Children's Home run by Aspris Children’s Services Limited in Devon

Inspection report for children‟s home - monitoring visit: 1271467 1

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The Priory Group

Monitoring visit 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 five children who have a learning disability. The home is operated by a national private organisation. A registered manager is in post but is currently absent from the home. At present, an interim manager is in day-to-day charge of the home, supported by the responsible individual.

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This monitoring visit

This children‟s home was judged to have declined in effectiveness at the interim inspection on 5 November 2018. At that inspection, inspectors identified serious weaknesses in how well children were helped and protected, stemming from poor leadership and management oversight. The management of medication was inadequate, and staff were not provided with the necessary training to meet a child‟s needs. As a result, two compliance notices under Regulation 13: the leadership and management standard, and Regulation 23: medicines, were issued. This monitoring visit was undertaken to review the actions that leaders and managers have taken to address the weaknesses. The actions set out in the two compliance notices have been met; however, other weaknesses remain. Since the interim inspection, staff have been provided with face-to-face handling of medication training. While this action is positive, the effectiveness of the training

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This monitoring visit

needs to be reviewed as medication and recording errors have continued to occur. Some staff have had their competency to administer medication assessed. However, this task has been completed by a person who has themselves been involved in medication errors. The medication room has now moved to a larger, more suitable space. However, this move did not take place promptly as required, and was not changed until 10 Inspection report for children‟s home - monitoring visit: 1271467 2 days after the interim inspection. In the intervening period, staff continued to prepare medication in a room that did not provide sufficient workspace to safely undertake this task. Insufficient action was taken to effect change quickly enough. The „pro re nata‟ (PRN) medication protocol has been revised and now provides clear information about when and how staff can administer this medication. However, not all staff who are working with the child have signed the document as required by the

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This monitoring visit

organisation, to demonstrate that they have read it. Most staff have received training in de-escalation and an introduction to supporting children who have autism spectrum disorder. Further training is scheduled in December 2018 to develop these skills more and measures should be taken to ensure that all staff have attended. Restraint training is also scheduled to take place in December 2018. Until the two remaining staff have completed this training, they have been advised not to intervene in incidents that occur in the home. In addition, staffing numbers have been increased to ensure that sufficient numbers of trained staff are available to intervene should this be required. Leaders and managers have started to assess the needs of the child who currently lives in the home. Part of this assessment includes discussions with family members, health practitioners and the placing authority to explore options.

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This monitoring visit

Serious behavioural incidents have continued to occur. In most cases, staff have managed to resolve these situations without the need to use restraint or PRN medication. During one serious incident, the child obtained staff keys that enabled him to enter the medication room and open the medication cabinets. Staff appropriately de- escalated this situation, preventing the child from harming himself. However, no action had been taken by leaders, managers or staff to ensure that this incident could not be repeated. At the time of this inspection, three days after the incident, no one had questioned the arrangement for storing and holding keys until prompted by the inspector. This is an example of poor leadership and poor recognition of risk. The restriction of accommodation issued after the interim inspection will remain in place. Although the compliance notices are met, Ofsted is not satisfied that sufficient

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This monitoring visit

action has been taken to manage this home effectively and to fully safeguard the one child who lives here.

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This monitoring visit

Inspectors will continue to monitor the home. Inspection report for children‟s home - monitoring visit: 1271467 3

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Inspection date Inspection type Inspection judgement

05/11/2018 Interim Declined in effectiveness 12/06/2018 Full Requires improvement to be good Inspection report for children‟s home - monitoring visit: 1271467 4

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Statutory requirements

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

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Requirement Due date

6: The quality and purpose of care standard The quality and purpose of care standard is that children receive care from staff who—understand the children‟s home‟s overall aims and the outcomes it seeks to achieve for children; use this understanding to deliver care that meets children‟s needs and supports them to fulfil their potential. In particular, the standard in paragraph (1) requires the registered person to understand and apply the home‟s statement of purpose; and ensure that staff— understand and apply the statement of purpose; protect and promote each child‟s welfare; provide personalised care that meets each child‟s needs, as recorded in the child‟s relevant plans, taking account of the child‟s background; and makes decisions about the day-to-day arrangements for each child, in accordance with the child‟s relevant plans, which gives the child an appropriate degree of freedom and choice. (Regulation 6(1)(a)(b)(2)(a)(b)(I)(ii)(iv)(ix))

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Requirement Due date

In addition:  ensure that the child is supported to engage in a wide range of activities, make measurable educational progress and is provided with access to primary healthcare practitioners. 21/11/2018

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Requirement Due date

11: The positive relationships standard The positive relationships standard is that children are helped to develop, and to benefit from relationships based on mutual respect and trust; an understanding about acceptable behaviour; and positive responses to other children and adults. In particular, the standard in paragraph (1) requires the registered person to ensure that staff— meet each child‟s behavioural and emotional needs as set out in the child‟s relevant plans; 21/11/2018 Inspection report for children‟s home - monitoring visit: 1271467 5 helps each child to develop socially aware behaviour; communicate to each child expectations about the child‟s behaviour and ensure that the child understands those expectations in accordance with the child‟s age and understanding; understands how children‟s previous experiences and present emotions can be communicated through behaviour and have the competence and skills to interpret these and develop

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Requirement Due date

positive relationships with children; and de-escalate confrontations with or between children, or potentially violent behaviour by children. (Regulation 11(1)(a)(b)(c)(2)(a)(I)(ii)(v)(ix)(xi)) 12: The protection of children standard The protection of children standard is that children are protected from harm and enabled to keep themselves safe. In particular, the standard in paragraph (1) requires the registered person to ensure that staff— understand the roles and responsibilities in relation to protecting children that are assigned to them by the registered person; take effective action whenever there is a serious concern about a child‟s welfare; and are familiar with, and act in accordance with, the home‟s child protection policies. (Regulation 12(1)(2)(a)(v)(vi)(vii)) 21/11/2018

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Requirement Due date

13: The leadership and management standard The leadership and management standard is that the registered person enables, inspires and leads a culture in relation to the children‟s home that helps children aspire to fulfil their potential; and promotes their welfare. In particular, the standard in paragraph (1) requires the registered person to— lead and manage the home in a way that is consistent with the approach and ethos, and delivers the outcomes, set out in the home‟s statement of purpose; ensures that staff have the experience, qualifications and skills to meet the needs of each child; ensures that the home has sufficient staff to provide care to each child; ensures that the home‟s workforce provides continuity of care to each child; understands the impact that the quality of care provided in the home is having on the progress and experiences of each 21/12/2018 Inspection report for children‟s home - monitoring visit: 1271467 6

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Requirement Due date

child and uses this understanding to inform the development of the quality of care provided in the home; and uses monitoring and review systems to make continuous improvements in the quality of care provided in the home. (Regulation 13(1)(a)(b)(2)(a)(c)(d)(e)(f)(h)) In particular:  Continue to prioritise the review and assessment of the child‟s needs.  In response to this review and assessment, continue to ensure that staff have the training, skills and experience required to meet his needs.  Take urgent action to ensure that staff who are administering medication have been assessed as competent by a suitable person.  Continue to ensure that staff have specialist training in meeting the needs of children with autism spectrum disorders, attention deficit hyperactivity disorder and obsessive-compulsive disorder. This training must provide sufficient knowledge and skills for staff to meet the needs of the child and to reduce his anxiety

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Requirement Due date

and isolation.  Take urgent action to ensure that where staff have not received up-to-date training in physical restraint that this training is provided without delay. 23: Medicines The registered person must make arrangements for the handling, recording, safekeeping, safe administration and disposal of medicines received into the children‟s home. In particular, the registered person must ensure that— medicines kept in the home are stored in a secure place so as to prevent any child from having unsupervised access to them; medicine which is prescribed for a child is administered as prescribed to the child for whom it is prescribed and to no other child; and a record is kept of the administration of medicine to each child. Paragraph (2) does not apply to medicine which— is stored by the child for whom it is provided in such a way that other persons are prevented from using it; and 21/12/2018 Inspection report for children‟s home - monitoring visit: 1271467 7

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Requirement Due date

may be safely self-administered by that child. In this regulation, “prescribed” means— ordered for a patient, for provision to the patient, under or by the virtue of the National Health Service Act 2006 or section 176(3) of the Health and Social Care (Community Health and Standards) Act 2003(b); or in a case not falling within sub-paragraph (a), prescribed for a patient in accordance with regulation 217 of the Human Medicines Regulations 2012(c). (Regulation 23(1)(2)(a)(b)(c)(3)(a)(b)(4)(a)(b) In particular:  Take urgent action to ensure that staff who are administering medication have been assessed as competent by a suitable person.  Take urgent action to review the storage or medication keys. 33: Employment of staff The registered person must— ensure that each employee completes an appropriate induction; and ensures that all employees receive practice-related supervision by a person with appropriate experience.

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Requirement Due date

35: Behaviour management policies and records The registered person must ensure that— within 24 hours of the use of a measure of control, discipline or restraint in relation to a child in the home, a record is made which includes— a description of any injury to the child or any other person, and any medical treatment administered, as a result of the measure; (Regulation 35(3)(a)(viii)) In particular: ensure that staff respond effectively when children are injured during incidents when restraint is used. 21/11/2018 Inspection report for children‟s home - monitoring visit: 1271467 8

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Information about this inspection

The purpose of this visit was to monitor the action taken and the progress made by the children‟s home since its last Ofsted inspection.

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Information about this inspection

This inspection was carried out under the Care Standards Act 2000.

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Children’s home details

Registered provider address: Priory Education Services Limited, 80 Hammersmith Road, London W14 8UD

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Inspector(s)

Tracey Ledder, social care inspector Paula Lahey, regulatory inspection manager Inspection report for children‟s home - monitoring visit: 1271467 9 to achieve excellence in the care of children and young people, and in education and skills for learners of all ages. It regulates and inspects childcare and children‟s social care, and inspects the Children and Family Court Advisory and Support Service (Cafcass), schools, colleges, initial teacher training, further education and skills, adult and community learning, and education and training in prisons and other secure establishments. It assesses council children‟s services, and inspects services for children looked after, safeguarding and child protection.

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Inspector(s)

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Inspector(s)

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Inspector(s)

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