Children's Home, Residential special school run by St Elizabeth’s Centre in Hertfordshire

Inspection report children’s home: 2495377 1 Registered provider: St Elizabeth’s Centre

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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 is run by a large charitable organisation and is registered to provide care for up to 58 children who have special educational needs and/or disabilities. The home caters for children aged five to 19 who have complex medical needs, autism spectrum disorders, epilepsy and associated learning disabilities. The children attend St Elizabeth’s School, which is on the same site. The manager registered with Ofsted in April 2019.

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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: inadequate

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requires improvement to be good

Enforcement action since last inspection: none Inspection report children’s home: 2495377 2

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Inspection date Inspection type Inspection judgement

04/03/2019 Full Inadequate Inspection report children’s home: 2495377 3

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improvement to be good

The last inspection identified significant shortfalls in the staff’s behaviour management of children. Since then, significant improvements have been made. However, several new shortfalls have been identified at this inspection. The management team acknowledged the changes needed to address the shortfalls and improve the quality of care.

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improvement to be good

The standard of children’s living accommodation is variable. Their bedrooms are personalised and individually decorated in line with their preferences. However, some areas of the home are unwelcoming and unclean. These areas include some bathrooms. There is damage to some of the bedrooms, and the gardens are not well maintained. These areas do not provide a homely and nurturing environment.

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improvement to be good

The children’s daily routines are structured and provide some consistency. However, it is unclear whether these routines are tailored to the children’s needs. For example, the children are expected to be in their bedrooms by 9pm. This does not enable the older children to have a later bedtime or a different bedtime at weekends. Staff do not always use children’s individual communication systems or take time to understand and explore children’s wishes. Therefore, some routines do not reflect individualised care.

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improvement to be good

The staff do not regularly review children’s targets. Failure to review these targets can limit staff’s expectations of children and means that targets may not be relevant for the child. Records do not make it clear whether children are making good enough progress.

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improvement to be good

The children enjoy the extensive garden and grounds. They use the play area, ride trikes, enjoy puzzles and use the trampoline. Holiday activities include trips away from the home. However, indoor activities are repetitive. The games and sensory items are dated and uninviting. These resources fail to ensure that children are sufficiently stimulated and challenged.

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improvement to be good

Staff help the children to have contact with their families. Staff support transitions well for children who go home.

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improvement to be good

The staff spend good-quality time with children and attend to their needs. The staff spoke fondly about the children for whom they care. They know the children’s likes and the importance of their daily routine.

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improvement to be good

Children make progress with their education. They all attend school daily. Staff support children in the classroom when required, which provides continuity of care for children who need additional help at school.

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improvement to be good

Staff meet the children’s healthcare needs. The children benefit from the on-site multi- disciplinary health team that meets children’s needs well. Inspection report children’s home: 2495377 4

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improvement to be good

All the children have current risk assessments. However, systems to communicate the risks to staff are weak. Consequently, it is unclear whether all the staff and, in particular, the agency staff, have a full understanding of the potential risks to individual children.

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improvement to be good

Some incident reports are unclear. It is not clear when a child has been ‘escorted’ to a quiet room or whether the staff stayed with the child. At times, staff cannot implement the identified behaviour management strategies. The use of the therapy swing is only an option when healthcare staff are available. This limits the resources available to staff and can mean an increase in the use of restrictive physical intervention.

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improvement to be good

The manager has reviewed the location risk assessment. Known hazards to children are identified, and actions to reduce the risk to children and staff are recorded.

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improvement to be good

The manager takes immediate action when there are concerns about staff’s practice. She informs the relevant agencies and implements the necessary procedures to safeguard children.

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improvement to be good

Following previous concerns about behaviour management techniques, staff no longer restrict children’s liberty. The staff are all aware that holding the doors closed is not an acceptable strategy to manage children’s behaviour. Additional behaviour management training is under way to help staff to manage behaviour effectively and safely.

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

The home is large, with seven individual houses. At times, the communication systems are ineffective and important information fails to reach the manager. Internal monitoring systems lack rigour, clarity and accountability.

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

Staff receive regular supervision. However, the supervision sessions fail to include reflection on practice or review previous supervision actions. Supervision records do not describe the action taken in response to staff concerns. Additionally, the manager has not always been informed of concerns raised by staff, which means that staff do not always receive appropriate responses.

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

There are enough staff to meet the children’s needs. However, some staff have not achieved a relevant level 3 qualification within the required timescales. Some of the new staff have not undertaken the organisation’s mandatory training, although these staff were continually supervised by experience staff and some staff require refresher training. It is unclear whether the staff have received specific training in the individual communication systems used by the children. Lack of training means that staff are not fully equipped to meet childrens needs. Inspection report children’s home: 2495377 5 The records require improvement. The rota does not clearly detail which houses the night staff are allocated to. This makes it difficult to identify which staff are involved in incidents and, in particular, which staff are agency staff.

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

The staff do not keep memorabilia for the children, despite some of the children living at the home for a considerable time. The children do not have photographs or records of significant events that they can take with them when they leave. Consequently, children are not helped to build positive memories.

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

The manager has taken the required action to meet the compliance notice that was served following the last inspection. She has met the previous requirements and recommendations.

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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—

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Requirement Due date

understand the children’s home’s overall aims and the outcomes it seeks to achieve for children;

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Requirement Due date

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—

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Requirement Due date

provide personalised care that meets each child’s needs, as recorded in the child’s relevant plans, taking account of the child’s background. (Regulation 6 (1)(a)(b)(2)(b)(iv)) 14/06/2019

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Requirement Due date

The quality and purpose of care standard is that children receive care from staff who—

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Requirement Due date

understand the children’s home’s overall aims and the outcomes it seeks to achieve for children; 14/06/2019 Inspection report children’s home: 2495377 6 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—

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Requirement Due date

ensure that the premises used for the purposes of the home are designed and furnished so as to—

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Requirement Due date

meet the needs of each child. (Regulation 6 (1)(a)(b)(2)(c)(i)) The enjoyment and achievement standard is that children take part in and benefit from a variety of activities that meet their needs and develop and reflect their creative, cultural, intellectual, physical and social interests and skills.

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Requirement Due date

In particular, the standard in paragraph (1) requires the registered person to ensure—

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Requirement Due date

participate in activities that the child enjoys and which meet and expand the child’s interests and preferences. (Regulation 9 (1)(2)(a)(ii)) 14/06/2019

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Requirement Due date

The positive relationships standard is that children are helped to develop, and to benefit from, relationships based on—

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Requirement Due date

an understanding about acceptable behaviour; and

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Requirement Due date

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—

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Requirement Due date

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;

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Requirement Due date

understand how children’s previous experiences and present emotions can be communicated through behaviour and have the competence and skills to interpret these and develop positive relationships with children; 14/06/2019 Inspection report children’s home: 2495377 7 are provided with supervision and support to enable them to understand and manage their own feelings and responses to the behaviour and emotions of children, and to help children to do the same. (Regulation 11 (1)(a)(b)(c)(2)(a)(v)(ix)(x)) 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—

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Requirement Due date

understand the roles and responsibilities in relation to protecting children that are assigned to them by the registered person. (Regulation 12 (1)(2)(a)(v)) 31/05/2019

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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—

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Requirement Due date

helps children aspire to fulfil their potential; and

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Requirement Due date

In particular, the standard in paragraph (1) requires the registered person to—

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Requirement Due date

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;

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Requirement Due date

ensure that staff have the experience, qualifications and skills to meet the needs of each child;

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Requirement Due date

ensure that the home’s workforce provides continuity of care to each child;

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Requirement Due date

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;

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Requirement Due date

use 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)(f)(e)(h)) 31/07/2019

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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— 30/08/2019 Inspection report children’s home: 2495377 8 the Level 3 Diploma for Residential Childcare (England) (‘the Level 3 Diploma’); or

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Requirement Due date

a qualification which the registered person considers to be equivalent to the Level 3 Diploma. (Regulation 32 (4)(a)(b)) The registered person must ensure that all employees—

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Requirement Due date

receive practice-related supervision by a person with appropriate experience. (Regulation 33 (4)(b))

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Requirement Due date

In particular, ensure that supervisions are reflective and include a review of actions from the previous supervision. 31/05/2019

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Requirement Due date

Schedule (4) sets out the other information that the registered person must keep in relation to a children’s home. The registered person must ensure that the records are kept up to date. (Regulation 37 (1)(2)(b))

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Requirement Due date

In particular, ensure that rotas are clear and up to date. 31/05/2019

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Recommendations

 Ensure that the home’s records on each child represent a significant contribution to their life history. Children and their parents should be supported to understand the nature of records kept by the home and how to access them. Staff should understand their important role in encouraging the child to reflect on and understand their history according to their age and understanding. Staff should keep and encourage children to keep appropriate memorabilia of the time spent living at the home and help them record significant life events. (‘Guide to the children’s homes regulations including the quality standards’, page 62, paragraph 14.5)

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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 Inspection report children’s home: 2495377 9 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: 2495377 10

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Children’s home details

Registered provider: St Elizabeth’s Centre

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Children’s home details

Registered provider address: The Provincialate, 29 Tite Street, London SW3 4JX

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Children’s home details

Responsible individual: Sister Veronica Hagen

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Inspectors

Natalie Burton, social care inspector Rosie Davie, social care inspector Kristen Judd, social care regulatory inspection manager Inspection report children’s home: 2495377 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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