Children's Home run by Keys Direct Care Limited in Lincolnshire

Inspection report for children’s home: SC419429 1 SC419429 Registered provider: Keys Direct Care Limited

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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 private provider. It is registered to provide care for up to four children who may have social and emotional difficulties.

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Information about this children’s home

At the time of the inspection, there were two children living in the home. One child was spoken to during the inspection.

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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

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: SC419429 2

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Inspection date Inspection type Inspection judgement

18/07/2024 Full Good 29/02/2024 Full Good 21/02/2023 Full Good 17/01/2022 Full Good Inspection report for children’s home: SC419429 3

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improvement to be good

The home presents as a spacious and well-resourced environment. Children benefit from thoughtfully designed spaces that promote both social interaction and individual support, such as a designated sensory room. The grounds are expansive and offer opportunities for outdoor play and exploration, with evidence of planned activities tailored to children’s interests. However, some areas of the home require renovation. These include damaged carpets, a broken window, and concerns about the cleanliness and décor of one child’s bedroom, which detract from the overall homeliness and quality of care provided.

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improvement to be good

Placement instability has significantly affected children’s experiences. There have been three placement breakdowns in a short period, each following serious incidents. While leaders have taken steps to reflect and learn from these events, including implementing a temporary pause on new admissions, further work is required. In particular, the level of support provided to one child has had a negative impact on the stability of the home. These unplanned endings have had a direct emotional impact on the remaining children, who have experienced disrupted relationships and inconsistent care.

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improvement to be good

Feedback from families and professionals is mixed. While staff and the registered manager are committed and genuinely care about the children, concerns have been raised regarding the consistency of communication with families and professionals. Nevertheless, some professionals reported positive working relationships with the staff team and registered manager, with one describing the registered manager and staff as ‘brilliant’, and ‘if all residential homes were like this one, it would make such a difference to children’.

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improvement to be good

Children’s sense of safety and emotional well-being has been inconsistent. One child reports feeling unsafe at times due to previous incidents in the home and inconsistent behaviour management by staff. This has, at times, negatively affected their emotional well-being and capacity to form trusting relationships. However, all children are identified to have a ‘safe person’ with whom they can share their feelings, which has been a protective factor. Children’s views about living in the home are mixed and reflect the variable quality of care and support they have received.

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improvement to be good

Key-work sessions are a strength of the home. Sessions are well-planned and demonstrate a nurturing and reflective approach. The way records are written directly to the child enhances their personal value and is likely to have a lasting, positive impact when children reflect on their records in the future.

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improvement to be good

There has been a delay in accessing education for one child. This has significantly affected the child’s ability to settle in the placement and has contributed to feelings of isolation and frustration. While the registered manager has raised a complaint with relevant professionals, advocacy has lacked urgency and effectiveness. There is limited Inspection report for children’s home: SC419429 4 evidence of interim educational activity being provided in the home, resulting in prolonged absence from education.

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improvement to be good

Planning for independence is underdeveloped. For one child approaching adulthood, there is no robust transition planning in place. This represents a missed opportunity to prepare the young person for the next stage of their life and may hinder their development of essential life skills and confidence.

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improvement to be good

A significant complaint has been made and was fully investigated by senior leaders. This was handled through appropriate procedures, and outcomes were clearly documented. Lessons were identified and shared with both the staff team and the registered manager, demonstrating a commitment to learning and improvement. Senior leaders ensured that robust action was taken following the investigation.

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improvement to be good

The use of physical restraint is inconsistent and, at times, inappropriate. There have been occasions when interventions were not used in situations that posed a clear risk to children, and conversely, instances where interventions were applied unnecessarily. For one child, the support plan was incomplete and did not provide clear guidance on the safe and appropriate use of restraint. While the manager has completed post-incident evaluations, these have not always identified key issues, such as the lack of clarity in records or absence of appropriate measures. In some cases, evaluations were completed outside of expected timescales, limiting their effectiveness to inform practice.

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improvement to be good

The use of consequences in the home, referred to as ‘reflections’, has been limited. However, where these have been used, they have not always been proportionate or supportive of the child’s development. For example, one child was prevented from seeing a friend again as a consequence, which is not restorative or helpful to the child’s emotional or social needs.

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improvement to be good

The response to incidents of children going missing from care has also been inconsistent. Staff have not always followed individual children’s missing-from-care risk assessments, which in some cases are out of date and lack specific, child-centred information. Not all staff are familiar with the risk information, which undermines the effectiveness of safeguarding strategies. Furthermore, shortfalls in following risk assessments have not consistently been identified by the manager during oversight and review processes. This limits opportunities for staff reflection and improvement and reduces capacity to learn from incidents.

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improvement to be good

There was a delay in the implementation of safeguarding procedures following an allegation made by a child. During this time, the staff member concerned continued to work in the home, without suitable risk mitigation in place. This led to a delay in informing safeguarding professionals and compromised the registered manager’s ability to maintain appropriate oversight and ensure prompt, protective action. Inspection report for children’s home: SC419429 5

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

The registered manager has a clear understanding of the needs of the children. There is evidence of reflective practice beginning to take place, with support and guidance from senior leadership. Leaders and managers have started to implement changes aimed at improving practice across the home. While this work is promising, it is at an early stage and not yet embedded across all areas of care and safeguarding.

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

Oversight and monitoring by the registered manager have not consistently identified significant events or learning opportunities. This has been affected by the manager’s direct involvement in incidents, which has reduced their capacity to maintain objective oversight. Staff report mixed experiences of support. They feel reassured by the manager’s presence during challenging situations but have also expressed that emotional support and follow-up after incidents are lacking. This has impacted staff well- being during periods of challenge.

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

There have been several changes to the staff team, including the departure of experienced staff, the recruitment of new staff, and the absence of a deputy manager. These staffing changes have hindered the development and consistency of the team. During a period marked by several significant incidents, staff morale has been adversely affected.

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

Training for staff has generally been adequate. There has been a focus on equipping staff with specific knowledge relevant to individual children, which has helped staff feel better prepared to support new admissions. However, one staff member is currently outside the expected time frame for achieving their mandatory qualification.

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

Team meetings and supervision discussions are identified by staff as valuable tools for reflection and development. There has been recent improvement in the structure and quality of these sessions, particularly in their use following significant events. Despite this, inconsistencies remain. Supervision has not always taken place in line with the relevant policy and statement of purpose, especially for new staff. Inspection report for children’s home: SC419429 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 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

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

help each child to understand how to keep safe;

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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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manage relationships between children to prevent them from harming each other;

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understand the roles and responsibilities in relation to protecting children that are assigned to them by the registered person;

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

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

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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; and

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that the premises used for the purposes of the home are designed, furnished and maintained so as to protect each child from avoidable hazards to the child’s health. 29 August 2025 Inspection report for children’s home: SC419429 7 (Regulation 12 (1) (2)(a)(b)(d)(i)(ii)(iii)(iv)(v)(vi)(vii))

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Requirement Due date

This specifically relates to ensuring that risk assessments and support plans are in place that outline to staff how they can keep children safe and mitigate risks to children. Effective and quick action needs to be taken from the registered manager and staff team to ensure the safety of children with a consistent approach to caring for children.

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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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helps children aspire to fulfil their potential; and

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In particular, the standard in paragraph (1) requires the registered person to—

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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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ensure that staff work as a team where appropriate;

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

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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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use monitoring and review systems to make continuous improvements in the quality of care provided in the home.

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(Regulation 13 (1)(a)(b) (2)(a)(b)(c)(f)(h))

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This specifically relates to ensuring that there is clear oversight and monitoring from leaders and managers and that proactive changes are made to the safety and care of children. This also relates to ensuring that the staff team are working in a consistent and effective way for children in line with the statement of purpose in the home and all staff have completed relevant qualifications required. 29 August 2025 Inspection report for children’s home: SC419429 8 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; and

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the measures of control, discipline and restraint which may be used in relation to children in the home.

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The registered person must keep the behaviour management policy under review and, where appropriate, revise it.

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

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the date, time and location of the use of the measure;

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a description of the measure and its duration;

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details of any methods used or steps taken to avoid the need to use the measure;

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

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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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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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has spoken to the user about the measure; and

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has signed the record to confirm it is accurate. Regulation 35 (1)(a)(b) (2) (3)(a)(i)(ii)(iii)(iv)(v)(vi)(vii)(viii)(b)(i)(ii)) 29 August 2025 Inspection report for children’s home: SC419429 9 This specifically relates to ensuring that there are clear plans and strategies for behaviour management for each child and the staff are aware and equipped to use them in line with policy. This also relates to clear reports completed of the measure and reasons for the use of the measure, and the registered manager’s oversight and evaluation completed within timescales.

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The quality and purpose of care standard is that children receive care from staff who—

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

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

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In particular, the standard in paragraph (1) requires the registered person to—

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understand and apply the home’s statement of purpose;

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understand and apply the home’s statement of purpose;

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protect and promote each child’s welfare;

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provide personalised care that meets each child’s needs, as recorded in the child’s relevant plans, taking account of the child’s background;

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help each child to develop resilience and skills that prepare the child to return home, to live in a new placement or to live independently as an adult;

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make decisions about the day-to-day arrangements for each child, in accordance with the child’s relevant plans, which give the child an appropriate degree of freedom and choice;

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

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meet the needs of each child. Regulation 6 (1)(a)(b) (2)(a)(b)(i)(ii)(iv)(vi)(ix)(c)(i))

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Requirement Due date

This specifically relates to children being provided with consistent care and support to meet their individual need in line with the 29 August 2025 Inspection report for children’s home: SC419429 10 home’s statement of purpose. Individual up-to-date plans in place for children to help staff protect and promote their welfare.

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The care planning standard is that children—

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

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have a positive experience of arriving at or moving on from the home.

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plan for, and help, each child to prepare to leave the home or to move into adult care in a way that is consistent with arrangements agreed with the child’s placing authority.

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Requirement Due date

This specifically relates to children having planned and positive experiences of moving out of the home. Children need plans and preparation for moving into adulthood independent to their individual need. 29 August 2025

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Recommendations

 The registered person should ensure where children placed in a home are not participating in education because they have been excluded or are not on a school roll for some other reason, the registered person and staff must work closely with the placing authority so that the child is supported and enabled to resume full-time education as soon as possible. In the interim, the child should be supported to sustain or regain their confidence in education and be engaged in suitable structured activities. If no education place is identified by the placing authority, the registered person must challenge them to meet the child’s needs under regulation 5. (‘Guide to the Children’s Homes Regulations, including the quality standards’, page 28, paragraph 5.15)  The registered person should ensure that any sanctions used to address poor behaviour should be restorative in nature, to help children recognise the impact of

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Recommendations

their behaviour on themselves, other children, the staff caring for them and the wider community. (‘Guide to the Children’s Homes Regulations, including the quality standards’, page 46, paragraph 9.38) Inspection report for children’s home: SC419429 11

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Information about this inspection

The inspector has 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: SC419429 12

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Children’s home details

Registered provider: Keys Direct Care Limited

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Children’s home details

Registered provider address: Maybrook House, Third Floor, Queensway, Halesowen, West Midlands B63 4AH

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Inspector

Eleanor Quanbrough, Social Care Inspector Inspection report for children’s home: SC419429 13 regulates and inspects 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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Inspector

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Inspector

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Inspector

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