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

Inspection report children’s home: SC464249 1 SC464249 Registered provider: Thoughts of Others Limited

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Full inspection Inspected under the social care common inspection framework

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Information about this children’s home

The home provides care and accommodation for up to two children who have emotional and/or behavioural difficulties. The statement of purpose identifies that a prerequisite of a child’s admission is that the placing authority will seek to obtain a deprivation of liberty order. A private provider operates the home.

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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 children and young people are not protected or their welfare is not promoted or safeguarded and the care and experiences of children and young people are poor and they are not making progress.

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inadequate

Date of last inspection: 22 November 2017

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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: SC464249 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

 Leaders and managers have repeatedly failed to take the required action to address the requirements raised at the last four inspections.  Managers have failed to take action in response to children’s allegations against members of staff.  Staff do not have the necessary skills or knowledge to meet the complex needs of the children living at the home.  Staff continue to fail to make a distinction between the supervision of children who have a legal order in place to deprive them of their liberty and children who do not.  Risk assessments are still out of date and do not reflect significant changes.  Children’s health is still not supported. Medication is not managed effectively and children’s health plans are out of date and do not contain relevant information.  Recording of physical interventions are inadequate and lack the required management oversight.  Not all staff are subject to all of the required recruitment checks.

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Key findings from this inspection

 Internal and external monitoring remains poor.  Some equipment used by children is not routinely checked to ensure that the children remain safe.

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Key findings from this inspection

 Children maintain good school attendance, which supports their academic progress.  Staff support children to participate in a range of activities which promotes their individual interests.

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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 children’s home: SC464249 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

In meeting the quality standards, the registered person must, and must ensure that staff seek to develop and maintain effective professional relationships with such persons, bodies or organisations as the registered person considers appropriate having regard to the range of needs of children for whom it is intended that the children’s home is to provide care and accommodation. (Regulation 5(d)) 04/05/2018

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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) and(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. 04/05/2018

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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 ensure that the premises used for the purpose of the home are designed and furnished so as to meet the needs of each child. (Regulation 6(1)(2)(c)(i)) In particular, ensure that the home is maintained to a good standard of repair. 04/05/2018

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Requirement Due date

The protection of children standard is that children are 04/05/2018 Inspection report children’s home: SC464249 4 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) and (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 assessments after any significant incident. 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 take effective action whenever there is serious concern about a child’s welfare. (Regulation 12(1)(2)(a)(vi)) This relates to staff taking timely and effective action when a child makes an allegation against a member of staff. 04/05/2018

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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 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 monitoring and review systems to make continuous improvements in the quality

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Requirement Due date

of care provided in the home. (Regulation 13(1)(a)(b) and (2)(a)(c)(e)(f)(h)) 04/05/2018

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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)) 04/05/2018 Inspection report children’s home: SC464249 5 The registered person may only employ an individual to work at the children’s home if the individual satisfies the requirements in paragraph (3). In particular that full and satisfactory information is available in relation to the individual in respect of each of the matters in Schedule 2. (Regulation 32(2)(a)(3)(d) 04/05/2018

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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)) 04/05/2018

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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 the effectiveness of measures of control. 04/05/2018

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Requirement Due date

The registered person must maintain records ("case records") for each child which are kept up to date and are signed and dated by the author of the entry. (Regulation 36(1)(b)(c) 04/05/2018

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Requirement Due date

The registered person must ensure that the following items, which may be kept in electronic form, are kept in an accessible manner: records of the use of measures of control, discipline or restraint. (Regulation 38(h)) 04/05/2018

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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 meet all elements of this regulation: consultation, action planning, reporting and sharing the report of the review with placing authorities. (Regulation45(1)(2)(b)(3)(4)(5)) 04/05/2018

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Requirement Due date

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)) 04/05/2018

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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. (Regulation 40(4)) 04/05/2018

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Recommendations

Inspection report children’s home: SC464249 6 To improve the quality and standards of care further the service should take account of the following recommendations:

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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, and 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) 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 and ensure that principles of food hygiene are implemented throughout the home.  The design of the home should provide staff that sleep in the home overnight 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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Recommendations

 Children should be encouraged by staff to see the home’s records as ‘living documents’ supporting them to view and contribute to the record in a way that reflects their voice on a regular basis. (‘Guide to the children’s homes regulations including the quality standards’, page 58, paragraph 11.19)  The children’s guide should help children understand how to contact the Office of the Children’s Commissioner. (‘Guide to the children’s homes regulations including the quality standards’, page 24, paragraph 4.22)

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Overall experiences and progress of children and young people: inadequate

There have been no changes in children living at the home since the last full inspection in November 2017. Inspection report children’s home: SC464249 7 Managers’ and staff’s oversight of children’s health remain poor. There continues to be gaps in records that relate to the administration of medication and some staff have not received training in the care of medicines. Managers set dates to review children’s health plans and then fail to complete the required review. Consequently, one child’s health plan has not been re-assessed for over three months. Key documentation to support children’s care continues to be either absent or chaotic. This is made worse by members of staff using a range of records, which prevent a clear narrative of a child’s plan and the intervention strategies required. For example, children’s case records do not hold details of children’s educational needs or the input of the child’s therapist. This means that staff continue to be without essential information

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Overall experiences and progress of children and young people: inadequate

that helps to support them to care for children. Children are not given sufficient opportunity to express their views or to be involved in decisions that affect their care. For example, staff do not encourage children to be involved in their care plans or their risk assessments. On the odd occasion when children are consulted, the staff make a summary of the child’s response, but fail to ensure that the child confirms that the record is an actuate reflection of their views. Children’s meetings no longer take place. Instead, children are spoken to individually to gain their views on practical matters such as menus and activities. The decision to stop the children’s meeting altogether has compromised the positive work to help to build up relationships between children and staff. When inspectors asked a child who she would talk to if she was unhappy, the child told the inspector that, although she would talk to

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Overall experiences and progress of children and young people: inadequate

the acting manager, she is not permitted to meet with the manager on her own. The young person’s guide does not give information about how children can contact the Children’s Commissioner. These elements restrict children from having an active engagement in the planning of their care or having a clear route of complaint when they are unhappy. Children continue to attend the organisation’s own school. However, despite children making progress in their learning, staff do not always help children to prepare for their school day. For example, inspectors observed children leaving for school in an anxious state due to the late arrival of staff who were going to take them to school. Children do have access to a range of interests away from the home. This can include going with staff to trampolining and swimming or having pamper sessions. Staff support children to maintain contact with their families. However, staff provide this

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Overall experiences and progress of children and young people: inadequate

support without having the up-to-date information they need about family contact arrangements. The staff fail to update records with an account of, or the outcome of, these visits. This means that staff do not have the necessary detail about recent contacts to support an accurate assessment about what is a safe level of family contact for the children.

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

The quality of practice in relation to safeguarding children continues to be of significant concern. Despite requirements being raised at the last four inspections, there is still no clear understanding by staff about the importance of safeguarding children effectively. Inspectors identified two incidents involving the use of physical restraint where children Inspection report children’s home: SC464249 8 have made allegations against members of staff. In both cases, managers have failed to follow up these allegations and have failed to take appropriate action. They had failed to make referrals to the appropriate designated officer for the local authority and had failed to inform the children’s social workers. During the inspection, one child made two further allegations against another two members of staff. The inspectors requested that the manager made an immediate referral to the appropriate agencies.

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

The statement of purpose for the home identifies that a prerequisite of any child’s admission is that the placing authority will seek to obtain a deprivation of liberty order. Despite this, only one child at the home is subject to the necessary court order and the manager was unable to produce the current copy of the order. Notwithstanding the continued requests made by Ofsted that staff should receive up-to-date guidance to inform their understanding of what a restriction of liberty is, no such guidance has been provided. Staff told inspectors that there is no differentiation in how children are supervised, irrespective of their legal status. Because of this blanket approach to practice, the rights of individual children are continually breached. Managers and staff have failed to ensure that risk assessments remain up to date. For example, one child’s risk assessment was completed in July 2017. This has not been

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

updated to reflect a recent incident when the child tried to use ligatures to self-harm. As a result of this omission to add details of this new and dangerous behaviour, different staff caring for the child do not have the information that they need to understand how to keep the child safe. The accuracy of children’s risk management plans remains in question. For example, one child’s risk management plan indicates that her access to the kitchen has been stopped. However, she was observed by inspectors to be cooking in the kitchen. Children’s risks are managed by having high levels of staff supervision. This means that staff follow children all around the house, in some cases on a ratio of three staff to one child. Staff will prevent children from leaving the house. Because of this, elements of children’s past risk-taking behaviour reduce. For example, children do not go missing from home. However, this reduction is because of the high level of direct staff

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

supervision and the intervention of staff who will stop any child who attempts to try to leave. This can include using physical restraint. The organisation continues to run two different behaviour management strategies. Although the aim is to move all staff to one approach, a period of transition is resulting in different staff applying different techniques that are dependent on the particular training that they have received. As a result, not all staff are using the same guidance and this means that inconsistencies in practice occur. Records of physical interventions continue to be inadequate. Staff fail to ensure that records relating to physical interventions are completed in line with regulation. For example, not all staff involved in a physical restraint sign the record. Managers have failed to enter their signature or the date of their review. In some cases, records contain notes that direct staff to add information retrospectively. This demonstrates a total lack

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

of transparency and accuracy in the records that pertain to provide an account of the physical restraint of vulnerable children. Inspection report children’s home: SC464249 9 Staff do not ensure that the home environment is maintained in line with health and safety legislation. For example, raw and cooked meats are stored together on one shelf in the fridge. In the yard area, one drain is blocked and causing an overflow of water. A trampoline set up for the children has a broken outer net. This has the potential to place children at risk of potential or actual harm. The manager took action to address the overflowing drain and the arrangements for storing food in the fridge during the inspection. However, the trampoline remains unsafe. There is now at least one trained fire marshal on each shift. However, the wider oversight of fire safety remains inconsistent. For example, fire drills are recorded in one

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

of three logs, which prevents a clear picture of the frequency of these tests. Leaders and managers fail to operate safe recruitment practices. As a result, managers are not clear that the staff that they employ are safe to work with children.

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The effectiveness of leaders and managers: inadequate

The established registered manager has not been in day-to-day control of the home since August 2017 due to her being on maternity leave. The temporary manager has not submitted an application to Ofsted to cover this long period of absence, despite Ofsted writing to her and informing her of the requirement to be registered. Nine of the requirements raised at the full inspection in November 2017 remain unmet and a further six requirements have been raised as a direct result of this inspection. In particular, there have been common themes of shortfalls in relation to safeguarding children and in leadership and management. A further concern emerging is the lack of capacity and/or inability to sustain improvement. For example, requirements to ensure that Ofsted receives notifications about serious events did start to be complied with and notifications were received, but once again this progress has not been sustained and the

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The effectiveness of leaders and managers: inadequate

receipt of notifications has stopped. This demonstrates managers’ and leaders’ lack of ability to sustain and embed the practice of routinely complying with regulations. The manager has taken action to begin to address issues of staff continuity and, as a result, staff duty rotas evidence that the majority of staff working at the home are now ‘core’ staff who are regular members of the team. However, the manager confirmed that the staffing for the home is managed centrally and is reviewed and amended monthly. This means that the ‘core’ staff are effectively subject to change on a monthly basis. Staff continue to lack the necessary skills required to provide the specialist care that the organisation states it offers in the statement of purpose. The manager told the inspectors that staff do not receive sufficient safeguarding training, especially in areas of missing from care and the risks of child sexual exploitation. Only the manager has

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The effectiveness of leaders and managers: inadequate

received advanced safeguarding training. This means that staff are not skilled to meet the safeguarding needs of children living in the home. Oversight of staff supervision and appraisal remains poor. Staff who are given the responsibility to supervise other staff have still not received training to assist them to ensure that all members of staff have practice-based supervision. The manager’s oversight of all supervision and appraisals fails to give an accurate account of these Inspection report children’s home: SC464249 10 sessions and, as a result, it is different to assess frequency and quality. Internal and external monitoring systems are ineffective. Internal monitoring systems used to produce documentation for the inspection were inaccurate. Documents required were either unavailable or submitted in multiple versions. The manager has submitted her six-monthly quality of care report to Ofsted. However, the report is missing key

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The effectiveness of leaders and managers: inadequate

information to inform the regulator how the manager has fully assessed children’s experiences over a six-month period. This includes the absence of the child’s voice and the views and opinions of key stakeholders. The statement of purpose has not been updated. For example, it continues to refer to a classroom at the home. However, there is no allocated classroom. This gives anyone who reads the statement of purpose inaccurate information. Leaders and managers continue to miss opportunities to engage in and improve partnership working. For example, the manager cancelled and failed to rearrange a meeting with the local police. In addition, one placing social worker told the inspector that communication remains a challenge. As a result, the home is increasingly becoming isolated and reliant on its own internal resources.

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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 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: SC464249 11

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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, Suttton Coldfield, West Midlands B73 5DL

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Inspectors

Tracey Coglan Greig, social care inspector Andrew Hewston, social care inspector Inspection report children’s home: SC464249 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 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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