Clayfields House Secure Unit

Inspection report for secure children’s home: SC036740 1 SC036740 Registered provider: Nottinghamshire County Council Full inspection Inspected under the social care common inspection framework

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Information about this secure children’s home

This secure children’s home is managed by a local authority. It is approved by the Department for Education to restrict children’s liberty.

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Information about this secure children’s home

The home can accommodate up to 20 children aged between 10 and 17 years. It provides accommodation for up to 12 children placed by the Youth Custody Service and has up to eight places for children accommodated under section 25 of the Children Act 1989. Twelve children were living at the home at the time of the inspection.

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Information about this secure children’s home

Admission of any child under section 25 of the Children Act 1989 who is under 13 years of age requires the approval of the Secretary of State.

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Information about this secure children’s home

The commissioning of health services in this home is the statutory responsibility of NHS England under the Health and Social Care Act 2012.

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Information about this secure children’s home

The manager has been registered with Ofsted since May 2018.

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Overall experiences and progress of

children and young people, taking into account

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inadequate

Children’s education and learning requires improvement to be good Children’s health requires improvement to be good How well children and young people are helped and protected inadequate

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inadequate

The effectiveness of leaders and managers inadequate Inspection report for secure children’s home: SC036740 2 There are serious failures that mean children and young people are not protected or their welfare is not promoted or safeguarded.

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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 secure children’s home: SC036740 3

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Inspection date Inspection type Inspection judgement

Good 05/01/2022 Interim Sustained effectiveness 22/06/2021 Full Good 01/10/2019 Full Requires improvement to be good Inspection report for secure children’s home: SC036740 4

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inadequate

Children have been subject to the inappropriate use of physical restraint and the inappropriate use of single separation (where children are locked into an area alone, such as their bedroom, when they meet the legal criteria of being a significant risk to themselves or others and there is no other way to keep people safe). Further details are set out in the help and protection section of this report. These practices significantly undermine the positive experiences and progress of the children.

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inadequate

Some children have trusting relationships with staff. They feel able to speak to staff and share important information about their needs, which helps staff to care for children more effectively. However, for other children, the restraint and single separation incidents mean that they do not always receive nurturing care.

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inadequate

Children do make progress. This is supported through regular case management meetings, where staff evaluate and review each child’s plans to meet their individual needs. There are clear processes in place that help staff across all professional disciplines to understand children and to provide them with individualised care.

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inadequate

Children benefit from the focused work undertaken with them. Children’s individual needs are taken into consideration when planning and undertaking intervention work. There is evidence that children’s emotional health needs are supported by the collaborative work between the care, interventions and health staff. This creates an environment in which children can make progress.

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inadequate

Children do not always experience continuity of care. This is due to staff leaving, or the movement of staff and children within the home. The impact of these changes is not fully recognised and children are not well prepared for these changes in advance.

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inadequate

Children are able to see the results of their views being listened to and acted on.

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inadequate

Children have a range of opportunities to share their views about life at the home, through the children’s council, advocacy service and one-to-one time with staff in intervention and key-work sessions.

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inadequate

Children understand how to make a complaint. Complaints are dealt with in a timely manner. However, records of any action taken in response lack sufficient detail to demonstrate rigour. Children do not receive a written response to their complaints. This means that children cannot be sure that their concerns have been understood and taken seriously, and they do not have the reassurance of a written outcome to their complaint. Inspection report for secure children’s home: SC036740 5 Children benefit from the commitment of staff in supporting them to prepare for leaving the home. This leads to children being better able to manage change and move on positively. An example of this was the transition planning for a child moving to the adult estate. The child has been supported to share their views about this move and to prepare for the practical and emotional changes involved.

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Children’s education and learning: requires improvement to be good

The recent inappropriate use of restraint and single separation on children impacts negatively on this judgement area.

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Children’s education and learning: requires improvement to be good

Managers, with support from the advisory board, use quality assurance and quality improvement strategies effectively to identify the strengths and weaknesses of the education provision. Swift action is taken to address areas for improvement and implement changes.

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Children’s education and learning: requires improvement to be good

Children benefit from the detailed assessments undertaken by managers and teachers. These accurately identify children’s starting points. Education staff plan an ambitious and rich curriculum that includes a wide range of academic and vocational subjects, such as psychology, mechanics and employability skills.

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Children’s education and learning: requires improvement to be good

Children enjoy their learning and build strong relationships with teachers and teaching assistants. Most children make good progress from their starting points and confidently explain the progress they make.

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Children’s education and learning: requires improvement to be good

Children respond well to the sensitive but consistent challenges from staff when addressing instances of poor behaviour. This reduces the necessity to remove children from the classroom and promotes their continued learning.

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Children’s education and learning: requires improvement to be good

Children benefit from the high priority given to the development of their English skills and, in particular, reading skills. This helps with their short-term and long-term prospects.

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Children’s education and learning: requires improvement to be good

Children benefit from appropriate careers education, advice and guidance. Education staff and external professionals support children well in preparing for their next steps.

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Children’s education and learning: requires improvement to be good

Children who refuse to attend their lessons do the work they have missed during activity time in the evening. However, education staff do not routinely communicate with care staff to check if the work has been completed. As a result, children do not always catch up with the work they have missed, which could slow their progress.

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Children’s education and learning: requires improvement to be good

The written feedback staff provide to children following assessment varies significantly across subjects. Children do not always know what they have done well or the specific areas where they need to improve. Children do not routinely revisit their work to make improvements. Inspection report for secure children’s home: SC036740 6

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Children’s health: requires improvement to be good

The recent inappropriate use of restraint and single separation on children impacts negatively on this judgement area.

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Children’s health: requires improvement to be good

Children are able to access appropriate services to meet their physical and emotional health needs. Healthcare staff carry out a comprehensive health assessment tool for all children on admission. They use this information to identify children’s current physical and mental health needs, and to develop healthcare plans that reflect children’s often complex needs.

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Children’s health: requires improvement to be good

At the time of this inspection, there were a number of vacancies across the healthcare team, including a general health nurse, an assistant psychologist, a speech and language therapist and a substance misuse lead. The impact of these vacancies on children’s progress is reduced due to the low number of children currently living at the home, and the skills and qualifications of the current healthcare team, including the operational healthcare lead. These staff take on extra work. However, as a result of these arrangements, the operational lead is unable to dedicate sufficient time and attention to management oversight and governance. Consequently, known areas for improvement, such as the audit of medication errors, have not been addressed.

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Children’s health: requires improvement to be good

There is a service-wide approach to implementing the ‘Secure Stairs’ framework for integrated care and this is well embedded across the home. The healthcare team is confident in using trauma-informed practice to support children to feel safe and this helps children to grow in confidence and build emotional resilience.

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Children’s health: requires improvement to be good

Healthcare staff take time to build positive relationships with children, which was seen by inspectors. Children said that they are involved in decisions about their healthcare and that they are able to discuss health matters that concern them. These good relationships help the healthcare team, through multidisciplinary formulation meetings, to personalise plans for children based on their individual physical, psychological, sensory and language needs. This supports children to start to recognise how their health needs may influence their progress and development.

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Children’s health: requires improvement to be good

When children are subject to physical restraint, or when incidents have occurred, the healthcare team carries out welfare checks to ensure that children are not injured or harmed. There are some occasions when healthcare staff have not recorded these checks or updated the children’s healthcare records following these incidents. This prevents effective management oversight of these events.

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Children’s health: requires improvement to be good

There are some occasions when children’s medication has not been safely administered. In response to these medication errors, the healthcare team provided care staff with additional training and competency assessments. When children refuse their medication or when staff do not administer this medication, records of these occurrences, including what happens to the medication, are not always clear. There are no records detailing the appropriate disposal of refused controlled drugs. Furthermore, when medication should be stored at fridge temperature to ensure Inspection report for secure children’s home: SC036740 7 effectiveness, these temperatures are not always within the required range, or consistently checked and recorded.

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Children’s health: requires improvement to be good

The healthcare team and care staff work together to deliver health promotion sessions. These educate children on how to keep themselves healthy and maintain an active lifestyle. Children also benefit from good access to primary healthcare services, including opticians and dentists.

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Children’s health: requires improvement to be good

Healthcare staff complete all mandatory training and receive good support from their managers. This support helps to ensure that, despite the current high number of vacancies, the healthcare team remains focused on supporting children and achieving good health outcomes for them.

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

Children are subject to the inappropriate use of physical restraint and single separation. Some children have been physically restrained and placed in single separation when the legal criteria of being a significant risk to themselves or others is not met. Many staff, including duty managers, have been involved in these incidents. This indicates that a number of staff at the home, including leaders, do not fully understand the legal criteria.

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

The children’s records for single separation are of poor quality. These records are not clear about the legal criteria for such action being met or continuing to be met for the duration of the separation. Management oversight has not picked up on this practice nor addressed these failings. Managers struggled to demonstrate that the restrictive measures used were legal and appropriate.

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

Children’s behaviour is not always positively promoted. There is no evidence of restorative practice being considered to help children understand the impact of their behaviour on others and to repair relationships. Sanctions used to address children’s poor behaviour do not always relate to the reason for the consequence being given. In a number of cases, the effectiveness of these measures is not considered.

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

There have been no complaints recorded from children about physical restraint or single separation incidents. However, there is a risk that children are not fully aware of their rights. The practice of some staff shows that children’s rights have not been promoted.

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

While children told inspectors that they feel safe and did not raise any concerns about their care, this is contrary to the findings of this inspection and suggests that the adults looking after them have not helped them to understand their rights. There are good quality up-to-date risk assessments that staff understand and usually implement to help keep children safe. Inspection report for secure children’s home: SC036740 8

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The effectiveness of leaders and managers: inadequate

Managers have not consistently protected all children. Monitoring processes had not identified all the shortfalls found during this inspection, such as in sanctions and inappropriate practice in physical restraint and single separation.

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The effectiveness of leaders and managers: inadequate

Children do benefit from the partnership working that managers and staff have established with all professionals and other agencies. This helps to provide positive support and care for children. Some professionals did say that information was not always provided to them in a timely manner. However, this is an improving picture and staff are responding to the feedback given.

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The effectiveness of leaders and managers: inadequate

There are regular, planned and purposeful meetings. These assist in disseminating essential information to staff. These forums promote more consistent care and opportunities to review and monitor children’s progress and achievements.

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The effectiveness of leaders and managers: inadequate

The manager generally implements safe recruitment practices to ensure that safe and suitable staff are employed to care for the children. However, no written assessment has been undertaken to assess risk for one Disclosure and Barring Service (DBS) check that contains cautions for a worker. This is a missed opportunity to ensure that all safeguarding measures are taken to protect children.

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The effectiveness of leaders and managers: inadequate

All staff benefit from routinely receiving good-quality formal supervision. There is a focus on staff welfare, practice and training. The regular monitoring by managers ensures that supervision is provided to all. Where staff practice issues have been identified, managers take appropriate action. In some instances, this has included disciplinary action.

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The effectiveness of leaders and managers: inadequate

Managers provide staff with training opportunities. This includes an induction, and mandatory and then specialist training. For example, staff receive training in relation to childhood trauma, self-harm and suicidal idealisation and county lines. This builds on staff knowledge and skills to be able to meet the needs of children.

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The effectiveness of leaders and managers: inadequate

Action has been taken to implement two of the three recommendations made at the last inspection. The one recommendation not met relates to the recording of single separation. Inspection report for secure children’s home: SC036740 9

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Statutory requirements

This section sets out the actions that the registered persons must take to meet the Care Standards Act 2000, The Children’s Homes (England) Regulations 2015 and the ‘Guide to the Children’s Homes Regulations, including the quality standards.’ The registered persons must comply within the given timescales.

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Requirement Due date

*Restraint in relation to a child is only permitted for the purpose of preventing—

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Requirement Due date

injury to any person (including the child);

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Requirement Due date

serious damage to the property of any person (including the child); or

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Requirement Due date

a child who is accommodated in a secure children’s home from absconding from the home.

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Requirement Due date

Restraint in relation to a child must be necessary and proportionate. (Regulation 20 (1)(a)(b)(c) (2))

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Requirement Due date

In particular, make sure that the legal criteria to hold a child is met, that staff and managers fully understand the legal criteria and that accurate records are kept. 1 September 2023

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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 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)(b)) 1 September 2023

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Requirement Due date

within 24 hours of the use of a measure of control, discipline or restraint in relation to a child in the home, a record is made which includes— 1 September 2023 Inspection report for secure children’s home: SC036740 10 details of the child’s behaviour leading to the use of the measure;

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Requirement Due date

the effectiveness and any consequences of the use of the measure. (Regulation 35 (3)(a)(ii)(vii))

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Requirement Due date

In particular, that physical restraint interventions, single separation and consequences records are accurate, that these records fully detail the incident and action taken and that managers review and evaluate their use. This is to ensure that the use is appropriate, proportionate, restorative and effective.

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Requirement Due date

The positive relationships standard is that children are helped to develop, and to benefit from, relationships based on—

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Requirement Due date

an understanding about acceptable behaviour; and

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Requirement Due date

positive responses to other children and adults.

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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

encourage each child to take responsibility for the child’s behaviour, in accordance with the child’s age and understanding;

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Requirement Due date

that each child is encouraged to build and maintain positive relationships with others. (Regulation 11 (1)(b)(c) (2)(a)(iii)(b))

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Requirement Due date

In particular, help children to be clear on what are acceptable responses to their behaviour and what are not. Prepare children well for change in the staff who are caring for them and for any move within the home, with the aim to assist in maintaining positive and trusting relationships. 1 September 2023

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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

promotes their welfare. 1 September 2023 Inspection report for secure children’s home: SC036740 11 use monitoring and review systems to make continuous improvements in the quality of care provided in the home. (Regulation 13 (1)(a)(b)(h))

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Requirement Due date

In particular, ensure that there is thorough scrutiny and monitoring of staff practice and records are kept relating to the management of behaviour, including physical restraint intervention, single separation and consequences.

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Requirement Due date

*These requirements are subject to a compliance notice.

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Recommendations

 The registered person should ensure that the children in their care understand their rights as a looked after child or a child living in a children’s home. (‘Guide to the Children’s Homes Regulations, including the quality standards’, page 43, paragraph 4.19)  The registered person should ensure that children’s progress in education can be measured and evidenced in various ways, including but not limited to: success in academic, vocational and other awards and qualifications; other formal attainment tests that are part of national assessment arrangements; and teachers’ ongoing assessments. Measurements of progress should include qualitative information such as how well the child is being prepared for their next stage of education, training or employment, and quantitative data where available. In particular, leaders need to improve the quality of feedback that children receive so that children know what they have done well and what they

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Recommendations

need to do to improve the quality of their work. (‘Guide to the Children’s Home Regulations, including the quality standards’, page 26, paragraph 5.2)  The registered person should ensure that each child’s day-to-day health and well- being needs are met. In particular, that as the number of children living in the home increases, there are sufficient healthcare staff to support the children and that the recruitment of healthcare staff ensures that leaders have sufficient capacity to govern and monitor the service effectively. (‘Guide to the Children’s Homes Regulations, including the quality standards’, page 33, paragraph 7.3)  The registered person should ensure that they make suitable arrangements for the safe administration of children’s medication and the storage and disposal of controlled drugs, and that fridge temperatures are checked daily and escalated when out of range. (‘Guide to the Children’s Homes Regulations, including the

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Recommendations

quality standards’, page 35, paragraph 7.15)  The registered person should ensure that each child’s day-to-day health and well- being needs are met. In particular, that when children have been physically restrained, that the welfare checks completed by the healthcare team are Inspection report for secure children’s home: SC036740 12 documented in all relevant records. (‘Guide to the Children’s Homes Regulations, including the quality standards’, page 33, paragraph 7.3)  The registered person should make sure that all information about the child is always recorded in a way that will be helpful to the child. In particular, children should receive written feedback at the conclusion of the investigation into their complaint. (‘Guide to the Children’s Home Regulations, including the quality standards’, page 62, paragraph 14.2)  The registered person should ensure that positive relationships are those which

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Recommendations

are characterised by consistency and unconditional positive regard for the child on the part of the carer, and where the carer acknowledges the importance of understanding and responding to the child’s lived experience of care. Positive, stable relationships help the child to feel secure and cared about and for. In particular, staff should ensure that children are prepared for changes of staffing and moving between units. (‘Guide to the Children’s Home Regulations, including the quality standards’, page 21, paragraph 4.3)  The registered person should maintain good employment practice. They must ensure that recruitment, supervision and performance management of staff safeguard children and minimise potential risks to them. In particular, ensure that information in DBS checks is explored, assessed and a record kept. These should include any mitigation and any actions taken if required when staff are employed.

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Recommendations

(‘Guide to the Children’s Home Regulations, including the quality standards’, page 61, paragraph 13.1)

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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 secure children’s home: SC036740 13

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Secure children’s home details

Registered provider: Nottinghamshire County Council

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Secure children’s home details

Registered provider address: Nottinghamshire County Council, County Hall, Loughborough Road, West Bridgford, Nottingham NG2 7QP

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Inspectors

Debbie Foster, Social Care Inspector Dawn Parton, Social Care Inspector Shaun Common, His Majesty’s Inspector, Social Care Lead Secure Estate Anita Pyrkotsch-Jones, His Majesty’s Inspector, Further Education and Skills Cat Raycraft, Health and Justice Inspector, Care Quality Commission Inspection report for secure children’s home: SC036740 14 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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