Children's Home, Residential special school run by Cambian Autism Services Limited in Dorset

Inspection report children‟s home: SC065261 1 SC065261 Registered provider: Cambian Autism Services 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

The children’s s home is registered for up to 60 children who have autism spectrum disorders and/or learning disabilities. The service operates as a residential special school that also provides accommodation for 52 weeks of the year. As a result, it is registered as a children’s s home. The home provides care across 9 houses. The home is owned by a private national organisation. The registered manager left in July 2019. This post is currently vacant.

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Information about this children’s home

Inspection dates: 24 to 26 September 2019

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Overall experiences and progress of

children and young people, taking into account

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requires improvement to be good

How well children and young people are helped and protected requires improvement to be good

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requires improvement to be good

The effectiveness of leaders and managers requires improvement to be good

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requires improvement to be good

The children’s home is not yet delivering good help and care for children and young people. However, there are no serious or widespread failures that result in their welfare not being safeguarded or promoted.

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requires improvement to be good

Overall judgement at last inspection: sustained effectiveness

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requires improvement to be good

Enforcement action since last inspection: none Inspection report children‟s home: SC065261 2

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Inspection date Inspection type Inspection judgement

09/01/2019 Interim Sustained effectiveness 17/07/2018 Full Requires improvement to be good 16/10/2017 Full Requires improvement to be good 27/06/2017 Full Inadequate Inspection report children‟s home: SC065261 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 s homes regulations including the quality standards’. The registered person(s) must comply within the given timescales.

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Requirement Due date

13: The leadership and management standard (1) The leadership and management standard is that the registered person enables, inspires and leads a culture in relation to the children’s s home that— (a) helps children aspire to fulfil their potential; and (b) promotes their welfare. (2) In particular, the standard in paragraph (1) requires the registered person to— (a) 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 s statement of purpose; (b) ensure that staff work as a team where appropriate; (c) ensure that staff have the experience, qualifications and skills to meet the needs of each child; (d) ensure that the home has sufficient staff to provide care for each child; (e) ensure that the home’s s workforce provides continuity of care to each child; (f) understand the impact that the quality of care provided in the home is having on the progress and experiences of each

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Requirement Due date

child and use this understanding to inform the development of the quality of care provided in the home; (h) use monitoring and review systems to make continuous improvements in the quality of care provided in the home. (Regulation 13(1)(a)(b)(2)(a)(b)(c)(d)(e)(f)(h) In addition, develop an effective system for monitoring staff training. 31/12/2019

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Requirement Due date

23: Medicines (1) The registered person must make arrangements for the handling, recording, safekeeping, safe administration and 30/11/2019 Inspection report children‟s home: SC065261 4 disposal of medicines received into the children’s home. (Regulation 23(1)) 25: Fire precautions (1) After consultation with the fire and rescue authority, the registered person must— (a) take adequate precautions against the risk of fire, including the provision of suitable fire equipment in the children’s s home; (b) provide adequate means of escape from the home in the event of fire; (Regulation 25(1)(a)(b)) In particular, ensure that all fire doors are compliant and operational. In addition, ensure that all means of escape are free from obstruction. 31/10/2019

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Requirement Due date

31: Staffing of children’s homes The registered person must ensure that the employment of any person on a temporary basis at the children’s s home does not prevent children from receiving such continuity of care as is reasonable to meet their needs. (Regulation 31(1)) In particular, leaders and managers must ensure that all agency staff have been recruited using safer recruitment practices, that they have the relevant experience to work in the home, that they receive a good-quality induction and regular supervision, and that they receive essential training prior to caring for children. Leaders and managers are required to maintain training records of agency staff. 31/10/2019

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Requirement Due date

37: Other records (1) Schedule 4 sets out the other information that the registered person must keep in relation to a children’s s home. (2) The registered person must— (a) maintain in the home the records in Schedule 4; (b) ensure that the records are kept up to date. Schedule 4 Register of children 1. A record in the form of a register showing in respect of each child— (a) the date of the child’s a dmission to the children’s s home; (b) the date on which the child ceased to be accommodated in the home; (c) the child’s s address immediately before being accommodated in the home; 30/11/2019 Inspection report children‟s home: SC065261 5 (d) the child’s s address on leaving the home; (e) the child’s s placing authority; and (f) the statutory provision (if any) under which the child is accommodated. (Regulation 37(1)(2)(a)(b). Schedule 4(1)(a)(b)(c)(d)(e)(f)) 40: Notification of a serious event (4) The registered person must notify HMCI and each other

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Requirement Due date

relevant person without delay if— (c) there is an allegation of abuse against the home or a person working there; (d) a child protection enquiry involving a child — (i) is instigated; or (ii) concludes (in which case, the notification must include the outcome of the child protection enquiry); or (e) there is any other incident relating to a child which the registered person considers to be serious. (Regulation 40(4)(c)(d)(i)(ii)(e)) 30/11/2019

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Requirement Due date

45: Review of quality of care (1) 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. (2) In order to complete a quality of care review the registered person must establish and maintain a system for monitoring, reviewing and evaluating— (a) the quality of care provided for children; (b) the feedback and opinions of children about the children’s s home, its facilities and the quality of care they receive in it; and (c) any actions that the registered person considers necessary in order to improve or maintain the quality of care provided for children. (3) 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”).

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Requirement Due date

(4) The registered person must— (a) 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 30/11/2019 Inspection report children‟s home: SC065261 6 completed; and (b) 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. (5) The system referred to in paragraph (2) must provide for ascertaining and considering the opinions of children, their parents, placing authorities and staff. (Regulation 45(1)(2)(a)(b)(c)(3)(4)(a)(b)(5))

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Recommendations

 For children’s s homes to be nurturing and supportive environments that meet the needs of their children, they will, in most cases, be homely, domestic environments. Children’s s homes must comply with relevant health and safety legislations (alarms, food hygiene etc.); however, in doing so, homes should seek as far as possible to maintain a domestic rather than ‘institutional’ impression. (‘Guide to the children’s s homes regulations including the quality standards’, page 15, paragraph 3.9) In particular, leaders and managers must review the size of the maintenance team to ensure that they can meet the demands placed on them. In addition, leaders and managers must raise staff vigilance and awareness of the environments that they are working in.  Each child should have permission for staff to administer first aid and non- prescription medication from a person with parental responsibility for them recorded in their relevant plan. For looked-after children, this permission should

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Recommendations

be sought and arranged by the child’s social worker. Where appropriate, the child’s family should be involved in supporting their child’s s health needs as well as in providing permission for treatment. (‘Guide to the children’s homes regulations including the quality standards’, page 35, paragraph 7.14)  No more than half the staff on duty at any one time, by day or night at the home should be from an external agency. (‘Guide to the children’s homes regulations including the quality standards’, page 1, paragraph 10.17)  As set out in regulations 31-33, the registered person is responsible for maintaining good employment practice. (‘Guide to the children’s homes regulations including the quality standards’, page 61, paragraph 13.1) In particular, risk assessments must be completed for staff with known medical conditions.  The registered person should only accept placements for children where they are

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Recommendations

satisfied that the home can respond effectively to the child’s s assessed needs as recorded in the child’s s relevant plans and where they have fully considered the impact that the placement will have on the existing group of children. (‘Guide to the children’s s homes regulations including the quality standards’, page 56, paragraph 11.4) Inspection report children‟s home: SC065261 7

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improvement to be good

Insufficient permanent staffing affects all areas of the provision and results in a lack of consistency of care provided for children. This has been an ongoing issue for three years and reported on in previous inspections. Vacant shifts continue to be covered by temporary staff in addition to permanent staff working overtime. While it is positive that staffing numbers are sufficient, it does mean that children are cared for by a number of different adults rather than a core group of consistent carers. This does not aid in the development of strong relationships between children and staff. Staff skilfully communicate with children and use social stories effectively to prepare children for situations that they may find difficult. As a result, children are making progress with developing their communication skills and independence skills. Staff use communication aids effectively and support children to learn skills at their own pace in

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improvement to be good

line with their individual needs. Children’s s achievements are celebrated. One child who is a gifted artist recently held an exhibition of their work which was attended by the local community. Staff have improved how they capture and evidence this progress. Improvements have been made to the quality of the residential environment and there is an ongoing refurbishment programme in place. Some houses continue to provide a better quality of accommodation than others. However, awareness of the children’s s environment is not consistent. Some staff are failing to pick up on potential environmental hazards, for example a trailing wire in one house which staff had not noticed. While maintenance issues are dealt with, further work is required to review the capacity of the maintenance team to ensure that issues are always dealt with promptly. Children’s s access to the community has improved, but staffing levels can impede this.

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improvement to be good

This issue was raised by parents and staff. Staff have developed personalised enrichment plans which are of good quality. These plans are being used to enhance children’s s experiences. Parents and social workers praised the staff for the support and care that they provide for the children, but all mentioned that staff shortages remain an issue.

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improvement to be good

The management of medication requires improvement. In one house, there are inconsistencies in stock records and medication packaging is missing for one medication. In another house, the disposal of medication has not been carried out as required. In addition, one child does not have parental consents in place for staff to administer medication or first aid. Medication errors have increased throughout the year, with six incidents in September 2019. Leaders and managers are acting to improve the management of medication, but this is not yet embedded into practice. Safeguarding incidents are responded to appropriately. Records of these events are clear, Inspection report children‟s home: SC065261 8 contain reflective practice discussions and show that lessons learned are being used to adapt practice. Referrals are made to the appropriate professionals, but Ofsted was not notified of one event as required.

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improvement to be good

Fire safety precautions require improvement. During the inspection, six fire doors were found to be ineffective despite daily checks being carried out by staff. In addition, a fire escape was blocked by wooden planks during emergency response works to an electricity supply and fallen ceiling. Both of these issues were addressed during the inspection. The site fire risk assessment is ineffective. The description of the premises is incorrect and does not contain details of the external fire escape.

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improvement to be good

All children have a personal evacuation plan. Where children have not taken part in a fire drill, this is recorded in their plan along with the reasons why. Staff carry out ‘silent drills’ with these children to ensure that they know what to do in the event of an emergency. Overall, behaviour is managed effectively. Behaviour support plans are up to date and provide staff with clear working strategies. The behaviour co-ordinator has good oversight of behavioural events. She reviews records for quality and to identify any patterns. However, she does not monitor the restraint training of staff and so did not identify that a member of staff had restrained a child after the member of staff’s s training certificate had expired. On four occasions, higher-level restraints have been used. The behaviour group has undertaken a thorough review of each of these incidents to identify ways to prevent them from happening again.

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improvement to be good

In most cases, debrief discussions with children after incidents of restraint have improved. Staff use creative approaches to ensure that these discussions are meaningful. For example, staff use a child’s s favourite character to engage the child and enable them to answer questions about how they feel. This approach has proved effective. Contrary to this good practice, on four occasions staff involved in the restraint carried out the debrief discussion with children, thus reducing the ability for independent reflection. The quality of discussions with staff involved in a restraint is now reflective and reviews staff practice. Staff respond appropriately when children have gone missing. Due to the vulnerability of the children, these four missing from home incidents have been fully investigated and have led to one agency worker no longer being used. Risk assessments vary in quality. Children’s s individual risk assessments are detailed and

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improvement to be good

provide staff with strategies to reduce the level of risk. However, the risk assessments completed for potential new children require improvement. They do not reflect all the information in the referral documentation or assess the risks alongside the other children’s s needs. Although the recruitment of permanent and bank staff adheres to safer recruitment practices, records maintained for agency staff do not. This does not safeguard children effectively.

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

Inspection report children‟s home: SC065261 9 Currently, there is no registered manager in post. The registered manager left on 16 July 2019. As an interim measure, two care managers with the support of senior managers are covering this role. Recruitment for this post is ongoing. Sufficiency of permanent staffing continues to require robust action. At times during the day and overnight, more agency staff have been deployed to care for children than permanent staff. Leaders and managers are aware of this weakness and are continuing to try to recruit permanent staff. Several agency staff have worked in the home for a number of years and know the children and their needs well. Leaders and managers do not understand all the home’s s strengths and areas for improvement. They had not identified all the shortfalls found by inspectors. Monitoring of the quality of care is hampered due to information being stored in several different

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

locations, thus causing a lack of cohesion. In addition, some staff spoken to were unclear of their role and responsibilities which may affect the quality of records maintained. Leaders and managers are receiving additional support from senior staff from within the organisation. This support is starting to help leaders and managers to develop the service. Leaders and managers have an ambitious vision for the future and are making improvements, but more work is required. During the inspection, leaders and managers acted to address some of the points raised. They have and continue to develop new working practices, but these have yet to be implemented or embedded. The frequency and quality of supervision of permanent staff has improved. These sessions are now reflective and help staff develop their practice. Staff who carry out supervisions have received training from senior managers on delivering good

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

supervision. This training has had a positive impact. However, agency staff are not currently receiving regular good-quality supervision. Leaders and managers have not carried out risk assessments for all staff with known health issues. Ofsted had not been sent a report following leaders and managers’ review of the quality of care as required. However, the review had been completed and the information was made available during the inspection. These reports are required to be sent to Ofsted at least every six months. The record of children moving into and leaving the home is incomplete. It does not consistently contain information about where the child moves from and to, or confirm the child’s s legal status. Induction training for staff has improved. Senior leaders have reviewed and implemented a new induction programme which is proving effective. New staff felt that this was preparing them for the role.

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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 Inspection report children‟s home: SC065261 10 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 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 s Homes (England) Regulations 2015 and the ‘Guide to the children’s s homes regulations including the quality standards’. Inspection report children‟s home: SC065261 11

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Children’s home details

Provision sub-type: Residential special school

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Children’s home details

Registered provider: Cambian Autism Services Limited

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Children’s home details

Registered provider address: Metropolitan House, 3 Drakes Road, Potters Bar EN6 1AG

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Children’s home details

Responsible individual: Virginia Bellard

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Inspectors

Wendy Anderson, social care inspector Clare Davies, social care inspector Janice Hawtin, social care inspector Inspection report children‟s home: SC065261 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

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