Children's home run by RNIB Charity in Camden

Inspection report for children‘s home – monitoring visit: SC485607 1 SC485607

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RNIB Charity

Monitoring visit Inspected under the social care common inspection framework

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Information about this children’s home

This is a large children‘s home that provides care and accommodation for up to 30 children and young people in five purpose-built bungalows. The children and young people have a visual impairment, a learning and/or physical disability and/or sensory impairment. One of the bungalows is also registered by the Care Quality Commission and provides a specialist service to children and young people who have high health and medical needs who require long-term ventilation, or who have life-threatening or life-limiting conditions. The establishment is owned by a large national charity. The majority of the children and young people attend a registered school on the same site. Some young people remain at the home until the age of 19 to complete their education.

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This monitoring visit

This monitoring visit took place to review the progress made since the last inspection on 27 February 2018. The visit was also conducted to consider some information received by Ofsted from local authorities regarding their concerns. This visit found that no further children or young people have been placed in the home. Since the last inspection, one child has moved out of the home. Further shortfalls with regards to keeping children and young people safe were identified as well as concerns about the overall quality of care provided.

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This monitoring visit

During this visit, it was identified that children and young people have limited access to a variety of activities. Activities that young people frequently take part in are trips to the nearby pub, local park and shops. They also spend considerable time in their bedrooms. This is because there is a limited availability of experienced staff who are able to take young people into the community. There are a limited number of staff able to drive the minibuses. This impacts on children and young people‘s social skills and opportunities for fun. For example, one young person voiced his wish to go swimming at the on-site hydrotherapy pool. This has not been possible for several weeks as the required risk assessments have not been completed. Inspection report for children‘s home – monitoring visit: SC485607 2 There are a number of vacancies within the home. There are only two team leaders currently in post across the four open bungalows. They do not have the current skills

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This monitoring visit

or competence to complete some of the managerial tasks. A manager told one inspector during this visit that they did not feel they had the skills to manage some children and young people‘s challenging behaviours. The team leaders have day-to- day responsibility for the running of each bungalow; however, they have limited duties in key areas, which are currently completed by consultants. For example, they do not currently respond to parental or social worker complaints and they are unable to update behaviour management plans.

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This monitoring visit

A social worker informed Ofsted prior to this inspection that one child is not having access to a multi-sensory impairment worker to support him as per his care plan. An inspector was told during this visit that it had not been possible to access this input. A staff member told one inspector that another child had not had access to the required habilitation support that is needed for him to maximise his learning and independence. This means that children and young people are not receiving the specialist level of care needed to enable them to develop their social skills and independence.

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This monitoring visit

Further shortfalls were also identified in the lack of training that staff receive in understanding the individual health needs of each child or young person and how this affects them. Concerns were also noted with staff competency in monitoring and ensuring the safe use of specialist equipment. For example, records showed that staff have not received competency training on how to administer one child‘s oxygen and insert another child‘s catheter. Some staff told inspectors during this visit that they had taught each other how to insert one child‘s catheter.

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This monitoring visit

During this inspection, it was also found that safety checks on an oxygenator are overdue by one month. A revised risk assessment for suction equipment did not make clear that one machine should be taken to school with the child. This means that children and young people are at significant risk because managers and staff are not making sure that equipment is monitored and reviewed properly. This also means that the health and well-being needs of some children are not being met.

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This monitoring visit

During this inspection, there were several examples of behaviour management plans not being updated in response to an increase in children and young people‘s self- injurious, aggressive and inappropriate behaviours. In addition, risk assessments did not identify an increase in challenging behaviour or adequately assess how to minimise this. This disorganised style of management means that basic care is being missed in some areas and that improvement is hindered.

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This monitoring visit

Management monitoring and review systems remain ineffectual within the home. There is another newly appointed interim manager, a new interim responsible individual and a number of management consultants. However, there continue to be serious and widespread concerns in relation to the quality of care provided to children. Current management arrangements are not identifying shortfalls in practice Inspection report for children‘s home – monitoring visit: SC485607 3 quickly enough. However, despite these shortfalls, staff reported to inspectors that they felt more able to share their concerns and had started to feel better supported.

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This monitoring visit

It is not clear that restraint is always managed in line with the legal requirements. Children and young people‘s freedom is routinely restricted by locked doors, without adequate risk assessment. This means that the individual needs of each child are not being considered by managers and staff. Monitoring has failed to find that restraint has been happening. Staff are not trained to safely restrain children and young people. Staff do not recognise restraint. For example, children are restrained by staff to administer health treatment. This is not in accordance with any agreed behaviour or health plan. This routine practice could potentially be harmful and emotionally upsetting to children and young people.

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This monitoring visit

Further medication errors have taken place within the home. On two occasions since the last inspection, children and young people were not given medication as prescribed. This is as a result of staff not communicating clearly and checking written records. There have also been issues in relation to prescribed medication running out. More recently, staff did not follow hospital advice when a young person was discharged and failed to give him his medication as prescribed.

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This monitoring visit

During this inspection, there were gaps in recordings of significant incidents relating to children and young people. For example, one young person was restrained by hospital staff during her stay and sedated as a result. There is no record of staff sharing this information with a parent.

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This monitoring visit

This inspection visit has identified further and significant concerns. Staff are not meeting the basic care needs of some children and young people. There are considerable shortfalls identified. The restriction of accommodation notice remains in place until 6 June 2018. Further requirements outstanding from the monitoring visits completed on 20 and 27 February 2018 will be assessed at subsequent monitoring visits.

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Recent inspection history

Inspection date Inspection type Inspection judgement 20/11/2017 Interim Sustained effectiveness 22/08/2017 Full Requires improvement to be good 29/03/2017 Interim Declined in effectiveness 14/11/2016 Full Good Inspection report for children‘s home – monitoring visit: SC485607 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

The enjoyment and achievement standard is that children take part in and benefit from a variety of activities that meet their needs and develop and reflect their creative, cultural, intellectual, physical and social interests and skills. (Regulation 9(1)) 01/06/2018

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Requirement Due date

The registered person must ensure that each child has access to such dental, medical, nursing, psychiatric and psychological advice, treatment and other services as the child may require. (Regulation 10(2)(c)) 01/06/2018

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Requirement Due date

The registered person must ensure that staff meet each child‘s behavioural and emotional needs, as set out in the child‘s relevant plans. (Regulation 11(2)(a)(i)) 01/06/2018

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Requirement Due date

The registered person must 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) and (2)(a)(i))* 30/04/2018

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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 understand the roles and responsibilities in relation to protecting children that are assigned to them by the registered person that staff take effective action whenever there is a serious concern about a child‘s welfare. (Regulation 12 (1)(2)(a)(v)(vi))* 30/04/2018

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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. (Regulation 13(1)(b)) 30/04/2018

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Requirement Due date

The leadership and management standard is that the registered person must— 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 30/04/2018 Inspection report for children‘s home – monitoring visit: SC485607 5 ensure that the home‘s workforce provides continuity of care to each child ensure that staff have the experience, qualifications and skills to meet the needs of each child use monitoring and review systems to make continuous improvements in the quality of care provided in the home. (Regulation 13(1)(2)(a)(c)(e)(h)) Restraint in relation to a child is only permitted for the purpose of preventing— injury to any person (including the child); serious damage to the property of any person (including the child); or a child who is accommodated in a secure children‘s home from absconding from the home. Restraint in relation to a child must be necessary and

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Requirement Due date

proportionate. (Regulation 20(1)(a)(b)(c)(2)) 01/06/2018

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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. (Regulation 23(1)) 30/04/2018

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Requirement Due date

A responsible individual must have the capacity, experience and skills to supervise the management of the home, or the homes, in respect of which the responsible individual is nominated. (Regulation 26(7)(b)) 30/04/2018

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Requirement Due date

A person may only manage a children‘s home if, having regard to the size of the home, its statement of purpose, and the number and needs (including any needs arising from any disability) of the children, the person has the appropriate experience, qualification and skills to manage the home effectively and lead the care of children. (Regulation 28(1)(b)(i)) 30/04/2018

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Requirement Due date

The registered manager must undertake such continuing professional development as is necessary to ensure that the registered manager has the skills needed for managing the home. (Regulation 29(4)) 30/04/2018

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Requirement Due date

The registered person must ensure that all employees undertake appropriate continuing professional development. (Regulation 33(4)(a)) 30/04/2018

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Requirement Due date

The registered person must prepare and implement a policy which is intended to safeguard children accommodated in the children‘s home from abuse or neglect; and sets out the procedure to be followed in the event of an allegation of abuse or neglect. The procedure to be followed in the event of an allegation of abuse or neglect must, in particular, provide for the prompt referral of an allegation about current 30/04/2018 Inspection report for children‘s home – monitoring visit: SC485607 6 or ongoing abuse or neglect in relation to a child to the placing authority and, if different, the local authority in whose area the home is located. (Regulation 34(1)(a)(b)(2)(b) The registered person must maintain records (―case records‖) for each child. (Regulation 36(1)) 01/06/2018

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Requirement Due date

The registered person must notify HMCI and each other relevant person without delay if there is any other incident relating to a child which the registered person considers to be serious. (Regulation 40(4)(e)) 30/04/2018

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Requirement Due date

*These requirements are subject to a compliance notice.

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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 address: c/o RNIB, 105 Judd Street, Camden, London WC1H 9NE

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Inspectors

Anna Gravelle, social care inspector Ms Wannop, social care inspector Inspection report for children‘s home – monitoring visit: SC485607 7 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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