Children's Home run by Bristol City Council in Bristol

Inspection report for children's home: SC031504 1 SC031504 Registered provider: Bristol City Council

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Full inspection Inspected under the social care common inspection framework

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Information about this children’s home

This home is owned by a local authority. It is registered to provide a short-break service and longer-term care for up to six children who may have learning disabilities and/or physical disabilities. At the time of the inspection, one child was living at the home full time, with another staying for four nights per week. Two children were receiving a short- break service.

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Information about this children’s home

The registered manager has been in post since 2007.

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Information about this children’s home

This inspection was brought forward following concerns being reported to Ofsted about the management of a child’s health needs.

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Overall experiences and progress of

children and young people, taking into account

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requires improvement to be good

How well children and young people are helped and protected requires improvement to be good

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requires improvement to be good

The effectiveness of leaders and managers requires improvement to be good

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requires improvement to be good

The children’s home is not yet delivering good help and care for children and young people. However, there are no serious or widespread failures that result in their welfare not being safeguarded or promoted.

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requires improvement to be good

Date of last inspection: 15 November 2023

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requires improvement to be good

Overall judgement at last inspection: good

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requires improvement to be good

Enforcement action since last inspection: none Inspection report for children's home: SC031504 2

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Inspection date Inspection type Inspection judgement

15/11/2023 Full Good 07/03/2023 Full Good 18/05/2021 Full Good 12/11/2019 Full Good Inspection report for children's home: SC031504 3

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improvement to be good

Children are making some progress in relation to their individual starting points and needs. There are examples of children becoming more independent, becoming calmer and improving their communication skills.

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improvement to be good

Children like coming to and/or living at the home. Staff have built strong relationships with the children and positive activities are enjoyed together. Parents said their children are happy at the home and those who come for short breaks are excited to visit.

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improvement to be good

Staff understand the needs of the children they care for and how these needs are to be met. Staff noted the changing needs of the children who now come to this home. There is a higher level of need, including more medical and behavioural needs. These changes have caused some anxiety within the staff team especially around the complex health needs of children. Leaders and managers are aware of these anxieties.

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improvement to be good

Due to the needs of some children, additional agency and support staff have been employed. This means there are a large number of staff on duty at any one time. This is generally well managed, with staff working together, sharing information and supporting the children.

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improvement to be good

Children’s plans are not of a consistently good quality. Some care plans provide clear and detailed information and guidance for staff, whereas other plans lack this important level of detail. For example, one child likes spending time on their own. Plans do not set out how staff should support the child with this to ensure they do not become isolated. This level of detail is essential to ensure consistency of care. Some care plans are written using first person narrative, but children are not always involved in the development of their plans.

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improvement to be good

Children’s health is generally well managed. To support some children’s complex health needs, additional nursing staff are working in the home each day and night. Healthcare plans are clear and have been developed with the relevant health professionals. Some children require specialist medical care, including the use of tracheostomy and gastrostomy equipment and the administration of oxygen. Staff are starting to receive training in how to manage these medical needs. Currently, agency nursing staff lead on managing these needs. For some children, visual and/or audio monitors are used due to their health needs. There is clear guidance on the rationale for the use of these devices.

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improvement to be good

Leaders and managers took appropriate action to investigate an incident of a child being injured when using a hot water bottle. Although action was taken to treat the injury in the home, an unprescribed dressing was applied, resulting in the child getting an additional infection. Staff have since been provided with additional guidance and direction about the use of hot water bottles and the risks for children who have limited Inspection report for children's home: SC031504 4 physical mobility and tissue viability needs, and the policy for using unprescribed dressings has been clarified.

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improvement to be good

There is a clear system for the management and auditing of medication. On two occasions, children have not received prescribed medication as required. The errors were identified quickly, and action taken to mitigate any adverse effects. Medication administration records relating to controlled medication require improvement. Some staff were not aware that one child was taking a controlled substance, which lead to poor recording of this medication.

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improvement to be good

There is ample space in the home for the number of children living there and visiting for short breaks. Most areas of the home are furnished and decorated to a comfortable standard. However, one of the bathrooms used by children is looking tired and worn. In addition, the soft-play room is not an inviting space, even when staff put cushions and a tent in it. There is padding on the walls which looks institutional and the floor is in need of repair.

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improvement to be good

Several parents gave feedback about their children’s experiences in the home. The majority of parents are pleased with the short-break provision, with one parent saying the home is amazing and another commenting on the support staff had given to them as well as their child. One family shared their concerns about an incident that their child had been involved in. The incident had been appropriately investigated and learning identified for the team.

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improvement to be good

Staff understand their safeguarding responsibilities and report concerns to the appropriate people. Staff discuss safeguarding events at team meetings, using these opportunities to learn from each other and develop practice. Investigations into safeguarding concerns are appropriate. Lessons learned from these investigations are used to improve and develop staff practice.

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improvement to be good

Typically, adverse behaviours are appropriately managed in practice. However, children’s behaviour support plans vary in quality. Some plans are good quality, providing clear guidance for staff, while others lack this same level of clarity and guidance. This does not promote the consistency of care provided. In addition, the challenge this brings is that not all staff confidently respond to one child’s behavioural needs and risks. This lack of confidence means some staff are becoming risk averse in their approach to the child, which is not helping the child to develop.

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improvement to be good

At times, protective clothing is worn by staff to ensure they are protected from physical aggression. Experienced staff are trialling a different approach to try to reduce the use of the protective clothing. Written plans lack a clear rationale as to why this equipment is needed and how it is to be used appropriately, and how the effectiveness of the alternative approach will be assessed. Inspection report for children's home: SC031504 5 Restraint is rarely used. When it is used, it is usually appropriate. However, on one occasion, staff shut a door between themselves and a child without this being an agreed technique. Meaningful conversations are held with children and staff involved and good- quality records of these conversations are maintained.

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The effectiveness of leaders and managers: requires improvement to be good

The registered manager has a clear understanding of the home’s areas for development and is striving to address them. However, the majority of actions required to develop the home are not fully embedded in practice. Some management tasks have not been completed. The registered manager has had to prioritise the direct care of children because of the impact vacancies and absences are having on staff sufficiency. To help reduce the number of administrative tasks having to be done by the manager, a support person has recently been appointed.

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The effectiveness of leaders and managers: requires improvement to be good

Currently, there is one registered manager for the home. There is a plan to register an additional manager to reflect the complexity and workload of managing a long-stay and short-break home. However, this plan has not progressed since the previous inspection in November 2023.

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The effectiveness of leaders and managers: requires improvement to be good

Staff sufficiency is a challenge and has impacted on managers’ ability to focus on management tasks and develop the service. Temporary agency nursing and support staff have been brought in to ensure the care of children is not affected by the shortfall in permanent staff numbers.

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The effectiveness of leaders and managers: requires improvement to be good

Staff praised the registered manager for her commitment to the home and the support she provides for the team. However, while staff receive the right training to help them to meet children’s complex needs, they do not always receive regular supervision as required. This limits the opportunity to promote staff development, enable them to reflect on their work and to receive feedback on their care of children.

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The effectiveness of leaders and managers: requires improvement to be good

Leaders and managers maintain most of the required safer recruitment information on the agency staff who work at the home. However, this does not include details of their training, which is particularly necessary to ensure the staff can meet children’s complex health needs. Inspection report for children's home: SC031504 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, The 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 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))

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Requirement Due date

In particular, the registered person should ensure that all children’s plans provide clear guidance for staff about how to best support the children and, where needed, include details about the rationale for any specific approach used, for example, the use of protective clothing. 8 July 2024

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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

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 work as a team where appropriate;

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Requirement Due date

ensure that staff have the experience, qualifications and skills to meet the needs of each child; 8 July 2024 Inspection report for children's home: SC031504 7 ensure that the home has sufficient staff to provide care for each child. (Regulation 13 (1)(a)(b) (2)(a)(b)(c)(d))

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Requirement Due date

In particular, the registered person should review the effectiveness of the current management structure to ensure that there is sufficient support in place to ensure management tasks can be carried out effectively. In addition, the registered person should ensure that they have obtained all the necessary information on temporary staff to ensure they can deploy them effectively.

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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

a record is kept of the administration of medicine to each child. (Regulation 23 (1) (2)(c))

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Requirement Due date

In particular, this relates to the effective management of controlled medicines. 8 July 2024

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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, the registered person should ensure that all staff including agency nursing and support staff receive regular supervision from the home’s leaders and managers. 8 July 2024

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Recommendations

 The registered person should improve the quality of the soft-play room and refurbish a bathroom to ensure both rooms provide welcoming spaces for children to use. (‘Guide to the Children’s Homes Regulations, including the quality standards’, page 15, paragraph 3.9)  The registered person should ensure staff are trained and supported to develop their confidence in the effective management of risk. (‘Guide to the Children’s Homes Regulations, including the quality standards’, page 42, paragraph 9.5) Inspection report for children's home: SC031504 8

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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: SC031504 9

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Children’s home details

Registered provider: Bristol City Council

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Children’s home details

Registered provider address: City Hall, College Green, Bristol BS1 5TR

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Inspector

Wendy Anderson, Social Care Inspector Inspection report for children's home: SC031504 10 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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Inspector

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Inspector

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Inspector

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