Children's home run by Exceptional Care Limited in Knowsley

Assurance inspection report for children’s home: SC483070 1 SC483070

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Registered provider: Exceptional Care Limited

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Inspected under the social care common inspection framework

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Information about this children’s home

This privately run home cares for up to four children. The home’s statement of purpose states that children living in this home may have a range of social and emotional difficulties. Three children can live in the main house, and there is additional accommodation for one child in a basement flat. At the time of the inspection, there were three children living in the home.

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Information about this children’s home

There is a suitably qualified manager in post who registered with Ofsted in April 2022.

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Inspection date: 24 August 2022

Judgement at last inspection: requires improvement to be good

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Inspection date: 24 August 2022

Enforcement action since last inspection: none

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Information about this inspection

At this inspection, the inspectors evaluated:

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Information about this inspection

 the care of children  the safety of children  the effectiveness of leaders and managers. Inspectors have looked closely at the experiences and progress of children, using the social care common inspection framework. This assurance 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’. Assurance inspection report for children’s home: SC483070 2

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Findings from the inspection

We identified the following serious and widespread concerns in relation to the care or protection of children at this assurance inspection:

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Findings from the inspection

 Children are not always safeguarded effectively or protected from harm.  Leaders and manager’s oversight and monitoring of the home is ineffective.  Children are not provided with continuity of care from a stable and consistent staff team.  Leaders and managers have failed to follow safe allegation management procedures.  Risk assessments are of poor quality and do not provide staff with clear guidance to safeguard children.  Records of restraint, including debriefs with children and staff have not improved in quality.  Direct work with children to help them reduce their risk-taking behaviour has not been completed.  Leaders and managers have failed to consistently notify Ofsted of all serious concerns.

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The care of children

This assurance inspection was bought forward because of a significant number of safeguarding notifications and two complaints submitted to Ofsted. Inspectors found serious and widespread concerns in relation to leaders and managers’ oversight of the operation of the home. Consequently, children have not been adequately safeguarded or protected from harm, and there has been an impact on the quality of care provided to children.

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The care of children

Children continue to smoke or use vapes. This was identified as a concern at the last inspection. Direct work has not been carried out with children to educate them about the risks of smoking. Additionally, the staff team has failed to liaise with relevant health professionals to support children to stop smoking and to help them understand the impact it has on their health.

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The care of children

Children told inspectors that they have developed some positive relationships with the staff team. One child said that staff have kept them safe and as a result their self-injurious behaviour has reduced. Some children have started to receive therapeutic support from in-house therapists and external mental health agencies. However, this now needs embedding by the staff team and professionals working with the children to promote children’s positive emotional well-being.

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The care of children

Children generally engage well in their education, and they are supported by staff to maintain regular attendance. When children are preparing to move out of the home, Assurance inspection report for children’s home: SC483070 3 staff support them to develop their independence skills and ensure that they are involved in and understand the plans for their future.

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The care of children

Since the last inspection, there has been an improvement in the language used by staff in children’s records. Staff record their observations in a more child-focused, nurturing and factual way, so that when children access their records they are provided with a clearer and more balanced account of their time in the home.

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The care of children

There have been some improvements to the home’s environment, to make it more comfortable. Children have been helped to personalise their bedrooms and they are proud of their rooms.

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The safety of children

The requirement raised at the home’s last inspection, relating to children’s safety and protection, has not been suitably addressed to make improvements to how children are safeguarded effectively. On one occasion, staff failed to follow a child’s water safety risk assessment, in particular relating to the child’s level of understanding of risk and staff adhering to beach safety signs. This placed the child at significant risk. The child was allowed to play in shallow water at a local beach, then continued to venture further out into the sea and refused to return. Consequently, the coastguard was required to rescue the child from the sea, as the staff were unable to do so without placing the child at further risk.

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The safety of children

The child was taken to hospital by staff as they suspected the child may have swallowed some sea water. However, on returning home, regular checks were not implemented throughout the night to check on the child’s health, well-being and safety. The manager has failed to recognise or address any lessons learned relating to poor staff decision-making and staff’s failure to follow the child’s risk assessment. Additionally, there has been no direct work carried out with the child to educate them about water safety and open water swimming.

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The safety of children

Managers and staff have not followed the correct procedures in relation to safe allegation management. This refers specifically to a failure to notify a child’s placing authority’s emergency duty team, a delay in notifying the local authority designated officer and a failure to seek medical assessment for a child after they alleged they had been injured by staff. Additionally, senior managers have not taken suitable action to keep the child and staff member safe, by allowing the staff member to remain working with children in the main home during the investigation.

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The safety of children

Risk assessments have not improved in quality since the last inspection. They are not reflective of children’s current risk-taking behaviour, and they do not provide staff with clear strategies on how to respond to children to safeguard them effectively. Furthermore, senior managers have not yet arranged a planned risk assessment workshop with the staff team to improve their understanding of risk management. Assurance inspection report for children’s home: SC483070 4 One child has not been provided with regular key-work sessions for almost three months. This means the child has not had focused support sessions from the staff team to help them to reduce their risk-taking behaviour or work through their individual needs. The manager has failed to address this with the staff team or agree a plan of direct work to support the child.

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The safety of children

The manager has worked with the staff team to make some improvements to the quality of restraint records. However, her oversight is not consistent. Some records do not provide sufficient or clear information. Staff do not always record the time that each restraint started or their positioning when holding the child. Children are not always spoken to about their feelings or views following a restraint. This is a missed opportunity to identify ways that staff can help keep children safe and reduce restraint levels. Consequently, the use of restraint with one child has remained high.

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The effectiveness of leaders and managers

Leaders and managers have failed to ensure that there is consistent and effective monitoring of the operation of the home. The manager has failed to identify the serious concerns that inspectors found relating to unsafe risk management and poor safeguarding practice. The manager’s ineffective monitoring means there is a lack of safe oversight of staff practice to ensure that children are safeguarded effectively.

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The effectiveness of leaders and managers

Children are not provided with continuity of care from a consistent staff team. Several staff have left the home since the last inspection. Bank staff and staff from other settings are regularly used to cover the shifts in the home. Therefore, children are regularly supported by staff they do not have established relationships with. Staff and children told the inspectors that the inconsistencies of different staff working in the home have had an impact on the quality of care for children and have also affected the morale of the staff team.

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The effectiveness of leaders and managers

The manager’s oversight of incident records is not consistent. She has failed to identify several gaps in records, specifically in restraint and missing-from-home records. Staff are not always provided with full or good-quality debriefs following serious incidents. This means they are not provided with an opportunity to reflect on their practice or identify lessons learned to support effective safeguarding. Return home interviews with children are not evidenced and this has not been suitably escalated by the manager with children’s placing authorities.

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The effectiveness of leaders and managers

On one occasion, the manager has failed to notify Ofsted about a serious concern raised by a child’s parent. This prevents the regulator from being able to monitor effectively any serious incidents or to assess if the correct action is being taken by the provider to safeguard children.

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The effectiveness of leaders and managers

The manager recognises the home’s strengths and weaknesses and the work that is required to improve the quality of care and protection provided to children. Staff spoken to say they feel supported by the manager and that she has started to Assurance inspection report for children’s home: SC483070 5 implement positive change in the home. Additionally, the compliance manager has undertaken a reflective session with the staff team following an unsettled period, to enable managers and staff to share knowledge and review practice.

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The effectiveness of leaders and managers

There has been an improvement in the quality of practice-related supervisions. Records evidence that staff are encouraged to discuss their practice and agree action plans to develop their skills. The quality of training has also improved. Face- to-face training has been reintroduced in place of online learning and staff have been provided with additional learning through training that is specific to children’s individual needs and risks.

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The effectiveness of leaders and managers

Following this assurance inspection, three compliance notices were raised, under regulations 12, 13 and 35.

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Inspection date Inspection type Inspection judgement

16/06/2022 Full Requires improvement to be good 15/03/2022 Full Requires improvement to be good 19/02/20-20 Full Outstanding 09/05/2018 Full Good Assurance inspection report for children’s home: SC483070 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

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)(b)(c)) 9 October 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

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

help each child to understand how to keep safe;

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Requirement Due date

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

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Requirement Due date

understand the roles and responsibilities in relation to protecting children that are assigned to them by the registered person;

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Requirement Due date

take effective action whenever there is a serious concern about a child’s welfare; and

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Requirement Due date

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. (Regulation 12 (1) (2)(a)(i)(ii)(iii)(v)(vi)(b)) 9 October 2022 Assurance inspection report for children’s home: SC483070 7 This requirement is restated.

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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 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

ensure that the home’s workforce provides continuity of care to each child;

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Requirement Due date

use monitoring and review systems to make continuous improvements in the quality of care provided in the home. (Regulation 13 (1)(a)(b) (2)(c)(e)(h))

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Requirement Due date

This requirement is restated. 9 October 2022

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Requirement Due date

*The registered person must ensure that—

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Requirement Due date

restraint in relation to a child in the home, a record is made which includes—

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Requirement Due date

the date, time and location of the use of the measure;

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Requirement Due date

a description of the measure and its duration;

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Requirement Due date

within 48 hours of the use of the measure, the registered person, or a person who is authorised by the registered person to do so ("the authorised person")—

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Requirement Due date

has spoken to the user about the measure; and

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Requirement Due date

within 5 days of the use of the measure, the registered person or the authorised person adds to the record confirmation that they have spoken to the child about the measure. (Regulation 35 (3)(a)(iii)(iv)(b)(i)(c))

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Requirement Due date

This requirement is restated. 9 October 2022

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Requirement Due date

The registered person must notify HMCI and each other relevant person without delay if— 9 October 2022 Assurance inspection report for children’s home: SC483070 8 there is an allegation of abuse against the home or a person working there. (Regulation 40 (4)(c))

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Requirement Due date

*These requirements are subject to a compliance notice.

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Recommendation

 The registered person should ensure that when a child returns to the home after being missing from care or away from the home without permission, the responsible local authority provides an opportunity for the child to have an independent return home interview. Homes should take account of information provided by such interviews when assessing risks and putting arrangements in place to protect each child. (‘Guide to the Children’s Homes Regulations, including the quality standards’, page 45, paragraph 9.30) Assurance inspection report for children’s home: SC483070 9

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Children’s home details

Registered provider: Exceptional Care Limited

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Children’s home details

Registered provider address: Exceptional Care Limited, Malthouse Business Centre, Southport Road, Ormskirk L39 1QR

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Inspectors

Cheryl Field, Social Care Inspector Amie Anders, Social Care Inspector Assurance inspection report for children’s home: SC483070 10 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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Inspectors

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