Children's home run by Positive Individual Proactive Support Limited

Inspection report children’s home: 1267402 1 Registered provider: Positive Individual Proactive Support Limited

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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 owned and run by a private provider. It is registered to accommodate one child or young person and was registered in April 2018, when the manager was also registered with Ofsted.

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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 inadequate

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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: sustained effectiveness

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requires improvement to be good

Enforcement action since last inspection: none Inspection report children’s home: 1267402 2

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Inspection date Inspection type Inspection judgement

15/03/2019 Interim Sustained effectiveness 09/10/2018 Full Good Inspection report children’s home: 1267402 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 engaging with the wider system to ensure children’s needs are met standard, paragraph (c), requires that—

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Requirement Due date

if the registered person considers, or staff consider, a placing authority’s or 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))

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Requirement Due date

Specifically:  escalate concerns to the local authority to obtain the most up-to-date health needs assessment for the young person  escalate the request for the update of the deprivation of liberty order. 30/09/2019

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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. 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; help each child to understand how to keep safe. (Regulation 12 (1)(2)(a)(i)(ii)) This specifically relates to:  managers assessing self-harm risks and having a robust oversight of all children’s and young people’s risk management plans to ensure that they are accurate, up to date and safe, with clear strategies to reduce identified risks  including in risk management plans the rationale for making 30/09/2019 Inspection report children’s home: 1267402 4 decisions to increase or decrease risk management strategies

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Requirement Due date

 carrying out room searches when concerns come to light about the risks to children’s and young people’s health, well- being and safety and keep this under regular review  improving the quality and frequency of individual work on risky behaviours with young people and include the young person’s comments. 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

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))

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Requirement Due date

This specifically relates to:  ensuring that decisive action is taken to meet the above and ensure that the training in positive behaviour management is fully embedded into practice  quality assuring all records to ensure that all documents are in place and are completed appropriately and that all staff have read and understand the contents and take remedial action as necessary  formalising a written development plan showing a clear focus on continually improving the experiences and outcomes for children and young people with details of the actions taken to address weakness and the timescales for completion  ensuring that all staff are regularly supervised and include the registered manager’s oversight  ensuring that children’s records are kept up to date and stored securely while they remain in the home  scrutinising and responding to the Regulation 44 reports to ensure they consistently provide a true reflection of care

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Requirement Due date

practices in the home  delivering training to staff on diversity matters and the use 30/09/2019 Inspection report children’s home: 1267402 5 of ligatures. The registered person must—

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Requirement Due date

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.

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Requirement Due date

Subject to paragraph (6), the registered person must ensure that the home is at all times conducted in a manner which is consistent with its statement of purpose. (Regulation 16 (3)(a)(b)(5))

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Requirement Due date

This specifically relates to the inclusion of the most up-to-date behaviour management policy in the statement of purpose. 30/09/2019

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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))

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Requirement Due date

This specifically relates to ensuring that medication is signed in and out of the home as standard practice. 30/09/2019

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Requirement Due date

The registered person must ensure that a record is made of any complaint, the action taken in response, and the outcome of any investigation. (Regulation 39 (3)) 30/09/2019

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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.

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Requirement Due date

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;

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Requirement Due date

the feedback and opinions of children about the children’s home, its facilities and the quality of care they receive in it; and

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Requirement Due date

any actions that the registered person considers necessary in order to improve or maintain the quality of care provided for children. After completing a quality of care review, the registered person must produce a written report about the quality of care review and the actions which the registered person intends to take as a result of the quality of care review (‘the quality of care review report’). The registered person must supply to HMCI a copy of the quality of care review report within 28 days of the date on which the quality of care review is completed; and 30/09/2019 Inspection report children’s home: 1267402 6 make a copy of the quality of care review report available on request to a placing authority, if the placing authority is not the parent of a child accommodated in the home. The system referred to in paragraph (2) must provide for ascertaining and considering the opinions of children, their parents, placing

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Requirement Due date

authorities and staff. (Regulation 45 (1)(2)(a)(b)(c)(3)(4)(a)(b)(5))

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Recommendations

 The home should play a full part in promoting the best interests of the child, proactively advocating for the child to ensure that others play their role and deliver the high-quality support that is needed. (‘Guide to the children’s homes regulations including the quality standards’, page 11, paragraph 2.4)

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Recommendations

In particular, ensure that staff receive training about care proceedings and care planning regulations to understand the processes involved and the responsibility of others in the child’s care.

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Recommendations

 Records of restraint must be kept and should enable the registered person and staff to review the use of control, discipline and restraint to identify effective practice and respond promptly where any issues or trends of concern emerge. The review should provide the opportunity for amending practice to ensure it meets the needs of each child. (‘Guide to the children’s homes regulations including the quality standards’, page 49, paragraph 9.59)

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Recommendations

Specifically, the records should clearly outline the details of the child’s behaviour leading to the use of the measure; the specific time of the restraint; and clear details of the physical intervention used. This will assist the manager in monitoring each incident.

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Recommendations

 Staff should be familiar with the home’s policies on record keeping and understand the importance of careful, objective, and clear recording. Staff should record information on individual children in a non-stigmatising way that distinguishes between fact, opinion and third-party information. Information about the child must always be recorded in a way that will be helpful to the child. (‘Guide to the children’s homes regulations including the quality standards’, page 62, paragraph 14.4) Inspection report children’s home: 1267402 7

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improvement to be good

The young person is engaging in dealing with his health needs and he is receptive to the staff and the multi-disciplinary team of professionals that work with him. This ensures that his complex health needs are managed well. The staff ensure that when the young person is becoming unwell that medical attention is sought quickly, which may include stays with him at the hospital. However, the staff do not sign the medication in and out of the home. This practice presents a risk of medication going missing and not being accounted for, which is not effective safeguarding practice. Furthermore, a health risk is presented in the home. This is because faecal waste from one of the pets has not been removed promptly and sterilised.

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improvement to be good

The young person attends college regularly, which bodes well for his future aspirations. Staff have reduced the levels of supervision of the young person to prepare him for adulthood. Observations of the young person range from fully supervised to 30-minute checks. There has also been a reduction in the number of staff supporting the young person. While this is positive and indicates progress on the young person’s part, there is no clear rationale or audit trail for these decisions. There is no evidence in the young person’s documents on how the staff will respond should the young person’s behaviours revert to his previous behaviours.

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improvement to be good

The young person knows how to express his views. However, there are concerns about the young person’s specific views relating to race. Staff are not uniform in their responses to this behaviour and no referrals have been made to outside agencies for support. As a result, the challenge to the young person is inconsistent and lacks a shared approach from the staff.

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improvement to be good

Staff facilitate contact between the young person and significant others, promoting family relationships and friendships both at the home and in the community. The young person is engaging in a range of activities that aid his fitness.

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improvement to be good

Overall, the young person is happy living at the home, which offers him stability from the consistent staff team that he trusts and gets along with, and which makes him feel valued. Consequently, the young person has continued to make positive progress.

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improvement to be good

The young person feels safe in his home and with the staff. He has good support from staff to keep himself safe. He does not go missing, use substances and is not involved in criminal or sexual exploitation. There are no reports of bullying and episodes of self- harm have reduced in severity and frequency in recent months.

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improvement to be good

The risks to the young person are known by the staff but are not accurately detailed in Inspection report children’s home: 1267402 8 the risk assessment. The risk assessment is not revised to include new risks following more recent incidents and it is not dated. This means that some staff may be unaware of current events and risks and therefore be unable to safeguard and manage the young person’s behaviour effectively.

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improvement to be good

Staff are aware of the need to conduct room searches, as detailed in the risk assessment and to remove any items the young person could use to self-harm. However, room searches are a reactive response following an incident of self-harm and are not used to prevent harm to the young person. Staff do not think about removing items that the young person could use to self-harm and neither are they consistent in their insight about dangers from ligatures. There is historical risk related to the young person using ligatures. Some staff did not know where the ligature cutters were located and had not received training on their use.

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improvement to be good

The behaviour management policy is outdated, and the current method used is not specified in the statement of purpose. Training in positive behaviour management is not yet embedded in practice. The young person has been subject to physical intervention, but there is no record and there is no review of events or debriefings to explore whether actions were necessary or proportionate.

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The effectiveness of leaders and managers: inadequate

Weak and ineffective leadership and management have resulted in a service that has significantly hindered the staff team’s ability to fully support the young person and promote his welfare to a consistently high standard.

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The effectiveness of leaders and managers: inadequate

The registered manager has failed to implement monitoring systems, which has resulted in a number of missed opportunities to take decisive action by prioritising effectively, challenging and making service improvements quickly. The manager has not escalated concerns when information has not been available about the young person’s health and well-being. For example, the manager failed to progress a health assessment and the outcome following a review of the young person’s deprivation of liberty order. The absence of a suitable monitoring infrastructure has not enabled the registered manager to have a robust oversight of the gaps in practice to enable her to make a clear evaluation of the young person’s progress, outcomes and safety.

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The effectiveness of leaders and managers: inadequate

The deputising arrangements in the registered manager’s absence are not effective. This is because staff do not have access to the relevant management information, which limits their capacity to deliver effective management oversight of the home.

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The effectiveness of leaders and managers: inadequate

Regulation 44 reports undertaken by the independent visitor are repetitive in parts and they do not provide a consistently accurate account of how the home is operating. For example, information in the reports confirm that the registered manager had completed the Regulation 45 review when one has not been done since the home was registered in April 2018. The requirement to complete the Regulation 45 review and send a copy to Ofsted was raised at the last inspection and is repeated. A complaint that has been received by the registered manager is reported to have been successfully addressed, but Inspection report children’s home: 1267402 9 there is no written audit trail to show how the outcome of the complaint was evaluated. These concerns call into question the level of rigour and scrutiny of the independent visits and the quality of the communication between the registered manager and the independent visitor.

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The effectiveness of leaders and managers: inadequate

The consistent staff team has supported the young person to make progress. Staff speak positively about the young person and about their trusting bonds. The staff feel supported by the management. However, not all of the supervisions are taking place frequently, which is demonstrated by a significant gap of six months for at least one staff member.

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The effectiveness of leaders and managers: inadequate

Gaps in staff training, in areas such as diversity issues, hinder staff practice when they are educating the young person about their discriminatory views, and staff may not be able to take timely action to protect the young person should they self-harm using ligatures.

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The effectiveness of leaders and managers: inadequate

The two recommendations raised at the last inspection have not been met. The registered manager has not sourced staff training about care proceedings and care planning regulations. This does not provide staff with a clear understanding of the processes involved and responsibility of others in the child’s care. Restraint records have not been implemented to ensure safe and effective practice. The registered manager’s capacity to improve is limited by her not taking prompt action to address these important matters. The current statement of purpose is not a true reflection of the service with regard to the type of behaviour management used by the home.

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The effectiveness of leaders and managers: inadequate

Not all of the young person’s records are consistently legible or available, which is concerning given the young person’s complex needs. Full information through the annex A was not available during the inspection. This did not reassure Ofsted that the provider had a robust and sufficient oversight of the home. The registered manager did not demonstrate a suitable understanding of the regulations linked to managing a children’s home. This raises serious concerns about her capacity to manage the home effectively and lead the care of children.

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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: 1267402 10 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: 1267402 11

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Children’s home details

Registered provider: Positive Individual Proactive Support Limited

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Children’s home details

Registered provider address: Endeavour House, 12 Ellerbeck Way, Stokesley, Middlesbrough TS9 5JZ

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Inspectors

Jacqueline Malcolm, social care inspector Deb Duffy, social care inspector Inspection report children’s home: 1267402 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 children looked after, safeguarding and child protection.

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Inspectors

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Inspectors

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Inspectors

T: 0300 123 1231 Textphone: 0161 618 8524 E: enquiries@ofsted.gov.uk W: http://www.gov.uk/ofsted

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