Children's Home run by Holywell Children’s Services Limited in Lancashire

Inspection report for children’s home - monitoring visit: 2519196 1

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Holywell Children’s Services Limited

Monitoring visit Inspected under the social care common inspection framework

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Information about this children’s home

This home is operated by a private company. The home is registered to provide care and accommodation for up to three children or young people. The home specialises in caring for children or young people who may have been, or who are, experiencing emotional and/or behavioural difficulties.

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Information about this children’s home

The registered manager has been in post since the home’s registration in October 2019.

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This monitoring visit

This home has not yet had a full inspection since registration.

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This monitoring visit

On 2 July 2020, regulatory inspection managers, Michelle Edge and Claire Deary, carried out an urgent monitoring visit at The Grange children’s home. The inspectors identified poor safeguarding arrangements that leave children at risk of harm and significant shortfalls in the leadership and management of this children’s home.

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This monitoring visit

The registered manager and staff do not fully understand their roles and responsibilities in regard to keeping children safe. They have failed to consistently report and record all safeguarding concerns and take appropriate action in a timely way. Due to the extremely poor recording in the home, it is unclear what action the registered manager or staff took to notify other safeguarding professionals to identify concerns about the potential exploitation of children.

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This monitoring visit

When children have sustained injuries that require medical attention, accident records and daily care records are not completed. There is no evidence available to demonstrate whether staff took appropriate action to monitor the child or seek Inspection report for children’s home - monitoring visit: 2519196 2 medical guidance to ensure that the safety and well-being of the child are paramount.

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This monitoring visit

The registered manager reported that the home had not undertaken any physical interventions to keep children safe. Despite this, the independent visitor’s report for May 2020 makes clear that restrictive practice was used and a debrief was reported to have taken place with staff. However, the registered manager confirmed that there are no records held in the home to demonstrate the reasons for the intervention, how it was safely managed and whether any injuries had been sustained. This is a safeguarding concern as it does not enable other professionals to have a clear oversight of incidents that occur in the home and how the children are safely managed.

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This monitoring visit

Contrary to the home’s admissions policy and procedures, children have not benefited from a detailed compatibility risk assessment or a thorough appraisal of their needs. The policy states that, ‘Every young person placed at The Grange requires a clear and detailed assessment.’ However, the registered manager offered a placement to a new child without clearly identifying, assessing, or planning how to address their full range of needs. The impact assessment was compiled 17 days after the placement began. Consequently, outcomes are poor as staff do not understand how to safely support children in all areas of their lives.

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This monitoring visit

There is limited documentation in the home. Staff confirmed that they had not had sight of any documents that identify the care needs of the child, the current risk factors or any strategies to safely support his needs. In addition, there is an inconsistent approach to behaviour management in the home. Behaviour management plans are not available for staff to follow. As a result, incidents are poorly and inconsistently managed by staff. Staff are not consistent in their approach to using rewards and sanctions, and they lack guidance from the registered manager on using these strategies. Consequently, there is no clear recording of sanctions and rewards that have been used.

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This monitoring visit

Doors inside the home were locked. This is not in line with the conditions of registration of this children’s home as it is not a secure unit. This is a restriction on a child’s liberty with no court directive documentation to support this poor decision- making.

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This monitoring visit

Not all significant events involving children living at the home have been reported to Ofsted. A failure to share information with all the relevant people compromises the safety and welfare of children. Furthermore, the regulator is unable to carry out its monitoring function to ensure that appropriate action is taken by the provider to safeguard children.

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This monitoring visit

Staff and a child confirmed that the registered manager is not based in the home. The registered manager confirmed that he has an office in another setting and will visit the home if required. This has resulted in a lack of stability and consistency for Inspection report for children’s home - monitoring visit: 2519196 3 children and has had a significant impact on the quality of care. Furthermore, staff have had limited direction or leadership, which has had an impact on their ability to provide a consistent team approach towards caring for children.

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This monitoring visit

Staff do not have the experience, skills or training to support the complex needs of the children who live at this home. For example, the staff member working with the child on the day of the visit had only been employed at the organisation for two weeks. He had no experience in residential childcare and was working without any direct supervision. He had not been provided with an opportunity to understand the care needs or identified risk factors for the child who he was left to care for alone.

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This monitoring visit

The oversight of care practice and risk management by leaders and managers is poor. When risks continue to escalate, there is insufficient action taken by the management team to address the concerns appropriately. For example, when children display aggressive behaviour and cause damage to the property, staff are unclear how to minimise the escalation of risk and they use strategies that are against the local authority care plan. This does not demonstrate appropriate or safe care.

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This monitoring visit

There are gaps in the home’s monitoring and review systems, which lessen the analysis and evaluation of care and its effect on outcomes for children. This means that leaders and managers are unable to identify and address shortfalls in staff practice to improve the service being provided. In addition, when staff have reported staff practice which has been inappropriate, these reports have been minimised and not appropriately managed. This has affected outcomes for children and compromised their safety and well-being.

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This monitoring visit

Staff duty rotas fail to accurately reflect the actual staff on duty, including the registered manager. In addition, when there are shortfalls in the rota, some records do not include the full name or any other information to indicate whether the shift was covered and by whom. This prevents a clear audit trail of who is working in the setting. During discussions with the registered manager, he accepted that the rotas did not contain all the required information. The lack of transparency of who is on duty potentially places children at risk and compromises the continuity of care.

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This monitoring visit

The independent visitor to the home has raised concerns about managerial oversight and poor care practices. However, the provider has not taken immediate action to respond to the recommendations.

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Recent inspection history

Inspection date Inspection type Inspection judgement The home has not been inspected. Inspection report for children’s home - monitoring visit: 2519196 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, the 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 understand the children’s home’s overall aims and the outcomes it seeks to achieve for children and that they use this understanding to deliver care that meets children’s needs and supports them to fulfil their potential. (Regulation 6(1)(a)(b)) 2/08/2020

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Requirement Due date

The children’s views, wishes and feelings standard is that children receive care from staff who—

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Requirement Due date

develop positive relationships with them;

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Requirement Due date

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—

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Requirement Due date

help each child to express views, wishes and feelings;

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Requirement Due date

help each child to understand how the child’s views, wishes and feelings have been taken into account and give the child reasons for decisions in relation to the child. (Regulation 7(1)(a)(b)(c)(2)(a)(ii)(iii)) 2/08/2020

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Requirement Due date

The positive relationships standard is that children are helped to develop, and to benefit from, relationships based on—

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Requirement Due date

an understanding about acceptable behaviour; and 2/08/2020 Inspection report for children’s home - monitoring visit: 2519196 5 positive responses to other children and adults.

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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

meet each child’s behavioural and emotional needs, as set out in the child’s relevant plans;

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Requirement Due date

help each child to develop socially aware behaviour;

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Requirement Due date

encourage each child to take responsibility for the child’s behaviour, in accordance with the child’s age and understanding;

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Requirement Due date

help each child to develop and practise skills to resolve conflicts positively and without harm to anyone;

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Requirement Due date

communicate to each child expectations about the child’s behaviour and ensure that the child understands those expectations in accordance with the child’s age and understanding;

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Requirement Due date

help each child to understand, in a way that is appropriate according to the child’s age and understanding, personal, sexual and social relationships, and how those relationships can be supportive or harmful;

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Requirement Due date

help each child to develop the understanding and skills to recognise or withdraw from a damaging, exploitative or harmful relationship;

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Requirement Due date

strive to gain each child’s respect and trust;

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Requirement Due date

understand how children’s previous experiences and present emotions can be communicated through behaviour, and have the competence and skills to interpret these and develop positive relationships with children;

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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 to do the same; Inspection report for children’s home - monitoring visit: 2519196 6 de-escalate confrontations with or between children, or potentially violent behaviour by children. (Regulation 11(1)(a)(b)(c)(2)(a)(i)(ii)(iii)(iv)(v)(vi)(vii)(viii)(ix)(x)(xi))

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Requirement Due date

*The protection of children standard is that children are protected from harm and 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

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;

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Requirement Due date

that the premises used for the purposes of the home are designed, furnished and maintained so as to protect each child from avoidable hazards to the child’s health;

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Requirement Due date

that the effectiveness of the home’s child protection policies is monitored regularly. (Regulation 12(1)(2)(a)(i)(v)(vi)(d)(e)) 2/08/2020

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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 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; 2/08/2020 Inspection report for children’s home - monitoring visit: 2519196 7 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

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;

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Requirement Due date

demonstrate that practice in the home is informed and improved by taking into account and acting on—

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Requirement Due date

research and developments in relation to the ways in which the needs of children are best met; and

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Requirement Due date

feedback on the experiences of children, including complaints received; and

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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)(2)(a)(c)(e)(f)(g)(h))

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Requirement Due date

The care planning standard is that children—

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Requirement Due date

receive effectively planned care in or through the children’s 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

manage and review the placement of each child in the home;

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Requirement Due date

that each child’s relevant plans are followed. (Regulation 14(1)(a)(2)(b)(ii)(c)) 2/08/2020

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Requirement Due date

The registered person must compile in relation to the children’s home a statement (‘the statement of purpose’) which covers the matters listed in Schedule 1.

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Requirement Due date

The registered person must— 2/08/2020 Inspection report for children’s home - monitoring visit: 2519196 8 keep the statement of purpose under review and, where appropriate, revise it; and

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Requirement Due date

notify HMCI of any revision and send HMCI a copy of the revised statement within 28 days of the revision.

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Requirement Due date

The registered person must ensure that the home is at all times conducted in a manner which is consistent with its statement of purpose. (Regulation 16(1)(3)(a)(b)(5))

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Requirement Due date

the privacy of children is appropriately protected;

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Requirement Due date

children can access all appropriate areas of the children’s home’s premises; and

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Requirement Due date

any limitation placed on a child’s privacy or access to any area of the home’s premises—

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Requirement Due date

is intended to safeguard each child accommodated in the home;

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Requirement Due date

is kept under review and, if necessary, revised; and

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Requirement Due date

allows children as much freedom as is possible when balanced against the need to protect them and keep them safe. (Regulation 21(a)(b)(c)(i)(ii)(iv)) 2/08/2020

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Requirement Due date

The registered person must prepare and implement a policy (‘the behaviour management policy’) which sets out—

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Requirement Due date

how appropriate behaviour is to be promoted in the children’s home; and

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Requirement Due date

the measures of control, discipline and restraint which may be used in relation to children in the home.

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Requirement Due date

The registered person must keep the behaviour management policy under review and, where appropriate, revise it.

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Requirement Due date

The registered person must ensure that— 2/08/2020 Inspection report for children’s home - monitoring visit: 2519196 9 within 24 hours of the use of a measure of control, discipline or restraint in relation to a child in the home, a record is made which includes—

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Requirement Due date

details of the child’s behaviour leading to the use of the measure;

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Requirement Due date

the date, time and location of the use of the measure;

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Requirement Due date

a description of the measure and its duration;

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Requirement Due date

details of any methods used or steps taken to avoid the need to use the measure;

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Requirement Due date

the name of the person who used the measure (‘the user’), and of any other person present when the measure was used;

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Requirement Due date

the effectiveness and any consequences of the use of the measure; and

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Requirement Due date

a description of any injury to the child or any other person, and any medical treatment administered, as a result of the measure;

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Requirement Due date

within 48 hours of the use of the measure, the registered person, or a person who is authorised by the registered person to do so (‘the authorised person’)—

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Requirement Due date

has spoken to the user about the measure; and

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Requirement Due date

has signed the record to confirm it is accurate; and

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Requirement Due date

within five days of the use of the measure, the registered person or the authorised person adds to the record confirmation that they have spoken to the child about the measure. (Regulation 35(1)(a)(b)(3)(a)(i)(ii)(iii)(iv)(v)(vi)(vii)(viii)(b)(i)(ii)(c))

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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; 2/08/2020 Inspection report for children’s home - monitoring visit: 2519196 10 are kept up to date and are signed and dated by the author of each entry. (Regulation 36(1)(a)(b)(c))

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Requirement Due date

Schedule 4 sets out the other information that the registered person must keep in relation to a children’s home.

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Requirement Due date

maintain in the home the records in Schedule 4;

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Requirement Due date

ensure that the records are kept up to date. (Regulation 37(1)(2)(a)(b))

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Requirement Due date

In particular, ensure that the records include a copy of the staff duty roster of persons working at the home, a record of the actual rotas worked, and a record of any persons who work at any time at the home. 2/08/2020

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Requirement Due date

The registered person must notify HMCI and each other relevant person without delay if—

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Requirement Due date

a child is involved in or subject to, or is suspected of being involved in or subject to, sexual exploitation;

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Requirement Due date

an incident requiring police involvement occurs in relation to a child which the registered person considers to be serious;

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Requirement Due date

there is an allegation of abuse against the home or a person working there;

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Requirement Due date

a child protection enquiry involving a child—

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Requirement Due date

concludes (in which case, the notification must include the outcome of the child protection enquiry); or

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Requirement Due date

there is any other incident relating to a child which the registered person considers to be serious. (Regulation 40(4)(a)(b)(c)(d)(i)(ii)(e)) 2/08/2020

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Requirement Due date

*These requirements are subject to a compliance notice. Inspection report for children’s home - monitoring visit: 2519196 11

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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. Inspection report for children’s home - monitoring visit: 2519196 12

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Children’s home details

Registered provider: Holywell Children’s Services Limited

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Children’s home details

Registered provider address: Dalton House, 9 Dalton Square, Lancaster, Lancashire LA1 1WD

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Inspectors

Michelle Edge, social care regulatory inspection manager Claire Deary, social care regulatory inspection manager Inspection report for children’s home - monitoring visit: 2519196 13 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

T: 0300 123 1231 Textphone: 0161 618 8524 E: enquiries@ofsted.gov.uk W: http://www.gov.uk/ofsted

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