Setting

X10029.doc Version 1.40 Page 1 FOSTERING SERVICE

p.1

BS5 9RH

Lead Inspector Jacqueline Sullivan Announced Inspection 6th – 9th March 2006 10:00 Bristol Social Services Fostering Service DS0000043438.V277900.R01.S.doc Version 5.1 Page 2 The Commission for Social Care Inspection aims to:

p.1

BS5 9RH

• Put the people who use social care first • Improve services and stamp out bad practice • Be an expert voice on social care • Practise what we preach in our own organisation

p.2

BS5 9RH

Reader Information Document Purpose Inspection Report Author CSCI Audience General Public Further copies from 0870 240 7535 (telephone order line) Copyright This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Internet address www.csci.org.uk Bristol Social Services Fostering Service DS0000043438.V277900.R01.S.doc Version 5.1 Page 3 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Fostering Services. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop

p.2

BS5 9RH

Every Child Matters, outlined the government’s vision for children’s services and formed the basis of the Children Act 2004. It provides a framework for inspection so that children’s services should be judged on their contribution to the outcomes considered essential to wellbeing in childhood and later life. Those outcomes are: • Being healthy • Staying safe • Enjoying and achieving • Making a contribution; and • Achieving economic wellbeing.

p.3

BS5 9RH

In response, the Commission for Social Care Inspection has re-ordered the national minimum standards for children’s services under the five outcomes, for reporting purposes. A further section has been created under ‘Management’ to cover those issues that will potentially impact on all the outcomes above.

p.3

BS5 9RH

Copies of Every Child Matters and The Children Act 2004 are available from The Stationery Office as above This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Bristol Social Services Fostering Service DS0000043438.V277900.R01.S.doc Version 5.1 Page 4

p.3

Name of service

Bristol Social Services Fostering Service

p.4

Name of service

Address The Cottage Avonvale Road Redfield Bristol BS5 9RH

p.4

(if applicable)

Bristol City Council (Social Services & Health)

p.4

manager (if applicable)

Type of registration Local Auth Fostering Service

p.4

of places

Bristol Social Services Fostering Service DS0000043438.V277900.R01.S.doc Version 5.1 Page 5

p.5

Conditions of registration:

Date of last inspection 17th September 2004

p.5

Brief Description of the Service:

Bristol City Council’s fostering service team is part of the children’s services division and based in a former school building at Avonvale Road in Redfield, Bristol.

p.5

Brief Description of the Service:

The resource is central for providing services to ‘Looked After Children’ in Bristol. The service provides for over 577 ‘Looked after Children’ in Bristol; 80% are within the foster care service placed with ‘in-house’ foster carers. Children are also placed with Independent Fostering Agencies. Some of these carers were approved ‘Fostering Plus’ Carers.

p.5

Brief Description of the Service:

Next to its considerable size the service also covers a wide range of essential key areas and supports a wide variety and styles of fostering such as Mainstream Family placements, Fostering Plus, Permanent, Remand (Youth Justice), Emergency placements, work with Relinquished Babies and Foster Carer Training.

p.5

Brief Description of the Service:

The team also deals with all aspects of adoption.

p.5

Brief Description of the Service:

The following additional services are also based at Avondale Road. • Birth Parent Counselling • Section 51 Counselling • Foster Panels • Commissioning team • Access to Resources Panel The Adoption Panel meets at The Council House.

p.5

Brief Description of the Service:

Core services are provided by 3 distinct teams each specializing in particular aspects of service delivery and supervised by a team manager:

p.5

Brief Description of the Service:

Recruitment Team : Recruitment, training and assessment of foster carers and adopters. Initial support for foster carers recently approved (up to six months). Preparing and supporting carers during their first reviewing process. Bristol Social Services Fostering Service DS0000043438.V277900.R01.S.doc Version 5.1 Page 6 Permanency Team : Support for long-term foster carers and their regular review. Assessment and support of prospective adopters.

p.5

Brief Description of the Service:

Short Term : Support and regular review of short-term foster carers and family finding. Out of Hours support (Overall management).

p.6

Brief Description of the Service:

A fourth team provides a Family Link Service for disabled children and operates largely independently from the fostering services with its own ‘Statement of Purpose’ and Children’s Guide. This team provides a range of additional services specific to the needs of disabled children such as Support groups including BSL interpreters, support for deaf carers, boys and girls groups for disabled children.

p.6

Brief Description of the Service:

The Kinship workers/service are based with the long-term/permanency team and has two workers. Their task is to identify and support Kinship Carers in Bristol. This service maintains a strong link to the ‘Hadley Centre for Adoption and Fostering’ (University of Bristol) to promote best practise by linking research, training and practise.

p.6

Brief Description of the Service:

All teams maintain strong links with the local Clinical Psychology Service team, the Education of Looked After Children Service (ECLAS) and the Avonside Foster Carers’ Association.

p.6

Brief Description of the Service:

The senior management of Bristol Children ad Young People’s Services fostering also supports regular meetings between AFCA, City Councillors and the Director of Social Services and Health.

p.6

Brief Description of the Service:

The fostering service is part of the newly- structured Children and Young People Service following implementation of the Children Act 2004 in Bristol on 1 April 2006, linking with Education, Health and other relevant agencies to form a cohesive service for young people. Bristol Social Services Fostering Service DS0000043438.V277900.R01.S.doc Version 5.1 Page 7

p.6

SUMMARY

This is an overview of what the inspector found during the inspection.

p.7

SUMMARY

This was Bristol Social Services Fostering Services’ fourth inspection under the National Minimum Standards for Fostering. It is therefore advisable that this inspection report is read in conjunction with the two previous inspection reports as reference is made to their findings.

p.7

SUMMARY

The teams have a wide range of highly demanding duties and responsibilities. The inspectors found a highly skilled and motivated team. However concerns were raised about the depleted administrative support and its impact across the teams, the remit of the administrative team and staff morale in some teams. It was generally perceived by the staff that “cuts from the bottom of the service rather than at the top” put increased pressure on them.

p.7

SUMMARY

The introduction of the Commissioning team was very positive. It was well staff, well supported and well managed. In a relatively short space of time it had reduced the waiting lists for children awaiting placement and had made positive links with the private sector. The access to resources panel brought together key staff to make cohesive decisions.

p.7

SUMMARY

The new service links with education in the form of ECLAS (Education of looked after children) was seen as positive by the service. The management of the service stated that they envisage that this will improve the outcomes for children.

p.7

SUMMARY

The kinship care teams have developed a more consistent service that provides good support to carers.

p.7

SUMMARY

The recruitment drives have been mostly positive with the service targeting carers to meet the shortfalls in the service.

p.7

SUMMARY

It was positive that the service managers were aware of the current shortfalls in the service and had developed a business plan to address the majority of the issues raised in this report.

p.7

SUMMARY

Evidence was gathered from a variety of sources including: • Attendance at the panel • Case tracking • Discussion with carers • Meeting with children • Meeting with supervising social workers • Discussion with management team • Examination of records held • Pre-inspection information Bristol Social Services Fostering Service DS0000043438.V277900.R01.S.doc Version 5.1 Page 8

p.7

What the service does well:

The staff teams have experienced, skilled workers committed to providing a good service to the young people.

p.8

What the service does well:

The young people benefit from being cared for in safe, healthy and nurturing environments.

p.8

What the service does well:

The access to resources panel assists young people receive appropriate placements and services.

p.8

What the service does well:

The educational achievement of the young people is being addressed by the service to improve outcomes.

p.8

What the service does well:

The service promotes contact and consultation arrangements for the young people.

p.8

What the service does well:

Two kinship care workers are in place and are developing the service fast and efficiently

p.8

What the service does well:

As previously stated the newsletter for foster carers is a good source of information.

p.8

What has improved since the last inspection?

The Service has amended the statement of purpose for Family Link service and added details of a new service on the BSS statement of purpose

p.8

What has improved since the last inspection?

Each child is provided with suitable equipment.

p.8

What has improved since the last inspection?

The input of the Commissioning team has improved the process of matching child need to carer skill/competence. The Commissioning team is a positive aspect of the service.

p.8

What has improved since the last inspection?

The young people are better protected as there is a “Missing in Care” policy in place.

p.8

What has improved since the last inspection?

The young people’s educational achievements will be better met as, under the new structure, closer links with the ECLAS Service have been developed.

p.8

What has improved since the last inspection?

Pathway plans better links to after care team. Bristol Social Services Fostering Service DS0000043438.V277900.R01.S.doc Version 5.1 Page 9 There has been some review of the operational administration, telephone and IT problems.

p.8

What has improved since the last inspection?

A health and safety assessment on the heating and draught proofing of the premises has been completed.

p.9

What has improved since the last inspection?

The staff and managers feel that improved partnership and communication with foster carers through the newsletter, regular meetings of managers and Councillors with AFCA and other carers, is valuable.

p.9

What they could do better:

The foster carers would be better informed about the service if the statement of purpose and foster carers handbook contained more information.

p.9

What they could do better:

The young people would be better protected if the staff records fully complied with Schedule 1 of the Fostering Services Regulations.

p.9

What they could do better:

The staff team would be clearer about their roles and responsibilities if accurate job description were in place.

p.9

What they could do better:

Although the Commissioning team has impacted positively upon the matching process, the outcomes for young people waiting placement would be further improved if the availability of emergency placements were further increased.

p.9

What they could do better:

The young people’s needs would be better met if the service were to increase the number of long-term placements, as there is limited movement between the placements made in the short-term teams and the long-term teams.

p.9

What they could do better:

As there is a discrepancy between the numbers of older teenage boys, particularly those on the autistic spectrum needing placements, and the number of available placements, additional placements should be prioritised.

p.9

What they could do better:

The young people would receive a more robust service if there were more short-term placements for children with a disability and a social worker in the assessment team for children who are deaf was in place.

p.9

What they could do better:

The young people would be better protected if the foster carers were provided with additional information about permissible sanctions and restraint, and if a monitoring system were in place by the fostering service.

p.9

What they could do better:

The health outcomes for young people would be improved if by all foster carers completed the healthy care programme by the National Children Bureau and there was evidence that all young people had a health action plan. Bristol Social Services Fostering Service DS0000043438.V277900.R01.S.doc Version 5.1 Page 10 There would be amore consistent service for the young people if all foster carers received sufficient support from the service.

p.9

What they could do better:

A review of the payments would allow carers more clarity about the service.

p.10

What they could do better:

The service would better evidence a consistent service if all carers attended core training and further training

p.10

What they could do better:

The needs of children who are deaf would be better met if the current services were reviewed and developed.

p.10

What they could do better:

Staff moral would be improved if the some operational administration and staff IT problems were resolved quickly

p.10

What they could do better:

The working conditions of the staff would be improved if the premises were to be reviewed.

p.10

What they could do better:

The young people would be better protected if all foster carers review of approval must take place annually.

p.10

What they could do better:

A more consistent service would be delivered if support social workers and foster carers attend joint training.

p.10

What they could do better:

The panels would be better informed and further assist the service if a report of all foster carer reviews of this past year was presented to them.

p.10

What they could do better:

Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Bristol Social Services Fostering Service DS0000043438.V277900.R01.S.doc Version 5.1 Page 11

p.10

CONTENTS

Statutory Requirements Identified During the Inspection Bristol Social Services Fostering Service DS0000043438.V277900.R01.S.doc Version 5.1 Page 12

p.11

The intended outcome for this Standard is:

• The fostering service promotes the health and development of children.(NMS 12)

p.12

The Commission considers Standard 12 the key standard to be

inspected at least once during a 12 month period.

p.12

JUDGEMENT – we looked at the outcome for Standard:

The fostering service could further assist the LAC nurses promote the health and development of service.

p.12

EVIDENCE:

The two LAC nurses have a wide brief across the whole service. Their remit covers all the children in the fostering service and residential care. The monitoring and tracking of the health care needs of the children via the health action plan and training of carers is only part of this brief. Consequently they are not all in place. Health passports/health action plans, which should move with the child from placement to placement, were not consistently in place. There was a discussion with the LAC nurses about how the service could best assist them with the huge task of ensuring that every child had a health action plan. The conclusion was that if they were prioritised as part of the supervision sessions by the service and then the information passed to the LAC nurses, this would assist them identify any gaps in provision. A recommendation has been made to this effect.

p.12

EVIDENCE:

Statistics available re LAC health checks for looked after children state that 50%in the South teams and 100% in the North team were completed last year.

p.12

EVIDENCE:

‘Health care’ features highly on foster carers training. However this could be further developed. Lac nurses stated that were not able to train foster carers easily. They stated that they would like to be able to identify training needs of foster carers and then put on relevant training courses. They stated that all training currently has to go through the training department this is not possible. Bristol Social Services Fostering Service DS0000043438.V277900.R01.S.doc Version 5.1 Page 13 LAC nurses stated that, ideally, all foster carers should complete the healthy care programme by the National Children Bureau. This is not currently in place. Until the foster carers handbook is updated the information the foster carers receive about their service is sporadic, relying too heavily on the LAC nurses to provide this information.

p.12

EVIDENCE:

The LAC nurses work closely together with the CAMHS psychology service and were able to produce evidence that they have assisted some foster carers meet the needs of the young people in their care. The rating of this standard is not indicative of the standard of work of the LAC nurses. The rating has been linked to the recommendations about how the service could assist the nurses improve the outcomes for the young people. Bristol Social Services Fostering Service DS0000043438.V277900.R01.S.doc Version 5.1 Page 14

p.13

The intended outcomes for these Standards are:

• Any persons carrying on or managing the service are suitable. (NMS 3) • The fostering service provides suitable foster carers.(NMS 6) • The service matches children to carers appropriately.(NMS 8) • The fostering service protects each child or young person from abuse and neglect.(NMS 9) • The people who work in or for the fostering service are suitable to work with children and young people.(NMS 15) • Fostering panels are organised efficiently and effectively.(NMS 30)

p.14

The Commission considers Standards 3, 6, 8, 9, 15 and 30 the key

standards to be inspected at least once during a 12 month period.

p.14

JUDGEMENT – we looked at outcomes for the following Standard(s):

The input of the Commissioning team has improved the process to ensure that each child or young person in foster care is carefully matched with carers who have the skills to meet their needs. The Commissioning team is a positive aspect of the service. However the process could be further developed if there were more foster carers for specific groups of children.

p.14

JUDGEMENT – we looked at outcomes for the following Standard(s):

The majority of foster carers were seen provide a safe, healthy and nurturing environment.

p.14

JUDGEMENT – we looked at outcomes for the following Standard(s):

The staffing records held in their files do not currently fully comply with the required standard.

p.14

JUDGEMENT – we looked at outcomes for the following Standard(s):

The young people would be better protected if the foster carers were provided with information about permissible sanctions and what constitutes a restraint. The fostering service should monitor and collate information about the frequency and use of restraint by foster carers.

p.14

JUDGEMENT – we looked at outcomes for the following Standard(s):

The fostering Panels are organised efficiently and effectively. However they would be better informed and further assist the service, if a report of all foster carer reviews of this past year was presented to them. Bristol Social Services Fostering Service DS0000043438.V277900.R01.S.doc Version 5.1 Page 15

p.14

EVIDENCE:

A sample of staffing information was examined, and provided evidence of a robust recruitment procedure. Staff files contained certificates of qualification, references, evidence of interview, and most other appropriate checks. There is a positive move forward in complying with the requirement of the last report. As noted at the last inspection to renew enhanced police checks every 3 years is ongoing but there are still gaps.

p.15

EVIDENCE:

The homes of the carers seen as part of the inspection were seen to be of a good standard. Each home is annually inspected by the foster service evidence of this was seen on files. All homes visited by inspectors presented as safe environments for children to live. Initial training for foster carers covers matters of health and safety. . None of the children who responded to the questionnaires raised any concerns about their accommodation. There were concerns raised at the last inspection about the availability of equipment needed to assist the carers meet the needs of children with a disability. However at this inspection there were no similar concerns raised. Risk assessments for the sharing of rooms were seen to be in place. The majority of these assessments were carried out by family placement social workers.

p.15

EVIDENCE:

The process of matching child need to carer skill/competence no longer falls to the duty team in the short-term team but is completed by senior administrative staff in the Commissioning team. Matches are achieved with due consideration to the assessed need of the child and the positive attributes of a carer to meet these needs. Some foster carers stated that they found it disconcerting that this role is not completed by family support social workers with whom they have a relationship. However the short-term team felt that this freed them to concentrate on their supportive role with the foster carers.

p.15

EVIDENCE:

The newly formed Commissioning team have analysed the current needs of the service and with the help of the access to resources panel are more effectively allocating resources across the organisation. A new software module, specifically designed to improve the matching system, allows locality social workers to communicate electronically with the commissioning team and family placement teams in relation to matching resources.

p.15

EVIDENCE:

Statistics provided by the manager of the new Commissioning team evidenced that; whilst there remains a shortfall in available short-term placements across the service there is an improvement in the number of available placements since the last inspection and consequently the services ability to match the children to the foster carers. This is largely because of the successes of recruitment and this Commissioning team. Bristol Social Services Fostering Service DS0000043438.V277900.R01.S.doc Version 5.1 Page 16 The commissioning team has good administrative support and work well as a team. They are effectively led and are focused on providing best value for the organisation and quality care for the young people. They have made effective links with the private sector to provide the service they require. For example, three emergency foster carers from one provider were in place.

p.15

EVIDENCE:

However, whilst the Commissioning team has impacted positively upon the matching process the limited availability of emergency placements still impacts upon the Service to match every child effectively. On one day of inspection there were two young people needing placements and two available placements. The team were seen to respond sensitively and efficiently to these requests. However if, on that day there were a greater choice of placements available to them then the team would have been able to demonstrate matching was more possible. It was noted that one of these young people was discussed at the access to resources panel and ultimately a better match was made.

p.16

EVIDENCE:

The current out of hours scheme is not, as yet, compatible with by the Commissioning team and is under review.

p.16

EVIDENCE:

The Commissioning team is not involved in the matching of children awaiting long-term foster carers, moving from the short-term placement. This job remains with the long-term team and the waiting lists are relatively long. Information provided from the management of the service on receipt of the draft report, stated that this list has 18 children’s names with two not being able to move on until September 2006.There is a shortage of long-term placements therefore there is limited movement between the placements made in the short-term teams and the long-term teams.

p.16

EVIDENCE:

Discussions with supporting social workers and supporting evidence available from the service confirmed that there is a discrepancy between the numbers of older teenage boys particularly those on the autistic spectrum needing placements and the number of available placements. This is exacerbated by the fact that the majority of carers who are newly registered want to foster young children.

p.16

EVIDENCE:

Discussions with the service managers confirmed they are aware of these issues and the majority are addressed in the business plan. The recruitment team have targeted some of the current shortfalls in provision.

p.16

EVIDENCE:

However, given these current shortfalls in provision, whilst still acknowledging the sound work of the commissioning team and the improvements since last year, a requirement has been made at this inspection.

p.16

EVIDENCE:

In relation to the outcomes for children, these have improved as they spend less time on the waiting lists. Bristol Social Services Fostering Service DS0000043438.V277900.R01.S.doc Version 5.1 Page 17 The service has written information for carers on how to respond in the event that a child goes missing. A protocol has been established. Specific information should also be included in a placement agreement if there are any issues of particular note in this regard. The fostering service was unable to offer definitive figures of children who had gone missing from carers over the past 12 months. These should be kept as a matter of good practice.

p.16

EVIDENCE:

Foster carers training consistently addresses issues around children who have been abused, safe caring skills, managing behaviour and recognising signs of abuse. Foster carers interviewed confirmed that they were happy with the support and training they received in these areas. However, there is nor sufficient evidence that all foster carers attend this training.

p.17

EVIDENCE:

There is little in the foster carers handbook about admissible sanctions and what constitutes a restraint. Feedback from the children’s questionnaires for the last inspection indicates that a variety of sanctions are being used including facing a wall and possessions being taken away. Little is evident in the foster carer’s files to indicate what sanctions are currently used.

p.17

EVIDENCE:

To ensure best practise the fostering service should monitor and collate information about the frequency and use of restraint by foster carers.

p.17

EVIDENCE:

Bristol’s fostering service has regular panel meetings in order to meet the needs of such a large service and there is the access to resources panel. Due to time limitations this standard was not fully assessed.

p.17

EVIDENCE:

The inspectors were able to observed one of the panels arranged for the month of March. The panel was observed to be very professional, well informed of the items on the agenda for the day. Panel members showed a high level of awareness of many complex issues, were comfortable at raising matters for clarity and made clear recommendations. A quality assurance feature was obvious within a case-by-case model.

p.17

EVIDENCE:

A process has not been undertaken for a report of all foster carer reviews of this past year to be presented to the panel, in accordance with Regulation 29(5). There is not a regular process established for the panel to receive management information about the outcome of the reviews as suggested in Standard 30.6. A recommendation is made about this and other information that the panel should be monitoring, i.e. the range and type of carers available to the Local Authority in comparison with the needs of children. If these were more formally in place the panel would have a clearer overview of the services attempts to ensure that all foster carers are reviewed annually. The statistics provided by the commissioning team are excellent and provide a strong starting point for providing information. Bristol Social Services Fostering Service DS0000043438.V277900.R01.S.doc Version 5.1 Page 18

p.17

The intended outcomes for these Standards are:

• The fostering service values diversity.(NMS 7) • The fostering service promotes educational achievement.(NMS 13) • When foster care is provided as a short-term break for a child, the arrangements recognise that the parents remain the main carers for the child.(NMS 31)

p.18

The Commission considers Standards 7, 13, and 31 the key standards

to be inspected at least once during a 12 month period.

p.18

JUDGEMENT – we looked at outcomes for the following standard(s):

Diversity was seen to be valued within the service.

p.18

JUDGEMENT – we looked at outcomes for the following standard(s):

The educational achievement of the young people is being addressed by the service to improve the outcomes.

p.18

JUDGEMENT – we looked at outcomes for the following standard(s):

The short break service is working well but is experiencing difficulties due to staffing shortages and gaps in provision.

p.18

EVIDENCE:

The service strives to match the ethnic needs of any child placed with a foster carer. Links with the child’s ethnic origins are maintained wherever possible and placements in a multi-racial area are supported if deemed an assessed need. Of the 37 newly recruited foster carers 10 were black and ethnic minority carers. Support groups for black and ethnic minority carers are well attended.

p.18

EVIDENCE:

There is evidence that the service is trying to improve the educational outcomes for the children in their care. For example: it is positive that ECLAS service (Education of looked after children) will be brought into the service, the educational input on the access to resources panel was seen to be positive in ensuring young people have the appropriate resources and staff members from ECLAS have trained family support social workers in assisting foster carers help children reach their educational potential. Unfortunately training offered by ECLAS to foster carers has had little uptake. Bristol Social Services Fostering Service DS0000043438.V277900.R01.S.doc Version 5.1 Page 19 Education achievements of Bristol “looked after” the children remain lower than those who are not accommodated. There is statistical monitoring available to evidence the service is aware of the shortfall.

p.18

EVIDENCE:

In the absence of foster carers taking up training it is vital that Information about e.g. ECLAS, P.E.P’s is to be updated in the foster carers handbook to ensure they can support the children in their care. Two carers stated they wanted the children in their care to have more than two hours a week support from ECLAS.

p.19

EVIDENCE:

The foster carers would be better assisted to help the young people if they received the computers purchased by the service which are still kept at the main office. If this is not completed promptly they will be out of date and little use to the young people.

p.19

EVIDENCE:

Overall, the inspectors recognise the positive work the service is doing to promote education within the service and the developments over the next year will be a focus of the next inspection.

p.19

EVIDENCE:

The family link team was briefly inspected as part of the fostering service inspection this year. The family link team approves family and friends as carers where this is possible and appropriate. Children placed for more than 120 days per year are monitored and reviewed in accordance with the Looked After Children system .

p.19

EVIDENCE:

The service was seen to be well managed and well run. Staff morale was mostly high. Although comments made else where about the impact of the building are relevant. Administrative support was perceived as limited and again some staff felt the current levels impacted upon their ability to provide a service. Since the last inspection the statement of purpose has been updated.

p.19

EVIDENCE:

The service are aware that there are about 10 children who are deaf receiving a service with little in the way of specialist help and support. They want to develop the service provided to these children. There is no specialist assessment worker in place. The Inspectors were told that this issue has been identified and recruitment started.

p.19

EVIDENCE:

The team have identified a gap in provision for children with a disability who need short-term placements. A member of staff stated that there are over 60% children on autistic spectrum and they have difficulty placing teenage boys with autism. A recommendation has been made that these gaps in provision are addressed by the service.

p.19

EVIDENCE:

Several groups are in place including girls group, a boys group and monthly group for deaf children. There have been four support groups but these have been poorly attended. A self-help group for carers is planed for the future. Bristol Social Services Fostering Service DS0000043438.V277900.R01.S.doc Version 5.1 Page 20 The recruitment of carers has been less than 10 in the last year. A staff member stated that there may be plans to link in with the family placement respite carers for children that need longer short-term placements.

p.19

EVIDENCE:

At the time of the inspection the team supported approximately 77 children in overnight placements. The team manager reported that new recruitment strategies were being tried, such as advertising in hospitals, and that numbers of carers have increased over the past year.

p.20

EVIDENCE:

A member of staff stated that the team is struggling, as there is no time to train new foster carers. They are half a post down and one social worker is moving to manage another team.

p.20

EVIDENCE:

On going training for carers includes safe caring. Concerns rose about training carers in accredited paediatric first aid. They had money to buy in this training but they no longer have it allocated. The response from the mangers from the draft report stated that money for this training was available but money for training to work with ADS children was withdrawn the previous financial year.

p.20

EVIDENCE:

There were concerns, expressed by the staff team about the new structuring where they will have stronger links with education and hospitals, and whether they will be isolated from the rest of the service.

p.20

EVIDENCE:

. Bristol Social Services Fostering Service DS0000043438.V277900.R01.S.doc Version 5.1 Page 21

p.20

The intended outcomes for these Standards are:

• The fostering service promotes contact arrangements for the child or young person. (NMS 10) • The fostering service promotes consultation.(NMS 11)

p.21

The Commission considers Standards 10 and 11 the key standards to

be inspected at least once during a 12 month period.

p.21

JUDGEMENT – we looked at outcomes for the following standard(s):

The service promotes contact arrangements for the young people.

p.21

EVIDENCE:

The service makes good arrangements to ensure young people maintain contact with relatives or significant others in their lives. The preparation training for foster carers covers contact issues and the supervising social workers discuss contact arrangements with the carers during supervision. Contact arrangements are detailed in the LAC paperwork. There were no concerns raised by carers or young people about contact arrangements.

p.21

EVIDENCE:

A number of children responses specifically referred to ‘missing family’ or ‘not being with own family’ as the worst thing about fostering.

p.21

EVIDENCE:

The majority of young people who responded to the inspection questionnaires stated they had not been asked their opinion on how the service could be better. However the majority felt they were receiving a good service from the foster carers. As an ongoing task, social workers represent the frontline responsibility in ensuring this is maintained although foster workers will routinely speak with foster children and ask for their views during supervision visits. Children have the opportunity of expressing their views through the consultation process in preparation for LAC reviews. The children’s guide gives clear advice on how to make complaints and contains a range of useful addresses. Bristol Social Services Fostering Service DS0000043438.V277900.R01.S.doc Version 5.1 Page 22 At the last inspection it was noted that a basic counselling and listening skills training was not offered foster carers. It was emphasised that basic counselling

p.21

EVIDENCE:

and listening skills play a prominent part in any training schedule enabling carers to support children’s wishes, views and feelings on a daily basis. The service has responded to this recommendation and a course is now in place for carers. As noted through out the report there are concerns about the uptake of training.

p.22

EVIDENCE:

Children’s feedback is included in foster carers annual reviews. The commissioning of Voice for the Child in Care (VCC) to provide a generic advocacy service for young people, including Looked After and Children is in place.

p.22

EVIDENCE:

Discussions with young people and information in the questionnaires confirmed they are aware how to make a complaint. Bristol Social Services Fostering Service DS0000043438.V277900.R01.S.doc Version 5.1 Page 23

p.22

The intended outcomes for these Standards are:

• The fostering service prepares young people for adulthood.(NMS 14) • The fostering service pays carers an allowance and agreed expenses as specified.(NMS 29)

p.23

The Commission considers Standards 29 the key standard to be

inspected at least once during a 12 month period.

p.23

JUDGEMENT – we looked at outcomes for the following standard(s):

There were concerns raised about allowances and expenses raised by carers.

p.23

EVIDENCE:

There is a written policy on fostering allowances in the foster carers’ handbook. The policy states clearly what expenses the allowances are expected to cover. As previously stated this needs to be updated to ensure carers have the up to date information. Details about allowances are published in recruitment information. Further payments are made automatically throughout the year.

p.23

EVIDENCE:

In line with findings during the inspection visit in Inspections 2003 and 2004 carers interviewed and questionnaire feedback indicated again that payment problems are still common. The service manger stated she is reviewing the payment scheme. Payments for “fostering plus” are a cause of concern to some foster carers. One carer stated that she was confused about “fostering plus” as she thought she met the criteria after discussions with finance, but was laterally told she was over paid. Other carers stated that carers meet up with each other informally and compare payments they receive and they are not clear why carers get the allowance and they don’t. Respite care payments were also highlighted by the carers as an area of confusion. They stated that they are dependent on one carer to pay another.

p.23

EVIDENCE:

Holiday payments can be negotiated with the locality children’s team managers but as they are dependant upon negotiation the carers felt inconsistent decisions were made. Bristol Social Services Fostering Service DS0000043438.V277900.R01.S.doc Version 5.1 Page 24 Consultation with carers in relation to any review to the payments would allow carers to focus on positive aspects of their role. Discussions with some members of the staff teams confirmed that they are also unclear about the remit of fostering plus. Social workers felt that it is difficult to take carers off this allowance and status if they assess that they are no longer providing an increased service.

p.23

EVIDENCE:

As this issue was also highlighted at the last inspection and requirement has been made that the payments for carers are reviewed promptly. Bristol Social Services Fostering Service DS0000043438.V277900.R01.S.doc Version 5.1 Page 25

p.24

The intended outcomes for these Standards are:

• There is a clear statement of the aims and objectives of the fostering service and the fostering service ensures that they meet those aims and objectives.(NMS 1) • The fostering service is managed by those with the appropriate skills and experience. (NMS 2) • The fostering service is monitored and controlled as specified. (NMS 4) • The fostering service is managed effectively and efficiently.(NMS 5) • Staff are organised and managed effectively.(NMS 16) • The fostering service has an adequate number of sufficiently experienced and qualified staff.(NMS 17) • The fostering service is a fair and competent employer.(NMS 18) • There is a good quality training programme. (NMS 19) • All staff are properly accountable and supported.(NMS 20) • The fostering service has a clear strategy for working with and supporting carers.(NMS 21) • Foster carers are provided with supervision and support.(NMS 22) • Foster carers are appropriately trained.(NMS 23)

p.25

The intended outcomes for these Standards are:

• Case records for children are comprehensive.(NMS 24) • The administrative records are maintained as required.(NMS 25) • The premises used as offices by the fostering service are suitable for the purpose.(NMS 26) • The fostering service is financially viable. (NMS 27) • The fostering service has robust financial processes. (NMS 28) • Local Authority fostering services recognise the contribution made by family and friends as carers.(NMS 32)

p.25

The Commission considers Standards 17, 21, and 24 the key standards

to be inspected at least once during a 12 month period.

p.25

JUDGEMENT – we looked at outcomes for the following standard(s):

The statement of purpose has been improved to include more detail of the service but needs to be further developed to include information about the Commissioning team.

p.25

JUDGEMENT – we looked at outcomes for the following standard(s):

The foster carers handbook does not include sufficient information to assist the foster carers meet the needs of the young people. Bristol Social Services Fostering Service DS0000043438.V277900.R01.S.doc Version 5.1 Page 26 The managers of the different parts of the service have the appropriate skills and knowledge to manage the work effectively. However, the management of the service would be improved if sufficient administrative time was allocated to the teams and there is sufficient staff time to meet demands of a developing service.

p.25

JUDGEMENT – we looked at outcomes for the following standard(s):

There would greater clarity about the responsibilities of the staff team if their job descriptions reflect all the work that they do.

p.26

JUDGEMENT – we looked at outcomes for the following standard(s):

There is not sufficient evidence that enough foster carers attend sufficient training to ensure they have the information and skills to meet needs of the young people.

p.26

JUDGEMENT – we looked at outcomes for the following standard(s):

The premises used by the service are not suitable for their purpose and are in need of urgent review

p.26

JUDGEMENT – we looked at outcomes for the following standard(s):

Foster carers mostly receive appropriate support but this could be further developed, as some foster carers were concerned about the levels they received.

p.26

JUDGEMENT – we looked at outcomes for the following standard(s):

Experienced and skilled staff support the foster carers.

p.26

JUDGEMENT – we looked at outcomes for the following standard(s):

Two kinship care worker are in place and they are developing the service fast and efficiently.

p.26

JUDGEMENT – we looked at outcomes for the following standard(s):

The service has ensured that the majority of foster carers approvals are reviewed but the timescales between the reviews must be improved

p.26

EVIDENCE:

The statement of purpose has recently been updated to include a more detailed description of services provided by the service i.e. the inclusion of information about fostering plus scheme. However the recent development of the Commissioning team needs to be included in this document. This should then be included in foster carers handbooks. Copy of the updated statement of purpose must then be sent to the Commission.

p.26

EVIDENCE:

The last inspection noted that the statement of purpose did not include sufficient information about “Fostering Plus” it was noted that there was confusion around the meaning and sphere of activity of this scheme. Discussions with foster carers, family support social workers and information in the questionnaires from foster carers confirmed that there is still a lack of clarity about the exact criteria that are currently being used to become part of this particular group. There is a detailed criteria but it is not known to foster carers. The service is currently reviewing this scheme, as it is aware of its inherent problems. Bristol Social Services Fostering Service DS0000043438.V277900.R01.S.doc Version 5.1 Page 27 The managers demonstrated a wide range of experience and expertise in managing the service. The appropriate professional qualifications are held with the exception of one part time manager in the long-term team who does not

p.26

EVIDENCE:

hold the recognised management qualification. She stated that working part- time leaves her little time to complete the award but plans to start the course shortly.

p.27

EVIDENCE:

• The team manager of the Family Link Service is CSS qualified and holds an NVQ 5 in management. • The ‘Recruitment’ team leader holds a DipSW and has a Certificate in Management. • The manager of the ‘Short Term Team’ holds a CQSW and DipSW and the Diploma in Management. • One part time ‘Permanency’ team manager holds a CQSW at Masters level. • One part time ‘Permanency’ team manager DipsW and certificate in management.

p.27

EVIDENCE:

Staff responses to the styles of management and effective leadership through out the service was mixed. Some staff felt supported whilst others felt” Controlled rather than managed”. This was particularly evident in one team. Some staff members expressed concern about the juxtaposition of being aware that higher management wanting the staff to present the service in the best possible light, either explicitly or implicitly, to the Inspectors getting in the way of them expressing their true views. These concerns were discussed in the feedback and the service managers stated that they were aware of some of the issues and the staff perceptions.

p.27

EVIDENCE:

There were concerns raised administrative staff across the service and staff morale in one team. In both cases the staff felt that the shortfalls were due to the financial crisis within Bristol City Council, which resulted in vacant posts. They felt that levels of administrative staff put additional pressure upon them. Some staff questioned whether this was a good use of resources.

p.27

EVIDENCE:

The administrative team described themselves as being at crisis point. Staff sickness is high and many spoke of being close to tears most of the time. In addition to their role with the service, administrative time is allocated to staffing the reception desk. They stated that this puts them under pressure and they feel intimated by the clients. The support social workers felt that they are doing administrative tasks at the expense of their role in supporting the carers. Bristol Social Services Fostering Service DS0000043438.V277900.R01.S.doc Version 5.1 Page 28 The I.T systems and their implementation aid staff to have access to information provided by the locality teams about the young people. This was seen as positive, but some staff struggled with system and did not always feel this was acknowledged by the management. Good support was available to them but as all the staff did not use the systems the administrators found it

p.27

EVIDENCE:

difficult to communicate with them via e -mails. Some computer systems like the “star” were not compatible with other systems.

p.28

EVIDENCE:

The successes of the recruitment drives have resulted in an already stretched team being put under more pressure and further impacted on their ability to manage their workloads.

p.28

EVIDENCE:

As noted at the last inspection the job descriptions of team managers were still found to be generic rather than detailing the exact remit of their functions. The service manager stated that is an ongoing problem, which she has tried to address but it is not in her power to change the descriptions so she has added an amendment to them. One manger has increased her remit to include the functions of the planning and development worker no longer employed by the service. Her job description does not include these additions. This manager’s remit would appear to be very broad and should be a focus of the next inspection.

p.28

EVIDENCE:

The majority of staff has worked for the service for a number of years. One staff member was retiring after 30 years service. She, like the majority staff spoken with showed high level of commitment and expertise in their roles.

p.28

EVIDENCE:

Managers were clear about their roles and responsibilities of managers. The team managers plan their leave to ensure that one manager is always available .

p.28

EVIDENCE:

The majority of staff employed have worked for the BSS fostering service for a number of years and are committed to its ethos and policies. Scrutiny of the foster carers files and discussion with staff confirmed that they are a skilled workforce. Supervision recording was of a good standard .

p.28

EVIDENCE:

The staff that were interviewed were satisfied with the training programme, although some felt that the changes around adoption and with “Every Child matters” put demands upon them to keep up with the current legislation. Staff have yearly appraisals with their managers. Joint training between the staff and foster carers does not take place routinely. This is an area for development to meet standard 19 .7.of the National Minimum Standards.

p.28

EVIDENCE:

Discussions with staff members and minutes of supervision sessions confirmed Team meetings are weekly. Two meetings were observed allowed staff to explore issues about practise, obtain information and allocate work. The staff stated that they often feedback training courses they have attended. Bristol Social Services Fostering Service DS0000043438.V277900.R01.S.doc Version 5.1 Page 29 Consideration should be given the teams meeting with the Commissioning teams to share information.

p.28

EVIDENCE:

A duty advice line is available for carers with additional after hours service which is shortly to be reviewed. Support groups are available and mostly well attended .

p.29

EVIDENCE:

The service was able to provide evidence that the majority foster carers reviews have been completed. However the time scales for these reviews has been extended to over a year. The Inspectors recognise the demands on such a large service to ensure foster carers reviews are completed regularly and the large number of panel meetings in place to meet this need. However the service must complete all reviews of carer’s approvals annually.

p.29

EVIDENCE:

On approval each carer should be, given a handbook, which covers a good range of policy, procedures and practical information. This was comprehensively reviewed by inspectors, and was found to be incomplete in some important aspects; for example health and safety, matters of contact arrangements, preparation for independent living, bullying, education and health information. A recommend has been made that a review be undertaken to update and make further inclusions to the current handbook.

p.29

EVIDENCE:

The service mangers stated that this task has been identified and a manager from the service has been given additional hours to produce a new handbook.

p.29

EVIDENCE:

The fostering service support workers supervise and support carers. These workers provide information, advice and support . The majority of foster carers spoken with had high praise for individuals within the team, whom they had built a good level of trust and an effective working relationship. Difficulties arose when staff were off sick, not in the office or staffing vacancies impacted upon allocation. Kinship carers seen were particularly complimentary of the support they received.

p.29

EVIDENCE:

Some foster carers stated that the frequency of support could be improved. Evidence in the f oster carers questionnaires confirmed that staff shortages remain an area of concern. Some carers were sufficiently concerned about the lack of support from social workers to contact the Inspectors by phone. They stated, “I ring no one gets back to me.” “I don’t know who my allocated family support social worker is”. “They constantly change.” It should be noted that not all the carers responded to the questionnaires therefore this may or may not be representative of the feelings of the majority of carers.

p.29

EVIDENCE:

Whilst evidence in the carer’s files confirmed the majority of carers receive appropriate support, there are some shortfalls. Therefore a recommendation has been made that the service ensures all foster carers are appropriately supervised. Bristol Social Services Fostering Service DS0000043438.V277900.R01.S.doc Version 5.1 Page 30 There are systems for practical support as detailed by standard 22.7. As previously noted there were concerns were noted from foster carers accessing respite care and payments.

p.29

EVIDENCE:

Two social workers in the recruitment, assessment and training team have responsibility for providing training for foster carers whilst also carrying a caseload. The trainers stated that their workloads inhibit their ability to provide training.

p.30

EVIDENCE:

An annual training programme is available. The effectiveness of training provided is evaluated from carers’ feedback after each session and at their annual reviews.

p.30

EVIDENCE:

There is a shortfall in foster carers taking up training. This has been noted through out the report as it impacts upon young people. There are little incentives in place to encourage foster carers to attend training and little repercussions if they consistently refuse to attend. There is also a disjointed process in relation to training. In that training is available from: the training department in the local authority; trainers who also have a case load in the fostering service and have limited time to provide training; ECLAS and the LAC nurses. It is positive that senior managers are reviewing this part of the service.

p.30

EVIDENCE:

A suggestion was made about linking payments to training, which has been successful in other fostering services. Some support workers stated they would like some courses to be mandatory.

p.30

EVIDENCE:

Some foster carers spoken to expressed a wish for more specialised and focused training to meet their needs at a higher level.

p.30

EVIDENCE:

No central record of all training undertaken by carers is available to fully evidence the level of training opportunities that carers have been given. Consideration could be given to support carers in establishing their own training portfolios.

p.30

EVIDENCE:

The newsletter produced by the service was seen to be a positive way of keeping the foster carers updated about the changes in legislation and providing information.

p.30

EVIDENCE:

A sample of case files and recording held on the PARIS system indicated that they well maintained. There are teething problems inherent with computer however the service is aware of the problems and has support in place. Bristol Social Services Fostering Service DS0000043438.V277900.R01.S.doc Version 5.1 Page 31 A new staff canteen is available in the premises used by the service. This is a positive development enjoyed by the staff. An electronic security system is also in place. However there is little else positive about the premises. Points about the age and general suitability of this old school building have been made in the three previous reports. Therefore this was a focus of this inspection.

p.30

EVIDENCE:

The windows are in poor state of repair with rotten windows sills. They are draughty and few open. In one room a blind was broken and the staff stated that there is a glare from the sun onto their computers. The rooms are overcrowded with wires mangled beneath the desks. There is not sufficient desks or computers for all the staff. The desks are old and not designed for computers. Many staff stated that these poor conditions contribute to staff sickness and levels of stress. Outside the building the enclosed area was covered in dog faeces and debris.

p.31

EVIDENCE:

The service is aware of the short falls of the old building and is trying to improve the working conditions for the staff. A contractor has been appointed to repair/replace the windows. The site outside the building has been cleared of the debris, the furniture is to be updated and the “cage”(metal structure in the centre of the building) will be taken down once the files are archived and the additional space used for the staff.

p.31

EVIDENCE:

Two kinship care workers are in place and are developing the service fast and efficiently. Kinship carers visiting were positive about the service and the support they received. The registration and support of kinship carers is good and its management robust.

p.31

EVIDENCE:

Discussions with the support social workers, evidence seen on a random selection of files and feedback from carers confirmed the Regulation 38 Kinship Carers are approved at panel and offered support. Cases transferred are not accepted without the relevant information including Form F, all checks and transfer summary. The kinship support workers stated that Kinship Carers can expect a minimum of 3 monthly contacts from the Kinship workers. Kinship Carers are reviewed annually and the review will be presented to panel every 3 years. Trainers in the Family Placement Recruitment Team appropriate courses. Bristol Social Services Fostering Service DS0000043438.V277900.R01.S.doc Version 5.1 Page 32

p.31

SCORING OF OUTCOMES

This page summarises the assessment of the extent to which the National Minimum Standards for Fostering Services have been met and uses the following scale.

p.32

SCORING OF OUTCOMES

4 Standard Exceeded (Commendable) 3 Standard Met (No Shortfalls) 2 Standard Almost Met (Minor Shortfalls) 1 Standard Not Met (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable

p.32

SCORING OF OUTCOMES

TBEING HEALTHY ACHIEVING ECONOMIC Standard No Score WELLBEING 12 2 Standard No Score 14 X STAYING SAFE 29 2 Standard No Score 3 2 MANAGEMENT 6 3 Standard No Score 8 2 1 2 9 2 2 3 15 X 4 X 30 2 5 2 16 2 ENJOYING AND ACHIEVING 17 2 Standard No Score 18 X 7 3 19 2 13 3 20 3 31 2 21 2 22 2 MAKING A POSITIVE 23 2 CONTRIBUTION 24 3 Standard No Score 25 X 10 3 26 1 11 3 27 X 28 X 32 3 Bristol Social Services Fostering Service DS0000043438.V277900.R01.S.doc Version 5.1 Page 33 Are there any outstanding requirements from the last inspection? Yes

p.32

STATUTORY REQUIREMENTS

This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Fostering Services Regulations 2002 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales.

p.33

STATUTORY REQUIREMENTS

No. Standard Regulation Requirement Timescale for action 1 FS1 3 4 The statement of purpose must include details of the role of the Commissioning team. A copy then must be sent to the Commission. 01/09/06

p.33

STATUTORY REQUIREMENTS

FS3 2 3 Staff records to comply with Schedule 1 of the Fostering Services Regulations. 01/09/06

p.33

STATUTORY REQUIREMENTS

3 FS31 33 The service ensure that each child or young person in foster care is carefully matched. (This was a requirement of the last report which has been partially met) 01/09/06

p.33

STATUTORY REQUIREMENTS

4 FS5 21 The updating of accurate job description needs to be ongoing. 01/09/06

p.33

STATUTORY REQUIREMENTS

5 FS23 17 The service review and develop the current training available to carers and have a system in monitor and encourage attendance. 01/09/06

p.33

STATUTORY REQUIREMENTS

6 FS29 44 The service reviews the payment for carers and ensure all carers receive clear information about any changes. 01/09/06

p.33

STATUTORY REQUIREMENTS

7 FS17 17 The service review the case load of number of family support social workers in the service 01/09/06 Bristol Social Services Fostering Service DS0000043438.V277900.R01.S.doc Version 5.1 Page 34 8 FS21 26 29 Reviews of approvals take place at intervals of no more than one year. 01/09/06

p.33

STATUTORY REQUIREMENTS

9 FS23 26 The working conditions are improved (see list in standard 26) or new premises found. 01/09/06

p.34

STATUTORY REQUIREMENTS

10 FS30 29(5) A process is developed to ensure that a report of all foster carer reviews of the past year is presented to the panel. 01/09/06

p.34

RECOMMENDATIONS

These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out.

p.34

RECOMMENDATIONS

No. Refer to Standard Good Practice Recommendations

p.34

RECOMMENDATIONS

1 FS9 The foster carers are provided with information about permissible sanctions and what constitutes a restraint.

p.34

RECOMMENDATIONS

Support social workers ensure they monitor in supervision the sanctions that are used by foster carers.

p.34

RECOMMENDATIONS

The fostering service should monitor and collate information about the frequency and use of restraint by foster carers. 2 FS21 The fostering plus scheme is reviewed and the service ensure that carers receive sufficient information about the scheme. 3 FS12 There is evidence that the service is ensuring that health action plan are place for all the young people. Consideration is given to foster carers completing the healthy care programme by the National Children Bureau. 4 FS19 Joint training between the social workers and foster carers takes place regularly. 5 FS16 There are sufficient administrative staff in place to support the service effectively.

p.34

RECOMMENDATIONS

FS22 The fostering service should review, update and make inclusions to the foster carer handbook. (Standard 22.5) The service has a system in place that ensures all foster carers are supervised at the required frequency. Bristol Social Services Fostering Service DS0000043438.V277900.R01.S.doc Version 5.1 Page 35 7 FS30 The foster panel should receive management information about information about foster carer reviews and the range and type of carers available to the authority in comparison with the needs of children. (Standard 30.6 & 30.7) 8 FS31 Consideration is given to develop services provided for children who are deaf. 9 FS31 A formal recruitment strategy should be developed aimed at recruiting long term foster carers, carers for teenage boys, particularly those on the autistic spectrum and carers who can provide short-term placement for children with a disability. Bristol Social Services Fostering Service DS0000043438.V277900.R01.S.doc Version 5.1 Page 36

p.34

Commission for Social Care Inspection

Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG

p.36

Commission for Social Care Inspection

National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI

p.36