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

Assurance inspection report for children’s home: 2495377 1 Registered provider: St Elizabeth’s Centre

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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 aged five to 19 years with complex medical needs, autism spectrum condition, epilepsy and associated learning disabilities. The home consists of seven 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 manager registered with Ofsted in July 2022.

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Information about this children’s home

Inspection dates: 15 and 16 November 2022

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Information about this children’s home

Judgement at last inspection: requires improvement to be good

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Information about this children’s home

Enforcement action since last inspection: not applicable

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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: 2495377 2

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Findings from the inspection

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

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Findings from the inspection

 Leaders and managers have failed to take effective action in relation to three of the requirements raised at the last inspection. A failure to respond to shortfalls demonstrates that managers have ineffective systems in place to make the necessary improvements.  Leaders and managers have not consistently ensured that children’s risk assessments provide practical strategies for staff following significant incidents.  Leaders and managers have failed to identify hazards in the gardens and a defective fire door. This shortfall was identified at the last inspection and is repeated.  Leaders and managers have failed to maintain effective oversight of statutory notifications made to Ofsted and the information shared with safeguarding professionals.  Leaders and managers have not ensured that staff have regular supervision at the required frequencies. This shortfall was identified at the last inspection and is repeated.

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The care of children

There are currently 24 children living at the home. The staff provide individualised support that children and their parents value. There are some positive developments that have improved children’s experiences. However, there are repeated shortfalls in the effectiveness of managerial monitoring, which hinder these improvements. Some of these shortfalls are long standing and demonstrate a lack of care and attention. If left unresolved, these may place children at increased risk of harm.

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The care of children

A communal fire door in one house has been repeatedly damaged and is not adapted to meet the needs of children with physical disabilities. This has been raised as a concern at the last two inspections. The general condition of this house is poor and showing signs of wear. These issues detract from the improvements and the good decorative standard of the other houses.

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The care of children

Senior nursing staff have devised and embedded systems to make sure that children’s complex clinical needs are met. Nurses have upskilled residential staff through training and targeted observations. As a result, the monitoring and support of children’s daily health needs are more effective.

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The care of children

The staff work successfully with speech and language therapists to support children to use their preferred communication systems. Increased guidance is included in children’s support plans, and communication aids are used more frequently by staff. Assurance inspection report for children’s home: 2495377 3 Visual aids now support children’s understanding of daily routines. One-to-one discussions with children have been adapted to help them to express their views. There is notable progress in staff’s practice in this area and this is valued by children.

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The care of children

Children are progressing well in their education. The residential staff work well with the school staff to ensure that the children work towards their educational targets. For one child, when school attendance was not possible, school staff supported home learning. This joint working ensures that gaps in children’s education are reduced.

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The care of children

The children have enjoyed a good range of activities. These have included trips to theme parks, safari parks and a short caravan holiday. These experiences provided new opportunities for children that supported their interests.

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The safety of children

Leaders and managers have failed to monitor and identify hazards in the garden and external walkways of the premises. Uncovered water-play resources have algae growing in the water, and sandpits were unprotected from inclement weather. Furthermore, crumpled paddling pools and disused rotary washing lines were discarded in the walkways. Ineffective monitoring by managers demonstrates a lack of attention and awareness of identifying hazards. These issues pose hygiene risks to children that should be avoidable.

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The safety of children

Leaders and managers do not always identify clear, effective strategies to manage risks for children. Following an incident between two children, the strategies that were put in place lacked depth and guidance for staff on what proactive actions they should take. A similar incident then reoccurred. A failure by managers to fully consider risks posed by and to children means that these risks are not reduced.

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The safety of children

The local fire authority visited the accommodation on 16 November 2022 and concluded that a reasonable standard of fire safety was in place. However, nine staff have not completed fire safety training. Two self-closing fire doors were being propped open by furniture during the inspection. This increases the risk to vulnerable children in the event of a fire.

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The safety of children

The staff use physical interventions proportionately and as a last resort. However, one manager has been involved in an intervention, and the supporting records have not been reviewed by another independent member of staff. This does not provide an objective analysis, and compromises the learning opportunities that could be had from this incident.

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The safety of children

The staff generally understand their safeguarding responsibilities and have good knowledge of whistle-blowing procedures. However, one safeguarding concern was not referred by managers swiftly through the appropriate reporting systems in line with local authority procedures. Assurance inspection report for children’s home: 2495377 4

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The effectiveness of leaders and managers

A registered, qualified and experienced manager oversees the care and support across seven individual houses. Although some systems have improved, long- standing and repeated shortfalls remain. The senior leadership team’s plans to reconfigure the home’s registration into smaller registrations has not been realised. Consistent managerial oversight across all of the individual houses has not been possible.

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The effectiveness of leaders and managers

External monitoring by the independent person has not improved. The frequency of feedback is still not consistent enough to represent the views of all the children. The visits are all announced, which reduces the intended safeguards of this monitoring.

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The effectiveness of leaders and managers

Leaders and managers have failed to maintain effective oversight of statutory notifications made to Ofsted. In one case, unclear and inaccurate information was sent to Ofsted and to safeguarding professionals. The information shared was not factual and prompted unnecessary action by the police.

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The effectiveness of leaders and managers

Most staff receive regular, child-focused and reflective supervisions. However, there are significant delays in staff receiving supervision in one of the seven homes. The regularity and quality of staff supervision has been raised as a shortfall at previous inspections. A failure to ensure regular supervision has a negative impact on the staff’s ability to provide consistent care for children.

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The effectiveness of leaders and managers

Leaders and managers have prioritised the training needs of staff to provide safer care to children. There are now a sufficient number of staff trained in physical interventions and medication administration. This has improved staffing continuity and reduced the need for staff redeployment across the houses. Additional autism awareness courses have been offered and have increased staff’s skills and knowledge. The staff have not had training in understanding learning disabilities, although this is scheduled. Overall, although more training is needed, progress has been made and staff are better equipped to meet the individual needs of children.

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The effectiveness of leaders and managers

Parents gave good feedback about the experiences of children. They highlighted that the extent of information shared and general levels of communication with staff have recently improved.

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The effectiveness of leaders and managers

The manager’s internal review of care now includes a wider range of feedback that more-reliably contributes to identifying developmental areas of staff practice.

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Recent inspection history

Assurance inspection report for children’s home: 2495377 5

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Inspection date Inspection type Inspection judgement

28/06/2022 Full Requires improvement to be good 24/01/2022 Full Requires improvement to be good 05/10/2021 Full Inadequate 28/01/2020 Interim Sustained effectiveness Assurance 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 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

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;

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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)(f)(h))

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Requirement Due date

In particular, ensure that leaders and managers monitor the environment to identify and resolve or remove potential hazards;

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Requirement Due date

ensure that leaders and managers review and revise children’s risk assessments following incidents of concern;

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Requirement Due date

implement effective monitoring to oversee statutory notifications to ensure that they contain accurate and reliable information within required timescales;

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Requirement Due date

ensure that leaders and managers hold regular, recorded supervision sessions with staff in line with the home’s policy across all the operating houses. 6 January 2023

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Requirement Due date

If the Regulatory Reform (Fire Safety) Order 2005(a) applies to the home— 6 January 2023 Assurance inspection report for children’s home: 2495377 7 the registered person must ensure that the requirements of that Order and any regulations made under it, except for article 23 (duties of employees), are complied with in respect of the home. (Regulation 25 (2)(b))

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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

A visit by the independent person to the home may be unannounced. (Regulation 44 (2)(a) (3))

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Requirement Due date

This requirement was made at the last inspection and is restated. 27 January 2023

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Requirement Due date

*This requirement is subject to a compliance notice.

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Recommendations

 The registered person should ensure that all incidents of control, discipline and restraint are subject to regular scrutiny. In particular, ensure that an independent member of the management team who has not been involved in the incident reviews the use of physical interventions. (‘Guide to the Children’s Homes Regulations, including the quality standards’, page 46, paragraph 9.36)  The registered person should ensure that staff can access resources to support their training needs. In particular, they should ensure that staff access training in understanding learning disabilities. (‘Guide to the Children’s Homes Regulations, including the quality standards’, page 53, paragraph 10.11) Assurance inspection report for children’s home: 2495377 8

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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 Paula Lewis, Social Care Inspector Assurance inspection report for children’s home: 2495377 9 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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