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

Inspection report for children’s home - monitoring visit: SC464249 1 SC464249

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Thoughts of Others Limited

Inspected under the social care common inspection framework

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Information about this children’s home

This home provides care and accommodation for up to two children who have emotional and/or behavioural difficulties. A private provider operates the home. The organisation operates a school nearby and can provide therapeutic services. The statement of purpose states that a prerequisite of any child’s admission is that the placing authority will seek to obtain a deprivation of liberty order.

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This monitoring visit

This children’s home was judged inadequate at the full inspection on 8 and 9 August 2017, and 11 regulatory shortfalls were raised. These included four priority requirements with early dates for action. A monitoring inspection took place on 3 October 2017 and found that the registered person had not taken effective action to meet any of these requirements, including the four priority requirements.

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This monitoring visit

A second full inspection on 22 and 23 November 2017 judged the home inadequate. This inspection found that the registered person had taken some action to begin to meet four of the previous 12 requirements, including two of the priority requirements.

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This monitoring visit

At this monitoring visit, nine out of 12 requirements have now been met.

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This monitoring visit

Since the last inspection, the responsible individual has appointed an operations manager who will start to take the lead on the supervision of the management of the home. The home’s registered manager is currently on maternity leave. The acting manager, appointed in September 2017, was absent due to sickness from 11 December 2017 until 16 January 2018. The responsible individual did not notify Ofsted of the arrangements to cover the acting manager absence and she has not submitted an application to register with Ofsted. Inspection report for children’s home - monitoring visit: SC464249 2 There have been gradual steps to improve the quality of care for children. For example, the acting manager has now produced her first quality of care review. Although this is a positive step in the right direction, the process has not included the views of children, staff, families and professionals. This limits the contribution of

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This monitoring visit

key stakeholders in helping to shape the future of the service and to evaluate the quality of care.

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This monitoring visit

Although progress is beginning to be made in staff training and development, the staffing model used by the organisation still means that a high number of different staff work with children on a regular basis. This creates considerable variation in staff members’ knowledge of children’s needs. The registered person acknowledges that the current staffing model does not allow staff to be supervised and led by the manager. This in turn affects children receiving continuity of care. However, the introduction of a new staffing model analysis record is beginning to help the registered person to make improvements in how staff need to be allocated, so that children are able to build meaningful relationships with a stable staff team.

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This monitoring visit

The acting manager has reviewed medication systems and has simplified them by removing all non-prescribed, homely medication. However, the acting manager acknowledges that in her absence there have been further occasions when medication has been administered but has not been signed for. Children’s health plans still give inaccurate medication information, which could lead to staff making potential administration errors.

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This monitoring visit

The registered person has a plan in place to ensure that by March 2018 each shift will have a trained fire marshal.

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This monitoring visit

The acting manager has set up a meeting with the police to share the organisation’s missing from care policy and children’s individual protocols to ensure that going forward there is effective partnership working to keep children safe.

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This monitoring visit

The acting manager has completed an initial review about children’s ends of placements and historical safeguarding concerns. This work has helped her to identify areas for improvement so that children stay protected.

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This monitoring visit

While the acting manager was on sick leave, there was no effective review of staff use of restraint. Since her return, she has started to work on the analysis of behaviour management incidents. However, poor records made by staff have failed to show how a child sustained a head injury during an incident when staff needed to use physical restraint. This incident is now subject to a police investigation. The responsible individual did not notify Ofsted of this event.

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This monitoring visit

There is still no distinction or individual guidance in children’s plans about the implications of children’s legal status. For example, one child’s behaviour management plan and risk assessment still does not refer to her deprivation of liberty order nor what that allows and prohibits. Staff are still not clear about the legal framework within which they exercise their duty of care. Staff remain at risk of Inspection report for children’s home - monitoring visit: SC464249 3 applying blanket restrictions to both children regardless of their legal status. Managerial oversight does not take account of this necessity to ensure that individual responses remain in line with children’s legal status.

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This monitoring visit

Managers have updated risk assessments recently. However, managers have not ensured that these assessments are shared with staff. Risk assessments still do not inform staff how they should safely manage physical interventions for children who have previously raised allegations of heavy and painful restraint. This means that staff may not know how to minimise harm and injury or which holds are most safe and effective.

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This monitoring visit

Some records for staff and children have been reviewed and revised. However, behaviour management and care plans have not been updated since August 2017. This means that staff have no clear, informative guidance to ensure that consistent care is established in respect of children’s behaviour, risk management and health. This is significant because of the high number of additional staff working with children who are not as familiar with the children’s needs.

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This monitoring visit

The acting manager acknowledges that in her absence core staff have not had sufficient supervisory support or guidance.

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This monitoring visit

The registered person now makes sure that information in the statement of purpose does not give the impression that nurses are employed to care for children.

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Recent inspection history

Inspection date Inspection type Inspection judgement 22/11/2017 Full Inadequate 08/08/2017 Full Inadequate 29/03/2017 Full Requires improvement 01/11/2016 Full Requires improvement Inspection report for children’s home - monitoring visit: SC464249 4

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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

In meeting the quality standards, the registered person 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)) 12/03/2018

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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; 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 understand and apply the home’s statement of purpose, and ensure that staff 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(1)(a)(b)(2)(a)(iv)) In particular, ensure that staff have ease of access to up-to- date and accurate information about children and that they deliver individual plans. 12/03/2018

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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 assess whether each child is at risk of harm, taking into account information in the child’s relevant plans, and, if necessary, make arrangements to reduce the risk of any harm to the child; and that the effectiveness of the home’s child protection policies is monitored regularly. (Regulation 12(1)(2)(a)(i)(e)) This relates specifically to assessment of risk from self-harm, risk during restraint and the manager’s monitoring and review of the effectiveness of risk assessment after any significant incident. 12/03/2018

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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 helps children aspire to 12/03/2018 Inspection report for children’s home - monitoring visit: SC464249 5 fulfil their potential and promotes their welfare. 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 delivers 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 and use

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Requirement Due date

monitoring and review systems to make continuous improvements in the quality of care provided in the home. (Regulation 13(1)(a)(b)(2)(a)(c)(e)(f)(h)) The registered person must ensure that 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. These Regulations do not prevent a child from being deprived of liberty where that deprivation is authorised in accordance with a court order. (Regulation 20(1)(a)(b)(2)(3)) 12/03/2018

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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. In particular the registered person must ensure that medicine which is prescribed for a child is administered as prescribed to the child for whom it is prescribed. (Regulation 23(1)(2)(b)) 12/03/2018

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Requirement Due date

The registered person must make arrangements for persons working at the home to receive suitable training in fire prevention. (Regulation 25(1)(c)) 12/03/2018

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Requirement Due date

The registered person must prepare and implement a policy (‘the 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 registered person must keep the behaviour management policy under review and, where appropriate, revise it. (Regulation 35(1)(b)(2)) In particular, improve guidance about restrictions of liberty and movement and managerial review of effectiveness of measures of control. 12/03/2018

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Requirement Due date

The registered person must complete a review of the quality of care provided for children (‘a quality of care review’) at least once every 6 months. This review must establish and 12/03/2018 Inspection report for children’s home - monitoring visit: SC464249 6 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)) The registered person must give notice in writing to HMCI, as soon as is reasonably practicable to do so, if any of the following events take place or are expected by the registered person to take place: a person other than the registered person carries on or manages the children’s home (Regulation 49(a))

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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. (Regulation 40(4)) 12/03/2018

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Recommendations

 Ensure that staff understand that a deprivation of liberty may occur when a child is both under continuous supervision and control and is not free to leave the home. A children’s home cannot routinely deprive a child of their liberty without a court order, such as a section 25 order to place a child in a licensed secure children’s home. In the case of young people aged over 16 who lack mental capacity, a deprivation of liberty may be authorised by the Court of Protection following an application under the Mental Capacity Act 2005. (‘Guide to the children’s homes regulations including the quality standards’, page 50, paragraph 9.63)  Continually and actively assess the risks to each child and the arrangements that are in place to protect them. This is with respect to inclusion in risk documentation of all risks, such as actions in the event of self-harm, or for occasions where staff restrict children’s movement. (‘Guide to the children’s

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Recommendations

homes regulations including the quality standards’, page 42, paragraph 9.5)  Ensure the home complies with relevant health and safety legislations (alarms, food hygiene etc.); however in doing so, homes should seek as far as possible to maintain a domestic rather than ‘institutional’ impression. (‘Guide to the children’s homes regulations including the quality standards’, page 15, paragraph 3.9.)

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Recommendations

In particular, ensure that the kitchen, new extension and partition meet the local authority health and safety and planning standards. Provide a garden area that takes account of children’s need for active play and for fresh air.  The design of the home should provide staff that sleep in the home overnight Inspection report for children’s home - monitoring visit: SC464249 7 with appropriate accommodation and facilities to do so. (‘Guide to the children’s homes regulations including the quality standards’, page 17, paragraph 3.26.)

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Information about this inspection

The purpose of this visit was to monitor the action taken and the progress made by the children’s home since its last Ofsted inspection.

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Information about this inspection

This inspection was carried out under the Care Standards Act 2000.

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Children’s home details

Registered provider: Thoughts of Others Limited

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Children’s home details

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

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Inspectors

Dawn Bennett, social care inspector Ms Wannop, social care inspector Inspection report for children’s home - monitoring visit: SC464249 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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Inspectors

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Inspectors

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Inspectors

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