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 aged from five to 19 years with complex medical needs, autism spectrum disorder, epilepsy and associated learning disabilities. The home consists of seven individual houses. Children attend the on-site school.

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Information about this children’s home

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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Overall experiences and progress of

children and young people, taking into account

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good

How well children and young people are helped and protected good

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good

The effectiveness of leaders and managers good

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good

The children’s home provides effective services that meet the requirements for good.

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good

Overall judgement at last inspection: requires improvement to be good

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Enforcement action since last inspection:

Following the assurance inspection carried out in November 2022, Ofsted served a compliance notice regarding the leadership and management of the home. At the monitoring visit in January 2023, Ofsted found that the provider had met the steps set out in the notice. Inspection report for children’s home: 2495377 2

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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 Inspection report for children’s home: 2495377 3

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Overall experiences and progress of children and young people: good

Since the last inspection, five children have moved into the home to begin an education placement at the on-site school and 12 children have moved on from the home. At the time of this inspection, 22 children were living at the home.

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Overall experiences and progress of children and young people: good

Children are making good progress from their starting points. Professionals and family members are pleased with the care that staff are providing to their children. Communication is reported to be good, and staff are warm and welcoming. Several children have lived at the home or have stayed there during school terms for a number of years, which gives children a sense of belonging.

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Overall experiences and progress of children and young people: good

Improvements have been made to make the environment feel welcoming, personalised and homely for children. Staff have considered children’s additional needs with neurodiversity and have installed specialist lighting and comfortable spaces for children to calm. Children appear happy and relaxed in their own personal areas as well as communal spaces where they spend time with their friends.

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Overall experiences and progress of children and young people: good

Children receive excellent healthcare support from a multidisciplinary team of nurses, physiotherapists and speech and language therapists. The director of children’s services works very closely with the lead therapist and nurse to ensure a child-centred approach. Staff receive training from this team and continued specialist oversight. The implementation of a new electronic medication management system has led to a significant reduction in the number of administration errors.

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Overall experiences and progress of children and young people: good

The manager has brought in new ways to obtain children’s views and wishes, including different interactive surveys using symbols. The meaningful conversations are now captured, and children can access two different advocacy providers.

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Overall experiences and progress of children and young people: good

Staff actively encourage children with their learning. All children have education plans. Staff link with the school staff very well to minimise gaps in children’s learning. Managers have recently improved monitoring systems that capture children’s progress in line with their educational goals and developmental stages. As a result, children are making measurable progress towards their education, health and social targets.

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Overall experiences and progress of children and young people: good

Children keep in close contact with their families, who are made welcome when they visit. Feedback from families is mainly positive. Parents recognise the progress made by their children and the good-quality care provided. However, some parents said that information about children’s day-to-day participation in activities is not shared as well as it could be.

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Overall experiences and progress of children and young people: good

Children take part in a range of activities that meet their interests. Some children participate in weekly ballet and swimming classes. Recent trips to animal safaris, Inspection report for children’s home: 2495377 4 indoor skydiving and skiing broaden children’s experiences. These activities encourage children’s social growth and positive well-being.

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Overall experiences and progress of children and young people: good

Some damage to door frames has not been repaired quickly and some trip hazards on outside paths had not been noticed. Staff, with the input of parents, restrict access to areas of the home for safety reasons or to help encourage positive behaviours. However, these have not always been reassessed to ensure that they remain proportionate and the least restrictive option.

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Overall experiences and progress of children and young people: good

Children have detailed plans of care for staff to follow. Joint working and sharing of expertise across the multidisciplinary teams, including on-site nurses and therapists, help staff to feel confident to provide good-quality care. Staff understand children’s complex needs. However, on one occasion, inspectors observed staff not working in accordance with a child’s plan when using a mobility aid.

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

Staff work closely with the specialist behaviour support team to create personalised strategies for children. Staff have a good awareness of children’s emotional needs and successfully use de-escalation approaches in line with thorough and responsive behaviour plans. Staff’s consistent approach helps to calm incidents and build the children’s tolerance to change. Consequently, there is positive behavioural change over time for children.

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

The number of occasions that staff use restrictive physical interventions has reduced. The provider has taken the decision to move to a new model of practice and training in de-escalation and intervention. The provider has found that the approach is better suited to the children’s needs. Staff have all completed training in delivering this approach. However, debriefing conversations with staff have not always taken place within the required timescales.

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

Managers devise good-quality risk assessments for children. These are detailed, followed by staff and consider children’s individual needs and abilities. This ensures that all children can navigate new experiences and guides the staff on how to reduce emerging risks effectively.

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

The number of safeguarding concerns has reduced substantially since the last inspection. Management and escalation of concerns have improved, with all concerns overseen by two senior managers. On one occasion, there was a delay in staff raising a concern to a senior manager by not following the stated process. Following this incident, a comprehensive investigation took place for learning and improvement. However, on one other occasion, a learning point was not identified in an investigation by a house manager.

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The effectiveness of leaders and managers: good

The manager has worked closely with the site’s multidisciplinary team to deliver a comprehensive improvement plan. Professionals and relatives all said that the Inspection report for children’s home: 2495377 5 quality of care provided has improved. The manager regularly monitors the seven homes to assess the quality of care provided and staff’s recording about children’s well-being. External quality monitoring has improved. The independent person seeks the views of children, their relatives and professionals. Managers use the independent person’s reports to drive improvement.

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The effectiveness of leaders and managers: good

Staff said that improvements in direction and training and clarity in expectations in providing good-quality care for children have improved morale and teamwork. Staff turnover has reduced to low levels and sickness levels among staff have improved. Children now receive support from a consistent staff team with virtually no use of agency staff.

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The effectiveness of leaders and managers: good

Most staff receive good-quality supervision. However, staff have not consistently received regular supervision in one of the homes. When the manager became aware of this shortfall, action to address it by providing additional sessions was slow. This means that staff have not benefited from the oversight and guidance that they need to support them in their roles.

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The effectiveness of leaders and managers: good

Each of the seven houses that form the home has a dedicated manager and deputy. They are managed by the registered manager or director of children’s services. All the managers said that they now benefit from the experience and commitment of this senior management support. The managers all have individual development plans that reflect their individual level of experience and skills. Managers are undertaking additional training and qualifications which are relevant to the bespoke needs of the children living in each house.

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The effectiveness of leaders and managers: good

The regular team meetings are well attended. On occasions, the therapy team has joined these meetings to talk about specific child-focused topics. As a result, staff are provided with consistent approaches to implement with the children. Levels of compliance with staff training are much improved. All staff have now completed training in learning disabilities and autism spectrum disorder. 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 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

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. (Regulation 12 (1) (2)(a)(iii)(v)) 7 July 2023

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Requirement Due date

The care planning standard is that children—

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Requirement Due date

receive effectively planned care in or through the children’s home.

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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 each child’s relevant plans are followed. (Regulation 14 (1)(a) (2)(c)) 7 July 2023

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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. (Regulation 33 (4)(b))

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Requirement Due date

In particular, ensure that staff receive supervision at frequencies stated in the provider’s policy. 7 July 2023

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Requirement Due date

The registered person must ensure that— 7 July 2023 Inspection report for children’s home: 2495377 7 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

has signed the record to confirm it is accurate. (Regulation 35 (3)(b)(i)(ii))

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Recommendation

 The registered person should ensure that they lead a team which provides high- quality care for all children living in the home. In particular, ensure that damage to the home’s premises, including trip hazards and door frame damage, is repaired without delay. Any decisions to restrict children’s access to some areas of the home should be regularly reviewed to ensure that the decision remains proportionate. (‘Guide to the Children’s Homes Regulations, including the quality standards’, page 52, paragraph 10.4)

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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: 2495377 8

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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

Jamie Cousins, Social Care Inspector Rachel Watkinson, Social Care Inspector Mark Anderton, Social Care Inspector Trudy Potter, Social Care Inspector 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 looked after children, safeguarding and child protection.

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Inspectors

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Inspectors

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Inspectors

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