Children's Home run by N H Care Limited in Birmingham

Inspection report for children’s home: SC432966 1 SC432966 Registered provider: N H Care Limited Full inspection Inspected under the social care common inspection framework

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Information about this children’s home

The home is registered to provide care for four children who have physical disabilities and/or learning disabilities. It is privately owned. The home has not had a registered manager in post since March 2022.

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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/or widespread failures that mean children and young people are not protected or their welfare is not promoted or safeguarded and/or 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: 13 October 2021

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inadequate

Overall judgement at last inspection: good

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inadequate

Enforcement action since last inspection: none Inspection report for children’s home: SC432966 2

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Inspection date Inspection type Inspection judgement

13/10/2021 Full Good 18/02/2020 Full Good 11/12/2018 Full Good 24/01/2018 Full Good Inspection report for children’s home: SC432966 3

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inadequate

Three children live in this home. One child has lived here for four years and another for 17 months. A third child, who has lived in the home for three months, had a well-planned move. Careful matching means that the child has quickly settled and enjoys positive relationships with other children.

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inadequate

During this inspection, serious shortfalls were found in the administration of medication. As a result, two serious medication errors have negatively impacted on the health of two children and resulted in them needing hospital treatment.

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inadequate

Managers have failed to ensure that medication is safely administered. For example, a child was admitted to hospital in an emergency. This was because a child became unwell and was not very responsive, which led staff to realise that the child had been administered the wrong dosage of medication. Healthcare professionals carried out tests and medical results found that the child was given a large overdose of prescribed medication.

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inadequate

Despite the very serious nature of this shortfall, managers failed to review staff training and competence to administer medication. A second medication error occurred when staff again administered the incorrect dosage of medication. Staff had not followed the correct procedure for booking in medication when a child returned from hospital with a new prescription. As a result of the child receiving an incorrect dosage of medication, the child was admitted to hospital for checks.

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inadequate

Despite the serious shortfalls found during the inspection, children make good progress and, for some children, this progress is sustained over time. For example, one child has developed his mobility skills, which has led to more independence for him. Another child can now feed himself from a pre-loaded spoon.

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inadequate

When children do not have a school place, managers advocate strongly for them to get a place. As a result, all children attend school full time. A teacher told the inspector that staff are very good at communicating about their child’s needs. They said that staff clearly want what is best for the child.

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inadequate

Staff support children’s cultural and religious needs and they enable children with complex communication needs to participate in everyday conversations. For example, staff support a child who follows the Muslim faith to participate in Friday prayers. The same child is provided with a halal diet. Staff understand children’s particular vulnerabilities and they talk with children in their preferred communication style about road safety and stranger danger, as well as events such as Halloween. Inspection report for children’s home: SC432966 4 The home is a homely place for children to live. Children and carers eat their evening meal together around the kitchen table. Sensory lights in communal areas and in children’s bedrooms help children to relax. Children enjoy spending time with staff in the sensory room and in the garden.

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

Management oversight of staff recruitment is weak. When managers identify serious shortfalls in the safe recruitment of staff, they do not consider how to improve practice to ensure that only suitable people work with children. This means that deficits continue and children are placed at risk.

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

Managers lack professional curiosity and fail to identify shortfalls in staff recording. For example, managers did not explore the vague recording of an incident of self- harm. They did not question the antecedents to the child’s behaviours, or if staff had monitored the child in line with their risk assessment. This means that managers cannot effectively evaluate staff practice, and this is a missed opportunity to further understand the triggers to a child’s complex behaviours.

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

Managers and staff are not vigilant about risks around the home. For instance, a radiator was extremely hot and risked children being burnt. There were loose bricks in the garden, food was incorrectly stored in the fridge and a cupboard containing hazardous substances was unlocked. All issues were dealt with by the end of the inspection.

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

Staff talk knowledgeably about children’s behaviours and how to manage them. Because of staff support, children become more able to manage their emotions without hurting themselves or other people. Consequently, physical intervention is rarely needed. Clear routines and boundaries help children with complex behaviours to know what is expected of them and they benefit from a consistent approach to their care.

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

All children have personal emergency evacuation plans and managers and staff ensure that regular fire safety checks and fire drills take place. This helps to keep children safe in the event of a fire emergency.

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The effectiveness of leaders and managers: inadequate

Management arrangements are unstable. The home has had three managers in six months and has been without a registered manager since March 2022. The acting manager was the deputy manager and has been in post since 1 October 2022. However, the acting manager does not intend to apply to register with Ofsted. Inconsistent management arrangements have seriously affected management oversight of the home. At the time of the inspection, senior managers are in the process of recruiting to the post of manager to bring greater stability to the leadership of the home moving forward. Inspection report for children’s home: SC432966 5 The responsible individual has not overseen the management of the home effectively in light of the instability in leadership. This shortfall has contributed to the decline in the quality of care and failings identified at this inspection.

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The effectiveness of leaders and managers: inadequate

Management oversight of the handling, recording and administration of medication fails to safeguard children. Following a serious medication error, staff did not receive additional medication training. In addition, managers have failed to re-assess staff’s competency to safely administer medication. Only one staff member has received a competency assessment since July 2022. The competency for five staff members is out of date. Managers have not ensured that staff’s skills and competence to administer medication has been refreshed annually, in line with the home’s medication policy.

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The effectiveness of leaders and managers: inadequate

Some staff do not have the necessary skills to care for vulnerable children with complex needs. For example, two staff have not received training in self-harm, and one staff member has not received training in epilepsy. This means that all staff are not equipped with the appropriate skills and training to better support children.

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The effectiveness of leaders and managers: inadequate

Upheaval in management has affected the frequency of staff supervisions. Managers do not provide staff with regular supervision support, or an annual appraisal in line with the organisation’s internal policy. Therefore, managers are unable to assess whether staff are making progress and understand their roles and responsibilities in providing care to children and how to keep them safe.

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The effectiveness of leaders and managers: inadequate

A team of core staff offers children consistent care. Shortfalls in staffing are covered by existing staff and some agency staff. Managers try hard to ensure that agency staff are from a small pool of familiar staff. This means that children are able to develop positive and healthy relationships with familiar adults who know them well.

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The effectiveness of leaders and managers: inadequate

As a result of this inspection, a compliance notice under regulation 23 of The Children’s Homes Regulations (England) 2015, (Medicines) has been raised. Inspection report for children’s home: SC432966 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 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; 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)(c )(h))

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Requirement Due date

This specifically relates to managers ensuring that all staff have training in self-harming behaviours, ligature and epilepsy. This also relates to senior managers ensuring that they maintain oversight of staff recruitment before new staff work with children. Additionally, that managers’ monitoring of incident reports explores shortfalls in staff recording. 28 November

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Requirement Due date

*The registered person must make arrangements for the handling, recording, safekeeping, safe administration and disposal of medicines received into the children’s home.

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Requirement Due date

In particular the registered person must ensure that—

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Requirement Due date

medicines kept in the home are stored in a secure place so as to prevent any child from having unsupervised access to them;

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Requirement Due date

medicine which is prescribed for a child is administered as prescribed to the child for whom it is prescribed and to no other child; and 28 November Inspection report for children’s home: SC432966 7 a record is kept of the administration of medicine to each child.

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Requirement Due date

Paragraph (2) does not apply to medicine which—

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Requirement Due date

is stored by the child for whom it is provided in such a way that other persons are prevented from using it; and

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Requirement Due date

may be safely self-administered by that child. (Regulation 23 (1) (2)(a)(b)(c) (3)(a)(b))

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Requirement Due date

This specifically relates to managers ensuring that all staff are suitably trained, and that managers assess staff competence to safely administer medication. Also, that policies and procedures are in place and implemented to ensure the safe administration of medication in the home.

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Requirement Due date

have the capacity, experience and skills to supervise the management of the home, or the homes, in respect of which the responsible individual is nominated. (Regulation 26 (7)(b))

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Requirement Due date

This specifically relates to senior managers ensuring that the responsible individual maintains effective oversight of the management of the home. 28 November

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Requirement Due date

The registered provider must appoint a person to manage the children’s home if—

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Requirement Due date

there is no registered manager in respect of the home; and

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Requirement Due date

is not, or does not intend to be, in day-to-day charge of the home.

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Requirement Due date

If the registered provider appoints a person to manage the home, the registered provider must, without delay, give HMCI notice of—

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Requirement Due date

the name of the person so appointed; and 28 November Inspection report for children’s home: SC432966 8 the date on which the appointment takes effect. (Regulation 27 (1)(a)(b)(i)(ii)(iii) (2)(a)(b))

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Requirement Due date

This specifically relates to managers ensuring that a manager is appointed to be in day-to-day charge of the home who fulfils the requirements in regulation 28, and that this person applies to register as manager of the home.

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Requirement Due date

The registered person must recruit staff using recruitment procedures that are designed to ensure children’s safety.

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Requirement Due date

employ an individual to work at the children’s home; or

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Requirement Due date

if an individual is employed by a person other than the registered person to work at the home in a position in which the individual may have regular contact with children, allow that individual to work at the home, if the individual satisfies the requirements in paragraph (3).

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Requirement Due date

full and satisfactory information is available in relation to the individual in respect of each of the matters in Schedule 2. (Regulation 32 (1) (2)(a)(b) (3)(d))

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Requirement Due date

This specifically relates to managers ensuring that they obtain information on new staff which satisfies all the requirements in schedule 2 before staff work with children. 28 November

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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)(a)(b))

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Requirement Due date

This specifically relates to managers ensuring that all staff receive practice-related supervision and an annual appraisal in line with the home’s supervision policy. 28 November

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Requirement Due date

* This requirement is subject to a compliance notice. Inspection report for children’s home: SC432966 9

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Recommendations

 The registered person should ensure that the home is a nurturing and supportive environment that meet the needs of their children; it will, in most cases, be a homely, domestic environment. Children’s homes must comply with relevant health and safety legislations (alarms, food hygiene etc.); however, in doing so, homes should seek as far as possible to maintain a domestic rather than ‘institutional’ impression. (‘Guide to the Children’s Homes Regulations, including the quality standards’, page 15, paragraph 3.9)

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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 for children’s home: SC432966 10

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Children’s home details

Registered provider address: 69, Steward Street Business Lofts, Steward Street, Birmingham B18 7AF

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Inspector

Karen Gillingwater, Social Care Inspector Inspection report for children’s home: SC432966 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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Inspector

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Inspector

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Inspector

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