Inspections Clinic: Five tips for outstanding residential care

The Firs children's home in Harrow is one of only a handful to have achieved an "outstanding" rating from Ofsted 10 years in a row.

The four-bed setting provides short breaks to children and young people aged five to 18 with learning disabilities and complex needs with conditions ranging from autism spectrum disorder and attention deficit hyperactivity disorder to cerebral palsy and Prader-Willi syndrome.

Respite care

Children come for overnight stays during the week and for longer stays over weekends and during school holidays - at any one time, there are on average 32 children and young people on the setting's books.

The service offers families respite from their caring responsibilities but also plays a key role in supporting children's learning and development in order to help them reach their full potential.

Since 2009/10 the children's home, which was last inspected in November 2018, has been rated "outstanding", which manager Eithne Staunton puts down to a range of factors not least the dedication and commitment of staff and an ethos of putting children at the centre of all decisions (see box).

"It is not down to any one person," she says. "It is definitely the result of a combined effort and the enthusiasm and dedication of the whole team and the families we work with."

Despite the setting's exemplary track record she admits inspection is still "stressful".

"Every year I think ‘That's it - we've lost it' then I have a talk with myself and say ‘What are you on about?'," she says.

Shawcase the good

In order to show a setting in its best light "you have to be a sales person", she explains. "You don't have control over the inspection but what you do have control over is the preparation and how you respond," she adds. "You have to be confident but not arrogant and showcase the things you are good at."

While the setting is at the top of its game there is always room for improvement, she stresses.

"What we have built over the years is a culture of continuous improvement and learning," she says. "Only this year we had a young boy join us who completely changed how we work because he had a different diagnosis and we needed to learn brand new skills to work effectively with him. We wouldn't still be here if we didn't change with the children."

STAYING OUTSTANDING: FIVE KEY WAYS TO ACHIEVE SUCCESS AND MAINTAIN IT

1. Strong leadership and management. In order to stay at the top "you have to have strong leadership and management", says Staunton. As registered manager of The Firs she tends to take a more strategic role but works very closely with her deputy team manager who looks after the day-to-day running of the children's home. "It's about being very visible in the home and actively involved in day-to-day activities," she says. "You need to be approachable to staff and you have to communicate a clear and compelling vision."
2. Support and training for staff. "Like Richard Branson I believe in training staff well enough so they can leave but treating them well enough so they stay," says Staunton, who does a lot of coaching herself. The Firs has a policy of "positive behavioural support" and staff do regular training around this way of working and have been supported to get qualifications.
   Ensuring staff have the time to do planning and preparation work is also very important. "We have full-time posts for our daycare staff even though the children are not around because they are at school," she says. "We have to do paperwork, care plans, risk assessments, short breaks reviews - there is a lot of work to do before the child comes in."
   She is also a great believer in promoting emotional resilience among staff who need to be able to deal with challenging situations and behaviour. "The more emotionally resilient we are the more able we are to look after these complex and extraordinary children to the best of our ability," she says.
3. Working in partnership. One of The Firs' main strengths is its good relationships with other organisations and agencies including the local child and adolescent mental health service, which accepts referrals direct from the setting. The home also has great links with children's social services, the local community nursing team, and the special schools its young residents go to, attending termly meetings with school heads or deputies to share information. Staunton believes these relationships needs to be nurtured at all levels. "As the registered manager I may have links with the head teacher or deputy head but I would also encourage my staff to link with teachers and teaching assistants down the line," she says.
4. Focus on children. Putting children at the centre of all decisions is something it's easy to aspire to but requires real commitment to put into practice. "Every phone call, conversation, and meeting you have should go back to the child and improving outcomes for the child," says Staunton. "If it does not, then question why you are doing it." One of the reasons she believes The Firs has maintained its "outstanding" rating for so long is that staff are constantly looking for new ways to enhance the lives of children and support their families. This includes taking children to get their hair cut or shopping for school shoes to help busy families short on time. "Things like that can be quite simple but profound," says Staunton. Other examples include helping to co-ordinate dental work for a young person who had to be treated under general anaesthetic and working with a hospital to enable the family of one young man with unstable epilepsy to go on holiday for a week.
   More than 80 per cent of children who attend The Firs are non-verbal but the setting makes every effort to consult them on the activities they would like to do, staging weekly children's meetings and using varied methods of communication.
5. Evidencing success. Part of being a successful setting is about being able to demonstrate that success, believes Staunton. "Evidence gathering is part of every staff member's job. It shouldn't be an additional task - if that's the case then change it," she says. The setting's policies, procedures, training and supervision records, team meeting minutes, and reports should all reflect the setting's core values. Each child has a diary to document their achievements with photos of activities they have taken part in. "It is not only good for inspection but also good for communication with the children who often want to take the diary out of their file and look through it," says Staunton.
   She prepares for inspection by starting work on her Annex A report well in advance. Over the past decade, she estimates The Firs has been visited by nine Ofsted inspectors each with "a different area of interest". Managers need to be very familiar with the children's home regulations, guidance and the framework for inspectors," she says. "I read how they inspect and what they are looking for in ‘good' and what they're looking for in ‘outstanding' and then I will evidence it, making it easy for them to find," says Staunton.

INSPECTIONS SHORTS

• OFSTED More families believe Ofsted provides a reliable picture of the quality of childcare and schools, according to its latest survey of parents. The 2018 survey of more than 1,100 parents found just under two thirds - 65 per cent - felt Ofsted provided a reliable measure of a school's quality - up from 59 per cent in 2017. Meanwhile, 63 per cent said the regulator offered a reliable measure of childcare - up from 57 per cent the previous year.
• EDUCATION Moving to an above/below the line grading system risks making Ofsted judgments even more high stakes, according to a report from the regulator setting out the reasons for sticking to the current four inspection categories. While the report acknowledges concerns that the existing four-grade system places "enormous amounts of pressure" on schools, it maintains parents, teachers and policymakers find it useful. Not grading schools or adopting a simpler pass or fail approach "could lead to the system becoming even more reliant on attainment or progress outcomes" and increase the risk of off-rolling and "gaming the exam system", it said.
• SOCIAL CARE Children's homes and fostering agencies have been urged to think more carefully about how and when they notify Ofsted about serious incidents. Figures collated by the regulator show more than 41,000 incident notifications were made by children's social care providers in 2017/18, with most coming from children's homes. Jason Bradbury, Ofsted's deputy director for data and insight and chief statistician, said providers often notified the regulator about incidents that did not fit the criteria or submitted multiple notifications for the same incident.
• EDUCATION Data published by Ofsted has shed new light on the problem of illegal schools with as many as 6,000 children being educated in unregistered settings inspected by the regulator to date. The figures show Ofsted has investigated 521 settings in England - and inspected 259 - since January 2016. The figures show alternative education provision is the most common type of unregistered setting at 28 per cent.
• YOUTH JUSTICE Cookham Wood Young Offender Institution has been criticised for failing to curb high levels of violence and locking too many children up during the day. An unannounced visit by HM Inspectorate of Prisons, Ofsted, the Care Quality Commission and General Pharmaceutical Council in December 2018 revealed assaults on staff and children at the facility in Kent had increased and a quarter of children spent the day locked in their cells.