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 part of an independent school for children who have an autism spectrum disorder and/or severe learning disabilities. The great majority of 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 15 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 and has made an application to register.

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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: inadequate Inspection report children‟s home: SC043994 2

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Enforcement action since last inspection:

Following the July 2019 inspection, five compliance notices were issued. These related to the protection of children standard, the leadership and management standard, fire precautions and the fitness of workers.

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Enforcement action since last inspection:

In addition to the compliance notices, a suspension of registration was served on 22 July 2019. This was subsequently lifted and replaced with a restriction of accommodation. The restriction notice was lifted on 19 August 2019. The five compliance notices were judged to be met on 27 August 2019. Inspectors have carried out three monitoring visits since the last inspection. Inspection report children‟s home: SC043994 3

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Inspection date Inspection type Inspection judgement

16/07/2019 Full Inadequate 09/10/2018 Full Good 24/01/2018 Interim Sustained effectiveness 14/06/2017 Full Good Inspection report children‟s home: SC043994 4

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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 children’s views, wishes and feelings standard is that children receive care from staff who— take their views, wishes and feelings into account in relation to matters affecting the children’s care and welfare and their lives.

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Requirement Due date

In particular, the standard in paragraph (1) requires the registered person to— ensure that each child— is enabled to provide feedback to, and raise issues with, a relevant person about the support and services that the child receives. (Regulation 7 (1)(c)(2)(b)(i)) 08/01/2020

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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. (Regulation 10 (1)(a)(b)(c))

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Requirement Due date

In particular, ensure that children are consistently supported to access their sensory diets within the children’s home. 08/01/2020

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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)) 08/01/2020

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Requirement Due date

The registered person must ensure that— children can access all appropriate areas of the children’s home’s 08/01/2020 Inspection report children‟s home: SC043994 5 premises; and any limitation placed on a child’s privacy or access to any area of the home’s premises— is intended to safeguard each child accommodated in the home; is necessary and proportionate; is kept under review and, if necessary, revised; and allows children as much freedom as is possible when balanced against the need to protect them and keep them safe. (Regulation 21 (b)(c)(i)(ii)(iii)(iv))

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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

In particular, ensure that systems are in place for the timely disposal of medication. 08/01/2020

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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;

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Requirement Due date

For the purposes of paragraph (3)(b), an individual who works in the home in a care role has the appropriate qualification if, by the relevant date, the individual has attained— the Level 3 Diploma for Residential Childcare (England) (“the Level 3 Diploma”); or a qualification which the registered person considers to be equivalent to the Level 3 Diploma.

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Requirement Due date

The relevant date is— in the case of an individual who starts working in a care role in a home after 1st April 2014, the date which falls 2 years after the date on which the individual started working in a care role in a home; or in the case of an individual who was working in a care role in a home on 1st April 2014, 1st April 2016. (Regulation 32 (4)(a)(b)(5)(a)(b)) 08/01/2020

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Requirement Due date

The registered person must ensure that all employees— receive practice-related supervision by a person with appropriate experience. (Regulation 33 (4)(b)) 08/01/2020

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Requirement Due date

The registered person must maintain records (“case records”) 08/01/2020 Inspection report children‟s home: SC043994 6 for each child which— are kept up to date; and are signed and dated by the author of each entry. (Regulation 36 (1)(b)(c))

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improvement to be good

The quality of the individualised care for children is variable. For example, inspectors identified two children who were not receiving their sensory diet as directed by the therapy team. This means that children may not receive the support they need to promote their well-being. Staff told inspectors that although they have tried to ensure that the dietary needs are met, they do not have the right equipment to make this happen. The records of therapy sessions were incomplete for some children and not filled in at all for others.

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improvement to be good

Children have been at risk of harm. During the inspection, it was identified that waking night staff have not received the same training as staff working in the day. This means that there have been periods where there has been disparity in the skills of staff. This is despite the risk not reducing during the evening and early hours. The provider took urgent and immediate actions to remedy this shortfall.

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improvement to be good

Leaders and managers have not ascertained whether appropriate levels of restriction are in place for each child. For example, many children have their wardrobes and vanity units locked. However, the justification for this is not always clear. This affects the children’s opportunities to develop their independence skills. It is noted that for some children this restriction is appropriate, but this is not the case for all children.

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improvement to be good

The impact of the new activity programme has been positive for the children. Staff report that children are more settled, happier and sleep better because of increased stimulation from activities. This is a marked improvement from the last inspection.

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improvement to be good

Children are supported to attend all health appointments. In some instances, this has led to some key achievements. For example, a child who previously struggled to do so has now attended a dental appointment.

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improvement to be good

Transitions are managed well, and a great deal of work is carried out to support children with change. This is particularly true for children either moving to different houses within the children’s home, but also for children who leave the children’s home to start the next chapter of their lives.

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improvement to be good

Inspection report children‟s home: SC043994 7 The environment is safer than it was at the previous inspection. Improvements have been made to the safety of the physical environment.

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improvement to be good

Night waking staff have not received recent refresher training in emergency seizure medication. Staff working in the daytime receive this refresher training annually. However, this is not currently the case for night waking staff. This is of particular concern as at least one child is at risk of seizures in the early morning as identified from information from her previous placement.

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improvement to be good

Children are not effectively supported to make complaints. An example of this is that the children’s visual support aid for making a complaint or sharing a problem is too narrow to support a child effectively to make a disclosure, allegation or alert staff to concerns. The support aids also referred the children to a previous member of staff who has not worked in the home for a significant period of time. This has the potential to confuse children or interrupt their thought processes when trying to raise concerns.

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improvement to be good

The home liaises effectively with other agencies such as the police and the designated officer to keep children safe. There are clear plans to improve safeguarding practice such as commissioning the National Society for the Prevention of Cruelty to Children to complete a safeguarding audit.

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improvement to be good

Incidents of physical intervention have reduced and there are plans in place to reduce this further. There is more emphasis put on de-escalation and early intervention to avoid incidents. The quality of the debriefs within the recording forms is variable and there is still room for further improvement in this area.

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improvement to be good

Medication systems have improved. However, medication that is no longer required is stored within a separate, locked area within the medication cabinet. This is untidy and medication that has not be used for five months is still being stored. This does not put children directly at risk but has the potential to increase the chance of a medication error.

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

Supervisions are not consistent, and one member of staff has not had formal supervision for over a year. Staff have not received the appropriate refresher training for emergency seizure medication and there are gaps in the staff’s training records for the home’s preferred behaviour management package.

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

Monitoring and review systems are not strong and consistent in identifying the home’s weaknesses and addressing them effectively. For example, inspectors found gaps in staff training and these had not yet been identified by leaders and managers.

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

There has been considerable investment in the physical environment. Most areas are now looking like comfortable, modern homely environments. Children have been involved in the development of these areas and have had the opportunity to influence how the houses look. Inspection report children‟s home: SC043994 8 Case records are not always signed and dated. In particular, the daily progress records that were sampled and the sensory diet records that were viewed during the inspection were not consistently completed. Leaders and managers have failed to identify these shortfalls through their monitoring and review processes.

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

Although there has been some progress since July 2019, there remain some shortfalls in how the home is monitored and reviewed. The responsible individual was present throughout the inspection, as was the acting manager. The leadership and management of the home are not yet fully effective in monitoring or reviewing the quality of care being provided.

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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 9

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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) Sarah Olliver, social care inspector Keith Riley, social care inspector Anna Williams, social care compliance inspector Inspection report children‟s home: SC043994 10 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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