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

Inspection report for 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. Most children attend the on-site school. The inspectors only inspected the social care provision at this 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

Date of last inspection: 24 January 2022

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requires improvement to be good

Overall judgement at last inspection: requires improvement to be good

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requires improvement to be good

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

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Inspection date Inspection type Inspection judgement

24/01/2022 Full Requires improvement to be good 05/10/2021 Full Inadequate 28/01/2020 Interim Sustained effectiveness 24/04/2019 Full Requires improvement to be good Inspection report for children’s home: 2495377 3

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improvement to be good

This inspection was brought forward to address specific concerns received by Ofsted.

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improvement to be good

One child has moved on from the home since the last inspection. There are currently 29 children living at the home. Children have positive experiences and make steady progress from their starting points. However, there are weaknesses in the effectiveness of managerial monitoring. Combined with staff training gaps, the continuity and quality of care for children continues to require improvement.

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improvement to be good

Nursing and specialist therapy teams have good oversight of children’s complex health needs. However, the monitoring of children’s daily health needs by residential staff needs to be addressed. Records are not always fully completed to reflect that children have had enough to eat or are given nutritional supplements when required. This shortfall has not been identified by managers and could lead to poor health for children if left unchecked.

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improvement to be good

The staff work closely with speech and language therapists to support children to use their preferred communication systems. Increased guidance is now included in children’s support plans and communication aids are now used more frequently by staff in the home. However, pictures, symbols and visual aids displayed in communal areas of the houses do not aid children’s understanding. The staff’s recorded one-to- one discussions with children do not always provide meaningful opportunities for children to express their views in line with their plans.

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improvement to be good

The staff continue to work hard to provide children with a welcoming and stimulating environment. The accommodation is spacious and well appointed, and meets children’s recreational and leisure interests. Children’s bedrooms are personalised and individual spaces are adapted to meet the children’s sensory needs. However, some garden areas and walkways have not been maintained to a reasonable standard. A communal doorway in one house has been consistently damaged and is not adapted to meet the needs of children with physical disabilities. These issues detract from the overall standard of the accommodation.

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improvement to be good

All the children have education plans. The staff actively encourage children with their learning. The residential staff’s links with the school staff minimise gaps in children’s learning. Consequently, children are making sustained progress towards their education targets from their starting points.

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improvement to be good

The staff team is motivated, child focused and committed to providing children with positive experiences. The staff offer activities that enhance the children’s interests and expand their social opportunities, including a recent trip to the Natural History Museum in London. Inspection report for children’s home: 2495377 4

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improvement to be good

There are clear and appropriate safeguarding procedures. Most allegations against staff have been managed effectively. However, in one case, an allegation of harm was investigated by managers but not shared with the local authority designated officer. This meant that there was a delay in external oversight. When safeguarding procedures are not followed, safeguards for children are reduced.

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improvement to be good

Improvements are necessary to ensure that thorough cleaning takes place in areas in which children with complex health needs live. Regular schedules for cleaning are not in place, which poses a risk to children with complex health needs who are prone to infection. Daily monitoring by managers does not consistently identify infection control issues.

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improvement to be good

Staff respond to children appropriately during behavioural incidents and in line with each child’s plans. There have been several physical interventions. These have been used as a last resort. Sanctions have been used occasionally for children who are able to learn from them. However, managerial evaluations and, in some cases, children’s views are missing from these records. Consequently, the intended safeguards of monitoring the records to ensure consistency and proportionality are not fully realised for children.

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improvement to be good

The staff deal with peer-on-peer harm effectively. Staff ensure that the immediate situation is de-escalated and are dynamic in making sure that children feel comfortable with one another. Staff review compatibility between children regularly. When necessary, person-centred moves for children take place between the houses. This ensures that harmony is maintained between children and helps them to feel safe.

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improvement to be good

Staff have good awareness of children’s individual missing-from-home procedures. Staff provide high levels of supervision and strong security arrangements. There have been no incidents of children going missing from the home.

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improvement to be good

The staff understand their safeguarding responsibilities and have good knowledge of whistle-blowing procedures. They receive training in safeguarding disabled children and are aware of the children’s additional vulnerabilities.

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good

The senior leadership team continues its plans to reconfigure the home’s registration into smaller registrations for each house. A qualified manager has been appointed and is in the process of registering with Ofsted to oversee this transition. Although improvements seen at the last inspection have been sustained, there are still several shortfalls that require attention. Inspection report for children’s home: 2495377 5 Managers have ensured that training for staff includes understanding autism spectrum disorders. More staff have attended sessions on using alternative communication systems. However, managers have not offered sessions to staff in understanding learning disabilities, and not enough of the staff have had training in using physical interventions. Furthermore, essential training in administering medication is not undertaken by enough of the staff. This means that there is an over-reliance on the on-site nursing team and short notice redeployment of staff

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good

between the houses to cover the gaps in meeting children’s care needs. Consequently, continuity of care to children is affected by these staffing changes.

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good

The quality of internal reviews and external monitoring have not sufficiently improved. The independent person has not consulted regularly enough with families and placing authorities. The manager’s review of the quality of care fails to consider a reasonable proportion of families’ and staff members’ views. This is an important factor in understanding the strengths and development opportunities of the home, as children have difficulties in expressing their own views and feelings.

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good

Systems for notifying Ofsted are usually effective. However, on one occasion, an allegation against a staff member was responded to but was not notified. As a result, Ofsted’s capacity to monitor safeguarding arrangements has been reduced.

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good

Staff now receive well-developed appraisals to reflect on their work objectives. Most of the staff, including agency staff, benefit from supervision that focuses on meeting children’s needs. However, this is not consistent across all of the houses. There are delays in staff receiving supervision in two of the eight houses. This does not ensure that these staff have the necessary support and guidance that they need.

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good

Parents value the home’s approach to making them feel welcome to come to visit and spend time with their children. Parents say that individual members of staff are ‘amazing’ in the care and support that they provide for their child. However, some parents and social workers say that the level of communication between staff at the home has not been as good as it could be. As a result, there have been delays in important information being shared.

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good

The staffing development plan continues to be modified. The management team has further enhanced strategies to attract and retain staff. This now includes an individual staff recognition scheme. This, coupled with successful recruitment drives, means that staffing turnover has now stabilised and vacancies are beginning to reduce.

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good

The management team understands and has plans in place to address the shortfalls identified at this inspection. Inspection report for children’s home: 2495377 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. (Regulation 10 (1)(a))

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Requirement Due date

managers must ensure that children’s health needs are understood and met by all staff involved in the children’s care;

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Requirement Due date

ensure that the records to monitor children’s health needs are fully completed and reviewed regularly. 29 July 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 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)(a)(vii)

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Requirement Due date

This requirement was made at the last inspection and is restated. 29 July 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 effectiveness of the home’s child protection policies is monitored regularly. (Regulation 12 (1) (2)(e)) 29 July 2022 Inspection report for children’s home: 2495377 7 Specifically, ensure that prompt referrals are made to the local authority designated officer following allegations of abuse against staff.

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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.

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Requirement Due date

ensure that the home’s workforce provides continuity of care to each child. (Regulation 13 (1)(a)(b) (2)(c))

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Requirement Due date

In particular, 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. 31 August 2022

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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)) 29 July 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. (Regulation 44 (2)(a) (4)(a)(b))

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Requirement Due date

This requirement was made at the last inspection and is restated. 29 July 2022

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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— 30 September Inspection report for children’s home: 2495377 8 the feedback and opinions of children about the children’s home, its facilities and the quality of care they receive in it.

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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 (2)(b) (5))

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Requirement Due date

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

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Recommendations

 The registered person should ensure that the home is decorated and maintained to a consistently high standard throughout the accommodation. When necessary, they should ensure that all communal areas are adapted for children’s individual needs. (‘Guide to the Children’s Homes Regulations, including the quality standards’, page 15, paragraph 3.9)  The registered person should ensure that children’s views, wishes and feelings are considered. In particular, ensure that when communication aids are used by staff to support one-to-one discussions with children that these are used in line with children’s plans. (‘Guide to the Children’s Homes Regulations, including the quality standards’, page 21, paragraph 4.5)  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, ensure that records of sanctions include managerial oversight within

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Recommendations

the required timescales. (‘Guide to the Children’s Homes Regulations, including the quality standards’, page 46, paragraph 9.36)  The registered person should develop effective working relationships with each child’s placing authority and with other relevant persons. In particular, they should ensure that levels of communication are established, agreed and adhered to with parents and professionals. (‘Guide to Children’s Homes Regulations, including the quality standards’, page 52, paragraph 10.3)  The registered person should ensure that all staff receive supervision in line with the home’s policy. (‘Guide to the Children’s Homes Regulations, including the quality standards’, page 61, paragraph 13.2)

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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 Inspection report for children’s home: 2495377 9 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 for children’s home: 2495377 10

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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

Mark Anderton, Social Care Inspector Jamie Cousins, Social Care Inspector Rosie Davie, Social Care Inspector Inspection report for children’s home: 2495377 11 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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