Children's Home, Residential special school run by MacIntyre Care in Buckinghamshire

Inspection report children‟s home: SC043994 1 SC043994 Registered provider: MacIntyre Care

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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 is a part of an independent school for children who have autism spectrum disorder and/or severe learning disabilities. Children who attend the school live in its children‟s home. The home provides 40 placements in seven houses. At the time of the inspection there were 25 children living in the home.

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Information about this children’s home

The home has not had a registered manager since 26 July 2018. A new manager was appointed in May 2019 but has yet to register with Ofsted.

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Overall experiences and progress of

children and young people, taking into account

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inadequate

How well children and young people are helped and protected inadequate

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inadequate

The effectiveness of leaders and managers inadequate

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inadequate

There are serious and widespread failures that mean that children and young people are not protected or their welfare is not promoted or safeguarded, and the care and experiences of children and young people are poor, and they are not making progress.

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inadequate

Overall judgement at last inspection: good Inspection report children‟s home: SC043994 2

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Inspection date Inspection type Inspection judgement

09/10/2018 Full Good 24/01/2018 Interim Sustained effectiveness 14/06/2017 Full Good 24/11/2016 Interim Sustained effectiveness Inspection report children‟s home: SC043994 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; 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)) 22/09/2019

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Requirement Due date

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— that staff help each child to— develop the child‟s interests and hobbies; participate in activities that the child enjoys and which meet and expand the child‟s interests and preferences; and make a positive contribution to the home and the wider community; and that each child has access to a range of activities that enable the child to pursue the child‟s interests and hobbies. (Regulation 9 (1)(2)(a)(i)(ii)(iii)(b)) 22/09/2019

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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; children receive advice, services and support in relation to their health and well-being; and children are helped to lead healthy lifestyles.

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Requirement Due date

In particular, the standard in paragraph (1) requires the 22/09/2019 Inspection report children‟s home: SC043994 4 registered person to ensure— that staff help each child to— achieve the health and well-being outcomes that are recorded in the child‟s relevant plans. (Regulation 10 (1)(a)(b)(c)(2)(a)(iii))

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Requirement Due date

Specifically, ensure that children are supported to attend all health and well-being appointments in line with their relevant plans.

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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. (Regulation 11 (1)(a)(b)(c)) 22/09/2019

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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— 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. (Regulation 12 (1)(2)(a)(i))* 25/08/2019

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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 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)(d))* 25/08/2019

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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— 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; 22/09/2019 Inspection report children‟s home: SC043994 5 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; that the home‟s day-to-day care is arranged and delivered so as to keep each child safe and to protect each child effectively from harm; that the premises used for the purposes of the home are located so that children are effectively safeguarded; that the effectiveness of the home‟s child protection policies is

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Requirement Due date

monitored regularly. (Regulation 12 (1)(2)(a)(ii)(iii)(iv)(v)(vi)(vii)(b)(c)(e))

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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.

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Requirement Due date

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)(2)(h))* 25/08/2019

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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. (Regulation 14 (1)(a))

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Requirement Due date

Specifically, ensure that agreed procedures and support plans are detailed within clear care plans that are understood and followed by care staff. 22/09/2019

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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)) 22/09/2019

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Requirement Due date

If the Regulatory Reform (Fire Safety) Order 2005 (30) applies to the home— the registered person must ensure the requirements of that Order and any regulations made under it, except for article 23 (duties of employees), are complied with in respect of the home. (Regulation 25 (2)(b))* 25/08/2019 Inspection report children‟s home: SC043994 6 A responsible individual must— have the capacity, experience and skills to supervise the management of the home, or the homes, in respect of which the responsible individual is nominated. (Regulation 26 (7)(b)) 22/09/2019

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Requirement Due date

The registered person must recruit staff using recruitment procedures that are designed to ensure children‟s safety.

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Requirement Due date

The requirements are that— the individual has the appropriate experience, qualification and skills for the work that the individual is to perform; full and satisfactory information is available in relation to the individual in respect of each of the matters in Schedule 2. (Regulation 32 (1)(3)(b)(d))* 25/08/2019

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Requirement Due date

The registered person must prepare and implement a policy which— is intended to safeguard children accommodated in the children‟s home from abuse or neglect; and sets out the procedure to be followed in the event of an allegation of abuse or neglect. (Regulation 34 (1)(a)(b))

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Requirement Due date

In particular, ensure that disciplinary proceedings are carried out even when a member of staff is no longer working in the home; and that the outcomes of these proceedings are referred to the disclosure and barring service (DBS) if required. 22/09/2019

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Requirement Due date

The registered person must ensure that— within 48 hours of the use of the measure [of control, discipline or restraint], 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; 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)(b)(i)(ii)(c)) 22/09/2019

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Requirement Due date

Case records must be kept— securely in the children‟s home during the period when the child to whom the case records relate is accommodated there. (Regulation 36 (2)(c)) 22/09/2019

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Requirement Due date

The registered person must notify HMCI and each other relevant person without delay if— there is any other incident relating to a child which the 22/09/2019 Inspection report children‟s home: SC043994 7 registered person considers to be serious. (Regulation 40 (4)(e))

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Requirement Due date

The registered person must review the appropriateness and suitability of the location of the premises used for the purposes of the children‟s home at least once in each calendar year taking into account the requirement in regulation 12(2)(c) (the protection of children standard).

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Requirement Due date

When conducting the review, the registered person must consult, and take into account the views of, each relevant person. (Regulation 46 (1)(2)) 22/09/2019

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Requirement Due date

* These requirements are subject to a compliance notice.

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Overall experiences and progress of children and young people: inadequate

Children are at risk of harm, and this affects their opportunity to develop and thrive. There are widespread, and significant, shortfalls which directly affect the safety, welfare and progress of children in the home.

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Overall experiences and progress of children and young people: inadequate

The physical condition of the environment is poor and not maintained in a way that promotes children‟s health and well-being. For example, one house has a wooden chair that is built into the bannister overlooking a stairwell. Inspectors identified that the fittings for this chair were loose and the potential risk to children had not been considered. Damaged areas and fittings in the home, such as a toilet seat and wall fixings, were not fixed in an appropriate timescale, leaving them to be exposed to children despite being in poor condition.

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Overall experiences and progress of children and young people: inadequate

Staff do not have access to the most up-to-date medical reports or information for children looked after. Healthcare plans do not always record the outcome of appointments. As a result, key health information is not always available to staff providing care to children. There was confusion about the frequency of appointments. One child missed a dental appointment and an optician appointment as a result of this confusion.

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Overall experiences and progress of children and young people: inadequate

Staff do not have the skills to care for children effectively or engage them in meaningful activity to stimulate them. Staff aspirations are low. During the inspection, children were observed as being unoccupied. For example, before dinner, children were observed to be wandering around the house unoccupied with no access to structured activity or organised play. In some cases, positive interactions between staff and children were observed, but these were not consistent. Staff do not have a clear understanding of the needs of the children in their care. This is despite there being the availability of various professionals on site. This results in children‟s experiences being poor and development opportunities being missed. Inspection report children‟s home: SC043994 8

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How well children and young people are helped and protected: inadequate

There are serious and widespread failures that mean children are at risk of harm and their welfare is not safeguarded. The home environment is not maintained or monitored effectively. Control of substances hazardous to health (COSHH) arrangements are not stringently followed, even though the independent visitor had warned against the practice of leaving COSHH cupboards unlocked.

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How well children and young people are helped and protected: inadequate

There is a lack of awareness around fire safety, and this compromises the safety of children and staff. Inspectors identified several fire doors across the residential site which were damaged and worn. Similarly, some fire doors have gaps between the door and the frames. This means that there is the potential for these doors to provide inadequate protection against the risk of fire in the home. There was an inconsistent approach to the locking of fire doors, some of which have electro-magnetic releases, with no underpinning risk assessment to explain the different approaches. Children do not have updated personal emergency and evacuation plans. This means that staff do not have current guidance on how to safely manage children in the event of fire or some other emergency. Ofsted referred these concerns to the local fire and rescue service.

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How well children and young people are helped and protected: inadequate

Risk assessments fail to effectively identify significant risks to children. Staff have limited guidance as to the control measures required to keep children safe. Known risks are not documented so, on occasions, staff do not act when children are placing themselves at risk of harm. For example, staff did not respond effectively when a child was observed to be using his knife in an unsafe way during the evening meal.

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How well children and young people are helped and protected: inadequate

One child‟s behaviour places them at potential risk in the home. This was identified in June 2019 following two incidents. Senior leaders did not take sufficient action to implement and monitor the control measures in response to a child at risk of significant harm. They did not place effective control measures in place to protect the child from harm. They did not follow up on the recommendations following a multi-disciplinary meeting when an external expert warned senior leaders of serious risks. Immediate action was taken during the inspection to rectify this at the request of the inspectors.

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How well children and young people are helped and protected: inadequate

When senior leaders have followed statutory guidance with due diligence, they keep records that identify accurately the actions and decisions they have made. However, they do not always complete investigations or continue the disciplinary process when staff have left. This means that staff who may pose a risk to children could be working in other settings.

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How well children and young people are helped and protected: inadequate

Staff responsible for recruitment do not carry out safer recruitment checks on agency staff. They rely on the agency itself to carry out these checks, without sampling or verifying that this is done in practice. They do not check the qualifications of agency staff. Potentially unsafe or unqualified adults are therefore working in the home.

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How well children and young people are helped and protected: inadequate

Following the use of physical restraint, records do not evidence that staff have spoken to the child about the measure. There is no evidence of managerial oversight. The Inspection report children‟s home: SC043994 9 opportunity to identify shortfalls in staff practice, or any behavioural patterns, is missed. Although managers have plans to improve the recording systems they have no clear time frame for such improvements to be made.

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How well children and young people are helped and protected: inadequate

Medication practice is unsafe. Staff leave oral syringes in staff toilets and offices. Internal compliance reports that revealed shortfalls in the recording and administering of medication have not been actioned. Children are at risk of not receiving their medication in a safe and hygienic way.

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How well children and young people are helped and protected: inadequate

A parent commented in the most negative of terms about the staff communication around significant events. The parent said they are often advised by email, and sometimes this is days after the event.

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The effectiveness of leaders and managers: inadequate

The registered manager‟s post has been vacant since July 2018. Although steps have been taken to address this, the impact on children has been significant due to the lack of management oversight and review of the provision. The newly appointed head of care has only been in post for a short time and has yet to register with Ofsted.

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The effectiveness of leaders and managers: inadequate

Leaders and managers have not taken appropriate action to meet the requirements from the last full inspection. The home has a monthly monitoring visit by an independent visitor, who subsequently produces a report. However, leaders and managers do not consistently act on the recommendations that are made and the shortfalls that are highlighted during these visits. Senior managers have failed to monitor and review the home.

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The effectiveness of leaders and managers: inadequate

Leaders and managers do not have a clear structure for the delegation of key roles. A new management structure has recently been implemented but is in its infancy. There is a lack of accountability, particularly in the area of health and safety. This has meant that children are being directly exposed to avoidable risks. A lack of management oversight and review has contributed to significant issues not being addressed. Leaders and managers have not notified others of all serious events in accordance with the children‟s homes regulations.

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The effectiveness of leaders and managers: inadequate

Care planning is poor. There is a lack of joined-up work with key professionals such as teaching staff, the speech and language therapist and the occupational therapist. Records for children looked after by the local authority are not kept in the house. Staff are unaware of the outcomes from statutory reviews. There is little evidence that information from key reports was either known by the home or written into care plans. For example, the positive behaviour support lead had produced a sensory diet for a young person in accordance with his identified needs. This was not evident in his care plan nor in observed practice.

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The effectiveness of leaders and managers: inadequate

Children‟s files have been stored haphazardly in staff toilets. Staff fail to identify that this is unhygienic and shows an utter disregard for these legal documents that provide a Inspection report children‟s home: SC043994 10 record of each child‟s journey through the home. This demonstrates that there is no clarity or accountability for the safe storage of children‟s files. However, managers have ensured that records relating to safeguarding are easy to follow.

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The effectiveness of leaders and managers: inadequate

The location assessment does not identify all known risks. For example, it fails to identify local risks such as the movement of agricultural vehicles operating in the local area. There is also limited information about the amenities situated locally.

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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: SC043994 11

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Children’s home details

Registered provider address: 602 South Seventh Street, Milton Keynes, Buckinghamshire MK9 2JA

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Inspectors

Daniel Healy, social care inspector (lead) Keith Riley, social care inspector Sarah Olliver, social care inspector Inspection report children‟s home: SC043994 12 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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