Children's Home, Residential special school run by St Elizabeth’s Centre in Hertfordshire

Inspection report children’s home: 2495377 1 Registered provider: St Elizabeth’s Centre Interim inspection Inspected under the social care common inspection framework

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Information about this children’s home

This home, which is run by a large charitable organisation, provides care for up to 52 children who have special educational needs and/or disabilities. The home caters for children aged five to 19 who have complex medical needs, autism spectrum disorders, epilepsy and associated learning disabilities. The home consists of seven individual houses. The children attend St Elizabeth’s School, which is on the same site. The manager registered with Ofsted in April 2019.

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Inspection date: 28 January 2020

Judgement at last inspection: requires improvement to be good

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Inspection date: 28 January 2020

Enforcement action since last inspection: none Inspection report children’s home: 2495377 2

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Inspection date Inspection type Inspection judgement

24/04/2019 Full Requires improvement to be good 04/03/2019 Full Inadequate Inspection report children’s home: 2495377 3

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children and young people since the most recent full inspection

This home was judged requires improvement to be good at the last full inspection. At the interim inspection, Ofsted judges that it has sustained effectiveness.

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children and young people since the most recent full inspection

At the last inspection, nine requirements and one recommendation were raised. The manager has addressed seven of these requirements and the recommendation. Two of the requirements have been reset and six further requirements have been set at this inspection.

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children and young people since the most recent full inspection

Since the last inspection, a significant restructuring of staff roles and responsibilities and modification of the children’s records have hindered the provider’s progress in making all the required improvements. However, these changes have been beneficial to the home and the quality of care provided for the children.

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children and young people since the most recent full inspection

The standard of the children’s living accommodation is variable. All the children’s bedrooms are personalised and individually decorated in line with their preferences. Living areas are homely. However, some bathrooms, kitchens and corridors remain unwelcoming and are not well maintained. Some areas outside the home are not inviting. The patio slabs in play areas are dirty and a Christmas tree has been left in a box outside one of the houses. These areas do not provide a homely and nurturing environment.

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children and young people since the most recent full inspection

The restructuring of the staff team has resulted in some staff changes. There is an imbalance of staff experience in some of the houses. In addition, some children are not consistently receiving their required level of allocated support when the staff are on a break. These shortfalls could place some children at risk.

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children and young people since the most recent full inspection

Some of the children’s plans fail to recognise their identity and cultural needs. On occasion, when a cultural need has been identified, the staff have not taken enough action to address it. In addition, some of the children’s records have gaps because the staff have failed to record the required information. These plans fail to identify the children’s needs, and do not ensure that the staff are given clear guidance on meeting these needs.

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children and young people since the most recent full inspection

The staff have made a high number of medication errors. The manager’s recent review identified the need to make some changes to medication administration. These changes include providing a larger medication room and implementing clearer medication recording systems. The use of alarms to alert the staff that a child’s medication is due has already significantly reduced the number of errors. The manager has identified that more changes are required to reduce the risk of further errors being made in relation to the children’s medication. However, these changes have not yet been implemented. Inspection report children’s home: 2495377 4 On one occasion, the staff failed to ensure that all potentially hazardous substances were safely secured. Although the item was behind a locked bathroom door, this was not in keeping with the home’s policy and potentially placed the children at risk of harm. It is of further concern that the staff had propped open a fire door in the

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children and young people since the most recent full inspection

kitchen with a chair. This fails to ensure that all possible action is taken to reduce the risk to the children and the staff.

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children and young people since the most recent full inspection

The home’s location risk assessment fails to include recent incidents of a child who has accessed some of the building’s roofs. In addition, not all known risks are detailed, such as the roads near the home, and the risk assessment does not include information from external agencies. This fails to ensure that the staff know what action to take to reduce the risks to the children.

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children and young people since the most recent full inspection

Some staff have not achieved a relevant level 3 qualification within the required timescales.

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children and young people since the most recent full inspection

Although the manager has updated the home’s statement of purpose, she has not submitted it to Ofsted. While this has no impact on the children, it is a breach of regulation.

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children and young people since the most recent full inspection

There have been nine admissions and six discharges since the last inspection. All but one of the children moved from the home in a planned way. The children continue to make progress and their engagement with the staff is positive.

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children and young people since the most recent full inspection

The staff seek the children’s views on their activities and what could make their experience at the home better. Records demonstrate that the children’s requests are followed through. The children can spend time with their friends in other houses and the staff support the children’s relationships with their families.

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children and young people since the most recent full inspection

The rota clearly details which house each staff member is allocated to. This provides a transparent audit trail for future reference.

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children and young people since the most recent full inspection

The children’s engagement in activities has significantly improved. New toys, sensory items, access to clubs and trips out in the community provide a stimulating experience for the children and develop their social skills.

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children and young people since the most recent full inspection

The staff receive regular reflective supervision. This provides them with a formal meeting that enables them to discuss any concerns, reflect on their practice and consider their own personal development.

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children and young people since the most recent full inspection

The children’s risk assessments provide clear guidance for the staff. Effective changes to the documents make the staff aware of known risks and the actions to take to reduce them.

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children and young people since the most recent full inspection

The children’s individual behaviour management documents provide the staff with clear guidance on responding to the children’s behaviour appropriately. Clearly recorded reports provide the manager with a detailed overview of any incidents, and document additional strategies for future use. The staff recognise the children’s Inspection report children’s home: 2495377 5 positive behaviour. They set achievable targets, in discussion with the child, that are in accordance with the child’s age and level of understanding. These actions have resulted in a reduction in the number of incidents and physical interventions.

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children and young people since the most recent full inspection

The children’s individual records have improved. The records provide an overview of the child’s day and important information for the staff to know. In addition, when possible, the staff seek the child’s involvement in maintaining the records.

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children and young people since the most recent full inspection

The restructuring of the staff team has led to improved support, with visible management in each of the seven houses. This support provides for better communication between the staff, improved oversight and clear responsibility. Each staff member is now mainly allocated to one of the seven houses. This enables the staff to build trusting and nurturing relationships with the children. During the inspection, these relationships were evident. The staff were attentive to the children’s individual needs and supported the children’s engagement in fun activities of their choice. The staff equally respected the wishes of those children who wanted to rest for a period after their day at school. Inspection report children’s home: 2495377 6

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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 quality and purpose of care standard is that children receive care from staff who—

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Requirement Due date

understand the children’s home’s overall aims and the outcomes it seeks to achieve for children;

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Requirement Due date

use this understanding to deliver care that meets children’s needs and supports them to fulfil their potential.

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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

ensure that the premises used for the purposes of the home are designed and furnished so as to—

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Requirement Due date

enable each child to participate in the daily life of the home. (Regulation 6(1)(a)(b)(2)(c)(i)(ii)) 31/03/2020

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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

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)) 07/02/2020

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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—

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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— 28/02/2020 Inspection report children’s home: 2495377 7 ensure that staff have the experience, qualifications and skills to meet the needs of each child; and

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Requirement Due date

ensure that the home has sufficient staff to provide care for each child. (Regulation 13(1)(a)(b)(2)(c)(d)) The registered person must—

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Requirement Due date

keep the statement of purpose under review and, where appropriate, revise it; and

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Requirement Due date

notify HMCI of any revisions and send HMCI a copy of the revised statement within 28 days of the revision. (Regulation 16(3)(a)(b)) 07/02/2020

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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)) 07/02/2020

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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—

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Requirement Due date

the Level 3 Diploma for Residential Childcare (England) (‘the Level 3 Diploma’); or

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Requirement Due date

a qualification which the registered person considers to be equivalent to the Level 3 Diploma.

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Requirement Due date

in the case of an individual who starts working in a care role in a home after 1 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

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Requirement Due date

in the case of an individual who was working in a care role in a home on 1 April 2014, 1 April 2016. (Regulation 32(4)(a)(b)(5)(a)(b)) 31/03/2020

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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

include the information and documents listed in Schedule 3 in relation to each child;

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Requirement Due date

are kept up to date. (Regulation 36(1)(a)(b)) 28/02/2020

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Requirement Due date

The registered person must review the appropriateness and suitability of the location of the premises used for the 07/02/2020 Inspection report children’s home: 2495377 8 purposes of the children’s home at least once in each calendar year, taking into account the requirement in regulation 12(2)(c) (the protection of children standard).

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Requirement Due date

When conducting the review, the registered person must consult, and take into account the views of, each relevant person. (Regulation 46(1)(2))

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Recommendations

 Children should be able to maintain and develop their cultural or religious beliefs as far as practicable and when appropriate, through participation and instruction, and by observing religious requirements, including dress and diet. (‘Guide to the children’s homes regulations including the quality standards’, page 17, paragraph 3.22) Inspection report children’s home: 2495377 9

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Information about this inspection

This inspection focused on the effectiveness of the home and the progress and experiences of children and young people since the most recent full inspection.

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Information about this inspection

Inspectors have looked closely at the experiences and progress of children and young people, 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: 2495377 10

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Children’s home details

Provision sub-type: Residential special school

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Children’s home details

Registered provider: St Elizabeth’s Centre

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Children’s home details

Registered provider address: The Provincialate, 29 Tite Street, London SW3 4JX

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Children’s home details

Responsible individual: Sister Veronica Hagen

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Inspectors

Natalie Burton, Social Care Inspector Mark Jackson, Social Care Compliance Inspector Inspection report children’s home: 2495377 11 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 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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