Children's homes inspection – Full
Inspection date
13/07/2016
Unique reference number
SC435322
Type of inspection
Full
Provision subtype
Children's home
Registered provider
Acorn Norfolk Limited
Registered provider address
1 Merchants Place
River Street
Bolton
BL2 1BX
Responsible individual
Jared Bubb
Registered manager
Samantha Millward
Inspector
Ashley Hinson
Clive Lucas
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Inspection date
13/07/2016
Previous inspection judgement
Inadequate
Enforcement action since last
inspection
Two compliance notices were issued on
14 June 2016, relating to the
protection of children and leadership
and management. The notices were
monitored at the full inspection on 13
July 2016 and have been met.
This inspection
The overall experiences and
progress of children and
Requires improvement
young people living in the
home are
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.
How well children and
young people are helped
Requires improvement
and protected
The impact and
effectiveness of leaders and Requires improvement
managers
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SC435322
Summary of findings
The children's home provision requires improvement because:
 Risk assessments do not fully consider known risks to children. This does
not provide strong enough guidance to staff to support consistent safe care.
 Debriefs are not consistently happening after physical interventions take
place. This does not ensure a robust enough reflection of incidents.
 Monitoring checks do not identify gaps in records, such as supervision,
restraint and health and safety checks. Where monitoring does identify an
issue, managers do not consistently take appropriate action to address it.
 The manager has failed to notify Ofsted of a significant incident. This does
not enable Ofsted to have an informed overview of the service provided or
to ensure robust oversight of children‟s safety.
 Not all eligible staff hold a level 3 qualification relevant to their role as
required in regulation.
 The staff do not routinely receive training in safeguarding children with
disabilities, despite the home providing care and accommodation for
children with disabilities. This does not provide staff with a full knowledge
and understanding of safeguarding concerns pertinent to these children.
 The location risk assessment does not fully consider the risks that the
location poses, nor does it identify the benefits. This does not enable full
consideration of risk reduction strategies or maximising of opportunities.
 Supervision records are not always clear on the actions taken to address
issues that the staff raise. There is a failure to demonstrate how action
leads to improvement.
The children's home strengths
 Since the last inspection, the staff and managers have made considerable
progress, in a short space of time, towards meeting the identified shortfalls.
 Feedback from families is good. They value the service and feel involved.
 The staff support the children to understand what is happening in a
personalised and child-centred way when they move on from the home.
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What does the children's home need to do to improve?
Statutory Requirements
This section sets out the actions which must be taken so that the registered
person(s) meets 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.
Requirement
Due date
12. The protection of children standard
04/08/2016
In order to meet the protection of children standard, with
particular regard to risk management, the registered provider
must ensure that staff:
2 (a) (i) 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.
12: The protection of children standard
04/08/2016
In order to meet the protection of children standard, with
particular regard to the premises, the registered provider must
ensure that:
(2) (d) 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. This is with particular
regard to ensuring that food is stored safely and that when
checks reveal issues appropriate action quickly follows.
13. The leadership and management standard
04/08/2016
In order to meet the leadership and management standard, with
particular regard to ensuring all necessary action has been taken
following physical interventions, the registered provider must:
(2) (h) use monitoring and review systems to make continuous
improvements in the quality of care provided in the home.
The registered person must ensure that an individual who works
in the home in a care role has the appropriate qualification, the
level 3 diploma in residential childcare (England) ("the level 3
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31/12/2016
Diploma"), or a qualification which the registered person
considers to be equivalent to the level 3 diploma by the relevant
date, which in the case of an individual who was working in a
care role in a home on 1 April 2014, is 1 April 2016. (Regulation
32 (4) (a) (b) (5) (b))
The registered person must ensure that an individual who works
in the home in a care role has the appropriate experience,
qualification and skills for the work that the individual is to
perform. This is with particular regard to ensuring that staff
receive training on the safeguarding of children with disabilities.
(Regulation 32 (3) (b))
31/08/2016
The registered person must ensure that within 48 hours of the
use of the measure of control, discipline or restraint in relation to
a child in the home the registered person, or a person who is
authorised by the registered person to do so (“the authorised
person”) has spoken to the user about the measure and has
signed the record to confirm it is accurate, and 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 (3) (b) (i) (ii) (c))
04/08/2016
The registered person must notify HMCI and each other relevant
person without delay if there is any other incident relating to a
child which the registered person considers to be serious.
(Regulation 40 (4) (e))
04/08/2016
Recommendations
To improve the quality and standards of care further, the service should take account
of the following recommendation(s):
 Ensure that the outcomes of supervision sessions are clearly recorded in
supervision records. ('Guide to the children's homes regulations including the
quality standards', page 61, paragraph 13.4)
 Ensure that the location risk assessment review includes the identification of
opportunities as well as risks presented by the home's location and
strategies for managing these. ('Guide to the children's homes regulations
including the quality standards', page 64, paragraph 15.1)
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Full report
Information about this children's home
The children‟s home and school is owned by a private organisation and is registered
to provide accommodation for up to 40 children with learning disabilities. There is a
school on site that is registered with the Department of Education to cater for
children and young people aged from four to 19 years. Children live at the home for
either 38 or 52 weeks a year. There are currently 18 children living at the home.
Recent inspection history
Inspection date
Inspection type
Inspection judgement
18/05/2016
Full
Inadequate
17/02/2016
Interim
Sustained effectiveness
23/09/2015
Full
Requires improvement
28/01/2015
Full
Good
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Inspection Judgements
Judgement grade
The overall experiences and
progress of children and young
people living in the home are
Requires improvement
This home requires improvement to be good. Risk assessments, monitoring
arrangements, restraint records and the training that staff receive need to improve
in order to provide a good level of care for children.
While there remains much work to do, in the short period of time since the since
the last inspection there has been considerable progress in the quality of care that
children receive. Parents report progress, with one stating: „There has been a
dramatic improvement in the last two months.‟ There is better managerial
organisation and monitoring of the care that the staff provide. The staff recognise
the commitment of the management team. They say that this supports them to
provide effective care. One member of staff commented: „There is a much better
awareness of what needs to be done to achieve the expected standards.‟
Interactions between the staff and the children are positive. The children are
comfortable in the presence of staff and vice versa. During the inspection, the
children were excited to tell the staff about their experiences and the staff were
keen to listen. The staff seek the views of the children who use the service. The
children have access to people independent of the staff team, and they also seek
the children‟s views. During a recent visit by an independent person, a child said:
„You get listened to.‟ These positive interactions convey the message to the
children that their experiences are important, and increase the likelihood that they
will share concerns or worries with staff or independent people should they arise.
The communication needs of the children vary. The staff adapt information to
make it more accessible. For example, the last Ofsted inspection report is available
in symbol format. The children‟s guide is also available in symbol and photographic
form. This reflects the children‟s needs and enables them to understand the
information about their home.
Children make progress in their health because the staff help them to attend
routine and specialist appointments, with the staff helping one child to give up
smoking. The managers access specialist help for children, such as liaising with
mental health professionals. Other children make progress with their social skills
and their behaviour. External professionals and parents recognise this social and
emotional progress. A parent said: „Before, he was a boy you could not take out on
an activity. Now he wants to go out, he plays outside. He has made friends for the
first time.‟ Another said: „His behaviour has improved and he is more relaxed.‟
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The action taken by the management team has resulted in improvements to the
quality of the residential environment for children. The rooms are consistently
clean and tidy. A deep clean has taken place of ovens and all of these are clean.
The stained carpet has been replaced. The stairwells have had the damage and
cracks plastered and have been repainted. The overall impression is much more
homely and welcoming, which helps children to feel valued.
The children say that they participate in a range of activities on a day-to-day basis.
The staff encourage them to broaden their leisure horizons. One child said: „I got
to try something new and really enjoyed it.‟ He now participates in this activity
regularly. This reduces the risk of social isolation and develops skills and interests.
When children move on from the home, the staff work with them to prepare them
for the transition. The staff created a pictorial social story for one child. This
explained very clearly the move that would be taking place. This approach
supports children to understand what is happening to them during these significant
changes. It reduces the level of anxiety and distress that children feel. The
potential for such moves to be a success increases.
Children from across the country live in the home. Families report that
communication is generally effective, and comment on recent improvement in the
availability of staff. One parent said: „They have worked very hard on pushing
parental contact. This is particularly important for a child who is feeling rejected.
He has been here for nine months and the contact is on such a good trajectory. It
is amazing compared to where he was four months ago.‟ The staff inform families
of the children‟s experiences in the home. Another parent said: „I get a weekly
update with everything in it.‟ Parents are welcome to visit the home when they
want. The ongoing communication and contact between the home and parents
provides additional safeguards for children who are living away from their family
homes.
The children all receive education at the on-site school, and all attend full-time.
There is improvement in the dialogue between the staff in the home and the staff
in the school. There is a greater understanding of one another‟s roles. Meetings
now take place between the children‟s keyworkers and those working with the
children in the school. As a result, there is a greater knowledge of the children‟s
educational needs. A member of staff said: „He has just completed some GCSEs.
He loves maths and science. He is a hard worker. He is very determined and selfmotivated to get things done.‟ The staff are now in a better position to support the
children to make educational progress because of the improved communication
with school.
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Judgement grade
How well children and young
people are helped and protected
Requires improvement
Children‟s risk assessments are significantly better than they were at the last
inspection. They are clear, easy-to-read and easy-to-use documents. They identify
risks and actions required to help reduce the risks. The staff are reading and
signing the assessments in a timely way. However, while much better, some risk
assessments do not include full information on some areas of risk and this prevents
the identification of effective action to reduce these risks. For example, one risk
assessment notes that a child has a history of fire starting but does not outline any
context to this history or any risk mitigation. Another does not include information
concerning known risks relating to travelling in a car. Following a recent incident
when a child cycled away from staff while off the school site, staff updated his
individual risk assessment but they did not update the generic risk assessment for
children using their cycles. While the action proposed reduces the risks for the
individual child, an opportunity has been missed to increase the safeguards for all
children who the staff take cycling away from the site.
The location risk assessment is now more thorough. However, it does not take into
account all issues relating to the location of the home. It does not consider how
the location of the home may increase social isolation, nor does it detail the
benefits of the location and accessibility of local services. This means that staff do
not have a comprehensive overview of the risks and opportunities for children.
There are occasions when the staff need to use physical interventions to manage
the children‟s behaviour. For significant restraints, there are in depth debriefs that
enable staff to reflect upon practice and managers to understand the incident. For
other interventions, this is not happening and managers do not reflect fully with
staff concerned. The benefits that these discussions bring are not being realised in
all incidents. In one instance, a front ground recovery hold was used with a child.
When a child experiences this kind of hold, checks should take place at set
intervals to ensure that they are well. While the child‟s breathing was monitored
throughout the restraint, the child was not monitored afterwards, as this method of
restraint requires. This is a potentially dangerous hold and internal management
monitoring did not identify the gap.
There is greater precision in risk assessments in relation to e-safety. When internet
usage checks are necessary, the staff now keep records to show that they take
place. These checks enable staff to identify issues and address them, so reducing
the risk to children of inappropriate internet use.
Processes for the management of medication are better. Following a review, there
is more frequent monitoring, and clearer records. The management team makes
appropriate referrals to meet children‟s individual needs, including reducing
smoking and drug use, and managing suicide ideation and risk-taking behaviours.
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In one case, the management team has been proactive in supporting a child to
access a specialist service which provides counselling, advice, information and
support relating to substance abuse.
Some of the children who live in the home do go missing. Behaviour management
plans provide appropriate guidance for staff. One child has gone missing from care
since the last inspection. The staff and managers responded appropriately to this
incident. The staff liaised with external professionals to agree a child-centred
response. As a result, an in-depth discussion took place with the child without
causing additional distress.
The staff are able to articulate what to do if they have a safeguarding concern.
They know who to contact and are clear that they will escalate any concerns that
they have. When children raise concerns, the staff react appropriately. This
includes making contact with designated officers and treating concerns as
complaints and responding accordingly.
Judgement grade
The impact and effectiveness of
leaders and managers
Requires improvement
A suitably experienced manager has been in post since April 2016 and she is
registered with Ofsted. She holds a level 4 qualification in residential child care and
a postgraduate diploma in management. She has considerable experience as both
a registered manager and a senior manager overseeing a range of residential
children‟s homes. She receives support from two deputy managers. They are
relatively new in post and the manager now provides them with coaching. Since
the last inspection, a consultant also provides additional support to the
management team.
The management team has responded positively to the last inspection and the
compliance notices. Significant improvements have taken place over a relatively
short period. However, not all of the previous requirements are met. Requirements
relating to decor, education, the use of the gates, recruitment, care planning,
updating the statement of purpose and key policies, medication, the appointment
of a manager, and the induction and supervision of staff are met. Those relating to
risk assessments, staff training, monitoring and behaviour management records
are not met. However, there is considerable progress in each of these areas in
comparison to the last inspection. This has had a positive impact on the quality of
care that children receive.
The management team generally notifies Ofsted when a serious incident occurs in
the home. However, they did not make a notification following one recent incident.
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This impacts on Ofsted‟s ability to monitor the quality of the service and the safety
of the children.
The staff now receive regular supervision. However, supervision records do not
consistently capture what supervisors are going to do or what direction they give
when staff raise issues. As a result, the records are not always clear on subsequent
actions or any outcome of the discussion.
Research shows that children with a disability are particularly vulnerable to abuse.
Despite this, the staff have yet to receive specific training in safeguarding children
with disabilities. Some staff were able to outline some factors that contribute to
increased vulnerability. However, the absence of this training within the existing
induction process means that there is an increased risk that children will not
benefit from new staff who have a current understanding and working knowledge
of the heightened safeguarding concerns for children with disabilities.
Due to the number of new staff, not all eligible staff hold a level 3 qualification
relevant to their role in accordance with regulation.
Monitoring arrangements are much better. However, there are shortfalls in
identifying issues and taking the required action to improve. In one example, fridge
temperatures have been consistently high with insufficient action taken to address
this. A high temperature increases the risk of food poisoning.
The manager has updated the statement of purpose. The staff and the
management team have a good understanding of the children. Monthly reports
provide a good snapshot of how children are progressing each month. The staff
report that the new management structure is providing the support to make the
necessary improvements. One member of staff said: „I am now getting supervision,
guidance and support. We were never going to improve until we had the right
person in place. There was no-one with the underpinning knowledge. We have that
now.‟ A child said: „Within the last six weeks it has definitely improved a lot. The
whole management team has improved a lot.‟
Since the last inspection, 10 new staff have commenced in post. As a result, the
use of agency staff, while still high, is reducing. Staff and children see this in
practice. A child said: „The use of agency staff has dropped very quickly and very
significantly.‟ Staff report improvement in morale after a difficult period. Existing
staff say that the new staff integrate well. A new induction programme is in place
to support new staff. This two-week training programme covers key elements such
as first aid, fire safety and physical intervention training. It also considers generic
safeguarding and behaviour management. As well as the training programme, new
staff shadow shifts prior to managers deeming them competent. This promotes
better care for children because managers can identify practice strengths and
concerns at the outset.
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Feedback from families is very positive. Feedback from professionals is also mainly
positive. There are effective working relationships between the staff, the managers
and the wider professional network supporting the children. This supports interagency working to promote children‟s well-being.
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What the inspection judgements mean
The experiences and progress of children and young people are at the centre of the
inspection. Inspectors will use their professional judgement to determine the weight
and significance of their findings in this respect. The judgements included in the
report are made against „Inspection of children's homes: framework for inspection‟.
An outstanding children's home provides highly effective services that contribute to
significantly improved outcomes for children and young people who need help and
protection and care. Their progress exceeds expectations and is sustained over time.
A good children's home provides effective services that help, protect and care for
children and young people and have their welfare safeguarded and promoted.
In a children's home that requires improvement, there are no widespread or
serious failures that create or leave children being harmed or at risk of harm. The
welfare of children looked after is safeguarded and promoted. Minimum requirements
are in place. However, the children's home is not yet delivering good protection, help
and care for children and young people.
A children's home that is inadequate is providing services where there are
widespread or serious failures that create or leave children and young people being
harmed or at risk of harm or result in children looked after not having their welfare
safeguarded and promoted.
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Information about this inspection
Inspectors have looked closely at the experiences and progress of children and
young people living in the children's home. Inspectors considered the quality of work
and the difference that adults make to the lives of children and young people. They
read case files, watched how professional staff work with children, young people and
each other and discussed the effectiveness of help and care given to children and
young people. Wherever possible, they talked to children, young people and their
families. In addition, the inspectors have tried to understand what the children's
home knows about how well it is performing, how well it is doing and what
difference it is making for the children and young people who it is trying to help,
protect and look after.
This inspection was carried out under the Care Standards Act 2000 to assess the
effectiveness of the service 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‟.
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Any complaints about the inspection or the report should be made following the procedures set out in
the guidance raising concerns and making complaints about Ofsted, which is available from Ofsted's
website: www.gov.uk/government/organisations/ofsted. If you would like Ofsted to send you a copy
of the guidance, please telephone 0300123 4234, or email [email protected].
The Office for Standards in Education, Children's Services and Skills (Ofsted) 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,
workbased learning and skills training, adult and community learning, and education and training in
prisons and other secure establishments. It inspects services for looked after children and child
protection.
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