Children's Home run by Birtenshaw in Bolton

Inspection report children’s home: SC484789 1 SC484789 Registered provider: Birtenshaw 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 operated by a private organisation. The home provides care and accommodation for up to three young people who have a learning disability and/or sensory impairment. The home has not had a registered manager since March 2019. A new manager has been appointed and has made an application for registration to Ofsted.

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Overall experiences and progress of

children and young people, taking into account

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Inadequate

How well children and young people are helped and protected Inadequate

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Inadequate

The effectiveness of leaders and managers Inadequate

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Inadequate

There are widespread failures that mean children and young people’s welfare is not promoted or safeguarded.

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Inadequate

Date of last inspection: 30 January 2019

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Inadequate

Overall judgement at last inspection: outstanding

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Inadequate

Enforcement action since last inspection: none Inspection report children’s home: SC484789 2

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Inspection date Inspection type Inspection judgement

30/01/2019 Full Outstanding 05/12/2017 Full Outstanding 02/03/2017 Interim Sustained effectiveness 26/07/2016 Full Outstanding Inspection report children’s home: SC484789 3

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inadequate

The children’s home has experienced significant change since the last full inspection in January 2019. These changes have negatively impacted on the young people accommodated here. Eight members of the core staff team, including the registered manager, resigned from the home. This resulted in young people being cared for and supported on a one-to-one basis by a range of unfamiliar support workers and agency workers. Young people have disabilities that include autism spectrum disorder and attention deficit hyperactivity disorder (ADHD). Because of this, they struggle to form trusting relationships and secure attachments with new staff. Consequently, the excessive use of agency and support workers at the home hampers the young people’s ability to develop and sustain secure relationships. Young people are not supported by staff who are suitably trained to respond to their specific healthcare needs. The independent visitor has raised a recommendation on

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inadequate

several occasions to address this shortfall. However, this remains unmet. Moreover, where a young person has a history of epilepsy, staff are not appropriately trained in how to respond. The service manager stated that all staff have received emergency first aid training. However, records of emergency first aid training show that staff have not received this within suitable timescales. This means that some young people’s healthcare needs are compromised by inexperienced and untrained staff. Education attendance and attainment are good. Parents report that young people enjoy the routine of school and are happy in the education environment. School reports emphasise young people’s commitment to learning and praise their positive behaviour and attitude within school. Contact arrangements are displayed for young people living in the home. This helps young people to begin to understand their plans and routine for each day. Staff

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inadequate

ensure that young people are transported to their contact and provide additional support where required. Young people are supported to undertake activities, including climbing walls, trampolining, visits to places of interest and visits to the park. On occasion, young people from other services join the activity. This enables them to play alongside each other, which helps them to develop friendships and social skills. However, a social worker commented, ‘The young people do not go out as much as they used to do because there is a shortage of staff being able to drive.’ Consequently, young people’s outdoor activities are determined by the availability of drivers within the current staff team. Residential care plans have recently been revised. As a result, young people’s individual targets are now displayed for them to see, and this helps them to recognise their individual tasks and achievements. Key-work sessions are now taking

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inadequate

place. These sessions provide the young people with the opportunity to develop essential skills and achieve simple tasks, such as making a drink or a simple sandwich and getting dressed. Inspection report children’s home: SC484789 4 Consultation with young people, parents and external agencies has also recently been revised. Pictorial documents are developed to help young people express their views and opinions. This has proved useful in the weekly young people’s meetings. In addition, photographic menus are currently being developed to enable young people to make decisions about their individual food preferences. However, feedback from parents reveals that there are significant difficulties in communication between parents and the staff working at the home. A parent said, ‘I find out things by chance and sometimes days later. I am concerned about how many staff work at the home and if they are trained or even know my child and his

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inadequate

needs.’ Another parent said, ‘I don’t feel welcome at the home. Staff are not welcoming and don’t provide me with details of what is nearby for us to do on a visit.’ Consequently, and because of significant staff changes, there is a failure to secure trusting partnerships with parents.

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

Risk assessments are completed for all the young people accommodated in the home. The risk assessments include triggers for specific risk-taking behaviours and basic guidance for staff for the safe care management of young people. However, risk assessments are not signed by all staff. Therefore, there is no evidence that all staff are aware of the assessment or indeed the guidance provided. Records of restraint reveal that staff have used restraint or have been involved in incidents with young people where a restraint has been required. However, staff have not received specialist training to undertake such an intervention. This is contrary to the home’s statement of purpose and young people’s risk assessments. Consequently, the safety and welfare of young people are significantly compromised by inadequately trained and inexperienced staff. Furthermore, the manager and staff have not considered the individual triggers for

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

one young person when devising a safe handling plan. For example, an identified trigger is physical contact. Records state that physical contact causes this young person to become highly agitated. Therefore, the use of restraint results in an escalation of behaviours. The failure to recognise this conflict and develop strategies to reduce the number of restraints for this young person compromises their safety and well-being. The home operates a locked-door policy. This policy is designed to keep the young people safe and specifically to stop them leaving the premises unaccompanied. However, on one occasion the front door was left unlocked and a young person left the home unseen by the agency staff member. The young person’s absence was only noted when another member of staff arrived at the home. A record of this incident is not recorded in the missing from home and absence log. In addition, information that is recorded about this incident is different to the information

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

provided to the parent and social worker for the child. The new manager has now taken steps to ensure that further sets of house keys are available to staff to lock the doors. However, due to continued high turnover of staff working in the home, the lack of experienced staff, and the failure of staff to Inspection report children’s home: SC484789 5 familiarise themselves with individual risk assessments, this matter is considered to be a continuing risk for the young people living in the home. The record of accidents or injuries sustained by young people living in the home and by staff working in the home is deficient. This is because the records are not consistently monitored or reviewed to ensure that pertinent information, such as the detail of an accident, is consistently recorded. As a result, no action is taken to reduce the likelihood of a repeated accident. Furthermore, emergency first aid training is not prioritised. Consequently, some staff did not receive this training until

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

six months after they commenced employment. This training is essential in the care and protection of young people living in the home. The record for complaints is unsatisfactory. The independent visitor recorded two complaints that were received by the home. However, the home has no records of concerns or complaints made by relatives. Therefore, information about how the home investigated and responded to complaints and concerns is not available. The service manager provided a letter of outcome for one concern, but was unable to provide additional detail. A relative said, ‘Communication with staff is poor. I don’t know what is going on. They don’t tell me anything. I tell them about things, but I don’t know if they do anything about it.’ Records of all concerns and complaints must be held in the home in accordance with regulation.

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The effectiveness of leaders and managers: inadequate

Since the last full inspection in January 2019, there have been significant changes to the management and staff at the home. The registered manager and a number of staff resigned from the service. A recruitment drive resulted in five new members of staff being recruited to vacant positions. In January 2020, a new manager was appointed and an application for registration with Ofsted has been received. This manager has approximately four years’ experience working in children’s residential care and is qualified at NVQ level 3. The number of different staff working in the home during this inspection period has been excessive. During the spring and early summer months of 2019, the home was operating without a core staff team. This resulted in young people being cared for by a high percentage of support workers, agency workers and learning support workers. New staff members have been recruited through the temporary to permanent

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The effectiveness of leaders and managers: inadequate

contracts offered by the organisation. On review of the staff recruitment files, it is evident that the new staff have little or no previous experience to support them in their work in a specialist disability service. Furthermore, the recruitment records identify significant weaknesses in the applicants’ understanding of working with and communicating with young people with autism spectrum disorder. Although weaknesses were identified at the point of staff being interviewed by the organisation, staff were appointed. It is concerning that there are no action plans or support plans developed to address the identified staff weaknesses. In addition, new staff commenced their roles without completing the mandatory training. This includes training around physical intervention, safeguarding children, emergency first aid and attachment. As a result, the new staff appointed to the home are not Inspection report children’s home: SC484789 6

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The effectiveness of leaders and managers: inadequate

suitably equipped to be effective in their work with the young people placed in the home. As detailed earlier in this report, not all staff receive additional specialist training to meet the needs of the young people they care for. For example, staff have not received training around ADHD, attachment disorder or epilepsy in accordance with the needs of the young people. In addition, some staff received emergency first aid training some six months after their employment. This significant failure means that staff are not provided with the underpinning knowledge and understanding of the complex disabilities of young people living in the home. The statement of purpose has been revised and updated several times since the last full inspection in January 2019. However, amended versions of the statement of purpose are not routinely forwarded to Ofsted for review. This means that the regulatory body is not informed of any changes within the service, specifically staff

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The effectiveness of leaders and managers: inadequate

changes. The external monitoring of the home by an independent visitor takes place on a consistent basis. The reports produced by the visitor clearly detail the progress young people make and the identified shortfalls in practice. However, recommendations made by the visitor are not addressed by the home. This results in recommendations being routinely repeated. Consequently, the practice within the home and the service provided to young people are not improved. The manager must consider all recommendations made by the visitor and respond accordingly with a suitable action plan. Since the last inspection in January 2019, staff have not received consistent supervision and support. A staff member said, ‘We can always ask for help, but we generally get on with it.’ This means that staff are not guided in their work with the young people. Furthermore, staff are not provided with an opportunity to discuss

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The effectiveness of leaders and managers: inadequate

their own feelings about young people’s behaviours, particularly if staff have been harmed by a young person. Because staff have little or no previous experience of residential care, they accept that this is the way the home is run. The newly appointed manager is taking steps to address this shortfall and has started supervising staff. The previous manager’s analysis of patterns, trends and shortfalls in practice and their evaluation of the skills and experience of staff were not good enough. The majority of concerns, as identified within this inspection report, were not recognised and therefore limited action was taken to address them. Inspection report children’s home: SC484789 7

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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

32: Fitness of workers 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 individual has the appropriate experience, qualification and skills for the work that the individual is to perform. (Regulation 32(1)(3)(b)) 13/04/2020

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Requirement Due date

10: The health and well-being standard is that—

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Requirement Due date

the health and well-being needs of children are met. (Regulation 10(1)(a))

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Requirement Due date

Specifically, staff should be appropriately trained so that they can respond to children’s specific healthcare needs. 13/04/2020

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Requirement Due date

11: The registered person must ensure— that staff—

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Requirement Due date

are provided with supervision and support to enable them to understand and manage their own feelings and responses to the behaviour and emotions of children, and to help children do the same. (Regulation 11(2)(x)) 13/04/2020

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Requirement Due date

12: 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 protect each child effectively from harm. (Regulation 12(1)(2)(b))

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Requirement Due date

Specifically, all staff must be trained in safeguarding children prior to commencing their role within the home. 13/04/2020 Inspection report children’s home: SC484789 8 13: 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

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 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 for each child;

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Requirement Due date

understand the impact that the quality of care provided in the home is having on the progress and experiences of each child and use this understanding to inform the development of the quality of care provided in the home. (Regulation 13(1)(b)(2)(a)(c)(e)(f)) 13/04/2020

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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)) 13/04/2020

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Requirement Due date

36: The registered person must maintain (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; and

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Requirement Due date

are kept up to date. (Regulation 36(1)(a)(b)) 13/04/2020

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Requirement Due date

39: The registered person must establish a procedure for considering complaints made by or on behalf of children.

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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)(3)) 13/04/2020 Inspection report children’s home: SC484789 9 44: The independent person’s report may recommend actions that the registered person may take in relation to the home and the timescales within which the registered person must consider whether to take those actions. (Regulation 44(5)) 13/04/2020

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Recommendations

 The registered person should ensure that staff can access appropriate facilities and resources to support their training needs and should understand the key role they play in the training and development of staff. (‘Guide to children’s homes regulations including the quality standards’, page 53, paragraph 10.11) This is with specific regard to ADHD, epilepsy and team teach.  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 need of each child. (‘Guide to the children’s homes regulations including the quality standards’, page 49, paragraph 9.59)  The registered person is responsible for ensuring that all their staff have been adequately trained in the principles of restraint and any restraint techniques

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Recommendations

appropriate to the needs of the children the home is set up to care for as defined in the home’s Statement of Purpose. (‘Guide to the children’s homes regulations including the quality standards’, page 49, paragraph 9.57)  Appropriate forms of contact should be promoted and facilitated for each child, including where possible visits to the child in the home. (‘Guide to the children’s homes regulations including the quality standards’, page 58, paragraph 11.18) Specifically, ensure that parents and relatives who are visiting the home are provided with information about local amenities to aid the quality of their visit.

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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: SC484789 10

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Children’s home details

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

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Inspector

Maria McGranaghan, Social Care Inspector Inspection report children’s home: SC484789 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 looked after children, safeguarding and child protection.

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Inspector

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Inspector

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Inspector

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