Children's Home, Residential special school run by Amberleigh Care Limited in Shropshire

Inspection report children’s home: SC448209 1 SC448209 Registered provider: Amberleigh Care Limited Full inspection Inspected under the social care common inspection framework

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Information about this children’s home

This is a privately owned children’s home for up to 12 young people who have 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/or widespread failures that mean young people are not protected or their welfare is not promoted or safeguarded.

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inadequate

Overall judgement at last inspection: Inadequate

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inadequate

Enforcement action since last inspection: none Inspection report children’s home: SC448209 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

 Staff recruitment checks are not fully completed and do not ensure that all those working with the young people are safe to do so.  Staff are not fully aware of the therapeutic model used within the home to support the emotional health of the young people.  Risk assessments contain some inaccurate information.  Staff are not implementing sanctions consistently or proportionately.  Not all young people have free access to their bedrooms because they have to ask the staff to unlock their bedroom doors, when they want to gain entry. This restricts their freedom of movement around their home.  Staff do not receive effective supervision and some staff do not receive timely appraisals that support their development.  Young people feel that they are not always listened to and their views responded to.  Staff turnover means that young people do not always receive consistent care from people who know them well.

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Key findings from this inspection

 Complaints records do not consistently show the outcomes of investigations.  The manager does not sign off behaviour-management records in a timely manner, and copies of these records are not always stored within young people’s individual case files.  The independent person does not provide an evaluation in her monitoring reports about whether staff safeguard young people effectively.

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Key findings from this inspection

 Young people enjoy a good range of activities.  Young people develop independence skills and are prepared for their next steps.  Young people attend school regularly and have made academic progress.

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Inspection date Inspection type Inspection judgement

04/10/2017 Full Inadequate 01/03/2017 Interim Sustained effectiveness 07/12/2016 Full Good 22/03/2016 Interim Sustained effectiveness Inspection report children’s home: SC448209 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 health and well-being standard is that the health and well- being needs of children are met. In particular, the standard in paragraph (1) requires the registered person to ensure that staff help each child to achieve the health and well-being outcomes that are recorded in the child’s relevant plans; and understand the child’s health and well-being needs and the options that are available in relation to the child’s health and well-being, in a way that is appropriate to the child’s age and understanding. (Regulation 10(1)(a)(2)(ii)) 02/03/2018

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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 positive responses to other children and adults. In particular, the standard in paragraph (1) requires the registered person to ensure that staff de-escalate confrontations with or between children, or potentially violent behaviour by children. (Regulation 11(1)(a)(2)(xi)) 02/03/2018

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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. (Regulation 12(1)(2)(a)(i)) 02/03/2018

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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 their welfare. In particular, the standard in paragraph (1) requires the registered person to ensure that that staff have the experience, qualifications and skills to meet the needs of each child; ensure that the home’s workforce provides continuity of care to each child; use monitoring and review systems to make continuous improvements in the quality of care provided in the home. (Regulation 13(1)(b)(2)(c)(e)(h)) 31/03/2018

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Requirement Due date

The registered person to ensure that no measure of control or discipline which is excessive, unreasonable or contrary to 02/03/2018 Inspection report children’s home: SC448209 4 paragraph (2) may be used in relation to any child. (Regulation 19(1)) This is specifically with reference to the use of sanctions. The registered person must ensure that the privacy of children is appropriately protected; children can access all appropriate areas of the children’s home’s premises; and any limitation placed on a child’s privacy or access to any area of the home’s premises is intended to safeguard each child accommodated in the home; is necessary and proportionate; is kept under review and, if necessary, revised; and allows children as much freedom as is possible when balanced against the need to protect them and keep them safe.(Regulation 21(a)(b)(c)(i)(ii)(iii)(iv)) 31/03/2018

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Requirement Due date

The registered person must recruit staff using recruitment procedures that are designed to ensure children’s safety. Specifically, the registered person must ensure that full and satisfactory information is available in relation to the individual in respect of each of the matters in Schedule 2. (Regulation 32(1)(3)(d))* 02/03/2018

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Requirement Due date

The registered person must ensure that all employees receive practice-related supervision by a person with appropriate experience; and have their performance and fitness to perform their roles appraised at least once every year. (Regulation 33(4)(b)(c)) 31/03/2018

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Requirement Due date

The registered person must ensure that, within 48 hours of the use of a measure of control, discipline or restraint, the registered person, or a person who is authorised by the registered person to do so (‘the authorised person’) has signed the record to confirm it is accurate. (Regulation 35(3)(b)(c)) 02/03/2018

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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)) 02/03/2018

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Requirement Due date

The independent person must produce a report about a visit (‘the independent person’s report’) which sets out, in particular, the independent person’s opinion as to whether children are effectively safeguarded; and the conduct of the home promotes children’s well-being. (Regulation 44(4)(a)(b)) 31/03/2018

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Requirement Due date

* These requirements are subject to a compliance notice.

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Recommendations

 Children must be consulted regularly on their views about the home’s care, to inform and support continued improvement in the quality of care provided. Due consideration should be given to the child’s cognitive ability Inspection report children’s home: SC448209 5 in the development and implementation of any consultation processes. Children should be able to see the results of their views being listened to and acted upon. (‘Guide to the children’s homes regulations and including the quality standards’, page 22, paragraph 4.11)

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Overall experiences and progress of children and young people: inadequate

Not all young people have access to their own bedrooms. To go into their bedrooms, four out of six young people need to ask staff to unlock their bedroom doors and this restricts young people’s movements around their home. Furthermore, when young people exit their bedrooms, they are required to ring a bell to alert staff to the fact that they are leaving their bedroom and returning downstairs. The absence of communal toilet facilities downstairs means that the young people use the ensuite facilities within their bedrooms. This means that young people are not always able to access toilet facilities in the home without staff’s permission. Young people do require high levels of supervision to keep them and others safe. However, this is not managed in a way that respects young people’s privacy and dignity.

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Overall experiences and progress of children and young people: inadequate

Young people know how to complain. However, some case records do not show how complaints have been investigated or what the outcome of each complaint is. One incident report references that a complaint was raised. There is no record of this complaint within the complaints file and it is not clear what, if any, action was taken. This poor quality of recording significant information does not support young people in being confident that any concerns they may have will be taken seriously and acted upon. The manager has taken some appropriate action to improve the complaints system, with the result that more-recent complaints have been responded to and feedback given to young people. However, this practice has yet to be fully embedded. The manager has not yet taken action to review all complaints to satisfy herself that all necessary action has been taken.

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Overall experiences and progress of children and young people: inadequate

The home uses the ‘Good Lives Model’ as the underpinning and therapeutic approach to practice within the home. However, and significantly, both managers and staff have insufficient knowledge, understanding and training to deliver the model effectively. Although young people’s case files contain therapy review reports, the actions arising from these reports do not inform young people’s plans sufficiently well. Placement plans do not contain detailed information about how staff can best support young people’s emotional well-being. As a result, staff do not and cannot support young people in line with their individual targets and in a way that is consistent with the home’s therapeutic model.

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Overall experiences and progress of children and young people: inadequate

The staff support young people’s physical health needs well and records show that young people attend their medical appointments. Staff encourage young people to keep active and eat healthily. Staff administer medication appropriately and keep accurate records. This aspect of care has improved since the last inspection.

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Overall experiences and progress of children and young people: inadequate

Young people raised concerns that some of the homes décor had changed without them Inspection report children’s home: SC448209 6 being consulted. Managers refute this and report that young people were given a chance to be involved in these decisions. However, there is no documentary evidence to support this. Young people raised concerns with the inspectors about this issue. Consequently, managers and staff have not helped young people to understand why improvements have been made to the home environment and how they can put forward ideas to change some of the things that they do not like. Young people have regular house meetings with staff, but accounts of the meetings are poorly recorded and, significantly, do not evidence what action is taken in response to young people’s views and wishes. This does not help young people to feel valued. Furthermore, it is not sufficiently clear how young people contribute to the day-to-day running of the home.

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Overall experiences and progress of children and young people: inadequate

Staff provide young people with good opportunities to take part in leisure activities. Young people talk about trips out that they have had at theme parks and said they go to the gym and cinema regularly. The young people enjoy participating in activities at the home too. For example, they make good use of the pool table and games consoles.

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Overall experiences and progress of children and young people: inadequate

Young people’s case files include reports in relation to their education. These show that young people are making progress and that their school attendance has improved since coming to the home. Young people are positive about school and during the inspection one was completing a cooking assessment, with positive comments from all of those who tasted their food!

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Overall experiences and progress of children and young people: inadequate

Placement plans contain clear information about young people’s contact arrangements. Staff support young people to maintain contact with their families and so help them to keep in touch with the people who are important to them.

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Overall experiences and progress of children and young people: inadequate

Staff provide some useful and positive support to young people to help them to develop good independence skills. For example, older young people have a budget for food, activities and transport to help them get used to handling their own finances. Staff talk to young people about the adjustments they will have to make when they live independently and prepare them for their next steps.

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

Staff recruitment processes are poor and recruitment checks do not protect young people from unsuitable individuals working in the home. Some staff have started work at the home without adequate reference checks being carried out. Furthermore, managers have not scrutinised information contained in the references that they have received. Moreover, managers have failed to follow up concerning information contained in other recruitment checks fully. This failure has the potential to leave children at unnecessary risk of harm. During the inspection, the manager showed a lack of awareness about her own responsibilities regarding the recruitment of staff. Weaknesses in staff recruitment were also identified at the last full inspection and a requirement raised in respect of this has not been met. The provider has now been served with a compliance notice to bring about required improvements.

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

Required checks in relation to health and safety matters are not undertaken thoroughly or consistently. For example, not all staff have completed fire-safety training. Staff do Inspection report children’s home: SC448209 7 not carry out necessary daily checks on fire exits and fire safety equipment in line with their organisation’s procedures. These poor practices mean that young people’s safety is not being fully supported.

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

Some aspects of young people’s individual risk assessments have improved since the last inspection and now contain more of the necessary detail required to manage and minimise identified risks. However, further improvement is required to ensure that assessments are as comprehensive and effective as they can be. Of concern is that the summary of risks in young people’s case files does not correlate to risks identified in individual assessments. This confusion means that the staff’s ability to manage risk accurately and effectively could be compromised. Of further concern is the inaccurate and misleading statement that young people are constantly supervised by staff; this is not the case and one-to-one staffing is not provided. This matter was identified at the last inspection and was due for review; the review has failed to be undertaken.

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

The manager does not review and sign off restraint records in a timely way. This means that the manager cannot be fully assured that restraint practice is proportionate and safe. Furthermore, the manager does not use monitoring systems to identify whether incidents could have been handled differently to inform future practice.

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

Managers have improved the quality of some aspects of record keeping. For example, safeguarding records now contain a detailed chronology of action taken when a serious incident occurs.

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

The number of missing episodes from the home has decreased since the last inspection. Staff respond to such incidents well. They search for young people and offer them support on their return. This promotes young people’s safety.

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

Staff respond to bullying incidents between young people through discussions and bridge-building exercises. Young people have also watched a DVD about bullying with staff. These strategies are helping young people to learn more about the impact of bullying behaviour on others. However, the impact of this work has yet to be fully realised. Physical altercations between young people do still occur and more work is needed to de-escalate potentially violent situations.

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

Staff do not always respond to incidents of negative behaviour appropriately. For example, one child was prevented from using a communal room in the home for several days following an alleged incident of bullying between young people. Preventing a young person from accessing an area of their home for a significant period is an inappropriate sanction. Despite this shortfall, this inspection identified that staff are beginning to use some restorative approaches to behaviour management. This approach is more effective in helping young people to become more aware of the effects of their behaviour on themselves and other people.

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

The home’s location risk assessment has recently been updated and includes safety measures taken to protect young people from the busy nearby road.

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The effectiveness of leaders and managers: inadequate

Inspection report children’s home: SC448209 8 The new manager and deputy have a good range of experience in residential care. They have started to implement some new systems and ways of working aimed at improving the quality of care young people receive. The staff team has made positive links with a range of professionals involved with the care of each young person. The need for police involvement has reduced since the last inspection, primarily because young people go missing less than they once did. Notifications to Ofsted have improved since the last inspection and are now being sent in the correct format and with necessary detail. Some requirements and recommendations raised at the last inspection have been met, which shows that some progress is being made.

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The effectiveness of leaders and managers: inadequate

However, significant shortfalls remain. The new manager has not submitted an application to register with Ofsted in a timely way. The home has been without a registered manager since April 2017.

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The effectiveness of leaders and managers: inadequate

The home has undergone a period of significant change with regards to staffing. Young people are aware of the turnover of staff and are able to articulate what this means for them. One young person said, ‘It’s like having to make a jigsaw time after time and then someone comes and breaks it up. You start to think, what’s the point?’ Although young people make positive relationships with some staff, they do not experience continuity of care from people who know them well. This has a negative impact on their ability to form attachments and on their experience of living in the home. The manager is aware of changes in the staff team and the challenge she faces in developing an effective staff team who work together well. The manager’s quality-of-care review highlights the need to develop the staff team and this work is ongoing.

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The effectiveness of leaders and managers: inadequate

An independent visitor monitors the effectiveness of the home each month. The independent visitor consults with young people, staff and professionals to inform her view. However, monitoring reports do not contain an evaluation about whether or not the home safeguards young people and promotes their welfare. This does not support the effective development of the home through monitoring.

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The effectiveness of leaders and managers: inadequate

The staff team receives supervision on a regular basis. However, supervision records are poor and do not show that issues raised by staff are responded to effectively. Supervision records do not evidence how managers support staff to understand and manage the impact of young people’s behaviour and emotions on their own well-being. The new manager acknowledges that some staff appraisals are overdue. Personal development plans are out of date and do not always set meaningful objectives that are work related. This lack of good-quality supervision and comprehensive annual appraisal fails to support staff development and does not maximise the potential to improve the standard of care provided to young people.

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The effectiveness of leaders and managers: inadequate

Although there is a system for monitoring staff training, this is not wholly effective. Some staff have not completed training in key aspects of the home’s function and purpose, such as the therapeutic practice model. As a result, staff are not afforded the opportunities they need to develop all of the skills and knowledge they need to support young people’s needs.

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Information about this inspection

Inspection report children’s home: SC448209 9 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 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: SC448209 10

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Children’s home details

Provision sub-type: Residential special school

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Children’s home details

Registered provider: Amberleigh Care Limited

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Children’s home details

Registered provider address: Amberleigh Care Ltd, Golfa Hall, Golfa, Welshpool, Powys SY21 9AF

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Inspectors

Andrew Hewston, social care inspector Tracey Coglan Greig, social care inspector Inspection report children’s home: SC448209 11 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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Inspectors

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Inspectors

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Inspectors

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