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

Inspection report for children‟s home - monitoring visit: 1263270 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 children‟s home is part of a large national organisation. This home is currently registered to care for up to five children.

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This monitoring visit

This monitoring visit was undertaken due to serious and widespread concerns being identified at an inspection on 9 and 10 January 2019. These concerns remain. Leaders and managers are failing to adequately care for children and keep children safe; enforcement action is being taken. Since this service was registered in August 2017, weaknesses and poor performance have been repeatedly identified at successive inspections and these stem from inadequate leadership and management. Since May 2018, this home has been issued with six compliance notices. Regulatory breaches found at this monitoring visit have been identified at previous inspections. Not all of the requirements have been met. There is a systemic and ongoing failure by senior leaders to make and sustain the improvements necessary to provide children with good care and to promote their safety and welfare. Leadership across all levels of this service is ineffective. Leaders do not have an

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This monitoring visit

accurate understanding of the home, and their scrutiny and oversight are inadequate. Leaders do not monitor incidents effectively; they do not ask important questions about what happened and why. Staff do not always receive debrief discussions. As a result, leaders do not fully understand the approaches staff take during an incident and whether these are in accordance with the children‟s agreed plans. This lack of oversight prevents leaders and managers from identifying poor practice and making the required improvements to the quality of care children receive. Leaders and managers do not fulfil their responsibilities to keep children safe. Important information about child protection concerns is not always shared with Inspection report for children‟s home - monitoring visit: 1263270 2 safeguarding agencies and significant incidents are not always reported. Since the previous inspection, a senior leader has been appointed to work with safeguarding

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This monitoring visit

agencies to investigate several child protection concerns. In addition, managers from the quality team are supporting the home to try to address these serious shortfalls. Leaders and managers do not ensure that health and safety requirements are adequate. Despite a child continuing to self-harm on windows, neither the manager nor the responsible individual can confirm that the windows in the home are safe. This question remains unanswered from the previous inspection. Children continue not to receive prompt medical attention when they are injured. One child did not receive medical attention for over nine hours. Essential medical equipment requested by a general practitioner and a social worker was not provided for another child as required. As a result, this child was exposed to ongoing self-harm that could have been less serious or avoided. Despite new systems being introduced, errors and confusion in respect of children‟s

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This monitoring visit

prescribed medication continue to occur. Accidents and injuries sustained by children continue to be recorded sporadically. Weaknesses in this area have been subject to two previous compliance notices. The out of hours on-call support system for staff is not always effective. During one significant incident, the on-call manager failed to answer their phone when staff called for support. This resulted in one child being left alone while their allocated staff member supported colleagues in another building to manage a difficult situation. Ofsted is not satisfied that this home is led and managed effectively. Enforcement action is being taken and inspectors will continue to monitor the performance of the home.

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Recent inspection history

Inspection date Inspection type Inspection judgement 07/08/2018 Full Requires improvement to be good 09/05/2018 Full Inadequate 20/11/2017 Full Requires improvement to be good Inspection report for children‟s home - monitoring visit: 1263270 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

5: Engaging with the wider system to ensure children‟s needs are met

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Requirement Due date

In meeting the quality standards, the registered person must, and must ensure that staff— seek to involve each child‟s placing authority effectively in the child‟s care, in accordance with the child‟s relevant plans; if the registered person considers, or staff consider, a relevant person‟s performance [in this instance this refers specifically to the school provider] or response to be inadequate in relation to their role, challenge the relevant person to seek to ensure that each child‟s needs are met in accordance with the child‟s relevant plans; and seek to develop and maintain effective professional relationships with such persons, bodies or organisations as the registered person considers appropriate having regard to the range of needs of children for whom it is intended that the children‟s home is to provide care and accommodation. (Regulation 5 (a)(c)(d))

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Requirement Due date

In particular:  Ensure that the placing authority is always involved in decisions being made about a child‟s school placement, before these decisions are agreed on.  Ensure that sufficient challenge is taken swiftly when there are concerns that decisions being made about a child are not in their best interests.  Ensure that an effective relationship is maintained with each child‟s school.  Ensure that the placing authority is always consulted when changes are made to agreed care planning arrangements. 28/02/2019

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Requirement Due date

6: The quality and purpose of care standard

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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 28/02/2019 Inspection report for children‟s home - monitoring visit: 1263270 4 outcomes it seeks to achieve for children, and use this understanding to deliver care that meets children‟s needs and supports them to fulfil their potential.

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Requirement Due date

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 home‟s 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 plan, taking account of the child‟s background; help each child to develop resilience and skills that prepare the child to return home, to live in a new placement or to live independently as an adult; provide to children living in the home the physical necessities they need in order to live there comfortably; make decisions about the day-to-day arrangements for each child, in accordance with the child‟s relevant plan, which give the child an appropriate degree of freedom and choice; ensure that the premises used for the purposes of the home are designed and furnished so as to meet the needs of each

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Requirement Due date

child and enable each child to participate in the daily life of the home. (Regulation 6 (1)(a)(b)(2)(a)(b)(i,ii,iv,vi,vii)(c)(i,ii)) 10: The health and well-being standard

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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 and that children receive advice, services and support in relation to their health and well-being.

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Requirement Due date

In particular, the standard in paragraph (1) requires the registered person to ensure— that each child has access to such dental, medical, nursing, psychiatric and psychological advice, treatment and other services as the child may require. (Regulation 10 (1)(a)(b)(2)(c))

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Requirement Due date

In particular:  Ensure that appropriate medical attention is provided swiftly when staff are concerned about injuries to a child.  Ensure that any medical equipment that children require is provided without delay. 28/02/2019

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Requirement Due date

11: The positive relationships standard 28/02/2019 Inspection report for children‟s home - monitoring visit: 1263270 5 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.

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Requirement Due date

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; help each child to develop socially aware behaviour; encourage each child to take responsibility for the child‟s behaviour, in accordance with the child‟s age and understanding; 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; de-escalate confrontations with or between children, or potentially violent behaviour by children. (Regulation 11 (1)(a)(b)(c)(2)(i,ii,iii,v,xi))

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Requirement Due date

In particular:  Ensure that staff have the skills to de-escalate and manage children‟s behaviour and avoid using the police or the threat of police to provide this support.  Ensure that staff do not use physical intervention techniques that they have not been trained to use or are not recorded in the child‟s behaviour plan.  Ensure that children‟s care plans are followed by all staff. 12: The protection of children standard

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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.

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Requirement Due date

In particular, the standard in paragraph (1) requires the registered person to ensure— that staff— have the skills to identify and act upon the signs that a child is at risk of harm; 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 28/02/2019 Inspection report for children‟s home - monitoring visit: 1263270 6 are familiar with, and act in accordance with, the home‟s child protection policies; 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)(iii,v,vi,vii)(d))

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Requirement Due date

In particular:  Ensure that staff maintain detailed and up-to-date records about injuries children receive.  Assess the premises effectively to ensure that all windows and glass doors contain appropriate safety measures.  Ensure that staff do not investigate child protection concerns, including undertaking physical checks of children, without following child protection policies.  Ensure that managers review incidents effectively when restraint and physical intervention have been used to accurately identify if children have been placed at risk of harm.  Take action to safeguard children.  Ensure that internal investigations are rigorously undertaken to ensure that leaders and managers accurately understand what has happened. 13: The leadership and management standard

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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 their full potential; and promotes their welfare.

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Requirement Due date

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 statement of purpose; 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 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 28/02/2019 Inspection report for children‟s home - monitoring visit: 1263270 7 improvements in the quality of care provided in the home. (Regulation 13 (1)(a)(b)(2)(a)(c)(f)(g)(ii)(h))

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Requirement Due date

In particular:  Ensure that staff are provided with ongoing support and training to meet the needs of children, specifically training in supporting children who have autistic spectrum disorder and in the use of augmented communication, restraint and medication administration.  Ensure that leaders and managers monitor and review practices in the home effectively, including the quality of records kept about children, to ensure that children are kept safe and to identify and act on any trends, patterns or concerns. Managers should seek to learn lessons from serious incidents.  Ensure that effective and robust management arrangements are in place regarding decision-making and support for staff out of hours.  Ensure that staff undertaking managerial roles and who make decisions have the skills and experience to carry out their duties effectively. 23: Medicines

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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.

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Requirement Due date

In particular, the registered person must ensure that— a record is kept of the administration of medicine to each child. (Regulation 23 (1)(c))

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Requirement Due date

In particular:  Ensure that a record is maintained of the treatment given and products administered when staff are providing first aid and ongoing treatment to injuries. 28/02/2019

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Requirement Due date

The registered person must ensure that each employee completes an appropriate induction.

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Requirement Due date

The registered person must ensure that all employees— undertake appropriate continuing professional development; and receive practice-related supervision by a person with appropriate experience. (Regulation 33 (1)(a)(4(a)(b)) 28/02/2019 Inspection report for children‟s home - monitoring visit: 1263270 8 In particular:  Ensure that all staff complete a thorough and appropriate induction that skills them effectively to work in the home and meet children‟s needs.  Ensure that staff undertaking internal investigations have the skills to ensure that these are carried out forensically and swiftly. 35: Behaviour management policies and records

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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 points i to vii as described in this regulation. 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— has spoken to the user about the measure and has signed the record to confirm it is accurate. (Regulation 35 (3)(a)(i,ii,iii,iv,v,vi,vii,viii)(b)(i)(ii))

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Requirement Due date

In particular:  Ensure that leaders and managers undertake thorough and effective debrief discussions with staff to understand what happened and why.  Ensure that all incidents where staff use physical intervention and restraint with children are recorded. 28/02/2019

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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; and are signed and dated by the author of each entry. (Regulation 36 (1)(a)(b)(c))

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Requirement Due date

In particular:  Ensure that accident and injury records are completed and provide a detailed account of what happened, and treatment received.  Ensure that each entry written in a daily log book can be clearly read and is signed and dated by each author. 28/02/2019

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Requirement Due date

The registered person must notify HMCI and each other 28/02/2019 Inspection report for children‟s home - monitoring visit: 1263270 9 relevant person without delay if— an incident requiring police involvement occurs in relation to a child which the registered person considers to be serious; and when there is an incident relating to a child which the registered person considers to be serious. (Regulation 40 (4)(b)(e))

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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: 1263270 10 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 looked after children, 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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