Children's Home run by Surrey County Council in Surrey

Inspection report children’s home: SC040638 1 SC040638 Registered provider: Surrey County Council Full inspection Inspected under the social care common inspection framework

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Information about this children’s home

The home is owned and run by the local authority. It provides care and accommodation for up to six young people with emotional and/or behavioural difficulties.

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Overall experiences and progress of

children and young people, taking into account

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inadequate

How well children and young people are helped and protected inadequate

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inadequate

The effectiveness of leaders and managers inadequate

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inadequate

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

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inadequate

Overall judgement at last inspection: good

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inadequate

Enforcement action since last inspection: none Inspection report children’s home: SC040638 2

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Key findings from this inspection

This children’s home is inadequate because:

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Key findings from this inspection

 There have been significant failures in the management of the home. The responsible individual failed to act on information provided by the independent visitor in line with Regulation 44, specifically with regards to allegations of harm.  During this inspection period, some restraint practice has been very poorly led and this has been detrimental to young people’s care, although this is no longer so at the time of the inspection.  Ofsted has not been informed of the severity of allegations of poor practice by the former registered manager nor kept up to date in developments, including new allegations.  There have been significant concerns regarding behaviour management and restraint practice, including the practice of holding door handles to prevent a young person leaving a room. These incidents were not recorded.  A culture had formed within the home that allowed poor practice to continue unchallenged.

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Key findings from this inspection

 Recruitment is not robust and is not following safer recruitment guidance.  Young people have been denied the opportunity to save up their monthly allowances in order to budget for more expensive items.

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Key findings from this inspection

 Young people are settled in the home and are confident when approaching staff. They are making progress personally and socially, and all are now attending education as planned.  The acting manager and acting assistant manager are working well with the staff team to improve their skills and to rebuild confidence.  Training, in particular behaviour management and whistleblowing, has been reviewed and updated for all staff.

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Inspection date Inspection type Inspection judgement

15/03/2017 Full Good 13/06/2016 Interim Sustained effectiveness 14/03/2016 Full Good 24/09/2015 Interim Sustained effectiveness Inspection report children’s home: SC040638 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

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. In particular, the standard in paragraph (1) requires the registered person to ensure that staff— provide to children living in the home the physical necessities they need in order to live there comfortably and provide to children personal items that are appropriate for their age and understanding. (Regulation 6 (1)(2)(b)(vii)(viii)) This relates to ensuring that all young people have adequate money towards personal care. 28/02/2018

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Requirement Due date

The positive relationships standard is that children are helped to develop, and to benefit from, relationships based on mutual respect and trust, an understanding about acceptable behaviour and positive responses to other children and adults. In particular, the standard in paragraph (1) requires the registered person to ensure that staff meet each child’s behavioural and emotional needs, as set out in the child’s relevant plans. (Regulation 11 (1)(2)(a)(i)) In particular, plans to support young people must be clear and unambiguous, including detail of any agreed physical intervention techniques for that young person. 28/02/2018

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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. In particular, the standard in paragraph (1) requires the registered person to ensure that staff have the skills to identify and act upon signs that a child is at risk of harm, understand the roles and responsibilities in relation to protecting children that are assigned to them by the registered person and take effective action whenever there is a serious concern about a 28/02/2018 Inspection report children’s home: SC040638 4 child’s welfare. (Regulation 12 (1)(2)(a)(iii)(v)(vi)) In particular, ensure that there are records of any action taken in response to a young person making a disclosure of any form of abuse or harm. The protection of children standard is that children are protected from harm and enabled to keep themselves safe. In particular, the standard in paragraph (1) requires the

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Requirement Due date

registered person to ensure that staff are familiar with, and act in accordance with, the home’s child protection policies. (Regulation 12 (1)(2)(a)(vii)) This is to include the whistleblowing procedure and how to act accordingly to any concerns within the home by any member of staff. 28/02/2018

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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 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. Particularly, the responsible individual making use of external monitoring systems and knowledge of practice within the home. 28/02/2018

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Requirement Due date

Restraint in relation to a child is only permitted for the purpose of preventing injury to any person (including the child) or serious damage to the property of any person (including the child). Restraint in relation to a child must be necessary and proportionate. (Regulation 20 (1)(a)(b)(2)) 28/02/2018

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Requirement Due date

The registered person must notify HMCI and each other relevant person without delay if there is an allegation of abuse against the home or a person working there and if a child protection enquiry involving a child is instigated or concludes (in which case, the notification must include the outcome of the child protection enquiry). (Regulation 40 (4)(c)(d)(i)(ii)) 28/02/2018 Inspection report children’s home: SC040638 5

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Recommendations

 The registered person should build a strong safeguarding culture in the home where children are listened to, respected and involved in both the development of the home and decisions about the home. (‘Guide to the children’s homes regulations including the quality standards’, page 43, paragraph 9.8.) Specifically, recognising when inappropriate language or practice is being normalised within the home and records.  Staff need the knowledge and skills to recognise and be alert for any signs that might indicate a child is in any way at risk of harm. The registered person should ensure that skills in safeguarding are gained, refreshed and recorded in the home’s workforce plan. (‘Guide to the children’s homes regulations including the quality standards’, page 43, paragraph 9.12.) Specifically, to test staff’s comprehension and knowledge after online training.  As part of the policies for protection of children, the registered person should

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Recommendations

include information about whistle blowing, with clear procedures for how a staff member should report to an appropriate authority any concern they have about a child within the home being either at risk of or already experiencing significant harm. The policy should reflect the principles set out in the Francis review ‘Freedom to speak up’. (‘Guide to the children’s homes regulations including the quality standards’, page 43, paragraph 9.15.)  Restraint also includes restricting a child’s liberty of movement. This includes, for example, changes to the physical environment of the home (such as using high door handles) and removal of physical aids (such as turning off a child’s electric wheelchair). Restrictions such as these, and all other restrictions of liberty of movement, should be recorded as restraint. Some children, perhaps due to impairment or disability, may not offer any resistance, but such measures should

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Recommendations

still constitute a restraint. (‘Guide to the children’s homes regulations including the quality standards’, page 47, paragraph 9.41.) Ensure that any use of a measure where a young person’s liberty is restricted is recorded as a restraint.  Approaches to restraint should recognise that children are continuing to develop, both physically and emotionally. Any use of restraint should be suitable for the needs of the individual child. The context in which restraint is used should also recognise that, as a result of past experiences, children will have a unique understanding of their circumstances which will affect their response to restraint by adults responsible for their care. (‘Guide to the children’s homes regulations including the quality standards’, page 48, paragraph 9.54.)  As set out in regulations 31-33, the registered person is responsible for maintaining good employment practice. They must ensure that recruitment,

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Recommendations

supervision and performance management of staff safeguards children and minimises potential risks to them. (‘Guide to the children’s homes regulations including the quality standards’, page 61, paragraph 13.1.) This specifically relates to verbal verification of references. Inspection report children’s home: SC040638 6

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Overall experiences and progress of children and young people: inadequate

Management oversight of the home, including by the responsible individual, has been poor. This allowed inappropriate practice to continue and safeguarding concerns to go unreported through much of this inspection period. Young people have not had consistently positive experiences living in the home. The combination of young people who were living in the home was not manageable, and some unacceptable behaviour management practice has taken place.

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Overall experiences and progress of children and young people: inadequate

The group of young people who are currently living in the home are settled and are making progress. They enjoy some extremely positive relationships with staff. Staff have a renewed energy and confidence in their abilities, resulting in young people feeling safe to express themselves. Young people’s successes are celebrated, and all receive a monthly letter in the post congratulating them on their successes in addition to staff identifying times when it has been a pleasure to be with them. However, two young people who left in the autumn did not experience such positive relationships at all.

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Overall experiences and progress of children and young people: inadequate

All young people attend education as programmed. Links with schools and colleges are strong. Staff attend meetings when young people are struggling, to consider how best to support their engagement. One young person told inspectors how much they were enjoying their construction course, and explained all the skills that they have learned. Those who have not been engaging in education have been supported to overcome barriers to learning. This includes slowly introducing them to online lessons until they are ready to function in a small classroom environment.

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Overall experiences and progress of children and young people: inadequate

Young people engage in a wide range of socially and emotionally stimulating activities. One young person successfully completed a National Citizenship Scheme programme in the summer holidays, including a residential aspect. This was a major achievement for him. Others attend youth clubs in their home area to maintain friendships. Those who have specific interests or needs are also supported well. Provision is made within the home for young people to express themselves through, for example, art or music. The cultural and gender mix of the staff team allows young people to explore who they are and to learn about others’ cultures. Gender and sexuality exploration is managed well, with young people being sensitive to others’, including staff’s, identity or sexuality. Young people who have moved on from the home have had mixed experiences of living in the home. Two young people have successfully moved on to independent living, and

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Overall experiences and progress of children and young people: inadequate

have been well supported in this process. For two other young people, staff were unable to meet their needs in the environment and they had to move to more specialist placements. Pre-placement planning is sound, and staff feel that there was no indication that they would not be able to meet either of the young people’s needs. However, it was beyond the skills of the team to manage these young people’s behaviour, and the team resorted to inappropriate management techniques. Those currently living in the home are still processing the impact of the treatment of these two young people and, when angry, ask if they will receive the same behaviour management response. Inspection report children’s home: SC040638 7 Young people are encouraged to learn new skills in preparation for adulthood and independence. The use of the independence flat allows young people to learn tangible skills and to start to experience how it feels to be alone and not surrounded by staff and

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Overall experiences and progress of children and young people: inadequate

other young people at all times. A young person was seen checking with staff the correct words to use when calling college to enquire about their bursary; this was a major step for him. However, young people are unable to save their allowance from one month to the next for toiletries and haircuts. This limits the development of skills in saving and budgeting, and reduces their choice of style or products. An explanation that it was reflecting the amount of money available to someone on job seekers allowance is unambitious and not reflective of the lives that young people are likely to live once they live independently. The ability to save this allowance was reinstated during the inspection.

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Overall experiences and progress of children and young people: inadequate

The physical environment continues to be improved. New bathrooms and a kitchen are now being installed after a long period of negotiation. Windows have been replaced to provide a more domestic look. Soft furnishings and ‘knick-knacks’ provide a more homely touch to what is an institutional looking building. Bedroom furniture is being replaced with typical household furniture, rather than institutional unbreakable furniture.

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

Young people have not been consistently kept safe while living in the home. Poor physical intervention practice only came to light through whistleblowing by staff, monitoring failed to pick this up. The reporting and recording of safeguarding concerns has not been timely and staff recruitment practice has been subject to weaknesses. Since the last inspection, a culture of normalising inappropriate practice had formed. Some staff failed to challenge unacceptable behaviour management practice, others are understood to have raised concerns without success. It is not clear why the responsible individual was not aware of what was happening within the home.

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

Incidents where young people have alleged that they have been hurt or harmed by a member of staff have not been consistently referred to relevant partner agencies. There are no records of two known concerns that were identified in Regulation 44 reports. Any concerns since November 2017 are properly recorded, and include a chronology of the actions taken.

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

Safer recruitment is not evident for two recently employed members of staff; there is no evidence within their files that references have been verified. Verification was later provided for one member of staff. Older files seen by inspectors did contain evidence that references had been verified with the author.

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

Approaches to behaviour management have been unacceptable on occasion. For instance, the gym has been used to help a young person to calm or burn off energy and has become known as ‘the room’ or the ‘time out room’. It became accepted practice to regularly hold the door handle on the outside to prevent the young person from leaving the room. The young person was treated with systematic disregard for their welfare by locking them in the gym by holding the handle. None of these instances were recorded Inspection report children’s home: SC040638 8 as a physical intervention.

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

Monitoring within the home by the independent visitor did not identify the use of inappropriate language or that unacceptable practice was taking place within the home. For example, reports used terms such as a young person being ‘put in the room’. Plans directed staff to ‘sit outside, blocking her door’ and for a young person to be ‘taken to the gym in order for her to self-regulate’. Plans to support young people were also unclear and ambiguous. They lacked detail in how to support a young person using agreed physical intervention techniques. The independent visitor, in line with Regulation 44, signed the plans but did not comment; this suggested that the plans had been endorsed. This was a missed opportunity to challenge poor practice within the home.

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

Behaviour management plans are in the process of being updated with a view to including specific detail about agreed holds should they be necessary. Additionally, young people now have the opportunity to add to their plans, including what they feel would calm them or what they may think the reason is when they are behaving in a certain way. Those that have been updated include positive behaviours to be actively promoted, such as hobbies and activities that young people enjoy; this helps to shift the focus away from negative behaviours and towards positive experiences and achievements.

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

Staff have benefited from group sessions and debriefs, along with regular supervision, to reflect on this situation. Recently, they have all engaged in behaviour management training as a team for the first time. Staff say that they feel this is much more effective as they have been able to talk about specific young people and consider the layout of the home when considering how best to support young people. Records since November of incidents are now clearer and all staff who have been involved sign to say that they agree with the account. There have been no physical interventions since November 2017.

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

Staff are confident in their responsibility for young people’s safety, and they have all renewed their child protection and safeguarding training through an online course. Managers have yet to test how well staff have understood and applied this training. Staff have been reminded of the whistleblowing procedure and how to escalate their concerns if necessary.

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

Young people’s actions and demeanour show that they feel safe in their home. If upset, young people are able to approach staff. Staff were seen to manage this extremely well, seeing the young person to be in need of help rather than being aggressive or rude. Staff were observed spending time with a young person, supporting her to understand what was troubling her and how they could help.

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The effectiveness of leaders and managers: inadequate

The previous registered manager left his post in January 2018. In the interim period, the home has been overseen by the assistant team manager and a manager from another home within the local authority. Due to long-term illness of the assistant manager, the Inspection report children’s home: SC040638 9 home is currently being managed by an acting manager from another team, with extensive residential management experience, and an acting assistant manager. Both have committed to remain in role while a permanent manager is sought.

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The effectiveness of leaders and managers: inadequate

There have been serious failures in the monitoring of the home by the responsible individual, and in particular not making use of external monitoring systems to inform him of practice within the home. Two reports from the independent visitor identify gaps in safeguarding practice, yet these have not been followed up. Some overly assertive practice by the independent visitor has also not been challenged effectively, for example signing behaviour management plans with no indication as to why. The new independent visitor has also requested that the home displays information and uses notice boards, which is inconsistent with a domestic setting.

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The effectiveness of leaders and managers: inadequate

Ofsted was not informed of the severity of the allegations made regarding the registered manager, when he was suspended in October 2017. Additionally, the responsible individual has not informed Ofsted of developments in this investigation, including a new allegation and police involvement.

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The effectiveness of leaders and managers: inadequate

The current management arrangements in the home are effective. Staff say they feel that the acting manager and acting assistant manager have had a positive impact. Specifically, they feel listened to more and that the team is stronger and happier. They feel that the young people are more settled and staff are regaining their confidence in their own skills and abilities. Staff are positive about the recent training in behaviour management, reflecting that doing the training as a whole group has given the opportunity to challenge and reflect as a group. Supervision is regular and effective, including group sessions with a member of staff from the therapy team.

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The effectiveness of leaders and managers: inadequate

Young people’s plans are regularly reviewed and updated. Their goals and targets are in line with their placement plans and agreements at statutory reviews. Their successes are clearly identified, with areas for development highlighted. Young people are becoming increasingly involved in their plans, and the format is being revised to make them more accessible. Joint working is highlighted throughout the plans, with clear indication of who is responsible for each piece of work. If there are concerns regarding a young person’s progress, multi-disciplinary meetings are convened to discuss a way to best meet their needs and overcome challenges.

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Information about this inspection

Inspectors have looked closely at the experiences and progress of children and young people. Inspectors considered the quality of work and the differences made to the lives of children and young people. They watched how professional staff work with children and young people and each other and discussed the effectiveness of help and care provided. Wherever possible, they talked to children and young people and their families. In addition, the inspectors have tried to understand what the children’s home knows about how well it is performing, how well it is doing and what difference it is making for the children and young people whom it is trying to help, protect and look Inspection report children’s home: SC040638 10 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: SC040638 11

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Children’s home details

Registered provider: Surrey County Council

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Children’s home details

Registered provider address: Quadrant Court, 35 Guildford Road, Woking GU22 7QQ

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Inspector

Jennie Christopher: social care inspector Inspection report children’s home: SC040638 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

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Inspector

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Inspector

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