Monitoring and Review

1. Suitability of Premises / Location Assessment

An annual review will be undertaken (in consultation with the Police and any other relevant bodies) of the appropriateness and suitability of the location of the home. The purpose of this review is to ensure that children and young people cared for in the home are effectively safeguarded and able to access services as identified in their Care Plans/Placement Plans and as per their views, wishes and interests.

This location assessment will be kept under review and should be amended to consider any new risks as and when these are identified.

Considerations when carrying out the location assessment include:

• Whether the location of the home influences the potential for an already vulnerable child or young person to be a victim of crime, such as being targeted for any form of exploitation;
• Whether there is a likelihood of children and young people placed in the home being at risk of gang crime or anti-social behaviour, or are at any other significant risk, in the local area (see also the Think Family Practice Toolkit section on Contextualised Safeguarding, this can be found in the Durham Resource Library, Section 3 Practice Standards, Toolkits and Guidance);
• The suitability of the local neighbourhood as a location to care for children and young people who may have already been victims of abuse and neglect; and
• Whether there are environmental factors that would represent a hazard to children and young people, such as locations near level crossings or busy roads, geographical and natural hazards, and former mine workings etc.

Location assessments may also identify factors that could positively contribute towards a child or young person’s well-being e.g. leisure activities or services to support a child or young person’s ethnic or religious identity.

2. Review of Quality of Care

The review of the quality of care provided within the home will be carried out by:

• Regular monitoring of the activities within the home by the registered manager or, in their absence, their appointed deputy;
• Reports prepared by an Independent Person following a Regulation 44 visit;
• A formal Review of Quality of Care (Regulation 45) completed by the registered manager and submitted to Ofsted and relevant Placing Authorities at least once every 6 months;
• The weekly update, and monthly submission to the Responsible Individual, of the Annex A by the 9th of each calendar month.

Regulation 44 Visits

See also Regulation 44.

The authority will arrange for its homes to receive monthly (Regulation 44) visits from an Independent Person. These visits are part of an on-going process to identify whether the home is meeting the needs of the children and young people living there. The visits should usually be unannounced but can be announced if it is necessary to arrange to meet a particular person.

The independent person cannot be a person employed by the local authority in connection with the carrying on of Social Care functions relating to children. For more information on who can be appointed as an Independent Person, see Children's Homes Regulations Amendments 2014: Advice for Children's Homes Providers on New Duties under Amendments to Regulations that came into Effect in January and April 2014.

The visit will be for a minimum of two hours. The Independent Person should complete a written report following the visit. This may include recommendations for improvement with timescales for completion.

The report should be shared with the registered manager and responsible individual within four days of the visit, who will then have the opportunity to make comment e.g. to clarify any possible inaccuracies or if there is disagreement with the comments and recommendations. A further four days is permitted to discuss or clarify any comments or recommendations, before the report is then agreed and signed by the registered manager and responsible individual and submitted to Ofsted by the commissioning manager.

Any delay in this process should immediately be brought to the attention of the responsible individual.

The final report should be lodged with the home for the registered manager and staff to read and respond to. Any recommendations should be discussed and minuted in team meetings and in child and young people’s meetings where appropriate.

A copy of this report is then sent to the Regulatory Authority before the end of the calendar month following the month of the visit.

The Independent Person, when carrying out a visit, is required to:

• Interview, with their consent and in private, a number of children and young people, their parents, relatives and persons working at the children’s home in order to form an opinion as to whether:
  • Children accommodated at the children’s home are effectively safeguarded; and
  • The conduct of the children’s home promotes the wellbeing of the children and young people accommodated there.
• Inspect the premises of the children’s home and be allowed access to the children’s home’s records (children and young people’s case records may only be inspected with the written consent of the child or young person and their placing authority – usually their social worker).

In a practical sense this may involve the Independent Person:

1. Meeting and talking to children, young people and staff at the home to ascertain their views, comments and any complaints or concerns about the running of the home;
2. Reading the Daily Log, records of restraints, incidents, reports of notifiable events and any missing episodes;
3. Checking any disciplinary measures and use of physical interventions in the home during the reporting period;
4. Reading the records of comments, compliments, representations and complaints and child protection or safeguarding referrals, commenting on the frequency and type made and whether they appear to have been dealt with appropriately;
5. Reading and commenting on the record of Children's and Staff Meetings, or other methods used by the registered manager, to consult the children, young people, and staff. The Independent Person should also check that staff supervisions have taken place as required, are meaningful and supportive;
6. Check on the physical condition and decoration of the home, including children and young people's bedrooms, the exterior, the wider locale and neighbourhood and the home’s proximity to services;
7. Developing a thematic response to any identified trends within, for example, the staffing dynamic, the needs of the children and young people, or any escalation in particular behaviours or events;
8. Reviewing the registered manager and staff team’s ability to advocate on behalf of children and young people, acting as effective parents would and escalating concerns when necessary;
9. Reviewing the effectiveness of the registered manager and staff team at engaging with the wider network to ensure that the needs of children and young people are appropriately met, employing escalation where necessary;
10. Reviewing the impact of the home’s care on the progress and development of children and young people, mapping their progress and achievement of identified goals within their individual plans of care and their own aspirations, and making a statement of findings;
11. Reviewing the key management and leadership documents and policies which include, but are not limited to:
    • The Statement of Purpose;
    • The Location Assessment;
    • The Workforce Development Plan and training matrix;
    • The development plan for the home and service.

Regulation 45 Report – Review of Quality of Care

As identified earlier, the formal Review of Quality of Care (Regulation 45) completed by the registered manager must be submitted to Ofsted and relevant placing authorities at least once every 6 months. The review should be submitted within 28 days of its completion.

It is the expectation of the responsible individual that these reviews are developed on a monthly basis, or as and when the registered manager assesses it to be necessary. The registered manager may assess that due to events in the home, changes in residents or significant changes in staff for example it may be appropriate to carry out a further review outside of these timescales.

To carry complete a review of the quality of care, the registered manager must establish and maintain a system for monitoring, reviewing, and evaluating the following:

1. The quality of care provided for children;
2. The feedback and opinions of the children and young people about their home, its facilities and the quality of care they receive from the registered manager and staff team; and
3. Any actions that the registered manager considers necessary to improve or maintain the quality of care provided for children and young people;
4. The feedback and opinions of the parents, placing authorities and other significant stakeholders in the care of the children and young people and the staff working there.

The registered manager should make available their schedule of monitoring to ensure that in their absence monitoring will continue.

The draft report should be sent to the service manager for quality assurance within 7 days of the new month. The report will then be quality assured and returned to the registered manager with comments and for submission to Ofsted.

Whilst it is the responsibility of the registered manager to establish and maintain their system of monitoring for the home, it is expected that the following will be covered:

Immediate

Response to Ofsted recommendations and requirements during and following an inspection. The quality assurance manager will support the registered manager to address any recommendations and requirements, also quality assuring the response to the draft inspection report. Any queries will be escalated to the service manager in the first instance, and also brought to the attention of the responsible individual.

Minimum of weekly

1. Incidents including:
   1. The use of physical interventions;
   2. Episodes of missing from home;
   3. Accidents and injuries;
   4. Safeguarding or Child Protection concerns and referrals;
   5. Notifications under Regulation 40.
2. Completion (or part completion) of the registered manager’s audit tool;
3. Daily notes;
4. Part-completion of the registered manager’s audit tool;
5. Minimum weekly keyworker sessions that relay the impact of our care on the individual journeys and development of our children and young people;
6. Complaints and compliments log;
7. Check of children and young people’s bedrooms to ensure cleanliness, good hygiene standards and maintenance or immediate repair/replacement of fixtures, fittings, and furnishings;
8. Fire log, tests, and drills, including a review of children and young people’s involvement or attendance in the fire drills;
9. Day and activity planners;
10. 1:1 consultation and debriefs following incidents;
11. Medication records;
12. Responses to behaviours including the effectiveness of relational practice, maintenance of expectations and boundaries;
13. Staff signing-in book.

Minimum of monthly (each calendar month)

1. Cleaning and hygiene rotas;
2. Fridge/freezer temperatures;
3. Menus, including quality and evidence of child and young person involvement in choice and preparation;
4. Communications book;
5. Rotas and timesheets;
6. Continuing development of the Reg 45 Quality of Care report;
7. Visitor’s log;
8. Staff supervision records and evidence of staff professional development and wellbeing;
9. 1:1 work/key worker sessions;
10. Maintenance log, including repairs and escalation of any drift in repairs, maintenance, or renewal;
11. Health records;
12. Monetary records;
13. Meetings – staff and children or young people’s minutes and actions;
14. The care planning/files for individual children and young people, including:
    1. Placement Plans;
    2. Individual Behaviour Support Plans;
    3. Monthly reports/summaries;
    4. Contacts with parents/social workers/others;
    5. Education attendance and attainment;
    6. Risk management and safety planning;
    7. The impact of our care on the development and progress of the child or young person.
15. Case management meetings;
16. Review of the training matrix to identify new initiatives to meet the specific needs of children and young people, and to monitor staff progress through identified core and mandatory training;
17. First aid;
18. Fire log and attendance at drills.

The registered manager’s monthly audit should be completed and submitted to the quality assurance manager by the 10th of the following month.

The responsible individual’s escalation protocol should also be followed with specific regard to:

1. Regulation 40 notification;
2. Regulation 44 process;
3. Significant incidents;
4. Ofsted inspections.

Please see: Appendix 2: Responsible Individual Escalation Protocol.

Minimum of Quarterly

1. Children and young people’s placement planning;
2. All documentation relevant to the statutory care of children and young people;
3. Statutory review meetings for children and young people in our care;
4. Risk assessment and safety planning review to identify themes and trends;
5. Continuing development of the regulation 45 Quality of Care review;
6. Education paperwork (plans and targets), progress towards desired outcomes and goals, and receipt of all necessary assessments and reports (including EHCPs);
7. Health reviews, documentation, and assessment, including those assessments that may be outstanding and require escalation.

For Guidance on what should be included within the report see Appendix 1: Regulations 45 Report on Review of Quality of Care.

Once a review is complete it must be sent to HMCI within 28 days.

Appendix 1: Regulations 45 Report on Review of Quality of Care

It is the responsibility of the registered manager to decide what should be included in the review of the home. The report should contain an analysis of the information monitored, reviewed, and evaluated, with the aim of learning from the information to inform and drive improvements in the home and for the quality care of the children placed there. The impact of our care on children and young people should be clearly described, helping to establish goals and outcomes that have been met and the identification of new targets for their growth and personal development. These plans, co-produced with children and young people wherever possible, should be aspirational as well as being achievable.

The following headings and guidance are for reference to help inform a structure for reporting. The views and wishes of children, young people, and other key stakeholders should form an integral part of the analysis within the report.

The Quality and Purpose of Care Standard

1. Any safeguarding concerns or incidents in respect of a child accommodated at the children’s home and the measures taken by the persons working at the children’s home to respond effectively to these to ensure the safeguarding and welfare of the child. What has been learnt from these incidents? What have we changed as a result? Who, within the wider network, have we worked effectively with to ensure these risks are removed or mitigated?
2. The arrangements for children and young people coming to and leaving their home. This should therefore include or correlate with:
   • Consideration of impact assessments, progress following admission;
   • How effectively we have developed relationships and can demonstrate the positive impact of these on, for example, educational attendance and attainment, health and well-being needs being met or the child or young person being safe from harm;
   • The care and practical support we have continued to provide when a young person has left our care.
3. The arrangements for monitoring the quality of care provided, including the actions taken in response to recommendations made by the Regulation 44 Independent Person or, as the case may be, the reasons why the registered manager did not consider it appropriate or necessary to take any such actions;
4. In respect of each child or young person accommodated in their home, compliance with the placing authority’s care plans and placement plans;
5. The arrangements for:
   1. Consulting children and young people about the quality of the care we provide and for acting on the results of such consultation, with examples provided;
   2. Involving children and young people in decisions about:
      1. Their own care; and
      2. The day to day running of their home.
6. Complaints in relation to the children’s home or the children and young people, including any actions taken in response to such complaints and how complaints were resolved;
7. Notifications of the events under Regulation 40 (see Notification of Serious Events Procedure), including a thematic analysis which seeks to identity any trends or escalating behaviours that may impact on the safety and well-being of the children and young people.

The Education Standard

8. The effectiveness of the home in promoting the educational attainment of children and young people in its care and the quality of relationships between the children’s home and local schools. This would include any educational goals that have been achieved, plans for alternative education or further education, and the aspirations for individual children and young people.

The Positive Relationship Standard

9. The arrangements for promoting and supporting the positive behaviour of children and young people in our care;
10. The effectiveness of the approach to behavioural support, including arrangements for commissioning training for staff in behaviour management, physical intervention, and relational practice;
11. The number of times that children and young people have needed physical intervention to ensure their safety and well-being, and the steps taken by the children’s home to minimise the use of physical intervention;
12. Whether there have been any occasions when children and young people in our care have been charged with a criminal offence.

The Health and Well-being Standard

13. The arrangements, if any, for commissioning therapeutic (or any other specialist) services appropriate to the needs of children and young people in our care and the effectiveness of any such arrangements in achieving health outcomes;
14. The arrangements for children and young people to be provided with general medical practitioner and other primary health care services, including access to preventive and screening services in the local community;
15. Details of any children and young people requiring accident and emergency treatment and other hospital services;
16. Illnesses of children in our care, and their progress through necessary treatment.

The Leadership and Management Standard

17. Risk assessments for health and safety purposes and subsequent action taken;
18. Fire drills and tests of alarms and of fire equipment;
19. The arrangements for the management and supervision of staff working at the home, including duty rosters and staff deployment in relation to any incidents at the home;
20. The arrangements for continuing professional development, recruitment and the training of staff working at the home.

Details of:

1. Disciplinary action concerning persons working at the home;
2. Staff grievances.

The reasons for staff ceasing employment at the home.

The arrangements for consultation with placing authorities, the local authority in whose area the home is located, and other community services used by children and young people in our care. The effectiveness of the home’s guidance and procedures concerning police involvement with the home.

On minimum annual basis, the registered manager must also review the home's Statement of Purpose, and make necessary improvements, which should be approved by the Regulatory Authority.

The Protection of Children Standard

19. The number of reports of children and young people in our care being absent without permission;
20. The measures taken by staff:
    1. To prevent children and young people from being absent from the home without permission; and
    2. The subsequent response to a child or young person being absent without permission from their home.
21. The effectiveness of arrangements agreed between the home, local Police, and the local authority for responding to missing person incidents in relation to children accommodated at the children’s home.

Appendix 2: Responsible Individual Escalation Protocol

Routes of Escalation to Responsible Individual

Last reviewed: 19/05/21

1. Regulation 40 notifications

Reg 40 can be QAd by service or quality assurance managers if the registered manager deems it necessary, but notifications should always be forwarded to Claire Morris when submitting to regulator.

2. Regulation 44 reports

Registered managers should receive the report within 4 days of the visit. If there are issues or queries regarding the information within the draft report, the registered manager must provide the Reg 44 Visitor with comments or suggested factual amendments by email without delay. This process should not exceed 4 days. Claire Morris should be notified by email of the queries and potential delay.

Seniors should be cc’d into the Reg 44 report by the Visitor to ensure there are no delays in the process due to the registered manager’s leave.

When the final draft is agreed, the registered manager completes the sign off field, including detail of how any recommendations will be/have been met, within 4 days and submits to Claire Morris for review and sign off.

3. Significant incidents

Incidents that could be considered significant should be reported to Claire Morris by the registered manager without delay. These reports should be brief, objective and factual, with clear timelines.

These incidents include but are not limited to:

• A child missing overnight;
• Hospital admissions;
• Significant Police involvement with a child or the home;
• Children who are moving in, moving on or enjoying unplanned holidays;
• Strategy meetings and s47 enquiries.

4. Ofsted inspections

Quality Assurance Managers will attend inspections to support managers. QA visits will currently focus on requirements and recommendations from the most recent inspection, and how these have been met. Bedrooms and general homeliness will also be a focus.