Children's home run by Ronanda Limited in Canterbury

Inspection report for children‟s home - monitoring visit: SC427331 1 SC427331

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Ronanda Limited

Monitoring visit Inspected under the social care common inspection framework

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Information about this children’s home

The home is privately owned. It is registered to accommodate four children who may have emotional/or behavioural difficulties. A therapeutic approach is taken in working with the children, with the aim of enabling them to move on to family placements, or to return to their birth families where appropriate. The manager was registered with Ofsted on 10 December 2015.

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This monitoring visit

This children‟s home was judged inadequate at the full inspection on 7 March 2019, at which 13 requirements were made. Two of these, in respect of regulation 12 and regulation 13, were escalated to compliance notices. The purpose of this monitoring visit was to measure the progress made by the provider in meeting the compliance notices. The provider‟s progress with regards to the requirements was not fully explored on this occasion. The registered manager was not present during the inspection, but the responsible individual was on site throughout the visit. The compliance notice served under regulation 12 required the provider to meet defined steps:  Ensure that every child has an individualised and up-to-date assessment of their known risks and triggers. Updated risk assessments in relation to all the children were examined and discussed with the responsible individual. These were all found to have significant gaps and

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This monitoring visit

omissions. Examples included the failures in identifying significant risks in relation to self-harm. Documents also failed to include details of children‟s known behaviours and Inspection report for children‟s home - monitoring visit: SC427331 2 triggers and relevant historic information.  Ensure that risk assessments reliably inform behaviour management plans and provide staff with clear and appropriate strategies to implement. Through the reading of risk assessment and behaviour management strategies, and discussions with staff, it was evident that appropriate strategies are not in place. One risk assessment of self-harm includes a child‟s current and ongoing use of ligatures. The guidance fails to steer staff in recognising early indicators, or to provide clear steps on preventative strategies and the action to take in response to actual incidents. When spoken with, staff were unable to describe children‟s triggers for their self-

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This monitoring visit

harming behaviour. Information provided to the inspector about incidents of self-harm since the last inspection is unreliable and confusing. The inspector was informed of one specific incident. However, through discussions with the responsible individual and staff, further incidents were described, but no clear records have been kept. It is of serious concern that such high-risk self-harming behaviour is so poorly understood and managed. Children remain at significant risk of harm.  Undertake an audit of all restraint practice and records for the last 12 months. Produce a report of the findings. Contact external safeguarding agencies to report any concerns that are identified. The responsible individual commissioned an independent consultant to undertake an audit of restraint practice. The report failed to demonstrate or describe the methodology used and was weak in terms of analysis and evaluation. While the report

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This monitoring visit

identifies the excessive level of incidents that use restraint, it fails to challenge and consider how and why this culture has evolved. Consequently, it does not make clear any recommendations to address this serious concern. The responsible individual stated that concerns arising from the report have been shared with the local authority designated officer (LADO). There is no clear mechanism in use for leaders to record and monitor safeguarding incidents and concerns. The responsible individual said that she has contacted the LADO; however, this could not be corroborated because appropriate records have not been kept. The responsible individual said that one incident reached the threshold for referral. This is being investigated internally, as are several other concerns identified from the report, some of which relate to restraint practice being imposed in response to non- compliance. The poor quality of the report, combined with weak records and the

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This monitoring visit

responsible individual‟s lack of safeguarding knowledge, raises serious concerns about the organisation‟s ability to competently undertake this task.  Complete an audit of all staff members‟ understanding of their roles and responsibilities in relation to protecting children and produce a report of the audit‟s findings and recommendations. Inspection report for children‟s home - monitoring visit: SC427331 3 The provider has not completed an audit in response to the above step. The inspector was provided with a report that was completed in response to the compliance notice served under regulation 13. No accompanying information, such as records of staff interviews, supervisions and performance-related information, has been considered by the provider to thoroughly assess staff‟s competencies and understanding. This approach fails to demonstrate how this audit has sufficiently explored staff‟s actual understanding of the wide range of safeguarding topics relating to their roles and

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This monitoring visit

responsibilities. It does not identify the significant gaps in the skill set of the team, in response to the needs of the children. Neither the responsible individual nor the registered manager were included in this piece of work. The responsible individual has identified some basic training courses. Topics such as emergency first aid and fire safety have been undertaken and other courses are planned over the next few weeks and months. The process undertaken to conduct an audit has failed to rigorously explore and understand the serious and widespread failings of the staff team‟s lack of skills, knowledge and understanding of safeguarding. This includes the responsible individual and registered manager. Overall, the provider has failed to understand the gravity of the concerns about the team‟s safeguarding practice. This is demonstrated by the provider‟s failure to follow the step to complete an audit. Systems and processes are either weak or not in place

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This monitoring visit

at all. Leaders and managers are unable to demonstrate that they are fully aware of the day-to-day risks of children in their care. The steps in this notice have not been met. Consequently, this compliance notice is not met.

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This monitoring visit

The compliance notice served under regulation 13 required the provider to meet defined steps:  Undertake an audit of all staff‟s training and skills. Consider how this relates to the delivery of the statement of purpose.  Produce a report that identifies any gaps in staff‟s training and skills. The responsible individual produced a table that contained the names of some staff members, a list of training attended and some basic comments about their skills. No description is included to demonstrate how staff skills have been assessed and evaluated. There is some commentary that indicates the responsible individual‟s conclusion that gaps are evident in respect of some staff members‟ training and skills. This is not comprehensive, and in some examples, it is inaccurate. Not all staff members are included, such as the responsible individual and registered manager. Since the last inspection, a serious medication incident has occurred for which an

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This monitoring visit

additional requirement is now made. This incident highlights ongoing gaps in staff competence; however, this has not been identified by the audit. The audit does identify shortfalls in respect of staff training in relation to self-harm, but the urgency and specific content of the training required are not recognised; for example, ligature training is not mentioned. Inspection report for children‟s home - monitoring visit: SC427331 4 The documentation provided by the responsible individual fails to demonstrate how the specific skills of individual staff members have been assessed. The focus has been to identify training attended or not, with a programme of planned training. This approach fails to demonstrate that the responsible individual understands the focus and meaning of the steps in this notice. The responsible individual has recognised that the collective staff team does not possess all of the skills and experience suggested in the statement of purpose.

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This monitoring visit

However, her response lacks sufficient insight and understanding of the serious risks and potential consequences for the safety of children. For example, she said that she is concerned that staff are not able to recognise and report safeguarding concerns, but there remains a lack of urgency in addressing this. During this inspection, it became evident that a child made an allegation against a staff member the previous day, and this was not passed on.  Produce an action plan to address any identified shortfalls, that sets out clear timescales and evaluation criteria. The responsible individual has produced some dates for training, some of which has been attended. This is not supported by a clear rationale to support why, how and when courses have been identified and prioritised. Also, there are no evaluation or success criteria described. The responsible individual has therefore not considered how she will assure herself of the impact of training attended, to upskill staff and

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This monitoring visit

improve the quality of care that children receive.  Conduct a review of the quality of current monitoring systems, including independent reports. Produce a report of the findings, identifying any shortfalls and strategies to be implemented to rectify these. The responsible individual commissioned an independent consultant to complete this review. The final report is weak and fails to recognise the significant deficits in management monitoring. The focus of the recommendations is largely aimed at the quality of regulation 44. The serious shortfalls in respect of the manager‟s own monitoring systems have not been identified. Therefore, this review does not provide leaders and managers with an accurate description of their significant monitoring failures. The findings do not recognise that leaders and managers do not possess sufficient skills and competence to monitor the service. In summary, leaders and managers have failed to understand the significance of the

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This monitoring visit

steps in this notice. Auditing and reviewing processes have been weak and superficial. The prevalent issues with regards to the staffing culture and serious safeguarding omissions have not been identified by leaders and managers. This compliance notice is not met. The provider‟s poor response to these compliance notices raises serious concerns for the safety and welfare of children. The provider‟s inability to undertake clear audits and investigations into safeguarding and monitoring systems fails to address the serious gaps and omissions identified at the last inspection, resulting in compliance action. Leaders and managers are failing to address the safeguarding concerns with the Inspection report for children‟s home - monitoring visit: SC427331 5 necessary skill, understanding and urgency. Consequently, the staff team is not receiving the management guidance and oversight it needs to keep the children safe.

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This monitoring visit

Ofsted will now consider its next steps.

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Recent inspection history

Inspection date Inspection type Inspection judgement 07/03/2019 Full Inadequate 12/12/2017 Full Good 18/01/2017 Interim Sustained effectiveness 29/06/2016 Full Good Inspection report for children‟s home - monitoring visit: SC427331 6

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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

In meeting the quality standards, the registered person must, and must ensure that staff— if the registered person considers, or staff consider, a placing authority‟s or a relevant person‟s performance or response to be inadequate in relation to their role, challenge the placing authority or the relevant person to seek to ensure that each child‟s needs are met in accordance with the child‟s relevant plans. (Regulation 5 (c)) 31/05/2019

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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— ensure that the premises used for the purposes of the home are designed and furnished so as to— meet the needs of each child; and enable each child to participate in the daily life of the home. (Regulation 6 (1)(a)(b)(2)(c)(i)(ii)) 31/05/2019

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Requirement Due date

The children‟s views, wishes and feelings standard is that children receive care from staff who— ensure that an explanation is given to each child as soon as reasonably practicable after the child‟s arrival about— what advocacy support or services are available to the child, how the child may access that support or those services and any entitlement the child may have to independent advocacy provision. (Regulation 7 (1)(d)(iii))

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Requirement Due date

This is with specific reference to children being made aware of the role of advocacy and their right to access an advocate. 31/05/2019 Inspection report for children‟s home - monitoring visit: SC427331 7 The health and well-being standard is that— the health and well-being needs of children are met; children receive advice, services and support in relation to their health and well-being; and children are helped to lead healthy lifestyles. 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)(c)(2)(c)) 31/05/2019

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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— 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; 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; help each child to develop and practise skills to resolve conflicts positively and without harm to anyone; 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. (Regulation 11 (1)(a)(b)(c)(2)(a)(i)(ii)(iii)(iv)(v))

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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; 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 31/05/2019 Inspection report for children‟s home - monitoring visit: SC427331 8 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.

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Requirement Due date

(Regulation 12 (1)(2)(a)(i)(v)(vi)(vii)(d))

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Requirement Due date

Specifically, ensure that when a child makes an allegation against a member of staff, this is reported to safeguarding professionals and records are kept of conversations and the outcome. 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; ensure that staff have the experience, qualifications and skills to meet the needs of each child; use monitoring and review systems to make continuous improvements in the quality of care provided in the home. (Regulation 13(1)(a)(b)(c)(2)(a)(c)(h)) 31/05/2019

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Requirement Due date

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)) 31/05/2019

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Requirement Due date

The registered person must compile in relation to the children‟s home a statement (“the statement of purpose”) which covers the matters listed in Schedule 1. 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 (1)(3)(a)(b)) 31/05/2019

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Requirement Due date

The registered person must ensure that— 31/05/2019 Inspection report for children‟s home - monitoring visit: SC427331 9 children can access all appropriate areas of the children‟s home‟s premises. (Regulation 21(b))

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Requirement Due date

Specifically, ensure that children can freely access laundry facilities. The requirements are that— full and satisfactory information is available in relation to the individual in respect of each of the matters in Schedule 2. (Regulation 32 (3)(d)) 31/05/2019

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Requirement Due date

The registered person must ensure that all employees— undertake appropriate continuing professional development; receive practice-related supervision by a person with appropriate experience; and have their performance and fitness to perform their roles appraised at least once every year. Regulation 33 (4)(a)(b)(c) 31/05/2019

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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 effectiveness and any consequences of the use 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 to do so (“the authorised person”)— has spoken to the user about the measure; and has signed the record to confirm it is accurate. Regulation 35 (3)(a)(vii)(b)(i)(ii) 31/05/2019

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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. (Regulation 23(1)) 31/05/2019

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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. Inspection report for children‟s home - monitoring visit: SC427331 10

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Children’s home details

Registered provider address: 87 Millstrood Road, Whistable, Kent CT5 1QB

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Inspectors

Joe Davys, social care inspector Pete Hylton, regulatory inspection manager Inspection report for children‟s home - monitoring visit: SC427331 11 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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Inspectors

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Inspectors

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Inspectors

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