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

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

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Information about this children’s home

This home is run by a large charitable organisation and provides care for up to 52 children. The home cares for children aged five to 19 with complex medical needs, autism spectrum disorders, epilepsy and associated learning disabilities. The home consists of eight individual houses. The children attend the on-site school.

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Information about this children’s home

The registered manager post has been vacant since September 2021.

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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 home on 19 June 2021 to carry out a monitoring 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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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 and young people are not protected or their welfare is not promoted or safeguarded and the care and experiences of children and young people are poor and they are not making progress.

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inadequate

Date of last inspection: 28 January 2020

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inadequate

Overall judgement at last inspection: sustained effectiveness Inspection report children’s home: 2495377 2 Enforcement action since last inspection: Ofsted conducted a monitoring visit in February 2021 following concerns raised by a third party about one of the individual houses. Ofsted served a compliance notice in relation to the leadership and management of the home as a result of the visit. Ofsted undertook a monitoring visit in March 2021 to monitor the action that the provider had taken. The provider had taken sufficient action to meet the compliance notice. Inspection report children’s home: 2495377 3

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Inspection date Inspection type Inspection judgement

28/01/2020 Interim Sustained effectiveness 24/04/2019 Full Requires improvement to be good 04/03/2019 Full Inadequate Inspection report children’s home: 2495377 4

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inadequate

This inspection has identified widespread and serious safeguarding concerns. The children are not safeguarded effectively and receive inconsistent and at times poor care. This leaves children who are unable to express their views and feelings extremely vulnerable.

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inadequate

Children have individual behavioural support plans that are devised by the positive behaviour support team and health professionals. However, these plans are often ignored by the staff, which increases behavioural incidents and does not support the children’s best interests.

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inadequate

Children have a range of complex communication needs. Some of the staff were observed communicating with children using their preferred method of communication. However, some staff failed to use any method of alternative communication. This means that children do not always have the opportunity to make choices and communicate their needs.

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inadequate

Some of the children are inactive and do not have a varied or stimulating routine. Some children eat unhealthy snacks that are not monitored or limited. Combined, these factors do not encourage a healthy lifestyle and mean that children’s dietary intake is not monitored.

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inadequate

The staff complete key-work sessions with the children, using communication methods that meet the children’s needs. However, these sessions are minimal and fail to take place following incidents when children most need support. This means that children are often unable to express their feelings or develop safe coping strategies.

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inadequate

The children live in eight separate houses. Some houses have damage to the walls and internal doors and there are areas that need redecorating or repairing. One child had a vanity unit with a toilet seat and unravelled toilet roll inside. This fails to ensure that children live in a well-kept and homely environment.

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inadequate

Staff take the children out on a range of activities. These have included day trips and an overnight stay at a theme park. The staff have worked hard to enable children to have fun away from the home and celebrate their specific interests.

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inadequate

Children have complex health needs that require specialist equipment and trained healthcare staff. A multi-disciplinary health team is on site and provides an immediate and responsive service to children who require medical support.

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inadequate

Children all attend the on-site school that meets their specific needs. Children’s attendance levels are good. Consequently, children have good education outcomes. Inspection report children’s home: 2495377 5

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

Since May 2021, there have been numerous allegations in regard to the staff’s practice which have not been managed in a way that safeguards the children. There are delays in some staff raising concerns. There are staff who have failed to report alleged abuse. There are also staff who have allegedly witnessed staff preventing a child from leaving a bedroom and not questioned this at the time. On three occasions a failure to report and refer concerns quickly has meant that staff have continued to work with the children after serious concerns were noted about their practice. There is a culture of the staff failing to raise concerns or question unsafe and abusive practice. The children are extremely vulnerable. Many cannot voice concerns or get away from the staff. These matters are currently being addressed by the senior management team as a matter of urgency.

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

The safeguarding policy designed to detail how and who to report safeguarding concerns is incorrect. It references old guidance and names staff who no longer work at the home. The policy specifies what to do in the event of an allegation about a member of staff, but the staff have failed to follow this. A number of staff have reported concerns to managers. However, these concerns have not been passed to the designated officer or the senior leadership team. Recent changes to managers and the duty manager system have resulted in a system that does not work and fails to protect children.

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

Children have been exposed to cleaning materials in one house because the cleaning cupboard lock is broken and has been for some time. The risk management of this was completely ineffective. The risk assessment stated that the materials had been moved despite the fact that they remained in the open cupboard. The staff have failed to identify that cleaning materials are hazardous to children with complex needs. This was addressed at the inspection.

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

The health and safety checks of the other aspects of the home are sufficient. Recruitment checks are carried out with care to ensure that staff are fully checked prior to employment.

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The effectiveness of leaders and managers: inadequate

The managers’ monitoring and oversight are poor. Managers are not aware of the serious shortfalls identified at the inspection. The senior leadership team is not aware that staff have raised concerns about the staff’s practice and that some staff have failed to raise concerns at the time.

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The effectiveness of leaders and managers: inadequate

The positive behavioural support team is resigned to the fact that staff do not implement their behavioural support plans. The physical intervention records have little information, and children’s risk assessments are disregarded by some of the staff. This has led to occasions when the children are not safeguarded and are at risk. Inspection report children’s home: 2495377 6 There are individual house managers who have failed to monitor records or process information and ensure that the senior leadership team is made aware of concerns.

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The effectiveness of leaders and managers: inadequate

The registered manager left the service in August 2021. There is an acting manager in post and the provider has appointed two senior managers for support. The senior leadership team has failed to update the statement of purpose to include these management changes.

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The effectiveness of leaders and managers: inadequate

The management structure is not working. Changes to the duty manager system and to the house manager’s responsibilities have left staff without a clear line of reporting. Three of the eight houses have a designated manager and a deputy. There are five houses that have either no manager or deputy manager. The removal of the duty manager role has compounded this shortfall, leaving children at increased risk. The management arrangements fail to provide the staff with a clear line manager or senior managerial oversight.

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The effectiveness of leaders and managers: inadequate

The managers have failed to notify Ofsted of all significant events as required. This fails to ensure that Ofsted has a current overview of the home. Therefore, it is unclear whether the action taken safeguards the children.

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The effectiveness of leaders and managers: inadequate

A high turnover of staff during the last year has left children being cared for by a number of staff who are new and a number of agency staff. For children who require routine-based care, this fails to provide continuity. Changes in management and staffing and difficult behavioural incidents have had a detrimental impact on the staff. The staff morale is low. Some staff do not receive regular supervision sessions, and incident debriefs are ineffective. At times, there are not enough staff on duty and a lack of experienced and skilled staff. As a result, children do not consistently receive good care or have good experiences.

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The effectiveness of leaders and managers: inadequate

Children’s daily records are not consistently completed and do not refer staff to other documents when incidents have occurred. Therefore, staff may not be aware of some aspects of a child’s day.

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The effectiveness of leaders and managers: inadequate

Communication with the children’s placing authorities is varied. Professionals raised concerns regarding the delay in information being sent to them and poor communication. This does not ensure good working relationships and timely responses in regard to planning children’s care.

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The effectiveness of leaders and managers: inadequate

The managers have failed to fully meet three of the four requirements and one of the three recommendations from the last visit.

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The effectiveness of leaders and managers: inadequate

The managers support the staff to access training. They provide training assessors and the space and time for staff to work on their level 3 qualifications. Staff are engaging with the support they are receiving and are working well towards completion of their qualifications. Inspection report children’s home: 2495377 7 The senior leadership team works well together. When senior leaders are made aware of concerns, they are responsive and decisive in taking immediate action to safeguard the children. Inspection report children’s home: 2495377 8

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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

In meeting the quality standards, the registered person must, and must ensure that staff—

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Requirement Due date

seek to develop and maintain effective professional relationships with such persons, bodies or organisations as the registered person considers appropriate having regard to the range of needs of children for whom it is intended that the children’s home is to provide care and accommodation. (Regulation 5(d))

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Requirement Due date

In particular, ensure that the staff maintain effective and regular communication with the children’s social workers. 1 December 2021

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Requirement Due date

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

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Requirement Due date

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

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Requirement Due date

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

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Requirement Due date

In particular, the standard in paragraph (1) requires the registered person to—

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Requirement Due date

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

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Requirement Due date

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

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Requirement Due date

In particular, ensure that all areas of the children’s accommodation are maintained to a good standard and that all children’s bedrooms are personalised and reflect their choices and requests. 1 December 2021 Inspection report children’s home: 2495377 9 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 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)(iii))

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Requirement Due date

In particular, ensure that the staff use children’s individual communication aids and that they seek the children’s views and wishes.

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Requirement Due date

This requirement was made at the last inspection and is restated. 1 December 2021

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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; and

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Requirement Due date

children are helped to lead healthy lifestyles. (Regulation 10 (1)(a)(b)(c))

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Requirement Due date

In particular, ensure that children are provided with healthy snack choices between meals and that they have a stimulating routine that includes physical activity. 1 December 2021

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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— 22 October 2021 Inspection report children’s home: 2495377 10 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. (Regulation 12 (1) (2)(b)(d))

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Requirement Due date

*The protection of children standard is that children are protected from harm and enabled to keep themselves safe.

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Requirement Due date

In particular, the standard in paragraph (1) requires the registered person to ensure—

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Requirement Due date

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

have the skills to identify and act upon signs that a child is at risk of harm;

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Requirement Due date

manage relationships between children to prevent them from harming each other;

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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

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

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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)(iv)(v)(vi)(vii)(e)) 22 November 2021

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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 22 November 2021 Inspection report children’s home: 2495377 11 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 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; 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)(a)(c)(e)(f)(h))

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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)) 1 December 2021

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Requirement Due date

The registered person must ensure that all employees—

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Requirement Due date

receive practice-related supervision by a person with appropriate experience. (Regulation 33 (4)(b))

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Requirement Due date

This specifically relates to the provider ensuring that the staff receive supervision in line with the home’s policy.

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Requirement Due date

This requirement was made at the last inspection and is restated. 1 December 2021

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Requirement Due date

* These requirements are subject to a compliance notice. Inspection report children’s home: 2495377 12

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Information about this inspection

Inspectors have looked closely at the experiences and progress of children and young people, using the ‘Social care common inspection framework’. This inspection was carried out under the Care Standards Act 2000 to assess the effectiveness of the service, how it meets the core functions of the service as set out in legislation, and to consider how well it complies with the Children’s Homes (England) Regulations 2015 and the ‘Guide to the children’s homes regulations including the quality standards’. Inspection report children’s home: 2495377 13

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Children’s home details

Registered provider: St Elizabeth’s Centre

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Children’s home details

Registered provider address: St Elizabeth’s Centre, South End, Much Hadham SG10 6EW

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Inspectors

Natalie Burton, Social Care Inspector Amy Miles, Social Care Inspector Deirdra Keating, Social Care Inspector Inspection report children’s home: 2495377 14 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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