Children's home run by Tees, Esk and Wear Valleys NHS Foundation Trust

Inspection report children’s home: 1253862 1 Registered provider: Tees, Esk and Wear Valleys NHS Foundation Trust

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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 children’s home provides short-break care and accommodation for children and young people who have a learning and/or physical disability. The home is operated by a National Health Service Foundation Trust. The manager is in the process of registration. He has been in post since May 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

Date of last inspection: 4 December 2018

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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

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Recent inspection history

Inspection report children’s home: 1253862 2

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Inspection date Inspection type Inspection judgement

05/02/2018 Full Requires improvement to be good Inspection report children’s home: 1253862 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 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; ensure that staff— understand and apply the home’s statement of purpose; protect and promote each child’s welfare; treat each child with dignity and respect; provide personalised care that meets each child’s needs, as recorded in the child’s relevant plans, taking account of the child’s background; help each child to understand and manage the impact of any experience of abuse or neglect; help each child to develop resilience and skills that prepare the child to return home, to live in a new placement or to live

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Requirement Due date

independently as an adult; provide to children living in the home the physical necessities they need in order to live there comfortably; provide to children personal items that are appropriate for their age and understanding; and make decisions about the day-to-day arrangements for each child, in accordance with the child’s relevant plans, which give the child an appropriate degree of freedom and choice. (Regulation 6 (1)(a)(b)(2)(a)(b)(i)(ii)(iii)(iv)(v)(vi)(vii)(viii) and (ix)) 23/02/2019 Inspection report children’s home: 1253862 4 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;

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Requirement Due date

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; manage relationships between children to prevent them from harming each other; 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)(i)(ii)(iii)(iv)(v)(vi) and (vii)) 23/02/2019

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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— use monitoring and review systems to make continuous improvements in the quality of care provided in the home. (Regulation 13 (1)(a)(b) and (2)(h)) 23/02/2019

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Requirement Due date

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 (3)(a)(b)) 23/02/2019

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Requirement Due date

The registered person may only use devices for the monitoring or surveillance of children if— the monitoring or surveillance is for the purpose of safeguarding 23/02/2019 Inspection report children’s home: 1253862 5 and promoting the welfare of the child concerned, or other children; so far as reasonably practicable in the light of the child’s age and understanding, the child is informed in advance of the intention to do the monitoring or surveillance; and the monitoring or surveillance is no more intrusive than necessary, having regard to the child’s need for privacy. (Regulation 24 (1)(a)(c)(d)) In particular, the manager ensures that there is signed consent from those who hold parental responsibility to use devices for monitoring and surveillance purposes. Additionally, there should be a review of monitoring devices to ensure they remain necessary and appropriate for safeguarding purposes. The registered person must ensure, by means of fire drills and

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Requirement Due date

practices at suitable intervals, that persons working at the home and, so far as reasonably practicable, children are aware of the procedure to be followed in case of fire. (Regulation 25(1)(d)) 23/02/2019

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Requirement Due date

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)(4)(a)(b) 23/02/2019

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Requirement Due date

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— the name of the child; details of the child’s behaviour leading to the use of the measure; the date, time and location of the use of the measure; a description of the measure and its duration; details of any methods used or steps taken to avoid the need to use the measure; the name of the person who used the measure ("the user"), and of any other person present when the measure was used; the effectiveness and any consequences of the use of the measure; and a description of any injury to the child or any other person, and 23/02/2019 Inspection report children’s home: 1253862 6 any medical treatment administered, as a result of the measure; within 48 hours of the use of the measure, the registered person, or a person who is authorised by the registered person

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Requirement Due date

to do so ("the authorised person")— has spoken to the user about the measure; and has signed the record to confirm it is accurate; and within 5 days of the use of the measure, the registered person or the authorised person adds to the record confirmation that they have spoken to the child about the measure. (Regulation 35 (3)(a)(i)(ii)(iii)(iv)(v)(vi)(vii)(viii)(b)(i)(ii) and (c)(iv)) The registered person must notify HMCI and each other relevant person without delay if— a child is involved in or subject to, or is suspected of being involved in or subject to, sexual exploitation; an incident requiring police involvement occurs in relation to a child which the registered person considers to be serious; there is an allegation of abuse against the home or a person working there; a child protection enquiry involving a child— is instigated; or concludes (in which case, the notification must include the outcome of the child protection enquiry); or

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Requirement Due date

there is any other incident relating to a child which the registered person considers to be serious. (Regulation 40 (4)(a)(b)(c)(d)(i)(ii) and (e)) 23/02/2019

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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; (Regulation 45 (1)(2)(a)) 23/02/2019

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Recommendations

Inspection report children’s home: 1253862 7  Ensure that children are consulted regularly on their views about the home to inform the quality of the care provided, giving due consideration to the child’s cognitive ability. (‘Guide to the children’s homes regulations including the quality standards’, page 22, paragraph 4.11)  Supervision of staff practice should ensure that individual adults in the home are engaged in the safeguarding culture of the home so they understand what they would need to do if they found other staff misusing or abusing their position to the detriment of the safety of a child. (‘Guide to the children’s homes regulations including the quality standards’, page 43, paragraph 9.14) In particular, safeguarding should be a standard item agenda in staff supervisions. The recording of supervisions should include the duration of time and any specific tasks set.  Staff skills for safeguarding should include being able to identify signs that

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Recommendations

children may be at risk, and support children in strategies to manage and reduce any risks. Staff should encourage children to express their views about whether they feel safe both within and outside the home. Staff should support children to understand how to ask for help to stay safe and that the home is an environment which supports this. (‘Guide to the children’s homes regulations including the quality standards’, page 42, paragraph 9.10) In particular, safeguarding should be a standard agenda item explicitly referred to within team meetings.

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improvement to be good

Practice in the home is not yet effectively complying with the social care regulations that the home is inspected but this has not impacted negatively on the experiences of children and young people. The property is suitably equipped to meet the needs of children and young people accessing short-break services. It is well maintained, and the standards of hygiene are high. Domestic staff are employed to maintain the home’s cleanliness. This enables the staff team to dedicate its time to the children and young people. Staffing levels are proportionate to the level of each child and young person’s needs. The children and young people accessing this provision enjoy a range of activities during their short-break stay. Some activities are specific to children and young people who have disabilities, such as cinema trips that are tailored for children and young people with autistic spectrum disorder. There is good evidence of care planning ahead of children and young people accessing

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improvement to be good

the service. The staff team consults with parents, carers and a range of professionals to assess the suitability of any provision being agreed. This means that the manager only accepts referrals and admissions if he feels the home can meet the needs of children Inspection report children’s home: 1253862 8 and young people as set out in the home’s statement of purpose. The staff team builds positive relationships with the children and young people that it cares for. Additionally, there are good relationships with parents and carers. Parents spoken to refer to the staff team as being ‘brilliant’ and ‘communication being excellent’. Good relationships help children, young people and their parents and carers to benefit from the provision. One parent commented, ‘[Name] gets excited about coming here. I feel reassured that he is being well looked after. I have no concerns, the staff are amazing.’ Observations made by the inspector are that children and young people are

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improvement to be good

welcomed on admission and staff are very nurturing. There is currently no system in place to consult with children and young people taking into account their individual abilities. Consulting with children and young people enhances their experiences as they are able to contribute to the care that they receive. The recommendation made at the last full inspection regarding consulting with children and young people remains a recommendation following this inspection. There is not yet an effective system in place to monitor and track children and young people’s progress from their starting points. Care plans do not explicitly refer to targets and goals for children and young people. This means it is difficult to measure progress. The physical needs and health needs of the children and young people are very well understood. Children and young people’s needs in this area are met to a good standard. This provides consistency of healthcare from admission point.

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improvement to be good

Due to health reasons, some children and young people require surveillance equipment to monitor them when they are asleep. In some cases, there was no evidence that parental consent had been obtained to use the equipment. Additionally, there is no evidence of any review taking place to assess the necessity of ongoing use of equipment.

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improvement to be good

There are shortfalls in safeguarding practice. There have been delays in the staff team reporting incidents to the relevant agencies when they occur. Furthermore, Her Majesty’s Chief Inspectorate had not been notified of a child protection investigation. This does not comply with regulations. The manager reports that there has been no missing from care episodes, physical interventions, sanctions or bullying. It was difficult for the inspector to obtain evidence to support this as the home does not have an effective system in place to separate these as recordable incidents as required. This means that isolated incidents may not be given the significance that they require to be monitored and reviewed by the manager. This could leave children and young people vulnerable. There is no evidence of fire drills being completed, which is not compliant with regulations. This means that children and young people’s safety and welfare could be

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improvement to be good

compromised if evacuation of the building was necessary. Inspection report children’s home: 1253862 9

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

The manager has been in post since May 2018. He reports that he is enrolled onto a level 5 diploma in management. His professional background is within a healthcare setting. The staff team mainly compromises qualified nursing staff with varying experience. The manager reports that members of the staff team are to be enrolled onto a level 3 NVQ in childcare. The practice in this provision is based on a medical model. This benefits those children who have highly complex medical conditions. The staff team has not yet been sufficiently trained to understand the social care framework that it is inspected against. This means that the team is unable to fully understand and implement an effective service in line with its own statement of purpose. Safeguarding is not added to supervisions as a standalone agenda item. Similarly, team meetings do not discuss safeguarding issues as a set agenda item. This means that

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

safeguarding is not regularly discussed to ensure the safety of children and young people. The manager has completed an updated statement of purpose to reflect changes in the service. He has not notified Her Majesty’s Chief Inspector. This is not compliant with regulations. There are shortfalls in the review and quality of care. This has restricted improvements being made to the service. Ineffective monitoring systems mean that there is poor management oversight to pick up on themes and trends. The manager and staff team are compassionate about the service that they provide to the children and young people that they care for. The manager is determined to motivate his staff team to drive improvements forward and bridge the gaps in shortfalls.

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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: 1253862 10

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Children’s home details

Register Provider: Tees, Esk and Wear Valleys NHS Foundation Trust

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Children’s home details

Registered provider address: West Park Hospital, Edward Pease Way, Darlington DL2 2TS

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Inspector

Jacqueline Tate, social care inspector Inspection report children’s home: 1253862 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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