Children's Home run by Homes 2 Inspire Limited in Somerset

Assurance inspection report for children's home: 2719389 1 Registered provider: Homes 2 Inspire Ltd

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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 registered to provide care for up to three children with social and emotional difficulties.

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Information about this children’s home

At the time of the inspection two children were living in the home having moved there in February 2023 and November 2023.

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Information about this children’s home

The home does not have a registered manager. An acting manager has been in post since November 2023 and recruitment for this role is ongoing.

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Information about this inspection

At this inspections, 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: 2719389 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

 A significant increase in the frequency and severity of incidents in recent weeks.  A high staff turn over has led to increased use of bank and agency staff. Staff have not fully understood children’s needs and risks. Children have not received consistent care.  Staff have not had the skills, experience, or relationships with children to effectively support them and de-escalate difficult situations consistently.  Guidance to staff in children’s care and support plans is unclear and at times, out of date and conflicting.  No management oversight on recent incident reports or restraint records.  Incident reports and restraint records are of poor quality and information within some of these is conflicting.

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Findings from the inspection

This assurance inspection was completed in response to a serious complaint about the care provided to children at this home. There has also been an escalation in safeguarding incidents.

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Findings from the inspection

One child has lived in the home since February 2023 and had made some progress from a difficult starting point. A second child moved into the home in November 2023. Since this point there has been a significant increase in the frequency and severity of incidents. This has included incidents of significant self-harm and physical assaults of staff.

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Findings from the inspection

Some areas of the home were not in a good state of cleanliness or repair. For example, two windows which had been smashed 4 days prior to the inspection were boarded up. Additionally, a door frame in one child’s bedroom was broken due to staff having concerns about the child’s welfare and forcing access. This incident took place approximately 2 weeks prior to the inspection and the damage had not yet been repaired.

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Findings from the inspection

There has been a high turnover of employed staff and this has led to the use of agency staff. Bank staff are also used to increase staffing ratios. As a result, several staff working at this home do not know the children well.

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Findings from the inspection

When incidents take place where children put themselves or others at risk, staff do not have the skills, experience, or relationships with the children to manage these safely. Guidance provided to staff on how best to support children is not clear. Some information in children's care plans is conflicting or out of date. As a result, staff do not always understand children’s needs and risks and children are not provided with consistent boundaries. Staff receive general training and training specific to the needs of the children living in the home. However, this has not had an identifiable Assurance inspection report for children's home: 2719389 3 impact upon how effectively staff support children and manage difficult or dangerous situations.

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Findings from the inspection

Staff have not always been able to successfully de-escalate difficult situations and have not been able to prevent children leaving the home, self-harming or causing damage to property. This has resulted in the police being called to support staff on several occasions. During one recent incident this resulted in both children being arrested and spending the night in custody.

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Findings from the inspection

Restraints have occurred in an attempt to keep children and staff safe. They have been used over periods of 20-25 minutes and in one account of an incident, for around 2.5 hours including a child being restrained on their bed. Records of incidents and restraints are at times lengthy and unclear. This makes it difficult to get a good understanding of the sequence of events and actions taken by staff. Some accounts of incidents given by different members of staff conflict with each other. On at least two occasions children have stated they have been hurt during restraint.

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Findings from the inspection

Leaders and managers do not have a good understanding on how staff are supporting children during these difficult incidents. Recent records and incident reports have not been reviewed by managers. Staff and children are not consistently spoken to following serious incidents. There has been a lack of reflection on incidents or any learning from these taken forward.

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Findings from the inspection

Staff are not providing children with sufficient support to meet their complex health needs. Care plans detail how staff should monitor a child's serious health condition, but staff do not follow these consistently. This means that managers are unable to effectively monitor the child's health and recognise if they need to seek further medical support.

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Findings from the inspection

The home currently has no registered manager with an acting manager in post since November 2023. Senior leaders have acknowledged the significant gaps in recording and lack of robust management oversight in the home.

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Findings from the inspection

One child has been moved out of the home on a temporary basis in response to a significant incident and actions had been agreed to address identified shortfalls. This includes staff receiving debriefs from CAMHS practitioners following incidents. At the time of the inspection these measures had not been fully implemented. Assurance inspection report for children's home: 2719389 4

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Inspection date Inspection type Inspection judgement

18/07/2023 Full Good Assurance inspection report for children's home: 2719389 5

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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 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

lead and manage the home in a way that is consistent with the approach and ethos, and delivers the outcomes, set out in the home's statement of purpose;

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Requirement Due date

ensure that staff have the experience, qualifications and skills to meet the needs of each child;

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Requirement Due date

ensure that the home has sufficient staff to provide care for each child;

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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

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

demonstrate that practice in the home is informed and improved by taking into account and acting on—

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Requirement Due date

feedback on the experiences of children, including complaints received.

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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. 30 January 2024 Assurance inspection report for children's home: 2719389 6 (Regulation 13 (1)(a)(b) (2)(a)(c)(d)(e)(f)(g)(ii)(h))

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Requirement Due date

This specifically relates to the registered person ensuring that the manager has the experience, qualifications and skills to meet the needs of each child, through meeting requirements specified in regulation 28 relating to fitness of manager for registration as required by s11 CSA 2000.

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Requirement Due date

It also refers to the registered provider ensuring that they provide staff with clear and accurate guidance so they can meet the needs of children, that care plans and risk assessments are up to date, management oversight is in place and effective and that following incidents practice is reflected upon, any issues are addressed and any learning used to inform future practice. 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.

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Requirement Due date

that the effectiveness of the home's child protection policies is monitored regularly.

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Requirement Due date

(Regulation 12 (1) (2)(b)(e) 30 January 2024

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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—

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Requirement Due date

details of the child's behaviour leading to the use of the measure;

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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

details of any methods used or steps taken to avoid the need to use the measure; 30 January 2024 Assurance inspection report for children's home: 2719389 7 the name of the person who used the measure ("the user"), and of any other person present when the measure was used;

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Requirement Due date

the effectiveness and any consequences of the use of the measure; and

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Requirement Due date

a description of any injury to the child or any other person, and any medical treatment administered, as a result of the measure;

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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

has signed the record to confirm it is accurate; 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.

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Requirement Due date

(Regulation 35 (3)(a)(i)(ii)(iii)(iv)(v)(vi)(vii)(viii)(b)(i)(ii)(c)(iv)) The quality and purpose of care standard is that children receive care from staff who—

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Requirement Due date

understand the children's home's overall aims and the outcomes it seeks to achieve for children;

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Requirement Due date

use this understanding to deliver care that meets children's needs and supports them to fulfil their potential.

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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 premises used for the purposes of the home are designed and furnished so as to—

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Requirement Due date

enable each child to participate in the daily life of the home. (Regulation 6 (1)(a)(b) (2)(c)(i)(ii)) 30 January 2024 Assurance inspection report for children's home: 2719389 8 In particular, ensure that the home is kept in an appropriate state of repair and cleanliness and that any damage caused to the home is repaired promptly. Assurance inspection report for children's home: 2719389 9

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Children’s home details

Registered provider: Homes 2 Inspire Ltd

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Children’s home details

Registered provider address: Lumonics House, Valiant Office Suites, Valley Drive, Rugby, CV21 1TQ

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Inspectors

Janet Jauregui, Social Care Inspector Polly Soper, Social Care Inspector Assurance inspection report for children's home: 2719389 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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