Children's home run by RNIB Charity in Camden

Inspection report children‘s home: SC485607 1 SC485607 Registered provider: RNIB Charity

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Full inspection 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 in five purpose-built bungalows. The children 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 (CQC) and provides a specialist service to children 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 17 children currently resident 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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Information about this children’s home

There has been no registered manager since March 2018. An interim acting manager was appointed in April 2018.

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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 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: 20 November 2017

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inadequate

Overall judgement at last inspection: sustained effectiveness Inspection report children‘s home: SC485607 2

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Enforcement action since last inspection:

A compliance notice was issued in respect of regulation 23: medication in December 2017 and judged to be met in February 2018.

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Enforcement action since last inspection:

Compliance notices in respect of different aspects of regulation 12: safeguarding have been issued three times since February 2018. One of these compliance notices is still in place until 24 August 2018.

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Enforcement action since last inspection:

A restriction of accommodation notice has been enforced since 20 December 2017 and continues to be in place until 30 August 2018.

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Enforcement action since last inspection:

A notice of proposal to cancel the service was issued on 9 March 2018. Ofsted did not proceed with this notice following assurance from the organisation that the service would make improvements.

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Inspection date Inspection type Inspection judgement

11/06/2018 Monitoring 02/05/2018 Monitoring 23/04/2018 Monitoring 27/02/2018 Monitoring 20/02/2018 Monitoring 13/12/2017 Monitoring 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 children‘s home: SC485607 3

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Statutory requirements

This section sets out the actions that the registered person(s) must take to meet the Care Standards Act 2000, Children‘s Homes (England) Regulations 2015 and the ‗Guide to the children‘s homes regulations including the quality standards‘. The registered person(s) must comply within the given timescales.

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Requirement Due date

The health and well-being standard is that— the health and well-being needs of children are met. (Regulation 10 (1)(a)) This is in respect of ensuring that health equipment is safe. 24/08/2018

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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 the home‘s day-to-day care is arranged and delivered so as to keep each child safe and to protect each child effectively from harm. (Regulation 12 (1) (2)(b)) This is in respect to safe daily care planning and managerial review of incidents to ensure child safety. 24/08/18

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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) (2)(a)(i))* 24/08/2018

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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 take effective action whenever there is a serious concern about a child‘s welfare. (Regulation 12 (1) (2)(vi)) This is in respect of staff having the skills to manage children safely. 24/08/2018

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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 ensure— that staff work as a team where appropriate; ensure that the home has sufficient staff to provide care for 24/08/2018 Inspection report children‘s home: SC485607 4 each child. 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. (Regulation 13 (1)(a–b) (2)(b)(d)(f)) This is in respect of managerial review to learn lessons about the impact that the decline in care quality and the high number of temporary staff, including interim managers, has

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Requirement Due date

on children in their houses. 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 ensure that staff have the experience, qualifications and skills to meet the needs of each child ensure that the home‘s workforce provides continuity of care to each child use monitoring and review systems to make continuous improvements in the quality of care provided in the home. (Regulation 13 (1) (2)(a)(c)(e)(h)) 24/07/2018

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Requirement Due date

The registered person must compile in relation to the children‘s home a statement (―the statement of purpose‖) which covers the matters listed in Schedule 1. The registered person must keep the statement of purpose under review and, where appropriate, revise it; and notify HMCI of any revisions and send HMCI a copy of the revised statement within 28 days of the revision. (Regulation 16 (1) (3)(a)(b)) 24/07/2018

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Requirement Due date

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 proportionate. (Regulation 20 (1)(a)(b)(c) (2)) 24/07/2018

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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)) 24/07/2018

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Requirement Due date

The registered person must recruit staff using recruitment procedures that are designed to ensure children‘s safety. The 24/08/2018 Inspection report children‘s home: SC485607 5 requirements are that— full and satisfactory information is available in relation to the individual in respect of each of the matters in Schedule 2. For the purposes of paragraph (3)(b), an individual who works in the home in a care role has the appropriate qualification if, by the relevant date, the individual has attained— the Level 3 Diploma for Residential Childcare (England) (―the Level 3 Diploma‖); or a qualification which the registered person considers to be equivalent to the Level 3 Diploma. (Regulation 32 (1) (3)(d) (4)(a–b)) The registered person must ensure that all employees— receive practice-related supervision by a person with appropriate experience. (Regulation 33 (4)(b)) 24/08/2018

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Requirement Due date

The registered person must ensure that— within 48 hours of the use of the measure, the registered person, or a person who is authorised by the registered person to do so (―the authorised person‖) has spoken to the user about the measure; and has signed the record to confirm it is accurate. (Regulation 35 (3)(b)(i)(ii)) 24/08/2018

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Requirement Due date

The registered person must maintain records (―case records‖) for each child which include the information and documents listed in Schedule 3 in relation to each child; are kept up to date. (Regulation 36 (1)(a)(b)) 24/07/2018

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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)) 24/07/2018

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Requirement Due date

The registered person must ensure that an independent person visits the children‘s home at least once each month. The independent person must provide a copy of the independent person‘s report to HMCI. (Regulation 44 (1) (7)(a)) 24/07/2018

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Requirement Due date

*This requirement is subject to a compliance notice.

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Overall experiences and progress of children and young people: inadequate

In the 11 months since the last full inspection, the quality of care has declined significantly. Since the last interim inspection in November 2017, Ofsted has made six unannounced monitoring visits that have been prompted by concerns or to check progress being made. Inspection report children‘s home: SC485607 6 The school on site has been in special measures since November 2017. The Care Quality Commission (CQC) inspected the health provision of the service in February 2018 and judged the service to be inadequate.

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Overall experiences and progress of children and young people: inadequate

This full inspection has not judged if the organisation has met the compliance notice issued in respect of safeguarding practice, or the eight requirements raised at the last inspection in June 2018. This is because the date for action to be taken has not expired. However, inspectors considered the progress made by the organisation. In addition, new requirements have been raised; some of these are reoccurring shortfalls in meeting regulations. This demonstrates that initial improvement has not been sustained. For example, there are reoccurring shortfalls in staff receiving supervision and the safe recruitment of staff.

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Overall experiences and progress of children and young people: inadequate

There continue to be significant failures in the quality of care that children receive and in the managerial oversight of staff practice. As a result, children are vulnerable to neglect or harm.

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Overall experiences and progress of children and young people: inadequate

Children‘s healthcare is compromised because checks on essential medical equipment are still not rigorous. Although regular medication audits are completed by a qualified nurse, this has not stopped staff making mistakes. For example, staff have failed to administer medication required to help children breathe. Information about medication in children‘s records is sometimes incorrect. One safeguarding notification about a child‘s admission to hospital was not sent to Ofsted. Staff do not understand how to use incident forms and ‗body maps‘ to record any injuries so that they can be used effectively to help keep children safe. Incident reports are poorly written and inadequately monitored by managers.

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Overall experiences and progress of children and young people: inadequate

Staff sometimes make unwise decisions about children‘s safety and dignity. For example, one child was left without a continence aid. Another child was dressed in clothing that was too small for them. One poorly planned trip with children in the community resulted in distress for one child. Staff were separated from each other. They were unable to contact each other for help and left one child alone. Staff were initially unable to locate the child on their return. The subsequent draft managerial review, completed during the inspection, did not identify a timeline of events, did not review the child‘s risk assessments or staff familiarity with the child‘s needs. The managerial response to this incident is poor. Consequently, there is a serious missed opportunity to learn lessons and to improve care practice.

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Overall experiences and progress of children and young people: inadequate

Staff still have conflicting and inconsistent views about how to provide care to children. This is made worse by the lack of clear guidance from managers. This is further compounded by the high number of temporary agency staff working at the home.

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Overall experiences and progress of children and young people: inadequate

The different bungalows lack a homely feel, with a lack of sensory equipment for the children to access. A programme of redecoration is planned, and some walls are bare in preparation for this. This has resulted in some children‘s artwork being taken down. This decision has been taken without full consideration of the children‘s feelings or help being provided to them to understand the reasons why it has been done. For instance, one Inspection report children‘s home: SC485607 7 child told the staff and his social worker that he objects to his artwork being moved. This demonstrates an unacceptable lack of regard for this child‘s wishes and feelings.

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Overall experiences and progress of children and young people: inadequate

Inspectors observed some positive relationships between staff and children. Some enthusiastic staff are willing to learn and develop their skills. There is also evidence to show that staff make appropriate challenges when community activities are inaccessible for children who use wheelchairs.

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Overall experiences and progress of children and young people: inadequate

Parents report that they have seen positive changes and they feel more involved in their child‘s care. Placing authorities are positive about recent developments.

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

Managers‘ systems designed to ensure that timely servicing and safety checks on medical equipment are not always reliable. For example, one ventilator safety check had expired before the inspection. Two others had only two weeks before they expired and there was no evidence to show that checks were being planned.

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

Staff do not promote children‘s health and safety. For example, one child received their prescribed food through a faulty gastrostomy feeding pump. This was despite indications that the machine was not working properly and subsequently had fallen to the floor. Staff failed to make adequate checks on the machine or on the child‘s welfare. The lack of monitoring resulted in the child receiving above the prescribed amount of fluid. This was because the feeding pump was allowed to run for longer than the prescribed time. The manager‘s review of the incident was poor and did not consider how to improve practice. Managers were unable to provide information to the inspectors to evidence what had happened and what action had been taken. Consequently, there was no informed review of the risk to the child after this incident.

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

Children‘s behaviour management plans still do not give sufficient detail to staff about providing safe care. Plans use euphemistic language such as ‗supporting‘ a child to their bedroom if upset or angry. Staff are unclear if they can, or cannot, use restraint to move children to their bedrooms as part of a behavioural strategy. Records of such incidents do not show how children reach their bedroom, or if staff shut the bedroom door. When restraint is used, the review directed by a manager lacks any independence or rigour.

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

New staff are not safely recruited. Records sampled lacked the required detail, such as proof of qualifications, references and a full employment history. The provider also does not ensure that sufficient recruitment information is gathered when using agency staff. This means that managers do not know if the temporary worker has the appropriate experience, qualification and skills to work with children. Basic details are missing, such as having an agency member of staff‘s date of birth or home address, as is required by regulation.

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

The consequence of poor recruitment checks is that the provider simply does not know if staff are suitable to work with children. For example, one agency member of staff was alleged to have acted abusively to a child. The provider upheld this concern in an Inspection report children‘s home: SC485607 8 internal investigation after liaising with the local authority designated officer. This investigation identified that the agency staff member in question had no prior experience of working with children and had doubtful qualifications.

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

A temporary safeguarding leader is now beginning to make improvements in how the service works with local safeguarding partners.

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The effectiveness of leaders and managers: inadequate

There is no registered manager and the person acting as the manager is a temporary consultant who has yet to successfully submit his application to register with Ofsted. The person nominated as responsible individual is referred to by managers at the service as an ‗interim‘ and has yet to make formal notification to Ofsted of their role.

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The effectiveness of leaders and managers: inadequate

Since late April, a team of consultant ‗interim managers‘ has overseen the temporary team leaders who are in day-to-day charge in each of the four bungalows currently in use. A qualified nurse has applied to register as manager with the CQC for bungalow five, where nursing and personal care is provided.

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The effectiveness of leaders and managers: inadequate

There are not enough permanent members of staff for children to experience continuity of care from people they know. For example, one bungalow only has six permanent members of staff. It should have 18. Children receive care from a high number of different staff, including agency staff. This is not conducive to building stable and consistent relationships with children.

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The effectiveness of leaders and managers: inadequate

Managers do not know the full extent of the usage of agency staff in the service or consider the impact of this on children‘s daily experience. Inspectors were told that agency use was currently around 28%. However, while this was the case as an average across the service, inspectors found that in one bungalow during the inspection, only 28% of staff on duty were permanent. Figures provided to inspectors by the administrative team indicate that there have been as many as 200 different agency staff working at the home since December 2017.

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The effectiveness of leaders and managers: inadequate

Inspectors viewed recent management meeting minutes that made clear that the proposed registered manager did not know whether the permanent staff team had the skills and qualifications for their roles. This was because he was unable to access their records. Three of the current permanent workforce have not achieved the nationally recognised qualification in working with children in residential childcare, despite support from the organisation. The figure for agency staff is not known. Managers have commenced work to gather information about staff competence.

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The effectiveness of leaders and managers: inadequate

Staff do feel better supported and feel that some progress is being made. For instance, they told inspectors about receiving behaviour management training, which had helped to inform their practice.

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The effectiveness of leaders and managers: inadequate

Staff at all levels, including team leaders and care staff, do not have professional supervision at the required frequency set by the organisation. Team leaders often cancel Inspection report children‘s home: SC485607 9 supervision sessions because they are required to work on shift because of staff shortages. Not all team leaders have been supervised by the new consultant care managers. They do not get the supervision they need to fulfil their management role and support the care staff team. Managers do not supervise agency staff at all. One member of staff previously involved in a medication error had not had the follow-up supervision and debriefs that were part of the plan for improvement. This means that staff do not get help to review their practice.

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The effectiveness of leaders and managers: inadequate

This recurrent weakness that goes back to August 2017 is particularly significant given the reliance on agency staff to meet children‘s basic care needs. This ongoing shortfall significantly hinders the improvements needed so that children experience good-quality care that is delivered by a stable group of staff that they are familiar with.

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The effectiveness of leaders and managers: inadequate

While current managers have been in place since April 2018, shortfalls in leadership and management go back to August 2017. Repeated shortfalls in meeting regulation show a lack of improvement over time.

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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: SC485607 10

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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

Lisa O‘Donovan, social care inspector Christy Wannop, social care inspector Inspection report children‘s home: SC485607 11 achieve excellence in the care of children and young people, and in education and skills for learners of all ages. It regulates and inspects childcare and children‘s social care, and inspects the Children and Family Court Advisory and Support Service (Cafcass), schools, colleges, initial teacher training, further education and skills, adult and community learning, and education and training in prisons and other secure establishments. It assesses council children‘s services, and inspects services for 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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