Children's Home run by Hexagon Care Services Limited in Westmorland and Furness

Inspection report for children’s home - monitoring visit: 1269215 1

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Hexagon Care Services Limited

Monitoring visit Inspected under the social care common inspection framework

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Information about this children’s home

The home is operated by a private company. It provides care and accommodation for up to four children and young people with social and emotional difficulties. The home is registered for single-sex occupancy only (female).

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Information about this children’s home

The manager has been in post since 1 August 2018 and registered with Ofsted on 24 October 2018. The registered manager has resigned from his post, a new manager has been appointed and is due to start working at the home on 16 November 2019.

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This monitoring visit

At the full inspection on 22 to 23 August 2019 and 24 September 2019, the home was judged inadequate. Several shortfalls were identified. The inspectors found evidence of managers and staff failing to protect children from harm, failing to follow safeguarding procedures and serious shortfalls in the leadership and management of the home which have had a detrimental impact on children’s well-being and progression.

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This monitoring visit

Two compliance notices were issued under section 22A of the Care Standards Act 2000 in relation to regulation 12, the help and protection of children standard and regulation 13, the leadership and management standard.

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This monitoring visit

On 6 November 2019, a monitoring visit was undertaken by Michelle Edge, regulation inspection manager, and Lisa Mulcahy, social care regulatory inspector, to consider the action taken by the provider to meet the steps within the compliance notices.

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This monitoring visit

The registered provider has taken sufficient steps to meet the two compliance notices. The home is now being led and managed in a way that is consistent with the approach and ethos outlined in the home’s statement of purpose, and delivers the outcomes as intended. The deputy manager, responsible individual and head of Inspection report for children’s home - monitoring visit: 1269215 2 care have been instrumental in achieving this.

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This monitoring visit

Young people spoken to during the visit told inspectors that there had been significant improvements in the home and things were much better. They feel listened to and are now part of the care planning process. There is a more consistent staff team and clear boundaries and routines in place. Consequently, the young people are safeguarded and have made good progress.

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This monitoring visit

Risk assessments have been revised, and now accurately identify the individual risks to young people and changes in risk levels. Furthermore, risk assessments provide staff with practical strategies to help them to keep young people safe. This approach ensures that risks to young people are managed consistently by the registered manager and the staff team and means that appropriate support is in place to promote the safety of young people. Consequently, the levels of risk regarding missing from home, self-harm and substance misuse have reduced for young people.

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This monitoring visit

New staff now receive a thorough induction to the home and are using the hexagon methods to use restorative practice. There are clear structures, routines and boundaries in place to keep young people safe.

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This monitoring visit

The serious allegations made against staff by the young people residing in the home have been fully investigated and are unfounded. The staff subject to allegations are either no longer suspended or have handed in their notice. The provider is no longer reliant on agency staff, only permanent staff and regular casual staff now work at the home. As a result, young people are cared for by staff who they know and have developed relationships with. This provides young people with continuity of care.

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This monitoring visit

Team meetings have taken place and the detailed minutes from these meetings demonstrate that the registered manager and staff have discussed roles and responsibilities, safeguarding, reporting and recording, complaints, whistleblowing and managing allegations. Additionally, the registered manager and staff have received supervision to discuss the inadequate inspection and what went wrong, the home’s ethos, statement of purpose and improvements that could be made. However, the supervision records viewed were variable in quality and do not all demonstrate that staff have reflected on practice and the needs of the young people.

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This monitoring visit

Improved monitoring systems are helping the registered manager to identify and act to address shortfalls. The provider has implemented more robust management monitoring systems that include monitoring young people’s files, supervision sessions, staff handovers, medication, incidents, physical interventions and room searches. Additionally, staff receive clear management direction and support. As a result, safeguarding practice and the quality and consistency in care have improved.

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This monitoring visit

Some records are still not consistently completed using the required detail, for example handovers and daily diary sheets. However, this has not impacted on the Inspection report for children’s home - monitoring visit: 1269215 3 improvements in the quality of care provided. It is positive that the provider has identified the action required to continue with the improvements made.

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This monitoring visit

The two compliance notices have been met. No further enforcement action is planned. However, a further inspection will take place to review how these improvements are being embedded into the home’s practice, and to ensure that the home’s ongoing development is sustained. Inspection report for children’s home - monitoring visit: 1269215 4

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Recent inspection history

Inspection date Inspection type Inspection judgement 22/08/2019 Full Inadequate 06/03/2019 Interim Improved effectiveness 08/01/2019 Full Good Inspection report for children’s home - monitoring visit: 1269215 5

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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 registered person must make arrangements for the handling, recording, safekeeping, safe administration and disposal of medicines received into the children’s home.

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Requirement Due date

In particular the registered person must ensure that—

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Requirement Due date

medicine which is prescribed for a child is administered as prescribed to the child for whom it is prescribed and to no other child. (Regulation 23 (1)(2)(b)) 01/11/2019

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Requirement Due date

The registered person must ensure that all employees—

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Requirement Due date

receive practice-related supervision by a person with appropriate experience. (Regulation 33 (4)(a)(b)(c)) 01/11/2019

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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—

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Requirement Due date

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;

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Requirement Due date

help each child to understand how to keep safe;

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Requirement Due date

have the skills to identify and act upon signs that a child is at risk of harm;

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Requirement Due date

understand the roles and responsibilities in relation to protecting children that are assigned to them by the registered person;

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Requirement Due date

take effective action whenever there is a serious concern about a child’s welfare; and 01/11/2019 Inspection report for children’s home - monitoring visit: 1269215 6 are familiar with, and act in accordance with, the home’s child protection policies. (Regulation 12 (1)(2)(a)(i)(ii)(iii)(v)(vi) and (vii)) 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—

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Requirement Due date

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. (Regulation 12 (1)(2)(b)) 01/11/2019

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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—

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Requirement Due date

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—

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Requirement Due date

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 statement of purpose;

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Requirement Due date

ensure that staff work as a team where appropriate;

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Requirement Due date

ensure that staff have the experience, qualifications and skills to meet the needs of each child;

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Requirement Due date

ensure that the home’s workforce provides continuity of care to each child;

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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)(a)(b)(c)(e)(h)) 01/11/2019

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Requirement Due date

The registered person must prepare and implement a policy which—

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Requirement Due date

is intended to safeguard children accommodated in the children’s home from abuse or neglect; and

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Requirement Due date

sets out the procedure to be followed in the event of an allegation of abuse or neglect. 01/11/2019 Inspection report for children’s home - monitoring visit: 1269215 7 The procedure to be followed in the event of an allegation of abuse or neglect must, in particular—

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Requirement Due date

provide for the prompt referral of an allegation about current or ongoing abuse or neglect in relation to a child to the placing authority and, if different, the local authority in whose area the home is located;

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Requirement Due date

provide for the prompt referral of an allegation about past abuse or neglect in relation to a child to the placing authority and, if different, the local authority in whose area the alleged abuse or neglect occurred. (Regulation 34(1)(a)(b)(2)(b)(c)) The care planning standard is that children— receive effectively planned care in or through the children’s home; and

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Requirement Due date

have a positive experience of arriving at or moving on from the home.

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Requirement Due date

In particular, the standard in paragraph (1) requires the registered person to ensure—

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Requirement Due date

that each child’s relevant plans are followed. (Regulation 14 (1)(a)(b)(2)(c)) 01/11/2019

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Requirement Due date

The registered person must maintain records ("case records") for each child which—

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Requirement Due date

are signed and dated by the author of each entry. (regulation 36(1)(b)(c) 01/11/2019

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Requirement Due date

Subject to paragraph (6), the registered person must establish a procedure for considering complaints made by or on behalf of children.

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Requirement Due date

In particular, the procedure must provide that no person who is the subject of a complaint takes any part in its consideration or investigation, except at the informal resolution stage if the registered person considers it appropriate.

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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(1)(2)(3)) 01/11/2019

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Requirement Due date

The independent person must produce a report about a visit ("the independent person’s report") which sets out, in particular, the independent person’s opinion as to whether— 01/11/2019 Inspection report for children’s home - monitoring visit: 1269215 8 children are effectively safeguarded; and

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Requirement Due date

the conduct of the home promotes children’s well-being. (Regulation 44(4)(a)(b))

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Recommendations

 When a child returns to the home after being missing from care or away from the home without permission, the responsible local authority must provide an opportunity for the child to have an independent return home interview. Homes should take account of information provided by such interviews when assessing risks and putting arrangements in place to protect each child. (‘Guide to the children’s homes regulations including the quality standards’, page 45, paragraph 9.30)

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Recommendations

Specifically, independent return interviews must occur following each missing episode and within the appropriate timescale.

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Recommendations

 Records must be kept detailing all individual incidents when children go missing from the home. Evaluation of missing incidents should be undertaken to identify any gaps in training, skills or knowledge for staff or to record and retain evidence of what worked well. This evaluation should inform the review of the quality of care. (‘Guide to the children’s homes regulations including the quality standards’, page 45, paragraph 9.31)

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Recommendations

Specifically, the manager’s evaluation will be recorded following each missing episode and will take account of any concerns arising from the independent return interview. However, the detailed content of the independent interview should not routinely be part of this record to be viewed by staff in the home.  Regulation 19(2) details sanctions that are prohibited in behaviour management. Any sanctions used to address poor behaviour should be restorative in nature, to help children recognise the impact of their behaviour on themselves, other children, the staff caring for them and the wider community. (‘Guide to the children’s homes regulations including the quality standards’, page 46, paragraph 9.38)

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Recommendations

Specifically, ensuring sanctions are relevant and proportionate to the behaviour exhibited.

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Recommendations

 The use of external agency staff can be a positive choice to complement the skills and experiences of the permanent workforce. Any external agency staff should meet the requirements in regulation 32(4) regarding mandatory qualifications and the registered person should consider their skills, qualifications and any induction necessary before they commence work in the home. The use of agency staff should be carefully monitored and reviewed to Inspection report for children’s home - monitoring visit: 1269215 9 ensure children receive continuity of care. (‘Guide to the children’s homes regulations including the quality standards’, page 54, paragraph 10.16)

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Information about this inspection

The purpose of this visit was to monitor the action taken and the progress made by the children’s home since its last Ofsted inspection.

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Information about this inspection

This inspection was carried out under the Care Standards Act 2000.

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Children’s home details

Registered provider: Hexagon Care Services Limited

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Children’s home details

Registered provider address: 1 Tustin Court, Port Way, Ashton-On-Ribble, Preston, Lancashire PR2 2YQ

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Inspector(s)

Lisa Mulcahy, social care inspector Mrs Michelle Edge, social care inspector Inspection report for children’s home - monitoring visit: 1269215 10 to 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(s)

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Inspector(s)

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Inspector(s)

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