Children's home run by Birmingham Children’s Trust Community Interest Company

Inspection report children‟s home: 1273658 1 Registered provider: Birmingham Children‟s Trust Limited

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Full inspection Inspected under the social care common inspection framework

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Information about this children’s home

This home provides care for up to 16 children who have physical and/or learning disabilities and/or sensory impairment, and are aged between five and 17. Children may stay beyond their 18 th birthday while they complete their education. The home provides 10 long-term placements and six short-break placements. The home has been in operation for over 20 years and run by a local authority. The service and the existing manager registered again under a children‟s trust limited company in March 2018. The Care Quality Commission (CQC) registers and inspects the healthcare that is carried out on the premises. It is one of four homes operated by this local authority children‟s trust.

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Information about this children’s home

Inspection dates: 12 to 13 September 2018

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Overall experiences and progress of

children and young people, taking into account

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requires improvement to be good

How well children and young people are helped and protected requires improvement to be good

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requires improvement to be good

The effectiveness of leaders and managers requires improvement to be good

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requires improvement to be good

The children‟s home is not yet delivering good help and care for children and young people. However, there are no serious or widespread failures that result in their welfare not being safeguarded or promoted.

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requires improvement to be good

Overall judgement at last inspection: not applicable

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requires improvement to be good

Enforcement action since last inspection: none Inspection report children‟s home: 1273658 2 Inspection report children‟s home: 1273658 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 protection of children standard is that children are protected from harm and enabled to keep themselves safe. In particular, the standard in paragraph (1) requires the registered person to ensure— that staff— assess whether each child is at risk of harm, taking into account information in the child‟s relevant plans, and, if necessary, make arrangements to reduce the risk of any harm to the child; help each child to understand how to keep safe; have the skills to identify and act upon signs that a child is at risk of harm; 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; and that the premises used for the purposes of the home are designed, furnished and maintained so as to protect each child from avoidable hazards to the child‟s health. (Regulation 12 (1)(2)(a)(i)(ii)(iii) (b)(d)) 31/12/2018

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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 have the experience, qualifications and skills to meet the needs of 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 31/12/2018 Inspection report children‟s home: 1273658 4 quality of care provided in the home; demonstrate that practice in the home is informed and improved by taking into account and acting on— feedback on the experiences of children, including complaints received, and use monitoring and review systems to make continuous improvements in the quality of care provided in the

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Requirement Due date

home. (Regulation 13 (1)(a)(b)(2)(b)(f)(g)(ii)(h)) This relates to a rigorous approach to tracking and reviewing children‟s progress against their plans, ensuring effective training systems, and implementing timely improvements as identified by internal and external monitoring and complaints. The care planning standard is that children— receive effectively planned care in or through the children‟s home; and have a positive experience of arriving at or moving on from the home. In particular, the standard in paragraph (1) requires the registered person to ensure— that arrangements are in place to— manage and review the placement of each child in the home. (Regulation 14 (1)(a)(b)(2)(b)(ii)) Specifically, conduct timely reviews and provide families or carers with a copy of their child‟s short-break or in-house placement plan to ensure full participation and agreement. 31/12/2018

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Requirement Due date

The registered person must ensure that— the privacy of children is appropriately protected; children can access all appropriate areas of the children‟s home‟s premises; and any limitation placed on a child‟s privacy or access to any area of the home‟s premises— is intended to safeguard each child accommodated in the home; is necessary and proportionate; is kept under review and, if necessary, revised; and allows children as much freedom as is possible when balanced against the need to protect them and keep them safe. (Regulation 21 (a)(b)(c)(i)(ii)(iv)) This relates to ensuring children‟s privacy and safety in their bedrooms and assessing the need for a blanket restriction on children‟s access to outdoor play space. 31/12/2018

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Requirement Due date

If the Regulatory Reform (Fire Safety) Order 2005(a) applies to the home— the registered person must ensure that the requirements of that 31/12/2018 Inspection report children‟s home: 1273658 5 Order and any regulations made under it, except for article 23 (duties of employees), are complied with in respect of the home. (Regulation 25 (2)(b)) The registered person must recruit staff using recruitment procedures that are designed to ensure children‟s safety. The registered person may only— employ an individual to work at the children‟s home; if the individual satisfies the requirements in paragraph (3). The requirements are that— the individual has the appropriate experience, qualification and skills for the work that the individual is to perform; and full and satisfactory information is available in relation to the individual in respect of each of the matters in Schedule 2. (Regulation 32 (1)(2)(a)(b)(3)(b)(d))

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Requirement Due date

The registered person must ensure that all employees receive practice-related supervision by a person with appropriate experience. (Regulation 33 (4)(a)) This relates to all permanent and agency staff. 31/12/2018

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Requirement Due date

The registered person must complete a review of the quality of care provided for children (“a quality of care review”) at least once every 6 months. In order to complete a quality of care review the registered person must establish and maintain a system for monitoring, reviewing and evaluating— the quality of care provided for children; the feedback and opinions of children about the children‟s home, its facilities and the quality of care they receive in it; and any actions that the registered person considers necessary in order to improve or maintain the quality of care provided for children. The system referred to in paragraph (2) must provide for ascertaining and considering the opinions of children, their parents, placing authorities and staff. (Regulation 45 (1)(2)(a)(b)(c)(5)) Inspection report children‟s home: 1273658 6

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Recommendations

 The registered person should actively seek independent scrutiny of the home and make best use of information from independent and internal monitoring (including under regulations 44 and 45) to ensure continuous improvement. They should be skilled in anticipating difficulties and reviewing incidents. They are responsible for proactively implementing lessons learned and sustaining good practice. („Guide to the children‟s homes regulations including the quality standards‟, page 55, paragraph 10.24)  For children‟s homes to be nurturing and supportive environments that meet the needs of their children, they will, in most cases, be homely, domestic environments. Children‟s homes must comply with relevant health and safety legislations (alarms, food hygiene, etc.); however, in doing so, homes should seek as far as possible to maintain a domestic rather than „institutional‟ impression. („Guide to the children‟s homes regulations including the quality

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improvement to be good

Children are provided with a range of experiences to keep them active and engaged in the home. Staff‟s use of a variety of communication aids to encourage children‟s participation is improving. This includes staff now being trained in the use of Makaton. Staff support children‟s school attendance and work in partnership with children‟s teachers. Staff also work well with parents to support good relationships and home visits. Planning to keep children in regular contact with their brothers and sisters is effective. Children are well supported to move on to their adult placements or back home, although planning for moves is dependent on the local authority priorities and timescales and has the potential to be delayed. One social worker commented that their expectations for the quality of care for her child had been exceeded. This child‟s communication and confidence has dramatically improved. One parent commented, „It‟s been a life saver for me. Literally home from

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improvement to be good

home.‟ Despite these positive comments, there are some long-standing shortfalls that pre-date the home‟s present registration and that affect the overall progress and experience of children. The home is a purpose-built „unit‟. Staff have worked hard to improve the internal appearance to make sure that the environment is child friendly. Despite this effort, there are still some unnecessary institutional aspects such as locked doors, viewing panels in bedroom doors, blanket restrictions on how children use areas of the building, notices to the public in children‟s areas, and private, personal information posted in children‟s bedrooms for the benefit of unfamiliar staff. Busy mealtimes are a missed opportunity to Inspection report children‟s home: 1273658 7 practise and model good social and eating skills with children in a homely way. These features have a negative impact on children‟s ability to enjoy a homely environment and

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improvement to be good

have an adverse effect on the quality of the service overall. One social worker commented that they would like to see more homely, comfortable furnishings in children‟s rooms to minimise the institutional effect.

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improvement to be good

Children do not have free access to a safe outdoor play space. A restriction necessary for one child has become a restriction for all children, without assessment of their individual risk. Signs placed at the front door tell children why doors are locked, are not meaningful or accessible to those who cannot read, speak or who have communication difficulties. This unimaginative restrictive approach is out of step with the service‟s other developments in giving children meaningful information and tools to communicate, so that they can make choices. The quality of care planning is inconsistent. Staff are working hard to improve this area of practice, but not in a coherent and consistent manner. Systematic tracking and reporting on progress at regular six-monthly reviews is absent and this particularly affects children staying for short breaks. Staff set and change children‟s targets or goals each month, but do not always link this to children‟s other educational or statutory care

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improvement to be good

plans, or to their continuing developmental needs. As a result, some of children‟s most important aspects of development no longer receive the attention that they need as targets change, or when a target has not been achieved but is still worth pursuing. Despite this, the placing local authority is positive. A senior manager commented, „We can confirm that most children are making progress with their plans and benefit from the short-breaks provision and long-term care provision.‟

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improvement to be good

During the inspection, children were vulnerable to avoidable, unnecessary hazards. Management monitoring and a review of health and safety considerations have not been sufficiently thorough to identify and learn important lessons to improve children‟s safety. The management of such risks is weak and this can be seen across several areas. The garden was identified as a risk to children‟s safety after a serious incident earlier in the year. There is still building debris in the garden that poses a danger to children. The lack of action leaves children at risk. After a child went missing, managers did not review the incident effectively. They did not review how effective their own policy and procedure was in guiding staff to take the most helpful action. Guidance to staff and the police would be improved by including information about the child‟s communication needs and what may help to reduce distress

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improvement to be good

when they are found. Despite recommendations being made by an internal review earlier this year following a serious incident, it remains the case that not all children have had a full re-assessment of the use of „sleeping systems‟. This had been identified by the independent visitor who informed the manager, but no action followed. Inspection report children‟s home: 1273658 8 Arrangements to protect children‟s privacy are compromising their safety. Curtains hung at viewing panels in children‟s bedroom doors are not all securely fixed and are a potential choke hazard for one child. Staff were not aware of this risk. Staff are not clear about what to do when they see bruising on a child or how to use a body map. Records fail to demonstrate any professional curiosity about how injuries may have occurred, or how the situation has been dealt with by a manager. Systems to ensure that fire safety is up to date are also ineffective. The registered

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improvement to be good

provider had lost track of the risk management arrangements for the safe storage of oxygen cannisters on site. This was rectified in the days following the inspection. Children and staff are now protected from any unnecessary hazards relating to the storage of oxygen. Systems to ensure the safe recruitment of staff are not effective. Checks made by managers do not always ensure that staff have the most appropriate qualifications, skills and experience for their role. Staff manage children‟s behavioural needs sensitively and through the use of good relationships and communication. The appropriate use of monitoring devices for children‟s safety is now appropriately documented and with consent.

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The effectiveness of leaders and managers: requires improvement to be good

The service has not made sufficient progress in areas of known weakness and, as a result, shortfalls remain. The registered manager oversees social care and works with health managers to fulfil dual management and regulatory responsibilities to both Ofsted and the CQC and respective employers. Managerial systems do not drive the prompt implementation of improvements as identified by internal and external monitoring processes.

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The effectiveness of leaders and managers: requires improvement to be good

Managerial monitoring has not ensured the systematic tracking and timely review of children‟s progress against their plans or actions from their last review. The service is responsible for reviewing and writing the care plans for children who have short breaks. In some cases, short-break reviews are not timely and are avoidably delayed. Staff remain unclear about whether parents should have a copy of the child‟s „in-house‟ plan and review, despite a major internal investigation identifying this as an area for improvement. This means that parents‟ participation in making and agreeing to the plan for their child is not fully effective. Not all staff have the training that they need. This also includes updates to training that would ensure their competence to deliver healthcare. Staff, including regular agency staff, do not receive professional supervision at the frequency required by the provider. This means that they lack the formal support, guidance and skills to provide good-quality

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The effectiveness of leaders and managers: requires improvement to be good

care to the children. The manager‟s quality of care review and development plan are not achieving improvements at the pace required. Consultation with children has improved; however, the impact of their views, and those of their parents and placing social workers, is not Inspection report children‟s home: 1273658 9 evident in the six-monthly report about the quality of care. Health and social care staff work alongside each other cooperatively. Staff feel part of a team and well supported. They report that there are generally sufficient numbers of staff. The placing authority, children, their parents and carers are largely positive about the service. The local children‟s disability team manager described the local authority‟s positive view of the manager and staff‟s support, flexibility and willingness to accommodate any suggestions or changes to children‟s plans.

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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: 1273658 10

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Children’s home details

Registered provider: Birmingham Children‟s Trust Limited

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Children’s home details

Registered provider address: Third Floor Zone 16, 1 Lancaster Circus, Birmingham B4 7DJ

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Inspector

Christy Wannop, social care inspector Inspection report children‟s home: 1273658 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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Inspector

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Inspector

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Inspector

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