My Ssec Capstone Project SC2 – Declarations and consent form 1 17/09/2017 20

SC2 – Declarations and consent form 1 17/09/2017 20

SC2 – Declarations and consent form
1 17/09/2017 20:46
You should read this introduction before filling in this form.
You can fill in the sections of the online form in any order you want. You can move around the form using the navigation
menu on the left-hand side of the screen or by using the ‘Next’ and ‘Back’ buttons at the top and bottom of each screen.
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symbol shows you have filled in all of the questions on the page
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you back to the homepage.
Please press ‘Submit’ when you have filled in the form. You must answer all the questions before you send the form.
Once you have sent us the form you will not be able to make any changes.
Information you will need to complete application

1. Ofsted URN or application reference

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2. Full five year address history

3. Details of qualifications and training

4. Details of referees
Access keys
The following access keys are available throughout the site to aid users. Other access keys are available, but only apply
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hold the ‘Alt’ key and then press the letter of the access key.
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Please note that in general we do not ask applicants to resubmit information if this is incorrect or shows the person has a
poor understanding of the service they are intending to provide. We also generally do not ask for an applicant to provide
additional information.
We make our registration decisions based on the original information you provide. The quality of information you supply
will be taken into account when we make our judgement about your fitness to register with Ofsted to provide or manage
a children’s social care setting.
We need references to confirm your competence to provide or manage a children’s social care service. This should
include your skills and experience in the areas of management and leadership, financial management, safeguarding and
health and safety. Please give the name and address of two people from whom we can obtain professional references.
Relatives cannot give you a reference.
One of the two referees must be your most recent employer. We generally accept an employer’s reference from the
owner or director of an organisation. We can accept a reference from someone other than the owner or director but we
must have written permission from the employer for a named person to supply a reference on their behalf. If you cannot
provide an employer’s reference you should provide two references from people who have known you in a professional
The second reference must be from someone who has known you in a professional capacity and can comment on your
work. It should also be from someone from a different organisation to your first referee.
This information is also available on the ‘References’ section by clicking ‘Help on this page’.
I have read and understood the applications to register a new service checklist
Import data
It is possible to import data from previous SC2 forms that you have started or submitted.
To do this you will need the Task ID of the form you wish to import. This can be found on the Tracking/Search tab of the
Workbench in the column named ‘ID / Type / Stage’.
You can only import forms of the same type (SC2) that you originally started. Once you have imported the form, all data
from it will be copied to this application. It is your responsibility to make sure that the data on this form is correct before
submitting it.
A: Setting details
This form must not
be submitted by anyone other than the person whose details are being added.
Is the provision…
already registered with Ofsted?
Ofsted registration number 1234374

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Name of establishment or
Kensey Valley
Type of service Children’s home
Address of establishment or agency
Postcode PL15 9NB
Address line 1 39 Kensey Valley Meadow
Address line 2

Town / city Launceston
County Cornwall
Postcode PL15 9NB
B: Personal details
Title Mr
Forename (in full) Mark
Middle name(s) (if applicable) John
Surname (family name) Deaconn
Surname at birth Deacon
Have you previously been known by a different first name or surname to those entered above?
Date of birth 14/02/1963
Gender Male
Have you/your organisation
made a previous application for
registration with Ofsted to register
a children’s social care setting
after 30 September 2010?

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Are you a member of a
Are you applying to be
registered as the manager of a
Are you a director of an
organisation applying for
B13) Current full postal address
I have lived here from 01/06/2014
Postcode PL14 4EF
Address line 1 12 Trevillis Park
Address line 2

Town / city Liskeard
County Cornwall
Postcode PL14 4EF
Local Authority Cornwall
B14) Any other addresses in the last five years
(in full, starting with the most recent)
B14) Any other addresses in the last five years (in full, starting with the most recent)
Address Postcode Local Authority From To
Greenbank House,
Doctors Lane,
PL14 3JW
PL14 3JW 908 06/06/2011 31/05/2014
B15) Any time unaccounted for in the last five years
(starting with the most recent)
B15) Time unaccounted
Details From To

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C: Contact details
Please provide us with a telephone and a mobile number. You can select your preferred contact number below.
Contact numbers (include area code)
Telephone 01579 347728
Mobile 074433643038
Please select your main contact
Your email address must be personal to you. It is not acceptable to provide an email address that may be shared by a
member of your household, such as jone[email protected] This is because we may need to send personal
information that must only be accessed by you as the applicant or registered person. You may opt out of receiving
electronic communications at any time.
Personal email address [email protected]
Work email address [email protected]
C3) Do you wish Ofsted to communicate with you electronically?
D: Registration details
Do you, or have you in the
past, carried on a business?
Do you have any current
financial or work interests in any
other establishments or agencies
registered with Ofsted?
Have you ever been registered, or licensed for, or been the owner, responsible individual or manager of, any service
registered or licensed under the:
Registered Homes Act 1984
Registered Homes (Amendment)
Act 1991
Children Act 1989
Childcare Act 2006
Nurses Agencies Act 1957
Care Standards Act 2000
Health and Social Care Act 2008
Have you ever had an
application refused or your
registration cancelled under any
of the above Acts?

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Have you ever been
adjudged bankrupt, been subject
to a debt relief order, been
subjected to the sequestration of
your estate, made a composition
or arrangement with creditors, or
granted a trust deed for creditors?
Have you ever been subject
to disciplinary procedures?
Is any person related to you:

· working at, or going to
work at, the
establishment; or

· working for the purposes
of the agency?
E: References
Make sure you have read the guidance on references in the ‘Checklist’ section or by clicking ‘Help on this page’ above.
Please provide the names and addresses of two people whom we can obtain professional references.
E1) Referee 1
Title Mr

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Forename Neil
Middle name(s) (if applicable)

Surname Rudd
Job title Residential manager
Full postal address
Postcode EX39 5RZ
Address line 1 Four Winds
Address line 2 Higher Clovelly
Town / City Bideford

Postcode EX39 5RZ
Telephone number (include area
07792 467115 01271 859732
Email address [email protected]
How you are known to the referee Work colleague
How long has this person known you (must be longer than 12 months)?
Months 7
Years 1
E2) Referee 2
Title Mrs

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Forename Louise
Middle name(s) (if applicable)

Surname Cullen
Job title 16 Plus Team in Cornwall
Full postal address
Postcode PL31 2FR
Address line 1 Cornwall Council
Address line 2 Chy Trevail, Beacon Technology Park
Town / City Bodmin

Postcode PL31 2FR
Telephone number (include area
Email address [email protected]
How you are known to the referee Past work colleague
How long has this person known you (must be longer than 12 months)?

Years 15
F: Qualifications
Qualifications relevant to role
Qualification Date obtained
NVQ Level 3 Caring For Children and Young People 01/08/2002

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Experience relevant to role Back in 1999 I became a bank worker for the local authority in their residential service
and was positioned at Pendean residential home in Liskeard , this home catered for
the needs and welbeing of eight children. I soon realized this was the career path I
wanted to take and soon became successful in gaining a full time contract . With this
came more responsibilities from becoming a keyworker for either male or female
residents and leading shifts. I then completed my NVQ Caring for Children level 3
before rising to the rank of a senior. Once again more responsibilities came my way
from supervision,appraisals,compiling a working rota,submitting written reports and
attending professional meetings.
I was asked in my role as a senior to be part of an emergency team put together at
short notice to worker with a young person who had extreme challenging behaviors.
This team was successful in keeping the young person safe so her needs could be
assessed.The outcome from her assessment was a move to Kensey Valley in
Launceston. As the part of the transition I was asked to follow to keep continuity and
consistency for a six month period but in the end I stayed at Kensey Valley. The only
difficult decision I had to make was giving up my senior position because the home
was run by a manager without senior support. I became a RCW and fitted well within
the new team. During this time I worked under three different managers and was
always appreciated which was always highlighted in my supervisions and appraisals
for my efforts hard work and commitment. Sadly on 23rd February 2015 the
residential services in Cornwall closed down for good so I was made redundant.
However, I soon realized i was missing my days working with young people and
children in residential services so in February 2016 I attended an interview for a
vacant post with Phoenix Learning and Care . I was successful and took up my role
coincidentally back at Kensey Valley. About eight months ago I became a senior and
took on those responsibilities once more. I was then made aware that the managers
post at Kensey Valley was becoming vacant so I applied and sat an interview on
Wednesday 6th September. After the interview I was informed I was successful so
hence that is why I am now completing this Ofsted registration form.
I have currently enrolled on my NVQ 5.
F2) Present Employer
Name Phoenix Learning And Care
Postcode EX31 1JE
Address line 1 Phoenix Learning And Care Ltd
Address line 2 Rolle Quay
Town / City Barnstaple

Postcode EX31 1JE
Job title Senior Residential Worker
Employed since 16/05/2016
Previous employers from when you left full time education

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Previous employers
Name Address Postcode Job title Employed
Reason for leaving
D R Ryan
TR7 Carpenters
19/12/1978 19/06/1979 Six Month YTS scheme
Djb Woodcraft
TR 14 Apprentice
20/06/1979 20/06/1982 The firm went bust.
Robbie Wilde
21/06/1982 20/04/1985 I had a badly broken wrist which restricted my job prospects
however i could work as a shop assistant. I left this position
after my wrist had made a full recovery.
Self Employed Disc
Jockey / Compare

TR7 2RP Disc Jockey/
02/03/1982 04/12/2008 Retired from this profession
Self Employed

02/02/1985 01/01/1999 Started working for Cornwall Council in their residential
Cornwall County

01/01/1999 23/02/2015 The residential Services in Cornwall was closed down and I
was made redundant.
Self Employed

PL14 4EF Multiskilled
01/07/2015 04/04/2016 Stopped self employment due to given starting date to new
job at Phoenix Learning and Care.
Phoenix Learning
And Care
Phoenix Learning
And Care Ltd,
Rolle Quay,
EX31 1JE
EX31 1JE Residential
Centre Worker

Please explain any gaps in
your employment history
23.2.15 – 01.07.2015 Claimed Job Seekers Allowance and attended PGL training
course in Plumbing. Gained Level 2 Diploma in Plumbing.
G: Suitability and disqualification
Do any of the circumstances
listed in The Disqualification from
Caring for Children (England)
Regulations 2002 apply to you?
Are you aware of any other
circumstances that might affect
your fitness to work or be in
regular contact with children
and/or young people?
Fit person questionnaire
This questionnaire is to help us assess your fitness to be registered as a provider of:

· an adoption agency

· adoption support agency

· a children’s home, including a secure children’s home

· an independent fostering agency

· a residential family centre

· a holiday scheme for disabled children

· social work services.
To run a children’s social care establishment or agency, you need to have a good understanding of the responsibilities
placed on you by the regulations, and where applicable, national minimum standards (NMS) and statutory guidance.

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We will use your answers as a basis for your fit person interview. We will also use them, together with all the other
information we ask for, to decide whether or not we will register you.
If you would like more information on how to register a social care service, please see, which has all
the latest links and guidance, including details of how to contact us if you still have questions.
You can complete the fit person questionnaire online now, or supply it at a later stage
Fit person questionnaire
Your Details
Name Deaconn, Mark
Name of the agency or
establishment that you are
applying to register to
Kensey Valley
Type of service Children’s home
Address of the agency or establishment you are applying to register to
Address line 1 39 Kensey Valley Meadow
Address line 2

Town / City Launceston
County Cornwall
Postcode PL15 9NB
Fit person questionnaire
About this questionnaire
This questionnaire gives you an opportunity to outline your skills, knowledge and experience, and to explain to us in
detail how you will ensure that children, young people and adult service users’ needs are protected and consistently met
Your answers must demonstrate:

· your understanding of the type of establishment or agency you are applying to register and the particular kinds of
services you propose to provide

· how you will ensure through your leadership, oversight and strategic management that the standards of care,
protection and support that your agency or establishment provides will be of a high standard

· how the services you offer will meet the specific needs of the individual children, young people and service users

· how your leadership and management will result in positive outcomes

· how you will promote equality and diversity, and tackle discrimination

· an ability to plan for the future to ensure that your establishment is sustainable, continues to meet legal
requirements and strives for improvement

· knowledge of Ofsted’s policies and procedures, including the guidance on the inspection framework for the type
of agency or establishment you are registering to provide1, which is available on our website:
Please answer all the following questions, illustrating your answers with examples.

12 17/09/2017 20:46
1 Ofsted will not inspect or report on providers of social work services (SWP) as an agency. Inspection of local authority
statutory functions will include the exercise by the SWP of those functions delegated to it.

13 17/09/2017 20:46
Fit person questionnaire
How do your experience,
qualifications and knowledge
make you suitable to be a
registered provider or responsible
I first started my career in residential services back in 1999 and have experienced
many changes nationally and locally.
When I decided to make a career in children’s services i needed to educate myself
and gain qualifications to prove my competence and ability in doing my job and role to
the best possible standard. Back in 2002 I gained my NVQ level 3 Caring For
Children and Young People and over the years have attended a variety of training
giving me the tools and skills to provide a safe caring environment for the children
who come into care so they have the opportunities to reach their full potential. I have
just enrolled into taking my NVQ 5.
What outcomes do you want to
achieve for the children, young
people or adult service users?
The nine quality standards highlight the outcomes that as management and a team
guide us to support each young person to achieve positive outcomes while living in
the children’s home.
How will you ensure that the
ways you provide your services
fully protect children’s, young
people’s and adult service users’

Safeguarding children is everyone’s responsibility. Its about sharing information and
working together.Sadly we have been involved in a young person leaving our care
recently where the sharing of information and working together was not totally
followed by the local authority and this impacted in a negative way on their welfare .
Make sure all staff are trained and aware of the following Whistle blowing procedures,
In Cornwall the MARU team in Devon the MASH team , LADO (Local Authority
Designated Officer).
In Phoenix we have our own Safeguarding Officer who is contactable for help and
advice if and when required.

How you will ensure you meet
your legal obligations in all areas
of your establishment or agency’s
I will ensure i meet all legal obligations in all areas of my practice by following and
adhering to the following :
Follow regulations from Ofsted and their new social care common inspection
framework as from 1st April 2017.
Phoenix Policy and Procedures.
The Equal Opportunity Act 2010.
Children’s Act 2004.
Data protection Act 1998.
DBS checks for all staff working with children or vulnerable adults.
Human Rights Act 1998.
Education and Inspections Act 2006.
Care Standards act 2000.
Children’s Home’s Regulation 2015
What will you do to ensure that
staff are properly trained and
supported? Please include details
of how you will support and
manage the proposed registered
manager (or manager for
adoption agencies).
Currently as a senior I take regular supervision among my team and in these
sessions we sit and talk about their skills base and how this can be expanded to help
and support the young people in our care. A prime example of this is a new member
of staff started at Kensey Valley on the 11th September and I have booked them on
their 3 day induction and STAIR training starting 18th September, its all about being
proactive and identifying the skills and qualifications of your staff and how this going
to benefit the young people in our care and their needs.

14 17/09/2017 20:46
Fit person questionnaire
Questions continued
What are your current plans to
develop the agency or
establishment, and how do you
intend to do this over the next

After talking to our HR department the other day one area that needs addressing is
staffing in our team. My understanding is we are one full time member of staff down
at present and a member of staff who is 18 weeks pregnant. With annual leave and
sickness i for see staffing problems if this void is not full. I want to empower the team
so they gain more confidence in their own abilities. I see real potential in our team at
Kensey and hope with our reg 44 checks and Ofsted inspections these improvements
are recognized.
What resources are or will be
available to meet the particular
needs of the children, young
people and adult service users?
Resources include all aspects of
the service, for example facilties
available and staffing numbers
and their deployment.

The interview process of new staff is an important area as I will try with the help of
my senior to put together a diverse team giving the young people in our care the
opportunity to explore new things in their lives.

Weekly finances are made available to each young person helping them visit and
see sights that we may take for granted that they have never experienced.
How you will monitor and
evaluate the quality of the
services that you intend to
There are many ways to monitor and evaluate the quality of our services at Kensey
Valley. In house we have weekly checks carried out by our RI. Each month we have
Reg 44 checks carried out by external assessors then reg 45 checks each six months
making recommendations on areas that may need addressing. Ofsted with their full
and interim inspection during a twelve month period, constructively highlighting areas
that may need improvement or give praise for noticeable improvements.
Attend regular managers meetings and sharing information.
Regular supervision with a senior manager discussing any issues that may be giving
you or them cause for concern.
How will you ensure that your
service has a positive impact on
outcomes for children, young
people and adult service users,
supported by continuous

I will ensure that my service will have a positive impact on outcomes for children by
Weekly monitoring with my RI
Monthly reg 44 checks ad six monthly reg 45 checks
Ofsted inspections and addressing any recommendations they make
Please outline any further
information or issues that you
would like to discuss with the
inspector at the interview.
Nothing at present
Supporting Documentation
Qualifications document
Health Declaration Booklet

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H: Consent and declaration
This section seeks your consent to carry out a series of checks to establish your suitability to work with or be in regular
contact with children. As part of these checks, we may ask you to provide information and we may ask other
authorities/people to share with us information that they hold about you.

We use the information from checks and any interviews to make a decision about your suitability to work with or be in
regular contact with children. It may be necessary to repeat these checks from time to time in order to assess your
ongoing suitability. The checks we carry out are listed in the Guide to registration for children’s social care services. By
signing the form, you give your consent to these checks, including your consent for Ofsted to access, at any time, your
record on the DBS update service.

If you give false information on the form, it may affect the application to provide care or the registration of the service.

It is an offence to knowingly make a statement in an application that is false or misleading. If you do this you may be
prosecuted and be liable to a fine of up to £5,000 if convicted. By signing the form in section H you are declaring that all
the details in your application are true, to the best of your knowledge and belief.
Please note:
if any of the information you have provided in your application changes, for example, if you are subject to
any disciplinary procedures, you must tell us about this. You can contact us either:

by post:

Application Regulation and Contact Team

Team 1

Piccadilly Gate

Store Street


M1 2WD

or by telephone on 0300 123 1231.
I consent to Ofsted carrying out checks and using information provided from the checks and this form as
described above.

I declare that all information I have given on this application form is true to the best of my knowledge and belief.
I consent to Ofsted rechecking my status with the DBS update service on a regular basis in order to assess my
continued suitability to work with or be in close contact with children.
Please tick one of the boxes below.
I declare that I have/my organisation has not made a previous application since 30 September 2010
I declare that I have/my organisation has made a previous application since 30 September 2010 and that where I
have not supplied information in this application form it is because no change has occurred to information supplied in
that previous application.


Date of signature

Ofsted would like to seek your permission to contact you on behalf of research organisations for research purposes.
Please mark the box if you do not agree.
I do not agree to Ofsted contacting me in connection with Ofsted approved research projects.
Please check you have filled in all the relevant parts of this form and added additional information where necessary.
Then click on “Submit”.