Children's home run by Mulberry House Care Homes Limited

Inspection report for children’s home - monitoring visit: SC436551 1 SC436551

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Mulberry House Care Homes Limited

Inspected under the social care common inspection framework

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Information about this children’s home

This children’s home is registered for three young people who have emotional and/or behavioural difficulties. It is one of several homes operated by an independent provider.

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This monitoring visit

An interim inspection took place on 9 November 2017. Ofsted judged that the home had declined in effectiveness.

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This monitoring visit

On 23 January 2018, the registered provider notified Ofsted of a serious incident that had occurred in the home. Ofsted subsequently carried out a monitoring inspection to investigate the safety of young people.

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This monitoring visit

At the monitoring inspection, the inspector found significant regulatory failures relating to the protection of children, leadership and management and the quality of care.

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This monitoring visit

Not all staff have the experience, qualifications and skills to meet young people’s needs safely. Staff have not received sufficient training in how to manage self- injurious behaviours and they are not adequately prepared should a serious incident occur.

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This monitoring visit

The registered person does not always ensure that at least one member of staff on duty has a first-aid qualification. This compromises the staff’s ability to respond appropriately in the event that a young person requires first-aid treatment.

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This monitoring visit

Not enough staff are suitably trained in behaviour management, including the use of physical intervention, to keep young people safe. As a result, the staff do not have Inspection report for children’s home - monitoring visit: SC436551 2 the necessary skills to intervene safely to prevent injury to a person or serious damage to property. This places young people and others at risk of harm.

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This monitoring visit

Staff do not manage behaviour well or take sufficient action to protect young people from access to inappropriate material. For example, the inspector observed young people watching YouTube videos which contained offensive language with staff. The staff failed to take action to stop this, or redirect young people to videos that have more appropriate content.

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This monitoring visit

The staff do not provide young people with consistent boundaries and routines. For example, some staff allow young people to stay up later than they should. As a result, young people do not know what is expected of them. Furthermore, poor routines do not help young people to develop good sleep patterns and this can have an impact on their well-being.

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This monitoring visit

Staff do not deliver personalised care that promotes the welfare of young people. For example, a young person who was placed before Christmas was not provided with the opportunity to discuss with staff his religious beliefs and whether and how he would like to mark the festive period. Furthermore, staff do not consider the information contained in young people’s written plans when delivering care. For example, staff and managers have continued to use a sanction that is known to trigger difficult and challenging behaviour from a young person. Managers and staff have not reviewed the effectiveness of behaviour management strategies, based on the individual needs of young people.

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This monitoring visit

A young person is known to suffer from allergies. Although some information about this is contained within the young person’s written plans, this is not sufficiently detailed. Consequently, the records do not provide staff with clear guidance on how to minimise child-specific risks to promote the young person’s health and well-being.

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This monitoring visit

Managers and staff do not sufficiently understand risk and take effective action to reduce risks to young people and others. For example, managers have admitted young people to the home without adequate information and evaluation as to whether the staff can meet their needs and manage their behaviour safely. Impact risk assessments contain insufficient information. These show that managers do not consider the compatibility of new young people with those young people who were already resident at the home. This has led to young people joining together in behaviours that have caused them harm. For example, on one occasion three young people left the home and on their return one of the young people required medical attention from paramedics because he was under the influence of an unknown substance. Furthermore, this serious incident was not notified to Ofsted. Consequently, the manager does not keep all relevant people informed of significant

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This monitoring visit

Staff fail to take effective action to safeguard young people who go missing from care. When a young person went missing from care for four days, records show that Inspection report for children’s home - monitoring visit: SC436551 3 staff did not take sufficient steps to try to locate the young person. Failing to take prompt and effective action does not protect young people from harm. Furthermore, the record of this event was incomplete and did not show the circumstances of the young person’s return and what support he was given.

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This monitoring visit

This inspection found that there is an insufficient number of core staff working at the home. Shortfalls on the rota are covered by bank staff, agency staff and staff who work at the organisation’s other children’s homes. Young people have not been provided with continuity of care from staff who know them well. Insufficient core staff and poor staffing arrangements do not promote young people’s well-being and safety.

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This monitoring visit

Managers do not escalate concerns quickly enough to the placing authorities when young people’s care plans are slow to progress. For example, one young person’s future plan remains uncertain as he prepares for independence. Although managers raised their concern about this with the young person’s social worker, they did not escalate their concerns quickly enough when progress remained slow. Consequently, managers did not take enough action to allay the young person’s anxieties and hold others to account.

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This monitoring visit

Young people do know how to complain and have raised complaints. However, records do not explain how complaints are investigated and what the outcomes are. This does not show that complaints are taken seriously and this does not help young people to feel listened to and valued.

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This monitoring visit

The standard of record-keeping in the home is poor. For example, young people’s daily records do not give a clear view of young people’s day-to-day lives and experiences. Consequently, young people’s records are not written in a way that helps them to understand their history.

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This monitoring visit

The manager was appointed in June 2017. She has not received a review of her probationary period. As a result, any practice issues or development needs have not been formally reviewed. Although the manager said that she receives supervision, she has not received a copy of the records from these meetings. This makes it difficult to assess the quality and effectiveness of supervision.

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This monitoring visit

Leaders and managers do not sufficiently understand the home’s areas for development. Furthermore, they have failed to take effective action to improve the quality of care that young people receive.

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This monitoring visit

Following this inspection, Ofsted has issued a restriction of accommodation notice. The restriction of accommodation will allow time for the provider to take action to reduce the risk of harm to young people and improve standards of care. Ofsted will monitor the home’s adherence to the restriction of accommodation notice. Inspection report for children’s home - monitoring visit: SC436551 4

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Recent inspection history

Inspection date Inspection type Inspection judgement 09/11/2017 Interim Declined in effectiveness 22/06/2017 Full Requires improvement to be good 09/02/2017 Interim Declined in effectiveness 31/08/2016 Full Good Inspection report for children’s home - monitoring visit: SC436551 5

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Statutory requirements

This section sets out the actions that the registered person 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 must comply within the given timescales.

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Requirement Due date

In meeting the quality standards, the registered person must, and must ensure that staff— 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(c)) In particular, if there are delays in progressing young people’s care plans, escalate concerns about this accordingly. 09/03/2018

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Requirement Due date

The quality and purpose of care standard is that children receive care from staff who understand the children’s home’s overall aims and the outcomes it seeks to achieve for children and use this understanding to deliver care that meets children’s needs and supports them to fulfil their potential.

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Requirement Due date

In particular, the standard in paragraph (1) requires the registered person to ensure that staff— protect and promote each child’s welfare; and provide personalised care that meets each child’s needs, as recorded in the child’s relevant plans, taking account of the child’s background. (Regulation 6(2)(b)(i)(iv)) 09/03/18

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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. (Regulation 12(2)(a)(i)) 09/03/2018

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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— promotes children’s welfare In particular, the standard in paragraph (1) requires the 09/03/2018 Inspection report for children’s home - monitoring visit: SC436551 6 registered person to— ensure that staff have the experience, qualifications and skills to meet the needs of each child; ensure that the home has sufficient staff to provide care for each child; ensure that the home’s workforce provides continuity of care to each child; and 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)(b)(2)(c))(d)(e)(f)) The registered person must ensure that each permanent appointment of an employee is subject to the satisfactory

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Requirement Due date

completion of a period of probation. (Regulation 33(1)(b)) 09/03/2018

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Requirement Due date

The registered person must ensure that a record is made of any complaint, the action taken in response, and the outcome of any investigation. (Regulation 39(3)) 09/03/2018

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Requirement Due date

The registered person must notify HMCI and each other relevant person without delay if there is any other incident relating to a child which the registered person considers to be serious. (Regulation 40(4)(e)) 09/03/2018

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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. (‘Guide to the children’s homes regulations including the quality standards’, page 62, paragraph 14.3) Specifically, keep clear and up-to-date records of missing from home incidents.  The home’s records on each child represent a significant contribution to their life history. Children and their parents should be supported to understand the nature of records kept by the home and how to access them. Staff should understand their important role in encouraging the child to reflect on and understand their history, according to their age and understanding. Staff should keep and encourage children to keep appropriate memorabilia of the time spent living at the home and help them record significant life events. (‘Guide to the children’s homes regulations including the quality standards’,

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Recommendations

page 62, paragraph 14.5)  It is good practice for a note of the content and/or outcomes of supervision sessions to be kept and to ensure that both the person giving the supervision and staff member have a copy of the record. (‘Guide to the children’s homes regulations including the quality standards’, page 61, paragraph 13.4) Inspection report for children’s home - monitoring visit: SC436551 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: Mulberry House Care Homes Limited

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Children’s home details

Registered provider address: Tollgate Business Centre, Tollgate Drive, Stafford, Staffordshire ST16 3HS

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Inspector

Michelle Spruce, social care inspector Inspection report for children’s home - monitoring visit: SC436551 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 children looked after, safeguarding and child protection.

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Inspector

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Inspector

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Inspector

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