Children's Home run by Cambian Childcare Limited in Staffordshire

Inspection report children's home: 1258091 1 Registered provider: Cambian Childcare Limited Full inspection Inspected under the social care common inspection framework

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Information about this children’s home

The home is privately owned and provides care for up to five children who have suffered early life trauma. The home provides therapeutic support from an in-house clinical team. There is a registered manager in post.

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Information about this children’s home

Due to COVID-19 (coronavirus), at the request of the Secretary of State, we suspended all routine inspections of social care providers on 17 March 2020.

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Information about this children’s home

We last visited this setting on 8 to 9 December 2020 to carry out an assurance visit. The report is published on our website.

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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 serious and widespread failures that mean children are not protected or their welfare is not promoted or safeguarded, and the care and experiences of children are poor, and they are not making progress.

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inadequate

Overall judgement at last inspection: good

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inadequate

Enforcement action since last inspection: none Inspection report children's home: 1258091 2

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Inspection date Inspection type Inspection judgement

08/05/2019 Full Good 31/07/2018 Interim Declined in effectiveness 11/04/2018 Full Good 12/12/2017 Full Requires improvement to be good Inspection report children's home: 1258091 3

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inadequate

Five children live in the home. Since the last inspection, one child has transitioned on from the home in a planned way. Two children have moved into the home and settled well.

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inadequate

One child lives with a complex, life-threatening, long-term health condition. They have undergone a serious operation and, as a result, they need a high level of care. The registered manager and staff have failed to provide them with such. There have been several errors when giving this child their medication. For example, staff have not provided the child with the correct dose at the correct time. If this had continued, then this could have had a serious and detrimental impact on the child’s health.

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inadequate

On one occasion, the manager did not correctly record the child’s medication dose. When the child returned home from the hospital, the manager relied on a verbal handover from staff. The manager did not check the child’s discharge papers. As a result, this child received an overdose of their medication for seven days.

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inadequate

The impact of this medication error has delayed the child’s recovery. Health professionals have had to review and amend the child’s medication. This is to compensate for any potential damage to the child’s health. Professionals say it is a ‘wait and see’ approach to check if there will be any long-term effects. An internal investigation is being undertaken into these significant errors.

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inadequate

Staff do not always follow the steps outlined in children’s health plans. For example, when a child was displaying signs that they were unwell, staff did not follow medical advice. This child is particularly vulnerable to infection. Staff contacted the hospital who advised them at the time to take the child to hospital. Staff did not do so. Staff took the child to hospital the next day. The child was then admitted with a suspected urinary tract infection. This infection could have had a significant impact on their health.

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inadequate

The home has a homely feel, but the décor requires improvement. Damage caused by children’s behaviour is not always repaired quickly and could present a risk to children. During the inspection repairs were undertaken to rectify this.

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inadequate

One child’s bedroom environment has significantly improved since the last inspection. Staff help this child to recognise and respond to feelings safely. The child no longer damages furniture, toys or clothes. They now understand that they deserve them. As a result, their self-esteem and self-image has significantly improved. Plans are now in motion for this child to transition to a long-term foster placement. The independent reviewing officer described their progress as ‘most fantastic’. Inspection report children's home: 1258091 4 All children have good attendance at school. One teacher reported ‘good communication’ between the school and the home. One child, who has global developmental delay, has achieved age related expectations. This is good progress as they completed their learning at home during the summer term due to the restriction in place relating to Covid-19.

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inadequate

At the time of the inspection, staff had taken the children on holiday to the seaside. The inspector saw and spoke to all the children during a video call arranged by staff. During the call, children gave ‘thumbs up’ when asked how they felt about living at the home. They said they like the staff and were able to identify staff who they trust. Children said they were having fun. Some children had been to the beach for the first time.

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

Staff do not always follow safeguarding procedures. They fail to report allegations and disclosures made by children to managers. Managers fail to investigate this poor safeguarding practice effectively or take sufficient action to protect children while investigations take place. As a result, the measures in place to keep children safe are inadequate.

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

Children are not helped to feel safe in the home. On two occasions, children have raised concerns to staff, including an allegation about a staff member ‘slamming’ a child on the floor and a disclosure to staff of possible abuse. On both occasions, children did not receive a response from the registered manager for a significant period of time after the concerns were raised. Children also did not receive any emotional support from the manager or staff. As a result, children are not supported after raising concerns and they are not provided with the reassurance that they are safe.

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

Managers do not always share accurate information with external professionals. Safeguarding notifications do not match with information recorded in the home. An allegation shared with the designated officer was missing information. Therefore, professionals make decisions without being aware of important detail. As a result, some of these decisions may not always be in children’s best interests.

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

Some staff do not have the skills to effectively respond to children’s needs and behaviours. During one incident, staff thought a child had gone missing. Three members of staff ‘scoured the streets’ looking for them. However, the child was hiding behind a curtain in the home. Staff failed to notice where they were, despite them being in the home. This incident resulted in the child being physically restrained. This was due to staff being unable to de-escalate the child’s behaviours. Some recordings of physical interventions are poor and contain errors.

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

Staff help children to recognise and manage their feelings safely. They use creative key work to help them to do so. As a result, incidents in the home have significantly reduced. There is also a dramatic decrease in the use of physical intervention. Inspection report children's home: 1258091 5

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The effectiveness of leaders and managers: inadequate

Management oversight in the home is inadequate. Their response to poor staff practice is inconsistent. There is often a delay and actions are ineffective. As a result, children are cared for by incompetent staff who do not keep them safe.

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The effectiveness of leaders and managers: inadequate

The registered manager has made serious errors when monitoring children’s health needs. One of these children has a complex and life-threatening condition. An internal investigation of these errors is underway. Leaders and managers have implemented additional measures to prevent the errors from reoccurring. However, the long-term effectiveness of these measures is not yet known.

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The effectiveness of leaders and managers: inadequate

The manager has continued to prepare medication without adequate oversight. For example, there is no contingency plan in place when senior managers are absent from the home. Another manager recorded that they had forgotten they were on- call twice in one week. This resulted in additional medication checks not being carried out. This is poor management oversight and increases the likelihood of further errors. Therefore, significant concerns remain in respect of children’s health needs. This includes children who require a high level of care.

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The effectiveness of leaders and managers: inadequate

The manager completes monthly audits as well as other forms of monitoring and reviewing. These audits identify some shortfalls. However, actions to rectify them are insufficient and are not reviewed effectively.

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The effectiveness of leaders and managers: inadequate

The responsible individual is absent from work. Leaders have implemented additional management oversight and are undertaking audits of practice in the home. They are scrutinising the care children receive. Leaders and managers are aware of the shortfalls and have identified the areas in need of improvement.

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The effectiveness of leaders and managers: inadequate

Staff do not receive regular supervision. When they do, the quality of this is variable. The manager does not always challenge poor practice. However, senior managers are now monitoring this. Staff do not receive appraisals. This hinders the progress of staff practice and the quality of care provided in the home.

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The effectiveness of leaders and managers: inadequate

The quality-of-care review does not fully reflect on the shortfalls in the home. The action plan in place does not address these shortfalls either. This hinders improvements in the quality of care children receive.

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The effectiveness of leaders and managers: inadequate

The manager sometimes completes a ‘lessons learnt’ exercise with the staff team. This helps staff to reflect on their practice. It also encourages them to develop professional curiosity. Staff receive some training which is pertinent to the needs of children living in the home. However, they do not receive training in relation to how they respond to allegations. As a result, staff are not equipped with the information they need to respond to safeguarding concerns effectively.

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The effectiveness of leaders and managers: inadequate

Due to the significant concerns identified during this visit, Ofsted has issued two compliance notices under regulations 10 (The health and well-being standard) and 12 (The protection of children standard). Inspection report children's home: 1258091 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 health and well-being standard is that—

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Requirement Due date

the health and well-being needs of children are met;

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Requirement Due date

children receive advice, services and support in relation to their health and well-being;

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Requirement Due date

and children are helped to lead healthy lifestyles.

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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

achieve the health and well-being outcomes that are recorded in the child’s relevant plans;

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Requirement Due date

take part in activities, and attend any appointments, for the purpose of meeting the child’s health and well-being needs;

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Requirement Due date

that each child has access to such dental, medical, nursing, psychiatric and psychological advice, treatment and other services as the child may require. (Regulation 10 (1)(a)(b)(c) (2)(a)(i)(iii)(c))

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Requirement Due date

This specifically relates to managers and staff ensuring that they understand and follow guidance provided by children’s medical and health professionals. 19 September

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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 that staff—

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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 19 September Inspection report children's home: 1258091 7 necessary, make arrangements to reduce the risk of any harm to the child;

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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

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Requirement Due date

are familiar with, and act in accordance with, the home’s child protection policies;

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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;

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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; and

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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)(iii)(v)(vi)(vii)(b)(d)(e))

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Requirement Due date

This specifically relates to the manager’s and staff’s understanding of their safeguarding responsibilities. This includes responding in a timely manner to any allegations and/or disclosures children may make. Thereafter implementing the necessary safeguarding measures to ensure that children are safe.

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Requirement Due date

This also relates to leaders and managers ensuring that the home environment is safe and that hazards which could be a fire risk are rectified as soon as possible.

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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;

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Requirement Due date

and promotes their welfare. 29 September Inspection report children's home: 1258091 8 In particular, the standard in paragraph (1) requires the registered person to—

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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

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

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)(a)(b) (2)(c)(f)(g)(ii)(h))

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Requirement Due date

This specifically relates to leaders and managers ensuring that children are cared for by staff who have the skills, knowledge, experience and ability to meet their needs.

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Requirement Due date

Leaders and managers should ensure that any shortfalls, identified when monitoring and reviewing the care children receive, are responded to promptly. This includes the investigation of poor staff practice during which stringent measures should be in place to ensure that children remain safe.

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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; and

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Requirement Due date

a record is kept of the administration of medicine to each child.

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Requirement Due date

In this regulation, "prescribed" means— 29 September Inspection report children's home: 1258091 9 ordered for a patient, for provision to the patient, under or by virtue of the National Health Service Act 2006 or section 176(3) of the Health and Social Care (Community Health and Standards) Act 2003. (Regulation 23 (1) (2)(b)(c) (4)(a))

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Requirement Due date

This specifically relates to the manager and staff ensuring that children’s medication is stored, recorded and administered safely.

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Requirement Due date

The registered person must ensure that all employees—

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Requirement Due date

undertake appropriate continuing professional development;

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Requirement Due date

receive practice-related supervision by a person with appropriate experience; and

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Requirement Due date

have their performance and fitness to perform their roles appraised at least once every year. (Regulation 33 (4)(a)(b)(c))

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Requirement Due date

This specifically relates to managers ensuring that staff receive regular and good quality supervision which enables them to reflect upon their practice and identify improvements. This is in addition to staff receiving an appraisal at least yearly. 29 September

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Requirement Due date

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; 29 September Inspection report children's home: 1258091 10 the effectiveness and any consequences of the use of the measure;

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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;

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Requirement Due date

has signed the record to confirm it is accurate;

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Requirement Due date

within 5 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 (3)(a)(ii)(iii)(iv)(v)(vi)(vii)(viii)(b)(i)(ii)(c))

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Requirement Due date

This specifically relates to leaders and managers ensuring that children are only physically restrained as a last resort. In the event of such, that children receive the appropriate support afterwards and that any measure used is recorded appropriately.

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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

there is an allegation of abuse against the home or a person working there. (Regulation 40 (4)(c))

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Requirement Due date

This specifically relates to the manager providing Ofsted and other relevant agencies with accurate information regarding serious incidents. 29 September

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Requirement Due date

The registered person must complete a review of the quality of care provided for children ("a quality of care review") at least once every 6 months.

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Requirement Due date

In order to complete a quality of care review the registered person must establish and maintain a system for monitoring, reviewing and evaluating—

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Requirement Due date

the quality of care provided for children; 29 September Inspection report children's home: 1258091 11 any actions that the registered person considers necessary in order to improve or maintain the quality of care provided for children. (Regulation 45 (1) (2)(a)(c))

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Requirement Due date

This specifically relates to the manager ensuring that the quality-of-care review effectively evaluates the care children receive. In addition, that clear actions are identified to rectify any shortfalls in order to improve the care children receive.

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Requirement Due date

* These requirements are subject to a compliance notice.

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Recommendations

 The registered person should ensure that improvements are made to provide young people with a more homely environment. In particular, ensuring that any damage is repaired as soon as reasonably practicable. (Guide to the Children’s Homes regulations, including the quality standards page 15, paragraph 3.7).

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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: 1258091 12

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Children’s home details

Registered provider: Cambian Childcare Limited

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Children’s home details

Registered provider address: Cambian Childcare Limited, Metropolitan House, 3 Darkes Lane, Potters Bar, Hertfordshire EN6 1AG

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Inspector

Sarah Berry, Social Care Inspector Inspection report children's home: 1258091 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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Inspector

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Inspector

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Inspector

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