13. The on-site inspection
What happens during a full inspection.
13.1 The start of the inspection
At the start of all inspections, the inspector confirms their identity by producing their Ofsted inspector authorisation and identification card and identity badge. They don’t need to carry paper copies of Disclosure and Barring Service (DBS) checks.
The inspector always meets with the registered manager/ person in charge at the beginning of the inspection to:
- outline the plan for the inspection and confirm whether it is a full or an interim inspection
- make arrangements to interview the registered manager during the course of the inspection; if the registered manager is not available and the responsible individual is not able to attend the inspection, the responsible individual should identify who is to be their representative during the inspection.
- outline any lines of enquiry for the inspection, including those generated through the reading of the statement of purpose
- provide the person in charge with the opportunity to share any current information or personal issues relating to any of the children living in the home or members of staff that the inspector needs to be aware of during the inspection
- ensure that Ofsted holds the correct details on the inspection database, including email address and contact telephone numbers for the manager, registered provider and/or responsible individual, any other partners, or directors or trustees (see Annex A)
- ensure that Ofsted hold records of the latest qualifications for the registered manager or progress made on any qualifications being undertaken to comply with regulation 28
- arrange the approximate time that verbal feedback will be given and who is to receive this; feedback will normally be given to the registered manager or senior member of staff present and the responsible individual; additional senior staff linked to the home may also attend at the discretion of the inspector, if agreed in advance
13.2 Case tracking and sampling
Evaluating the experiences and progress of children and young people at the home is a core inspection activity. This is largely based on evidence from case tracking and sampling.
For tracked cases, the inspector takes an in-depth look at the quality of the help, care and protection that individual children have experienced. For sampled cases, the inspector looks at elements of practice within individual cases, usually to follow lines of enquiry.
We take into account individuals’ starting points and circumstances during inspections. We recognise that even slight progress in a particular aspect of their lives may represent a significant improvement for some children and young people. We also recognise that for some children, because of their experiences of trauma, abuse or neglect, progress is not always straightforward. Progress in one area may result in deterioration in another as they work through the impact of their past experiences.
Children’s overall experiences and progress are, in part, a result of how well they are helped and protected and the effectiveness of leaders and managers. Inspectors consider the ‘help and protection’ and ‘leadership and management’ judgements first so that they can take these into consideration when reaching the ‘overall experiences and progress’ judgement.
In small homes, the inspector tracks the experiences and progress of all children living there. In larger homes, the inspector tracks the experiences and progress of a representative sample of children.
The inspector may also sample elements of further cases to follow specific lines of enquiry. The size of the provision and the nature of any line of enquiries determines how many cases are tracked and sampled.
Tracked and sampled cases should be selected by the inspector from the case list provided and may include (where relevant):
- children who have recently moved into the home (or in the case of a service providing short breaks, a child or young person who has recently started using the service)
- children who have recently left the home (whether their move was planned or unplanned)
- any children who have gone missing from the home since the last inspection
- any child at risk of, or subject to, child sexual exploitation
- any child who lives a considerable distance from their placing authority
- in a short breaks service, a child who is subject to a child protection plan or a child whose services are delivered as a child in need, to see how well the service works with others to help and protect children
Inspections also usually assess the management of a recent serious incident (where relevant) so that they can understand how the staff team responds to complex and difficult circumstances and whether the actions and responses of leaders, managers and staff are focused on promoting and safeguarding the welfare of children.
Case files (either electronic or paper-based) are usually discussed with the allocated key worker (unless on leave), using their knowledge of the case, file structure and recording systems. In the absence of the allocated key worker, a suitable colleague will be asked to assist.
Case files are only one aspect of tracking the child’s journey. The inspector increases their understanding of the child’s experience through evidence from other sources. These sources include observation of practice and evidence from the child themselves, their carers, birth family (where appropriate), social worker, the children’s guardian, health and education professionals and other practitioners involved in their care. When tracking the case of a looked-after child, the inspector must always consult the independent reviewing officer, the placing social worker and the key worker.
The inspector examines, discuss and evaluates cases in line with the evaluation criteria set out in the evaluation schedule. They look for evidence that living at the home has had a positive impact on the experiences and progress of children and how managers and staff know they are making a difference to children’s lives.
The detail of activities undertaken and discussions held varies depending on the lines of enquiry for each individual inspection.
13.3 Listening and talking to children and young people
The views of children who live in or stay at the children’s home provide important evidence of their experiences and progress.
The inspector assesses how well the children’s home consults with children. Children’s views that have been gathered by the home are taken into account as part of the inspection evidence.
The inspector always tries to meet with children during the inspection. The inspector may make alternative arrangements to speak to children, such as telephone calls at a pre-arranged time.
The inspector must take into account the specific communication needs of individual children. For some children, the inspector may request the assistance of staff who know and understand the young person’s preferred means of communication, particularly if this is unique to the child. In other instances, it may also be appropriate for the inspector to spend time observing children and how they interact with staff and respond to their environment.
The inspector can request the services of an interpreter to join the inspection. This is helpful when the children are fluent in British Sign Language. The inspector requests this service via the inspection support team and gives 2 weeks’ notice where possible.
Many of the experiences of children living in the home take place after the normal school, college or work day and it is therefore essential that the inspector is present at this time. The inspector should involve the children in inspection activity wherever they can. Opportunities to gather the views and experiences of children may include:
- asking children to show inspectors around the premises
- holding structured meetings (as a general guideline, a meeting should not include more than 5 children)
- having individual conversations
- joining in leisure activities such as computer or console games
- preparing snacks or drinks
- spending mealtimes with children
- conversations during homework
- outdoor activities
Children, including those with limited or no verbal communication, may wish to share their views in a letter to the inspector.
Inspectors demonstrate safe and sensitive practice by:
- telling staff where conversations with children are taking place and who is involved
- being sensitive to the fact that some children may not want to be involved in the inspection
- explaining to children that they will not include comments that will identify them in the inspection report or in feedback to staff working in the home without their permission
- ensuring that staff are aware of any arranged meetings with children and that children may leave the meeting at any time
- where appropriate, explaining to that information suggesting that they or another child is at risk of harm will be passed by the inspector to an appropriate person able to take necessary action about that concern
13.4 Observation of activities
Inspectors can use the home’s scheduled activities as opportunities for observing and following lines of enquiry. These activities could include:
- staff handover between shifts
- children’s meetings
- staff meetings or briefings
The privacy and confidentiality of personal information are respected at all times by inspectors. The inspector always involves staff in any decisions about children’s involvement in the inspection.
Inspectors always try to strike a balance between the time taken to observe an activity with the significance of the likely evidence to be gained.
13.5 Gathering views of other professionals
Inspectors consult with professionals to inform the inspection findings. This is usually through a telephone call during the inspection and may not always take place on site. These professionals may include:
- placing social workers
- independent reviewing officers
- school staff
- local police
- the placing authority’s quality assurance officer (or equivalent) and designated officer
- youth offending teams
- monitors from the youth justice board or independent visitors
Inspectors ask for the relevant contact details via Annex A. Inspectors should always take account of privacy and confidentiality when talking to stakeholders on the telephone during the inspection.
13.6 Discussions with managers and staff
Individual interviews are held with the registered manager/person in charge and other staff. The inspector should always try to talk to the responsible individual. The number of staff interviewed depends on the size of home but includes a sample of permanent staff and any agency staff working in the home at the time of inspection.
Where the registered manager is not available, the inspector should ask to interview the responsible individual.
The inspector always asks to interview the responsible individual where:
- there is no registered manager in post
- there are concerns about the quality of care and/or the effectiveness of monitoring arrangements, or the quality of the leadership and management of the home or
- evidence indicates that the home is failing to protect children or
- there are concerns about staffing, the premises or resources to manage and run the provision
The interview with the registered manager usually covers:
- issues that have arisen from pre-inspection information/early lines of enquiry
- a discussion about the ethos of the home as described in the statement of purpose and any specific lines of enquiry arising from this
- the registered manager’s evidence of the effectiveness of the home on the experiences and progress of the children living there and those who have recently left; this includes how the home works with individual children to meet their needs and the help on offer to support them to make and sustain attachments with adults
- questions about the theoretical and professional understanding and approach to work with vulnerable and upset children
- a summary of the needs of the children living at the home, including how any incidents or concerns are managed and the action taken to prevent similar situations or difficulties arising
- discussions about how regular routines are established for children around meal times, bed times, school and weekend activities
- the registered manager’s knowledge and understanding of the strengths and weaknesses of the home and plans for future development and how they effectively lead the team and promote a culture of continuous improvement
- discussions about helping children to have safe contact with their families and friends
- follow-up on progress in response to previous requirements and recommendations
- the quality and effectiveness of practice-related supervision received by the manager and given by the manager to staff
- challenge and enquiry about the relationship of the children’s home with other professionals and services
- plans for staff development, including arrangements to ensure that staff have obtained appropriate qualifications by the relevant dates
- discussions about the recruitment and selection of staff to ensure that they have an appropriate qualification or are able to get one
- the manager’s qualification; if their qualification does not meet regulation 28 of the Children’s homes regulations (England) 2015, how they intend to obtain an appropriate qualification
- any further evidence that the manager may wish to highlight to the inspector
During the inspection, the inspector shares emerging findings about the home’s strengths and weaknesses with the registered person (usually the registered manager) so that they fully understand emerging issues. The inspector usually meets with the registered person at the end of day 1 to share emerging findings. The inspector normally sets out for the manager what they intend to consider later in the inspection (where relevant) so that the manager can prepare or direct inspectors to any specific information or evidence required.
Shortfalls that could have an immediate impact on the safety of staff or children should be brought to the attention of the manager or senior member of staff on duty as soon as the inspector has identified the problem.
Inspectors want to establish that the monitoring systems in the home are robust enough to identify any strengths and weaknesses in practice. Inspectors do not spend time routinely counting medication or petty cash, undertaking vehicle checks, checking water temperatures or contents of fridges, freezers and food storage areas unless these are a specific line of enquiry.
Inspectors should be prepared to alter interview arrangements if staff have to attend to the needs of children.
13.7 Assessing financial viability
The children’s homes regulations state that the ‘registered provider must carry on the children’s home in such manner as is likely to ensure that the home will be financially viable for the purpose of achieving the aims and objectives set out in its statement of purpose’ (regulation 47(1) of the Children’s homes (England) regulations 2015).
Inspectors are only expected to undertake a lay person’s assessment of the financial information. Their assessment of financial viability focuses on whether an applicant’s financial plans appear broadly realistic and are likely to result in, at a minimum, acceptable outcomes for children. Where, during the course of a routine inspection, the inspector has concerns about the financial viability of a provider due to, for example, the poor repair of premises or the standard of day-to-day care or services, they should follow registration guidance.
Inspectors should explain to providers why they are requesting financial information during an inspection or at any other time.
The financial information Ofsted can request ranges from professionally produced business plans to a collection of accounts (including profit and loss accounts), records and financial forecasts (regulation 47(3) of the Children’s homes (England) regulations 2015).
13.8 Examining records, policies and procedures
The home’s statement of purpose and children’s guide should be available on its website and form part of the pre-inspection data. We should also hold copies in our database because homes are required to submit these documents to Ofsted whenever they are changed.
Inspectors do not routinely examine all policies and procedures. Documents are examined where it is a line of enquiry for that individual inspection.
Inspectors focus on the impact of documents such as risk assessments and how they work in practice, rather than the format. What matters is that they are fit for purpose, and provide enough information to all relevant people so that they can care for the children safely and appropriately. Where paper or electronic personnel records are maintained at the home, the inspector may ask to see those records, if they are included within the lines of enquiry for the inspection. Homes can maintain electronic records if:
- they meet the requirements of regulation
- are appropriately accessible to children if they want to access their records
- staff have access to the information they require to care for those placed
Where recruitment records are not maintained at the home, inspectors look at the home’s list or electronic records that summarise the vetting and recruitment checks for staff. These records could be maintained in checklist or spreadsheet formats. The manager must be able to provide evidence that they are satisfied that all staff working at the home are fit to do so and that recruitment and selection arrangements comply with regulations 32 and 33 of the Children’s homes (England) regulations 2015.
Where the provider uses the Disclosure and Barring Service (DBS) update service to check the status of an individual’s DBS certificate, the home should be able to demonstrate how it manages and records details of any check it carries out. If any lines of enquiry require additional information, then the inspector may request that a small sample of full personnel records are made available at the inspection visit.
Where members of staff are subject to TUPE arrangements, we recognise that the new employer is reliant on the previous employer for all recruitment records relating to those staff and in some instances may not be able to access all the information including documents required by the regulations. Where this is the case, we still expect the new employer to hold enough relevant information to make sure staff are suitable, including criminal record checks or vetting records. Where there are any gaps in requirements, the new employer should have taken steps to assure themselves that the person is suitable to work in their role. This would include reference to employment records such as appraisals.
13.9 Implications of the Equality Act
The Equality Act 2010 (the Act) came into effect on 1 October 2010. The Act makes it unlawful for an employer to ask a potential employee questions about their health or disability before they are offered employment, whether on a conditional or unconditional basis.
Social care providers must comply with both the Equality Act and the remit-specific regulations that require them to employ people who are fit, both physically and mentally, for the work. In order to comply with both laws, this means that providers may give conditional offers of employment to potential employees after the recruitment process, subject to appropriate medical and health checks. However, there are a number of exemptions to the provisions in the Act. If a provider believes that an exemption applies to their recruitment of staff, they should take their own legal advice on the matter.
Inspectors will assess whether providers have a rigorous recruitment and vetting process in place, including ensuring that their employees are mentally and physically fit before they commence work as part of their inspection.
13.10 How inspectors record the evidence
The inspector must analyse the information they gather on inspection and use their professional judgement to assess the impact on the experiences and progress of children and other service users.
The inspector’s evidence should be clear, evaluative and sufficient to support the judgements.
The evidence should tell the story of the experiences and progress of children and other service users, as appropriate. Evidence should not include information that could identify individuals unless it is necessary to protect a child or to support further action. In these instances, the inspector can use individuals’ initials.
The inspector can record direct quotes from children, adult service users and other interested parties in evidence to support judgements.
The record should clearly indicate the source of the evidence (for instance, whether the evidence is from observation, a written record or a face-to-face interview). If evidence comes from an interview, the record must indicate the time of the interview and the interviewee’s job title or relationship to the child.
Throughout the inspection, inspectors maintain a record of their evidence. Electronic evidence is recorded within the inspection database. Summarised evidence must be sufficient to support the judgements and any recommendations or requirements. The inspector must ensure that the provider understands the evidence that the judgements are based on and any requirements that stem from the judgements.
After the summarised evidence has been placed in the inspection database, any duplicate handwritten evidence should not be destroyed by the inspector until at least 10 days after the inspection. In some circumstances, the inspector will be required to keep any handwritten notes they have made during the inspection for longer. This may, for example, be necessary when legal action or a complaint about the judgement is being considered.
All handwritten evidence should be legible and dated. Handwritten evidence that has not been summarised forms part of the inspection evidence base and should therefore be scanned and added into the inspection database within 5 working days of the end of the on-site visit.
Evidence may be scrutinised for quality assurance and will be considered in the event of any complaint.
13.11 Feedback at the end of the inspection
At the end of the inspection, the inspector will give verbal feedback of the main findings and provisional judgements. This feedback will usually be given to the responsible individual (as appropriate). Additional senior staff from the provider may also attend, if agreed in advance with the inspector. In some circumstances, the inspector may need extra time after the inspection fieldwork to take advice before giving feedback. The day of feedback is counted as the last day of the inspection.
The inspector should:
- cover the main findings of the inspection, including both strengths and weaknesses
- clearly communicate the likely judgements
- indicate likely recommendations, with clear reference to the relevant national minimum standard or quality standard (where relevant), providing a clear direction for improvement
- use the grade descriptors and the evidence to clearly indicate how the judgements have been reached
- confirm when the report will be sent to the manager for comments on factual accuracy (see ’timeframe‘)
Inspectors will not provide a written summary of the inspection or written feedback in advance of the inspection report being sent. Providers may choose to take their own notes at feedback.
13.12 Feedback to children and young people
Inspectors should give feedback to children and young people, as appropriate to their age and understanding. Inspectors should make efforts to address matters raised by children.