and communication of a young person, essential elements during a supine restraint. Management monitoring of these events is insufficiently analytical, in terms of potential themes, patterns and trends and how many staff were involved in the restraint.

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improvement to be good

This misses opportunities to learn from incidents. Sanctions records show that negative consequences are used infrequently.

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improvement to be good

Staff responses to behaviour are not always consistent. This does not support young people‟s learning of appropriate behaviour. A changing workforce makes this consistency difficult to achieve. Where staff are clear and apply a similar approach in their responses to young people‟s behaviour young people respond positively and learn the benefits of constructive interaction.

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improvement to be good

Established staff are knowledgeable about and understand the identified risks for each young person as outlined in the plans and risk assessments for them. The strategies that staff should adopt to reduce an identified risk are not always specific and so fail to provide adequate guidance.

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improvement to be good

Managers have an established relationship with the local authority safeguarding personnel. Managers respond to allegations about staff practice promptly with action proportionate to the nature of the concern. This includes suspension as a neutral act Inspection report children's home: SC367623 8 pending an investigation, dismissal and referral to the Disclosure and Barring Service when an allegation has been substantiated. Following two significant incidents in the home, senior managers have initiated further work with staff on understanding and reporting safeguarding concerns and the whistleblowing policy and procedure. In one case unexplained injuries to a young person have not been fully explored or reported on to the satisfaction of interested parties. There has been a delay in response to a request for information.

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improvement to be good

Young people live in a safe environment. There is routine and responsive servicing and maintenance of systems to ensure the health and safety of children and young people. The grounds are well maintained and have appropriate levels of security. There have been just two instances of young people leaving the site and going missing. When this happens managers consider if the home remains suitable for a young person, in one case a child stopped coming for short breaks.

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improvement to be good

Where door sensors are used managers have identified that this is not in line with the statement of purpose for the home and changes to the statement are planned. Although parents and social workers are aware of the sensors they have not in every case signed the necessary consent.

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The effectiveness of leaders and managers: requires improvement to be good

At the time of this inspection there was no registered manager in post. The previous post holder‟s last official day was 31 October 2017, although he had not been working in the home since September 2017. The manager‟s post has been advertised, interviewed for and the post offered to an external candidate subject to usual checks.

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The effectiveness of leaders and managers: requires improvement to be good

The Assistant Director (Operations) has been supporting the deputy heads of care in managing the homes since September 2017. The management team see themselves as a collective and work as a team and share responsibilities.

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The effectiveness of leaders and managers: requires improvement to be good

There is a large staff team needed to meet the needs of the young people placed, at the time of this inspection there were 78 permanent staff in post. In order to achieve the levels needed (41 staff on duty on the first day of this inspection) they regularly supported by agency and bank staff. The management is consistently challenged by the significant staff turnover, which occurs for a variety of reasons, including dismissal. Prospective staff engage in a series of interviews, having to pass one to move to the next. This includes a written exercise and observation of interactions with children. The required checks are requested and received before staff start work in the home. Despite evidence of robust efforts the recruitment team have some difficulty in obtaining verified references from overseas employers.

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The effectiveness of leaders and managers: requires improvement to be good

Since the last inspection the management team have introduced a new working pattern for staff, following extensive consultation. Staff work a 13 hour day, including breaks. The aim is to provide young people with consistency of care throughout the day and enable whole day activities. This system is in its infancy. At the time of this visit there was a mixed response from staff. Some enjoyed the change, others found the length of Inspection report children's home: SC367623 9 shifts onerous, particularly when working five out of seven days. The responsible individual said staff would have the opportunity to comment on the working pattern at a six month review.

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The effectiveness of leaders and managers: requires improvement to be good

Staff receive a structured induction which includes a number of mandatory courses. They describe these as useful and informative. The induction process has been reviewed and since November 2017 includes a training session for staff on preparation for reflective practice during supervision. Managers have introduced this in recognition of the personal challenges that staff may face in working with children with very complex needs.

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The effectiveness of leaders and managers: requires improvement to be good

Staff receive an established training programme and this is added to in the light of emerging needs. Many courses are delivered by staff of the organisation, who are trained to do so. Managers have attended a train the trainer course on safeguarding run by the local authority. This enables their delivery of timely training to staff. Managers are making a concerted effort to support staff to achieve a relevant level three qualification in timescales, both now and in the future. At the time of this visit there were nine staff outside the required timescale, a significant improvement since the last inspection.

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The effectiveness of leaders and managers: requires improvement to be good

Managers have identified the need to improve the frequency and quality of supervision. They have a plan in place to address this, beginning with training for all those delivering supervision.

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The effectiveness of leaders and managers: requires improvement to be good

Managers have an action plan which they update in the light of emerging issues identified in the minutes of senior management team meetings. The systems for management oversight are not embedded and do not easily lend themselves to follow up.

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The effectiveness of leaders and managers: requires improvement to be good

Professionals and parents have mixed views of their relationships with the service. Most express generally satisfaction with the day-to-day care staff provide for their children. Where there are concerns these are mainly about management response times and a shortfall in the effectiveness of communication between managers and staff.

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The effectiveness of leaders and managers: requires improvement to be good

Managers are committed to gaining the views of young people and allocate resources to this. For example speech and language assistants support young people on a one to one basis to answer questionnaires. This work was begun in July 2017, and responses have been individually discussed and analysed. As yet there is no overarching analysis or conclusion drawn.

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The effectiveness of leaders and managers: requires improvement to be good

Staff have a sound understanding of the records that they need to keep. Some daily records seen are of a good standard and are illustrated with photographs. Other records lack detail and some are not dated or signed.

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Information about this inspection

Inspectors have looked closely at the experiences and progress of children and young Inspection report children's home: SC367623 10 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: SC367623 11

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Children's home details

Provision sub-type: Residential special school

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Children's home details

Registered provider address: The Old Vicarge, 61 High Street, Swinderby, Lincoln, Lincolnshire, LN6 9LU

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Children's home details

Responsible individual: Donna Varley-Turner

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Inspector(s)

Maire Atherton, social care inspector Keith Riley, social care inspector Suzy Lemmy, social care inspector Inspection report children's home: SC367623 12 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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Inspector(s)

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Inspector(s)

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Inspector(s)

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