Children's Home, Residential special school run by Wandsworth Borough Council in Wandsworth

Inspection report for children's home – monitoring visit: SC470513 1 SC470513 Wandsworth Borough Council

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Inspected under the social care common inspection framework

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Information about this children's home

This is a local authority-run service that provides care for up to 40 children with autism spectrum disorder, learning disabilities and associated conditions. The home is on the same site as the organisation’s school and is comprised of separate individual houses so that children live in small groups. It accommodates children for short breaks and for placements of 38 weeks of the year. There were 37 children living in the home at the time of this inspection.

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Information about this children's home

There has been no registered manager since 31 August 2023.

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This monitoring visit

This visit was undertaken in response to concerns shared with Ofsted relating to the administration and management of medications. In addition, concerns were shared in relation to a number of allegations against staff.

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This monitoring visit

An urgent education inspection took place at the same time as this inspection of the children’s home. The concerns raised in this report are not related to the education provision. This is primarily because very few children receive medication during school hours and there are different arrangements in place for administering this medication in school.

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This monitoring visit

There is an on-going investigation in relation to the administration of medication. Inspectors did not investigate this specific concern, but they did look closely at the records, systems and practice in relation to medications.

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This monitoring visit

There are significant shortfalls in the way that medication is managed and, as a result, a compliance notice has been issued by Ofsted to address these concerns. Inspection report for children's home – monitoring visit: SC470513 2 The provider has taken some steps to improve oversite and practice to reduce the risk of medication errors and to keep a tighter control of stock. This includes having clearly defined, trained staff to administer medications and increased oversight of recording and practice. However, these measures are undermined by the electronic system being used to record medications. This is currently not fit for purpose and renders the efforts of leaders and managers to improve practice, ineffective.

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This monitoring visit

Staff are not able to operate the electronic system effectively and anomalies in the system are not fully understood by leaders, staff or health professionals in the residential setting. In addition, record keeping in relation to medication is poor. In several cases, the prescribed dose and frequency of medication was inaccurate and potentially misleading in some records. For example, the doses recorded in some children’s health care plans was different from the dose recorded on the electronic system and, in some instances the dose prescribed on the medication packaging.

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This monitoring visit

Some medications are prescribed to use as and when children require them. In some instances, the instructions for when these medications should be given are unclear. In addition, some medications that are meant to be given routinely are being treated as medications that are given ‘as and when required.’ This means that in some instances, children do not receive their medications as prescribed.

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This monitoring visit

The system used for stock control is ineffective. Some doses of medication have not been given to children as the stock had run out. The system used to record the reasons why doses of medication are not given is ineffective, therefore the reasons for missed doses are not always clear.

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This monitoring visit

There is no clear audit trail to track medications that are disposed of and records in relation to the date that medications are received are inaccurate. Some medications that were not administered could not be accounted for.

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This monitoring visit

The shortfalls in the systems and practice with regards to medications place children at risk of not receiving their medication correctly. It is also of concern that medications not administered are unaccounted for. When errors are detected, the leaders and managers of the school take prompt action to address this in terms of any immediate health needs of children and any learning for staff. However, the shortfalls in the management and administration of medication practice increases the risk that errors may not be detected.

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This monitoring visit

The provider recognises that their current systems are ineffective and have an action plan to address urgent concerns in order to make their systems safer for children.

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This monitoring visit

In relation to wider safeguarding practice, the provider has good systems in place to monitor low level concerns and to respond effectively to child protection issues. They liaise promptly with relevant safeguarding agencies to address concerns and take Inspection report for children's home – monitoring visit: SC470513 3 effective action to safeguard children.

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This monitoring visit

There is a positive culture of staff reporting concerns and a keen focus from leaders and managers to promote a positive safeguarding culture. Leaders and managers generally explore all concerns to see if there are any practice issues that need to be addressed, however, in one example where an allegation was made and deemed to be unfounded there was insufficient exploration as to whether there were any wider practice learning points for staff. In all other respects, the allegation was investigated and shared appropriately with the relevant safegaurding agencies and parents.

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This monitoring visit

Due to the scope of this monitoring visit, the shortfalls identified at the last full inspection were not explored in full. As a result, the requirements and recommendations from that inspection will remain in place. Inspection report for children's home – monitoring visit: SC470513 4

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Inspection date Inspection type Inspection judgement

12/12/2023 Full Requires improvement to be good 20/06/2023 Full Good 13/09/2022 Full Good 19/01/2022 Interim Improved effectiveness Inspection report for children's home – monitoring visit: SC470513 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, 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 with the given timescales.

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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

medicines kept in the home are stored in a secure place so as to prevent any child from having unsupervised access to them;

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Requirement Due date

medicine which is prescribed for a child is administered as prescribed to the child for whom it is prescribed and to no other child; and

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Requirement Due date

a record is kept of the administration of medicine to each child. Paragraph (2) does not apply to medicine which— is stored by the child for whom it is provided in such a way that other persons are prevented from using it; and

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Requirement Due date

may be safely self-administered by that child.

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Requirement Due date

In this regulation, “prescribed” means—ordered for a patient, for provision to the patient, under or by virtue of the Nation- al Health Service Act 2006 or section 176(3) of the Health and Social Care (Community Health and Standards) Act 2003(1); or

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Requirement Due date

in a case not falling within sub-paragraph (a), prescribed for a patient in accordance with regulation 217 of the Human Medicines Regulations 2012(2).

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Requirement Due date

Regulation 23 (1)(2)(a)(b)(c)(3)(a)(b)(4)(a)(b) 9 June 2024 Inspection report for children's home – monitoring visit: SC470513 6 The health and well-being standard is that—

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Requirement Due date

the health and well-being needs of children are met;

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Requirement Due date

children are helped to lead healthy lifestyles.

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Requirement Due date

In particular, ensure that health guidance to staff remains reviewed and updated so that staff fully understand how to respond to the health needs for all children. 9 June 2024

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Requirement Due date

The registered person must prepare and implement a policy (“the behaviour management policy”) which sets out—

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Requirement Due date

how appropriate behaviour is to be promoted in the children’s home.

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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

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. (Regulation 35 (1)(a) (3)(b)(i)(ii)(c)) 9 June 2024

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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 staff— 9 June 2024 Inspection report for children's home – monitoring visit: SC470513 7 assess whether each child is at risk of harm, taking into account information in the child’s relevant plans, and, if necessary, make arrangements to reduce the risk of any harm to the child;

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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

take effective action whenever there is a serious concern about a child’s welfare; and

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Requirement Due date

are familiar with, and act in accordance with, the home’s child protection policies.

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Requirement Due date

(Regulation 12 (1) (2)(a)(i)(iii)(vi)(vii))

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Requirement Due date

In particular, ensure that any concerns are investigated promptly and that any learning from incidents is considered to inform care practice.

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Requirement Due date

*These requirements are subject of a compliance notice.

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Recommendations

 The registered person should ensure that a record of supervision should be kept for staff, including the manager. The record should provide evidence that supervision is being delivered in line with regulation 33(4)(b). (‘Guide to the Children’s Homes Regulations, including the quality standards’, page 61, paragraph 13.3)  The registered person should ensure that staff are familiar with the home's policies on record keeping and understand the importance of careful, objective, and clear recording ('Guide to the Children's Homes Regulations, including the quality standards', page 62, paragraph 14.4)  The registered person should ensure that the children’s home is a nurturing and supportive environment that meet the needs of their children, they will, in most cases, be homely, domestic environments. Children's homes must comply with relevant health and safety legislations (alarms, food hygiene etc.); however in

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Recommendations

doing so, homes should seek as far as possible to maintain a domestic rather than 'institutional' impression. (‘Guide to the Children’s Homes Regulations, including the quality standards’, page 15, paragraph 3.9)  The registered person should ensure that when considering whether restraint is warranted, staff in children's homes need to take into account: Inspection report for children's home – monitoring visit: SC470513 8 o the age and understanding of the child; o the size of the child; o the relevance of any disability, health problem or medication to the behaviour in question and the action that might be taken as a result; o the relative risks of not intervening; o the child's previously sought views on strategies that they considered might deescalate or calm a situation, if appropriate; o the method of restraint which would be appropriate in the specific circumstances; and – o the impact of the restraint on the carer's future relationship with the child.

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Recommendations

(‘Guide to the Children’s Homes Regulations, including the quality standards’, page 49, paragraph 9.55)  The registered person should ensure that there are clear plans in relation to providing personal care to ensure that staff respect children’s privacy and support the other children living in the home to do so. (‘Guide to the Children’s Homes Regulations, including the quality standards,’ page 16, paragraph 3.17)

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Information about this inspection

The purpose of this visit was to monitor practice in response to concerns shared with Ofsted relating to the administration of medication and how allegations and child protection concerns are managed within the home.

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Information about this inspection

This inspection was carried out under the Care Standards Act 2000. Inspection report for children's home – monitoring visit: SC470513 9

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Children's home details

Provision sub-type: Residential special school

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Children's home details

Registered provider: Wandsworth Borough Council

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Children's home details

Registered provider address: The Town Hall, Wandsworth High Street, London SW18 2PU

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Children's home details

Responsible individual: Penelope Doswell

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Inspectors

Lee Kirwin, Social Care Inspector Sara Stoker, Social Care Inspector Inspection report for children's home – monitoring visit: SC470513 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 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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