Marydale Lodge

Inspection report secure children’s home: SC022448 1 SC022448 Registered provider: Nugent Care Full inspection Inspected under the social care common inspection framework

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Information about this secure children’s home

This secure children’s home is operated by a voluntary organisation and is approved by the Secretary of State to restrict children’s liberty. The children’s home can accommodate up to 12 children who are aged between 10 and 17. The home provides for children accommodated under section 25 of the Children Act 1989, who are placed by local authorities.

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Information about this secure children’s home

Admission of any young person under section 25 of the Children Act 1989 who is under 13 years of age requires the approval of the Secretary of State.

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Information about this secure children’s home

The commissioning of health services in this home is the statutory responsibility of NHS England under the Health and Social Care Act 2012. Education is provided on site in dedicated facilities.

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Information about this secure children’s home

The manager is registered with Ofsted and has managed the home since March 2020. She holds qualifications that exceed those required for this role.

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Information about this secure 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 secure children’s home

We last visited this setting on 12 October 2020 to carry out an assurance visit. The report is published on the Ofsted website.

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Overall experiences and progress of

children and young people, taking into account

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outstanding

Children’s education and learning good Children’s health outstanding How well children and young people are helped and protected outstanding Inspection report secure children’s home: SC022448 2 The effectiveness of leaders and managers outstanding

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outstanding

The secure children’s home provides highly effective services that consistently exceed the standards of good. The actions of the children’s home contribute to significantly improved outcomes and positive experiences for children and young people who need help, protection and care.

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outstanding

Date of last inspection: 21 January 2020

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outstanding

Overall judgement at last inspection: good

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outstanding

Enforcement action since last inspection: none Inspection report secure children’s home: SC022448 3

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Inspection date Inspection type Inspection judgement

21/01/2020 Full Good 15/10/2019 Full Inadequate 09/07/2019 Full Inadequate 05/03/2019 Interim Improved effectiveness Inspection report secure children’s home: SC022448 4

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outstanding

The children make excellent progress because of the consistently high standards of care that are delivered by a well-led, highly skilled and dedicated multidisciplinary team. Effective communication and collaborative working run throughout this home. This supports the delivery of a highly individualised and adaptable programme of trauma-informed support. An independent reviewing officer for a child wrote: ‘[name of child] has made more progress than I ever thought possible. Staff have shown skill and commitment in improving [name of child]’s life chances that don’t involve his liberty being restricted.’

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outstanding

A prominent feature of this home is the ability of staff to break down barriers and build positive and secure relationships with the children. Staff skilfully use these relationships to make children feel valued and worthy. Inspectors observed staff managing the diverse complexities of each child in an attentive, nurturing and patient way. The children and staff spoke with a genuine fondness for each other. One child said: ‘The staff are the best thing about being here. They keep me safe and spend quality time with me. I would recommend this home to any other child in a similar position to me because they would get the help they need. I am leaving soon, and I will be sad to go.’ All the inspectors commented on how nice it was to see happy children and staff.

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outstanding

Excellent levels of communication between staff and children facilitate good consultation. Various forums exist where children are empowered to influence their care and be involved in decisions about their future. When possible, managers and staff act on children’s views to continually review and improve the home.

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outstanding

Managers place a great deal of emphasis on the importance of getting admissions right. Time is spent gathering information to assess whether the child’s needs can be met, without detriment to the children already in the home. Although the manager retains the final decision, the views of the staff working directly with the children are a major consideration.

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outstanding

The children’s individual needs are identified early and clear plans and strategies, based on an assessment of risk, are quickly put in place. The regular review and revision of these plans ensures that they are kept up to date and remain relevant. Individual and group work is programmed, and the staff carry out needs-specific work with each child. Most of these interventions are based on current research, an area that has been significantly developed since the last inspection.

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outstanding

The arrangements for children moving out of the home are exceptionally well thought out and meticulously planned. From the point of admission, staff are leading other professionals to think about what children need when they leave the home. They work in partnership with the placing authority and offer excellent innovative Inspection report secure children’s home: SC022448 5 ideas to help find and/or develop the right placement. For example, managers and staff have helped develop bespoke placements for children with complex needs. A professional said: ‘The home’s approach to transition planning is excellent. They have worked in a coordinated way to help develop the right placement for [name of child]. It is testament to them that [name of child] has the opportunity of a placement in the community. It would be easy to say that she continues to meet the criteria for secure and keep her locked up.’

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outstanding

Children benefit from a range of stimulating and purposeful activities that enable them to spend their time constructively. They are encouraged to pursue their hobbies and interests wherever possible. Staff take a risk-aware approach to supporting children to spend risk-assessed time in the community, which further enhances children’s experiences. Their activities in the community include going shopping, visiting the hairdresser’s or going to the gym. Additionally, mobility has been used to prepare children for leaving, such as spending time at new placements or visiting colleges in the area that they are moving to.

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outstanding

Staff recognise the importance of supporting children to keep in touch with the important people in their lives. Managers have responded to the restrictions brought about by the COVID-19 pandemic and have ensured that contact has been maintained in a safe way.

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outstanding

Overall, the standard of accommodation is good, with most areas being child- friendly, within the limitations of being a secure home. However, the communal lounges could be made to feel more homely.

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outstanding

The quality of food is variable. The home is currently relying on agency catering staff, which has led to menus being repetitive and often unhealthy. Managers had already taken action to address this by appointing a specialist chef who is due to join the team shortly. However, in the interim, managers need to maintain better oversight of menus and ensure that children are receiving a balanced and nutritious diet.

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Children’s education and learning: good

Education, care and health staff work very effectively together and agree consistent approaches to supporting each child. Staff set high expectations about behaviour and the need to attend education. Children’s attendance and participation in education are good.

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Children’s education and learning: good

The education lead and staff have reviewed the curriculum and made well- considered changes. The curriculum has been designed so that children study a varied and appropriately challenging range of subjects.

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Children’s education and learning: good

Education managers and staff assess children’s needs effectively when they first arrive at the home and use this information effectively to plan and teach a personalised curriculum in each subject. Teachers are highly skilled at adapting the Inspection report secure children’s home: SC022448 6 way that they deliver lessons to make the content and delivery appropriate for each child, including those with special educational needs and/or disabilities.

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Children’s education and learning: good

Children make good progress based on their starting points, and where appropriate they achieve accredited qualifications. It is testament to the creativity and persistence of staff that one child with complex and challenging behaviour now attends one-to-one lessons in a range of subjects that staff skilfully plan and teach to meet his specific needs.

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Children’s education and learning: good

Education areas, including the gymnasium, are tidy and well maintained. They are decorated with displays of the children’s work. Children treat their learning environments with care and respect.

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Children’s education and learning: good

Within the education curriculum, children study a wide range of topics to support their personal development. In addition, children participate regularly and enthusiastically in well-planned enrichment activities.

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Children’s education and learning: good

Education managers and staff ensure that all children receive impartial careers information, advice and guidance. Younger children understand the importance of the subjects they follow to support their aspirations. Older children can make well- informed choices about their planned next steps.

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Children’s education and learning: good

Suitable action has been taken to address the recommendation made at the last visit. Educational specialists within the wider organisation act in the capacity of governors, providing support and challenge for the education lead.

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Children’s education and learning: good

Recent staff absence and unfilled vacancies have resulted in lessons in English and mathematics being covered by non-subject specialists. Staff covering lessons follow the planned curriculum but lack the specialist subject knowledge to respond quickly to all the subject-related needs of children. Furthermore, the suspension of lessons in science and humanities for the first half of the autumn term means that the curriculum available to children is not as broad as leaders intended.

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Children’s education and learning: good

Children, particularly those who are older, who would benefit from having more vocational subjects in the curriculum are unable to study them due to a lack of physical space and specialist resources. Managers are fully aware of this and are progressing with plans to enable them to enhance the vocational offer.

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Children’s health: outstanding

Children benefit from the support of a highly skilled and diverse multidisciplinary healthcare team. This flexible and proactive service ensures that children make excellent progress in this area of their development.

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Children’s health: outstanding

The Children’s Health Assessment Tool (CHAT) process is very comprehensive. Healthcare professionals competently use this tool to develop highly individualised healthcare plans. Collaborative working throughout the home ensures that these Inspection report secure children’s home: SC022448 7 plans are implemented effectively, resulting in positive, often significant improvements in children’s physical, mental and emotional health.

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Children’s health: outstanding

There is an inspiring and well-coordinated approach to the implementation of ‘Secure Stairs’, an integrated framework that addresses the needs of children across the secure estate. Staff understand and have passionately embraced this trauma- informed approach, using it effectively to provide a nurturing environment that makes children feel safe and improves their emotional health and self-esteem.

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Children’s health: outstanding

Healthcare staff are exceptionally well supported in their roles and are passionate about providing outstanding outcomes for children. They receive regular managerial and clinical supervision and have good access to training that supports their personal development. Knowledge is disseminated to the wider staff team to ensure that children receive the best possible experiences. For example, the occupational therapist is working with the wider staff team to raise their awareness of the importance of exploring the sensory needs of children, and the impact this can have on fostering regulation of feelings and emotional control.

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Children’s health: outstanding

The inspirational mental health team works relentlessly to engage children who have extremely complex and challenging mental health needs. Its members are heavily involved in influencing well-thought-out interventions that enable children to better understand themselves and develop positive coping strategies. It is positive that this is underpinned by the concept that every child deserves a chance to have better life opportunities. This is demonstrated by successful transitions back into the community for a few children who would otherwise require secure mental health accommodation.

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Children’s health: outstanding

Children have good access to a broad range of primary healthcare services that are well delivered. Prompt action is taken to address any outstanding health needs, such as immunisations and routine checks. Emerging health needs are constantly assessed and responded to in a timely manner.

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Children’s health: outstanding

Strong working relationships have been established with a range of external health professionals, such as dentists and opticians. Particularly impressive is the care and support from the extremely child-focused GP, who goes above and beyond when she visits. For example, she has supported a child to explore her aspirations to be a paramedic by spending time with the child teaching her basic medical procedures, such as taking blood pressure.

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outstanding

A diligent and conscientious approach to keeping children safe is an integral feature of the practice in the home. Managers and staff have successfully integrated a centre-wide culture in which each child’s well-being is valued and promoted through a multidisciplinary and multi-agency approach. Children leave this home less traumatised and better equipped to keep themselves safe than when they were admitted. Inspection report secure children’s home: SC022448 8 Managers and staff have a comprehensive understanding of each child’s needs, behaviours, risks and vulnerabilities. Multidisciplinary and trauma-informed support plans and risk assessments are used effectively to help children manage their risk- taking behaviours. When incidents of concern occur, these are meticulously scrutinised by managers to identify any lessons learned. In addition, children are given the opportunity to reflect on and influence how staff support them if incidents

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outstanding

reoccur. This has resulted in children taking more responsibility for keeping themselves safe, including the management of self-harm.

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outstanding

Relationships between children and staff are strong and provide a solid foundation for children to feel safe and thrive. Staff are constantly looking for ways to help children recognise their triggers and develop positive coping strategies. Given the complexity of need of some of the children, this approach has been highly effective in supporting exceptional progress, relative to the child’s individual needs. For example, staff have supported one child to better manage his emotions and significantly reduce the need for physical intervention. It was a pleasure to hear the child talk about how much his life has improved since being at the home.

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outstanding

There is a strong focus on promoting and reinforcing positive behaviour. Clear expectations, routines and boundaries help children to feel safe. The home’s incentive programme is adapted to suit each child’s understanding and promote opportunities for them to achieve realistic goals. Recognition and praise are used well, and children’s progress and achievements are celebrated. This builds their confidence and self-esteem as well as helping children grow.

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outstanding

A full review of restraint practice has been undertaken. Managers have explored five different models of restraint and chosen the one that best suits the complex needs of the children coming into the home.

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outstanding

Physical restraint, single separation and managing children away from the group are used in a supportive and proportionate manner. Detailed records of each intervention are maintained and evidence that the measures taken were necessary and for the minimum amount of time. Staff clearly see these incidents as an opportunity for children to learn and reduce their reliance on external measures of control.

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outstanding

Managerial oversight and monitoring of behaviour management practice are effective in ensuring that high standards are consistently maintained. Senior managers make good use of CCTV to identify any patterns, trends and themes to support improved practice through learning. The positive ethos of the home encourages staff to critique their own practice and self-report if they feel that they have not reached the standards expected. There is a layer of independent scrutiny from the designated safeguarding officer.

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outstanding

Managers are proactive in their response to safeguarding concerns and allegations. Swift action is taken to manage the immediate risk and information is quickly shared with the relevant safeguarding professionals. Investigations are thorough and well Inspection report secure children’s home: SC022448 9 coordinated. Managers ensure that children are kept informed about matters they have raised and provided with a formal letter informing them of the outcome. The designated safeguarding officer expressed a confidence in the home’s commitment to safeguarding children and improving practice.

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outstanding

Staff take a risk-informed approach to searching children, placing the dignity of the child at the forefront of practice. When concerns emerge, they patiently encourage the child to hand in anything that is a prohibited item.

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The effectiveness of leaders and managers: outstanding

The change since the last full inspection is remarkable. The registered manager and the senior leadership team are collectively committed to achieving the best outcomes for the children. They inspire their teams by creating an infectious culture of high aspiration and positivity. All staff have contributed to developing and embedding a well-researched model of trauma-informed practice. The effectiveness of this model of care is evident in the significant and potentially life-changing progress that children make.

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The effectiveness of leaders and managers: outstanding

The registered manager is constantly looking for ways to improve practice in response to the changing needs of children who require secure care. Research- based practice runs throughout all aspects of the service. For example, the registered manager and the clinical psychologist have spent the last year analysing various models of care to find the right approach that will enhance the already well- established ‘Secure Stairs’ framework.

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The effectiveness of leaders and managers: outstanding

Significant effort and time have been put into developing a skilled and highly effective staff team. Excellent access to high-quality and purposeful training enables staff to develop an array of skills that help them to confidently support this highly complex and challenging group of children.

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The effectiveness of leaders and managers: outstanding

The staff say that they feel valued and express high levels of job satisfaction. They spoke with genuine pride about how they are making a difference to the lives of hard-to-reach children. The staff express a confidence in the leadership team, whose members encourage and empower them to contribute and take responsibility for the home’s development.

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The effectiveness of leaders and managers: outstanding

Middle managers have clearly defined roles and responsibilities and are effective in supporting staff in their day-to-day roles. All staff benefit from high-quality supervision that promotes professional development and improved care practice. This is further enhanced through regular clinical supervision which enables staff to understand how the demands of their work can affect their own emotional well- being. This self-reflection helps staff to develop resilience and work positively with children regardless of how challenging the situation or circumstances are.

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The effectiveness of leaders and managers: outstanding

Managers place a great deal of emphasis on keeping staff informed and up to date. In addition to well-structured and purposeful meetings, the manager shares a Inspection report secure children’s home: SC022448 10 weekly podcast providing a summary of the week and any new initiatives. This is also used to recognise and validate the contribution that staff make.

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The effectiveness of leaders and managers: outstanding

Working relationships with partner agencies are used effectively to promote a team around the child approach. Feedback from professionals is extremely positive, with them recognising the benefits of their children spending time at the home. Managers and staff are strong advocates for the children in their care and present appropriate levels of challenge when external parties do not fulfil their duties. Inspection report secure children’s home: SC022448 11

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Recommendations

 The registered person must ensure that children are provided with nutritious meals. (‘Guide to the children’s homes regulations including the quality standards’, page 15, paragraph 3.8)  The registered person must ensure that communal living areas are made as homely as is safely possible. (‘Guide to the children’s homes regulations including the quality standards’, page 15, paragraph 3.9)  The registered person must ensure that as soon as practicable, they recruit to the vacancies in education, ensuring that those appointed have the appropriate specialist subject knowledge to support implementation of a full education curriculum. (‘Guide to the children’s homes regulations including the quality standards’, page 29, paragraph 5.18)  The registered person should continue to progress with their plans to provide the physical resources necessary to enable the delivery of an increased range of vocational subjects that will better meet the needs of children, particularly those

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Recommendations

who are older and want to progress to vocational training and careers. (‘Guide to the children’s homes regulations including the quality standards’, page 29, paragraph 5.18)

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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 secure children’s home: SC022448 12

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Secure children’s home details

Registered provider address: 99 Edge Lane, Edge Hill, Liverpool L7 2PE

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Inspectors

Paul Scott, Social Care Inspector Cath Sikakana, Social Care Inspector Natalie Burton, Social Care Inspector Malcolm Fraser, Her Majesty’s Inspector, Further Education and Skills Gary Turney, Health and Justice Inspector, Care Quality Commission Inspection report secure children’s home: SC022448 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

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