Children's Home run by Birtenshaw in Bolton

Inspection report children’s home: 1232380 1 Registered provider: Birtenshaw Full inspection Inspected under the social care common inspection framework

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Information about this children’s home

This privately run short-breaks service provides care and accommodation for up to six young people who may experience learning difficulties and/or emotional and behaviour difficulties.

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Information about this children’s home

Inspection dates: 23 to 24 September 2019

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Overall experiences and progress of

children and young people, taking into account

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good

How well children and young people are helped and protected good

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good

The effectiveness of leaders and managers good

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good

The children’s home provides effective services that meet the requirements for good.

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good

Overall judgement at last inspection: good

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Enforcement action since last inspection:

Aa a result of a concern received by Ofsted, a monitoring visit of the service was undertaken on 24 March 2019. This visit resulted in the suspension of the service and three compliance notices being served in respect of: regulation 6, the quality and purpose standard; regulation 13, the leadership and management standard; and regulation 14, the care planning standard.

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Enforcement action since last inspection:

A further monitoring visit was undertaken on 2 May 2019 to review the progress in meeting the actions detailed in the compliance notices. This visit deemed that suitable Inspection report children’s home: 1232380 2 action had been taken in respect of regulations 6 and 14, however steps to address all the matters detailed under regulation 13 had not been taken and therefore this notice was deemed not to have been met.

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Enforcement action since last inspection:

An additional monitoring visit was undertaken on 4 June 2019 to review the progress in meeting the compliance notice in respect of regulation 13. This visit deemed that staff had now received the appropriate level of training in order to carry out their role adequately. The service was deemed to have met the compliance notices and therefore the suspension notice was lifted from the service. Inspection report children’s home: 1232380 3

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Inspection date Inspection type Inspection judgement

14/08/2018 Full Good 24/08/2017 Full Good 07/03/2017 Interim Declined in effectiveness 27/04/2016 Full Outstanding Inspection report children’s home: 1232380 4

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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 the child. (‘Guide to the children’s home regulations including the quality standards’, page 49, paragraph 9.59) Specifically, managers should ensure that a copy of any restraint is held on a young person’s file and should analyse the use and effectiveness of such measures.  The behaviour management strategy should be understood and applied at all times by staff, and must be kept under review and revised where appropriate. (‘Guide to the children’s home regulations including the quality standards’, page 46, paragraph 9.34) Specifically, enable those children who have the capacity to undertake, and to

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Recommendations

learn from, restorative justice for unacceptable behaviours.  All children’s case records must be kept up-to-date and securely stored while they remain in the home. Case records must be kept up-to-date and signed and dated by the author of each entry. (‘Guide to the children’s home regulations including the quality standards’, page 62, paragraph 14.3) Specifically, ensure that any additional information pertaining to a specific record, such as complaints and/or accidents, is securely filed together at the home and is regularly reviewed and updated by staff.  Children’s home staff should take reasonable precautions to make informed professional judgements based on the individual child’s needs and developmental stage about when to allow a child to take a particular risk or follow a particular course of action. Staff should discuss the decision with the child’s placing authority where appropriate. If a child makes a choice that would place them or

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Recommendations

another person at significant risk of harm, staff should assist them to understand the risks and manage their risk-taking behaviour to keep themselves or others safe. (‘Guide to the children’s home regulations including the quality standards’, page 42, paragraph 9.7) Specifically, ensure that risk assessments are complied with and that any changes made to the risk assessment are updated along with the current risk management strategy. Inspection report children’s home: 1232380 5

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Overall experiences and progress of children and young people: good

Since the last inspection in August 2018, the service has endured a period of significant crisis. As a result, in March 2019, three compliance notices were served on the service and the service registration was suspended. Details of the action taken to address the concerns are recorded in the enforcement section of this report.

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Overall experiences and progress of children and young people: good

Since the last inspection in August 2018, six young people have been discharged from this short-break service. Five young people have moved on to adult provision and one young person has moved to a long-term residential provision. There have been five new admissions to this short-break service. At the time of this inspection, nine young people are accessing this service.

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Overall experiences and progress of children and young people: good

Planning for care is improved. Referrals to the service are screened by both the registered manager and senior managers. This practice ensures that the service offers short-break care and accommodation only to young people whom the staff are trained and competent to care for. In addition, consideration is given to the needs of others accessing the service. This means that the young people having short breaks are more likely to meet comparable peers.

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Overall experiences and progress of children and young people: good

Consultation with young people, their parents, education and social workers is considerably improved. Managers and staff have worked together to devise for young people simple feedback forms using emojis and symbols. This helps young people to inform the staff of their likes, dislikes, favourite foods and activities. This also enables young people to let staff know if they are unhappy. Symbols and emojis are available in all rooms, and are now part of young people’s daily routine.

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Overall experiences and progress of children and young people: good

The registered manager has worked hard to form trusting relationships with parents. Communication is improved. Parents receive regular updates on the progress that their child makes and the activities that they have undertaken. For example, each young person now has a ‘My time at short breaks’ folder. This provides parents and social workers with a full account of the work undertaken with their child, including photographs, consultation forms and key-worker summaries. One parent said: ‘I can’t believe how well he is doing. We have been shopping for the first time, and he loved it.’ Another parent said, ‘This is a great service that is provided to children and their families, and it cannot be over-emphasised.’

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Overall experiences and progress of children and young people: good

Young people now enjoy a range of indoor and outdoor activities. The service includes a smallholding with goats and hens, which is regularly used for enrichment activities with young people. Likewise, young people access the on-site gym, outside playground and specifically designed play area, including static cycles, a trampoline, a playhouse and sandpits. In addition, and in accordance with their placement goals, there are plenty of in-house activities, such as two sensory rooms, simple board games, arts and crafts equipment and regular baking and cooking sessions. As a result, young people benefit in many ways. For example, the social activities help them to develop a better tolerance of Inspection report children’s home: 1232380 6 people around them, and the outside equipment provides exercise and helps to develop coordination and fine and gross motor skills. In addition, young people who have difficulty in tolerating different tastes and textures begin to try different foods in the

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Overall experiences and progress of children and young people: good

Healthcare planning is improved. All staff have received additional medication training. Policies and procedures now include the service admission procedure, which has been reviewed and amended. This means that there is a more coherent overview of the medical needs of the young people accessing the service. As a result, systems are further developed to ensure that medication processes are followed and any medical concerns are reported immediately, in accordance with the young person’s plan.

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Overall experiences and progress of children and young people: good

Since the last inspection in August 2018, there has been one concern raised to Ofsted about this service. There have been no further complaints or concerns. However, upon reviewing the record of complaints it is noted that the investigations and outcomes are either stapled to, or loose in, the complaints file. This means that pertinent information about a complaint is at risk of being compromised or mislaid. Records of complaints must be held securely at the service. A recommendation is made to address this matter.

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

Although young people accessing this service do not have a history of absenting themselves from home, the short-break service provides for such an eventuality through risk assessment and management. These assessments ensure that young people are suitably monitored, both at the service and when they are in the community. In the event that a young person should absent themselves, clear procedures are known to all staff.

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

Individual risk assessments are completed for each young person in respect of their time in the service and the activities that they may undertake. However, some risk assessments are not consistently followed, for example in taking a change of clothes for a young person when they are out in the community. Although this measure had not been required for a period of time, on the one occasion that it was required the staff had not followed the risk strategy. As a result, the consistent response required by the young person to manage this behaviour was not delivered. A recommendation is made to address this matter.

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

Young people develop good relationships with the staff within the service. On the whole, staff are able to distract young people from presenting negative behaviours and redirect them to different activities. However, when young people have the capacity to understand their behaviours, particularly towards peers, there is limited opportunity for them to learn about the consequences through restorative justice to help them to make a change in their behaviour. A recommendation is made to address this matter.

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

There are occasions where young people require physical intervention to protect them or their peers from harm. Parents provide consent for such interventions and are provided with a summary of the event. The use of physical intervention is minimal. Since the last Inspection report children’s home: 1232380 7 inspection there have been nine incidents. The central record provides sufficient detail of each incident and is supported by an incident report. However, the records are not transferred to the young person’s file. Therefore, should the young person or their family wish to review their file, no information on physical interventions would be available.. In addition, managers have not reviewed or analysed physical intervention at the home.. This means that potential patterns and trends that may provoke a change in a young person’s behaviour are not identified. A recommendation is made to address this matter.

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

Young people accessing this service may have gross motor and/or coordination difficulties. There are occasions where young people have sustained minor injuries because of a fall or bump while at the service. A log of accidents is maintained at the service and parents and social workers are made aware of any injury that has been sustained. In addition, full reports are forwarded to the organisation’s health and safety department for review. However, records of accidents are not held on the young person’s file. Consequently, young people and parents cannot review such incidents, should they view a young person’s file. Moreover, managers have not reviewed or analysed all the accidents at the home’ This means that potential activities and service dynamics are not checked to identify any patterns and trends. A recommendation is made to address this matter.

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The effectiveness of leaders and managers: good

The manager has been in position since May 2018, becoming the registered manager in July 2018. She has a number of years of experience in working with young people with learning disabilities. She is supported by a stable and enthusiastic staff team.

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The effectiveness of leaders and managers: good

Since the last inspection, a new independent visitor has been appointed to the service. Reports received to Ofsted now provide a clear overview and analysis of the service being provided. The registered manager said: ‘The new visitor is very thorough and reviews the practice as a whole. Feedback has been central to the ongoing development of our service.’

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The effectiveness of leaders and managers: good

Staff training is further developed. During the closure of the home, staff received a full package of refresher training. A staff member said: ‘We have a new manager and new senior managers. They are helping us to get it right. It is sad that the service had to close, but it was the right decision and we are now a much stronger and competent as a team.’

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The effectiveness of leaders and managers: good

Supervision of staff is further developed. Staff now receive consistent supervision which reviews their work practice, training and development needs. In addition, team meetings take place on a regular basis. Importantly, the staff have been provided with opportunities to review and discuss the deficits in previous practice, alongside developing the service’s aims and continued development. A staff member said: ‘Things are much better. Staff morale has really improved, and we are all enjoying our work again.’

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The effectiveness of leaders and managers: good

The manager and staff demonstrate that they are committed to developing and improving practice. The effectiveness of this approach is measurable in the progress that Inspection report children’s home: 1232380 8 young people make from their initial starting point and the feedback from parents and social workers.

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The effectiveness of leaders and managers: good

The manager is aware of the procedure for notifying Ofsted of incidents under regulation 40. The service has demonstrated ongoing improvements and is committed to maintaining consistent care for the young people accessing the service. There are four good practice recommendations made as a result of this inspection. Inspection report children’s home: 1232380 9

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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 difference 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: 1232380 10

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Children’s home details

Registered provider address: Darwen Road, Bromley Cross, Bolton BL7 9AB

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Inspector

Maria McGranaghan, social care inspector Inspection report children’s home: 1232380 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 looked after children, safeguarding and child protection.

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Inspector

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Inspector

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