Providing Personalised Care

1. Principles

The Home will provide personalised care to each child: care and help which meets each child’s needs and promotes their welfare, and is sensitive and responsive to the child’s identity and family history, age, gender identity, religion, ethnicity, faith, belief, cultural and linguistic background, sexual identity and orientation, mental health, any disability, their assessed needs, previous experiences and any relevant plans.

Staff will help each child to develop resilience and skills that prepare the child to return home, to live in a new placement or to live independently as an adult, and which will help the child to cope with and withstand challenges and difficulties, both mentally and emotionally.

Children will receive care from staff who:

• Understand the Home’s overall aims and the outcomes it seeks to achieve for children;
• Use this understanding to deliver care that meets children's needs and supports them to fulfil their potential;
• Place the well-being of individual children at the centre of their practice.

The registered person is required to:

• Understand and apply the Home’s Statement of Purpose;
• Ensure that staff:
  • Understand and apply the Home's Statement of Purpose;
  • Protect and promote each child's welfare;
  • Treat each child at all times with dignity and respect;
  • Provide personalised care that meets each child’s needs, as recorded in the child’s relevant plans, taking account of the child’s background;
  • Help each child to understand and manage the impact of any experience of abuse or neglect;
  • Help each child to develop resilience and skills that prepare the child to return home, to live in a new placement or to live independently as an adult;
  • Provide to children living in the Home the physical necessities they need in order to live there comfortably;
  • Provide to children personal items that are appropriate for their age and understanding; and
  • Make decisions about the day-to-day arrangements for each child, in accordance with the child's relevant plans, which give the child an appropriate degree of freedom and choice;
• Ensure that the premises used for the purposes of the Home are designed and furnished so as to:
  • Meet the needs of each child; and
  • Enable each child to participate in the daily life of the Home.

Children placed in the Home may undergo a difficult transition and what should be simple aspects of their care take on a substantial significance in this context. Staff should provide a nurturing environment that is welcoming, supportive, and which provides appropriate boundaries in relation to their behaviour. The Home must meet children's basic day-to-day needs, such as routine, privacy, personal space, nutritious meals and enjoyable mealtimes, and physical necessities. This includes but is not limited to, a clean environment, continuous access to drinking water, varied and nutritious food, clothing, hot water, bedding and so on.

Staff should seek to meet the child's basic needs in the way that a good parent would, recognising that many children in residential care have experienced environments where these needs have not been consistently met - doing so is an important aspect of demonstrating that the staff care for the child and value them as an individual.

Children must be provided with nutritious meals suitable for each child's needs. Where appropriate, children should be involved in choosing and preparing meals and opportunities to sit together and eat should be promoted. See also Provision and Preparation of Meals Procedure.

For the Home to provide a nurturing and supportive environment that meet the needs of the children living there, staff will endeavour to provide a homely, domestic environment. Whilst the Home must comply with relevant health and safety legislation, staff will seek as far as possible to maintain a domestic rather than 'institutional' impression.

Just as in a family home, children should be able to access all shared areas of their home unless there are specific reasons why this would not meet a child's needs. Limits on privacy and access may only be put in place to safeguard each child in the Home. Any decisions to limit a child's access to any area of the Home and any modifications to the environment of the Home, must only be made where this is intended to safeguard the child's welfare. All decisions should be informed by a rigorous assessment of that individual child's needs, be properly recorded and be kept under regular review. For information on restraint and deprivation of liberty, see Use of Restraint and Physical Interventions Procedure.

Children will have varied pre-care experiences. A large proportion of children come into care for reasons relating to trauma, neglect and abuse. The registered person should ensure that staff are prepared and able to listen to children who want to talk about their past experiences.

Leaders and staff will work proactively with the local community, including neighbours, faith groups, leisure organisations and local businesses, to support children to use the facilities and to develop a sense of belonging, security and purpose.

All children's achievements are to be celebrated and appropriately rewarded.

2. A Safe and Supportive Environment

Staff should take every step to make sure that individual children and young people are not subject to discrimination, marginalisation or bullying from their peers by virtue of their gender, religion, ethnicity, cultural and linguistic background, sexual identity, mental health, disability or for any other reason. Children must be protected, and helped to keep themselves safe, from bullying, homophobic behaviour, racism, sexism, radicalisation and other forms of discrimination. Any discriminatory behaviours must be challenged and help and support given to children about how to treat others with respect.

Children in residential care may be worried about being stigmatised or bullied by their peers for being "different" because of where they live. The Home's environment and care should be designed to take account of this and staff should support children to talk about and help them address any concerns they have.

The importance of understanding who we are and where we come from is recognised in good social work practice, for example through undertaking life story work or other direct work. Staff in the Home should play a full role in work of this kind.

The relevant plan may include a strategy for a particular type of care, treatment or intervention (for example therapy relating to neglect or abuse). Staff will need to understand the purpose of any such care and the way in which the past experiences of abuse or neglect may manifest itself in the day-to-day life of the child.

In relation to use of CCTV or other monitoring equipment, see Surveillance and Monitoring Procedure.

3. Providing Personal Space

Children in residential care usually live in a group environment, and so it is particularly important that they can spend time away from other group members. Staff should respect children's privacy and support the other children living in the Home to do so.

Each child should have their own personal space which will usually be their bedroom. See Bedrooms Procedure.

4. Choice and Expression of Preference

Children should be supported to express themselves as individuals and should be given an appropriate degree of freedom and choice in relation to day-to-day arrangements for their care, depending on their individual needs. This is in relation to both activities and personal items such as clothing, technology, and leisure items. Children's reasonable preferences in relation to day-to-day arrangements should be met with consideration given to safeguarding, particularly in relation to the use of technology. Where a child's preferences are unreasonable or cannot be met for safeguarding reasons, staff should discuss this with the child to help them understand why.

Children should be able to maintain and develop their cultural or religious beliefs as far as practicable and where appropriate, through participation and instruction, and by observing religious requirements including dress and diet.

5. Location and Design

The Home should be located in an area that supports children's safety, well-being and personal development. The location of the Home should support its aims, objectives and ethos, as described in the Statement of Purpose (see Guidance on Part 6 of the Regulations – Monitoring and Reviewing Children's Homes, Review of premises for information on assessing the location of the Home).

The design of the Home should include any necessary adaptation to meet the needs of children with disabilities or specific health issues.

The design of the Home should, where appropriate, enable children to develop independence skills within the supportive environment of the Home, including through encouraging independent use of kitchen and laundry areas.

The design of the Home should provide staff that sleep in the Home overnight with appropriate accommodation and facilities to do so.

The registered person will review the appropriateness and suitability of the location and premises of the Home at least once a year – see Monitoring Quality Procedure.

6. Specialist Care

Specialist help must be made available according to the individual needs of children, including those who live away from their 'home' authority. This help must be available as soon as it is needed, at the intensity required and for as long as it is required. Where specialist services from elsewhere are not available, or children are waiting for a long time for help, the Home must be proactive in challenging and escalating concerns with the placing authority and/or other partners.

Where any specific type or model of care is delivered or commissioned by the Home, the registered person must ensure:

• That the care is approved, and kept under review throughout its duration, by the placing authority;
• That the care meets the child's needs;
• That the care is delivered by a person who:
  • Has the experience, knowledge and skills to deliver that care; and
  • Is under the supervision of a person who is appropriately skilled and qualified to supervise that care; and
• That the registered person keeps the child’s general medical practitioner informed, as necessary, about the progress of the care throughout its duration.

If the Home offers this type of care, it should have in place an assessment process for the child in advance of the placement whereby input is sought from the child, the social worker and other relevant persons on the implementation and arrangements for the care.  In establishing whether the care meets the child's needs, the child must be appropriately supported throughout the care and given opportunities to discuss the impact of the care, or any changes they feel they might need to it.

Where the care provided in the Home involves the provision of a Regulated Activity, the registered person should check that the provider of the service is registered with the CQC. See CQC and Ofsted guidance, Registration of Healthcare at Children's Homes. Not all activities that may be regarded as care are regulated activities. For example, counselling services and play therapy are not regulated activities and are not eligible for CQC registration. In these cases, the registered person should ensure that the practitioner is registered with their relevant professional body where one exists. Most importantly, the registered person must be confident that the person delivering the care will do so in a way that is safe and appropriate for the individual child. The approach to delivering this type of care should be included in the Statement of Purpose (see Schedule 1 - Health).

Where the type of care outlined above is commissioned, the child's General Medical Practitioner (GP) should be kept informed of the progress of the care, including any suggested changes to that care. Where a child is also under the care of a consultant or other health professional, the GP may agree that it should be the consultant or other health professional that is kept informed of the progress of the care. It is good practice for all of those involved in the healthcare of a child, including consultants and/or health professionals to be kept informed of the progress of the care at appropriate intervals.

Further Information

Culturally Appropriate Care (Skills for Care) - a range of resources to support embedding culturally appropriate care in everyday good practice.