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. It provides care for up to 52 children and young people aged five to 19 with complex medical needs, autism spectrum disorder, 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 inspectors only inspected the children’s home, not the on-site school.

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Information about this children’s home

The registered manager left in September 2021. There is a manager in post who has applied to register with Ofsted.

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Overall experiences and progress of

children and young people, taking into account

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requires improvement to be good

How well children and young people are helped and protected requires improvement to be good

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requires improvement to be good

The effectiveness of leaders and managers requires improvement to be good

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requires improvement to be good

The children’s home is not yet delivering good help and care for children and young people. However, there are no serious or widespread failures that result in their welfare not being safeguarded or promoted.

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requires improvement to be good

Overall judgement at last inspection: inadequate

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requires improvement to be good

Enforcement action since last inspection: none Inspection report children’s home: 2495377 2

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Inspection date Inspection type Inspection judgement

05/10/2021 Full Inadequate 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 3

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improvement to be good

The quality of care has improved. The management team has addressed the previous shortfalls and prioritised these in a planned way. Some improvements have been hindered because of the COVID-19 pandemic. The management team made the decision to lock down each of the children’s homes for three weeks for the first three weeks in January 2022. Since then, the number of staff having to self-isolate has reduced and the children have returned to school.

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improvement to be good

Most children use alternative communication systems. Pictures, symbols and visual prompts are displayed in children’s bedrooms and communal areas. However, staff are not consistently using these when working directly with children. There is a lack of specific guidance in some children’s support plans about how staff should use these communication systems. This reduces the opportunity for all children to make choices and express their views.

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improvement to be good

The residential staff work closely with the school staff to ensure that the children work towards their education targets. During the COVID-19 pandemic restrictions, the staff made sure that children’s education plans were implemented each day. This reduced gaps in children’s learning and maintained a daily routine.

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improvement to be good

Children eat well-balanced meals and are offered healthy snacks. The on-site nursing team provides medical support and guidance for the staff. There is 24-hour nursing support, which helps to ensure that children receive professional medical care for their complex health needs and in accordance with their individual healthcare protocols.

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improvement to be good

Children have individualised timetables to ensure that care is routine based and meets their learning needs. Speech and language therapists provide tailored social stories for each child. Staff follow timetables with the children to help them know what is happening next. This reduces the anxiety that children have about the day.

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improvement to be good

Staff help children to maintain relationships with their families and friends. Feedback from parents is unanimously positive. The staff take children to visit their families and support these visits. Families visit the home. Parents say that they feel kept up to date and involved in their children’s lives.

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improvement to be good

Social workers fed back that communication and the quality of care have improved recently.

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improvement to be good

Children’s bedrooms are personalised with artwork and individual colour schemes. Photos of family, friends and pets help children to feel at home. Recent improvements in two of the homes include new furniture and refurbished sensory spaces. There are further plans for redecoration. The current and planned Inspection report children’s home: 2495377 4 improvements mean that children will benefit from a more welcoming and stimulating environment that meets their needs.

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improvement to be good

The staff have failed to address two environmental hazards. One home has a piano that is raised off the ground and held in place by the plaster in the wall. Another house has a sensor detector cover missing, which leaves wires exposed. The staff have not taken action to make these hazards safe.

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improvement to be good

The staff occasionally use sanctions for children who are able to learn from them. However, some of these sanctions are not meaningful or linked to the child’s behaviour. Therefore, they do not help children to learn from their actions.

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improvement to be good

A recent safeguarding campaign at the home has reinforced the safeguarding reporting systems. A safeguarding champion has been appointed to each house. This active campaign has given safeguarding an increased profile. The staff are more confident in their knowledge of how and when to report concerns.

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improvement to be good

The staff have improved the clarity and detail of children’s risk management plans. These plans now include recent incidents and provide staff with clear strategies to manage any potential difficulties. Clear and concise information helps the staff to minimise any behaviour-related incidents. Positive behaviour management plans are more succinct and prescriptive. These plans guide the staff well in the management of behaviours that can lead to challenges for the children and the staff.

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improvement to be good

The children have high levels of adult supervision at all times. However, on one occasion, a child decided to run away from the staff for a very short period during a local shopping trip. The missing-from-home procedures were immediately actioned and the child was quickly located.

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improvement to be good

The staff deal with any bullying quickly and effectively. Bullying incidents are rare. However, when bullying is identified, the staff are dynamic and decisive in making sure that children feel comfortable with one another and safe.

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good

The senior leadership team has reviewed the management arrangements, taking account of the number of children and size of the site. A new, qualified manager has been appointed and is in the process of registering with Ofsted. He will provide oversight throughout the planned reconfiguration of the home’s registration into smaller registrations for each house.

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good

The senior leadership team has been restructured and now includes a new quality assurance lead. This has led to several improvements, particularly in regard to Inspection report children’s home: 2495377 5 effective oversight of care and the safeguarding systems. Despite the improvements, several shortfalls remain.

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good

There is a comprehensive training programme with a range of courses to enhance staff’s skills. However, not enough of the staff have had training in understanding autism spectrum disorder, learning disabilities and using alternative communication systems. There are gaps in physical intervention training and delays in some staff completing required safeguarding refreshment sessions. There are 12 members of staff who have not achieved a required level 3 qualification within the appropriate time frames. Overall, this does not ensure that staff have all the necessary skills to support children’s individual and complex needs.

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good

Most of the staff, including agency staff, benefit from constructive supervision that focuses on meeting children’s needs. However, the overall quality of the supervision records is inconsistent. One house manager has failed to record and follow up concerns about team dynamics and a practice concern. A large number of staff have not had an appraisal within the required timescales. This does not ensure that all staff have the necessary support and guidance that they need.

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good

The quality of internal reviews and external monitoring needs improvement. The independent person fails to consult regularly with families and placing authorities. The independent person’s evaluation of safeguarding arrangements is inconsistent. The manager’s review of the quality of care fails to consider children’s and families’ views. These shortfalls mean that opportunities to understand the strengths and weaknesses of practice are missed.

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good

Some aspects of managerial monitoring have improved, particularly the senior management presence at the home, and the review of surveillance equipment for children with health needs. However, the supervision matrix does not always correspond with the supervision records. The fire drills do not include all necessary information, and the staff have failed to complete reliable health and safety checks. These shortfalls had not been identified by the management team and could undermine some of the improvements that have been made.

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good

There continues to be a high number of staff vacancies. The leadership team has initiated a strong recruitment drive. The strategies to address staff turnover include a pay increase and enhanced package of support.

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good

The managers deploy the staff’s skills and experience effectively and provide consistent cover to ensure that there are enough staff on duty. This has been managed well despite the complications of the COVID-19 pandemic.

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good

Staff morale has improved and staff turnover is beginning to reduce. This helps children to experience continuity of care.

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good

The staff undertake numerous medication administration rounds each day, and there are several medication errors. Auditing systems and stock checks identified these Inspection report children’s home: 2495377 6 medication errors. The managers have investigated each incident and looked at the context and implemented protective factors to reduce recurring errors.

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good

The leadership and management team has influenced areas of improvement to raise the quality of care provided. The management team has met four out of the seven requirements that were raised at the last inspection. Three requirements are restated and four additional requirements have been raised at this inspection. Inspection report children’s home: 2495377 7

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Statutory requirements

This section sets out the actions that the registered person(s) must take to meet the Care Standards Act 2000, Children’s Homes (England) Regulations 2015 and the ‘Guide to the children’s homes regulations, including the quality standards’. The registered person(s) must comply within the given timescales.

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Requirement Due date

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 staff consistently use children’s individual communication aids.

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Requirement Due date

This requirement was made at the last inspection and is restated. 25 February 2022

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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

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; 25 February 2022 Inspection report children’s home: 2495377 8 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 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

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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 staff have the experience, qualifications and skills to meet the needs of each child. (Regulation 13 (1)(a)(b) (2)(c))

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Requirement Due date

ensure that all staff complete the required training within relevant timescales;

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Requirement Due date

ensure that staff receive training to meet the individual needs of the children they are allocated to work with.

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Requirement Due date

This requirement was made at the last inspection and is restated. 25 March 2022

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Requirement Due date

For the purposes of paragraph (3)(b), an individual who works in the home in a care role has the appropriate qualification if, by the relevant date, the individual has attained—

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Requirement Due date

the Level 3 Diploma for Residential Childcare (England) ("the Level 3 Diploma"); or

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Requirement Due date

a qualification which the registered person considers to be equivalent to the Level 3 Diploma.

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Requirement Due date

in the case of an individual who starts working in a care role in a home after 1st April 2014, the date which falls 2 years after the date on which the individual started working in a care role in a home; or 24 June 2022 Inspection report children’s home: 2495377 9 in the case of an individual who was working in a care role in a home on 1st April 2014, 1st April 2016.

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Requirement Due date

The registered person may defer the relevant date if the individual—

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Requirement Due date

does not work, or has not worked, in a care role in a home for a prolonged period; or

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Requirement Due date

works, or has worked, in a care role in a home on a part- time basis. (Regulation 32 (4)(a)(b) (5)(a)(b) (6)(a)(b))

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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; 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)(b)(c))

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Requirement Due date

ensure that supervision records are maintained consistently and are monitored by managers to inform future actions when necessary; and

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Requirement Due date

ensure that all staff receive an appraisal within the required timescales.

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Requirement Due date

This requirement was made at the last inspection and is restated. 31 March 2022

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Requirement Due date

When the independent person is carrying out a visit, the registered person must help the independent person—

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Requirement Due date

if they consent, to interview in private such of the children, their parents, relatives and persons working at the home as the independent person requires.

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Requirement Due date

The independent person must produce a report about a visit ("the independent person’s report") which sets out, in particular, the independent person’s opinion as to whether—

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Requirement Due date

children are effectively safeguarded; and

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Requirement Due date

the conduct of the home promotes children’s well-being. (Regulation 44 (2)(a) (4)(a)(b)) 31 March 2022 Inspection report children’s home: 2495377 10 In particular, ensure that safeguarding statements by the independent person are supported by specific information.

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Requirement Due date

supply to HMCI a copy of the quality of care review report within 28 days of the date on which the quality of care review is completed; and

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Requirement Due date

make a copy of the quality of care review report available on request to a placing authority, if the placing authority is not the parent of a child accommodated in the home.

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Requirement Due date

The system referred to in paragraph (2) must provide for ascertaining and considering the opinions of children, their parents, placing authorities and staff. (Regulation 45 (4)(a)(b) (5)) 30 June 2022

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Recommendations

 The registered person should ensure that all incidents of control, discipline and restraint are subject to systems of regular scrutiny to ensure that their use is fair. In particular, they should ensure that records of sanctions include managerial oversight within the required timescales. (‘Guide to children’s homes regulations, including the quality standards’, page 46, paragraph 9.36)  The registered person should oversee the welfare of the children in their care through observation and engagement with the home’s staff. In particular, they should ensure that monitoring systems are consistently reliable and identify shortfalls in practice effectively. (‘Guide to children’s homes regulations, including the quality standards’, page 54, paragraph 10.23)

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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 11

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Children’s home details

Provision sub-type: Residential special school

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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

Deirdra Keating, Social Care Inspector Mark Anderton, Social Care Inspector Mandy Start, Social Care Inspector Inspection report children’s home: 2495377 12 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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