Children's Homes Regulation 44 Visits Guidance and Procedures

RELEVANT GUIDANCE

Guide to the Children’s Homes Regulations including the Quality Standards

1. Procedures of Regulation 44 Visits

1.1 Purpose and Requirements of Regulation 44

Management visits to Children's Homes, known as Regulation 44 Visits, are carried out under Regulation 44 of the Children's Homes Regulations 2015.

They are also covered by the Quality Standards for Children's Homes. See Section 9, Government Guidance, Regulations & Quality Standards for Children's Homes to access this information.

The Children Act 1989 Guidance and Regulations - Volume 5, under section entitled - Proper Oversight. paragraph 3.12 and 3.13:

(3.12): Regulation requires the registered provider to have quality assurance arrangements in place. As a minimum, these will involve visiting the home at least once a month, either announced or unannounced in order to observe the care provided, the practice of the staff, inspect compliance with regulations, systems and processes and the quality of the environment. One important focus for these visits will be to scrutinise how the home is supporting children to enjoy and achieve. The person making the visits will wish to be satisfied that the home has an effective approach to behaviour management. Visits should routinely examine records of restraint and logs of missing person's reports, to check that the home provides stable, safe and secure care;
(3.13): The visit wherever possible include private interviews with children and young people living at the home (and if appropriate their parents, relatives or carers). Where English is not their primary language, the visitor must have access to appropriate translation support. Staff employed at the home must also be interviewed privately. A written report on the conduct of the home must be prepared after the visit and made available to HMCI, the registered manager, and anyone else with responsibility for the management of the home.

The Children's Homes (England) Regulations 2015 states Regulation 44 visits states that:

'The registered Personshould actively seek independent scrutiny of the home and make best use of information from independent and internal monitoring to ensure continuous improvement'

Ofsted reviews the content of Regulation 44 reports to inform the next inspection and uses the information to decide if we need to take any other action;

Failure to submit any regulation 44 report will be noted in the lines of enquiry for the next inspection. Findings in this area may impact on the judgement for Leadership and Management.

The visits will be undertaken by a person not involved in the day-to-day operation of the home. NYAS have been commissioned to undertake this function.

Elected members will have ready access to individual reports, should they wish to follow up trends and issues more closely.

1.2 Planning of Regulation 44 visits

The Visiting Officers will structure their visits on the following basis:

Visits will take place each calendar month; and can be either announced or unannounced;
The purpose of the announced visit being to meet with young people - parents - staff - the registered manager. The purpose of the unannounced visit, being to aid spot checking the running of the home;
Times of day for visits should be varied, and be when the children and young people are most likely to be present. Contact with parents should be established either by phone or face to face when visiting the home. A minimum of one parent should be spoken to during or immediately after the visit;
The Visiting Officer should read the previous reports, paying particular attention to which children and young people were seen, which parents were spoken to and what actions were recommended. The Visiting Officer should also read the recommendations of the Ofsted inspection reports;
The Visiting Officer will have access to a copy of the Quality Standards for Children's Homes and the Department of Health and Social Care Guidance on Permissible Forms of Control in Children's Residential Care 1993;
The Visiting Officer must have their identity cards available for inspection, and on arrival should introduce themselves and the purpose of their visit to the person in charge, and follow the home's signing in procedures, including presentation of ID;
The Visiting Officer will ascertain which children and young people are in, and request that they are informed of their arrival, and the purpose of the visit;
The Visiting Officer will ascertain which parents might also wish to meet them or have a phone conversation.

1.3 Minimum Requirements

To comply with the statutory regulations the Visiting Officer must:

Provide an opportunity for any child, parent or member of staff who wishes to meet the visitor (in private if they wish) to do so. (This links in with Standard 2 of the Quality Standards whereby the Visitor is ensuring that Children and Young People's wishes and feelings are heard);
Check on the physical condition of the home;
Form an opinion on the standard of care provided;
Check the following records: Daily log, Complaints record, Sanctions record and Restraint record.

1.4 Report Circulation and Administration

1.4.1	The visiting Officer will provide a copy of the completed report to both the Registered Manager to check for accuracy (including correct URN number) and for their comments to be added. Upon confirmation of accuracy, Project Lead will forward a copy to Senior Manager - Resources (Responsible Individual) within five days of completion of visit, for monitoring.
1.4.2	NYAS will ensure a copy of the report is supplied to Ofsted (including the correct URN Number) before the end of the following month.

2. Guidance on Completion of the Regulation 44 Report Format

2.1 Physical condition and Management of the Home

This part of the visit links in with The Quality and Purpose of Care Standard whereby the physical conditions of the Home are assessed.

The building, its location and environment, the condition of the furniture and decoration, the use made of the rooms and the personal space available for individual children can affect the whole atmosphere of a home. These factors send a powerful message to children and others of the value that those responsible for their welfare place upon the children they care for. The physical environment will have an effect upon the self-esteem of the children living here and impact on their development and behaviour.

It may give a different view of the home if one or two of the children or young people are prepared to show the Visiting Officer around. This is also a good way of getting a view of the home from the young person's viewpoint and gives an opportunity to talk privately with the young person.

The Visiting Officer should not look round the bedroom areas alone, and should not enter any bedrooms without the permission of the young person.

Particular issues to check are:

That the condition of furniture and equipment, heating and lighting within the home are of a high standard. Toilets, baths and showers in good working condition; with locks working to provide privacy;
There are personal signs of it being a home such as flowers, plants, and photographs. Do young people have a key to their own bedroom door, and have they been supported to personalise their rooms with posters, photos or pictures?
Is the kitchen, clean, safe and adequately equipped, are young people, supported to make snacks, or prepare drinks or meals?
Does access to and movement through the building allow people with disabilities, whether children, staff or visitors to use the building easily. Do young people use the garden and are outdoor areas cared for and reasonably tidy?

Within the visit the Visiting Officer should also review the Regulation 34 checks being completed by the Registered Manager (or in their absence Deputy). These checks should be completed each month, and separate guidance is provided to staff undertaking these checks. These checks are linked to the Quality Standards and should provide clear evidence of compliance. The Visiting Officer should have also read the recommendations of the Ofsted inspection reports prior to visit, and should ask to see evidence that action points are being completed.

2.2 Record Checks

Daily log and behaviour management records

This part of the visit links in with The Positive Relationships Standard; this assesses behaviour and relationships.

The daily log must be inspected on every visit. This and other records should provide the Visiting Officer with a picture of what has been happening in the home for individual children and the group as a whole since the previous Regulation 44 visit. Look out for issues such as the number of absences without authority, difficulties with neighbours, incidents between young people in the home, use of alcohol or illegal drugs, exclusion from school, involvement of the police, fire setting, serious illness, and self harm.

Look for evidence that the records of sanctions imposed or the use of physical intervention are regularly monitored by managers, and that their comments upon the appropriateness of such actions are recorded. Track a sanction through the home's daily log or incident book to try to understand the circumstances that led to the sanction. Does the sanction appear fair and appropriate in the light of the recorded incident?

Similarly, read the circumstances leading up to the use of physical intervention on a child and consider if it was necessary and appropriate. Visiting Officers should be able to consult the positive behaviour plans when looking at the appropriateness of a sanction or intervention with a particular resident.

The Visiting Officer should sign and date the records to evidence that they have been checked.

Sanctions, Permissible Forms of Control, Achievement and Rewards

Young people living in children's homes may be coping with strong emotions of loss, pain and anger as well as the practical difficulties of day to day living. They need to feel safe and cared for within a structure, which they understand and respect as fair and just. Young people do thrive with positive parenting, and it is our responsibility to provide this. Children with disabilities may have some form of communication difficulty which can limit their ability to readily ask for what is important to them. Young people who struggle to express themselves will do so by doing things, which supportive staff will observe to better understand what they are wanting or trying to communicate. Young people who are new to the Home or having a short break may feel upset and confused about not being at home, with strangers or the significant changes to routines they feel comfortable with. This links in with The Quality and Purpose of Care Standard, whereby staff need to ensure that they introduce new children and support them to feel settled in the home environment.

Homes should have written guidelines for staff regarding behaviour management and use of sanctions and interventions, which should form part of the Statement of Purpose & Function (This links in with The Quality and Purpose of Care Standard, in relation to the staff and children's understanding of the Statement of Purpose of the Home).

What you want to establish is that behaviour within the home is tackled positively and proactively, by rewarding positive behaviour. Are staff recognising, noting and celebrating achievements. In giving rewards to young people are they developing trust and promoting their independence;
For young people with disabilities; are their daily living tasks structured with regular prompts and encouragement to do things for themselves. Likewise is their regular praise and reassurance offered. Are there lots of new activities and other positive distractions to break up attention seeking behaviour or self absorbing rituals;
To evidence that young people are engaged in the decision making about rules and behaviour within the home. Check with young people if they know what behaviour is unacceptable and if they feel the rules are fair, and are applied fairly.

Can staff explain the philosophy of the home for the care and discipline of the children, and do sanctions used fit the guidelines. You want to know that staff are clear on prohibited measures that are never acceptable as disciplinary measures (e.g. corporal punishment, deprivation of food or drink, restriction of contact, requiring a child to wear distinctive or inappropriate clothing, the use or withholding of medication, medical or dental treatment, the use of accommodation to physically restrict the liberty of any child, intentional deprivation of sleep, the imposition of fines or intimate physical searches) This links in with the Protection of Children Standard, Regulation 12 of the Children's Homes (England) Regulations 2015 whereby the visitor is ensuring that Children and Young People are safeguarded from harm as highlighted above.

Physical interventions

Physical intervention should be a last resort to ensure that young people and others are kept safe. There is clear guidance in place for staff which sets out the legal position and the duty of care placed upon them. The Visiting Officer should ensure that they are familiar with this guidance, in order to check with staff their own practice. You may wish to check with staff their understanding of the Physical Intervention Policy and their understanding of their duties in relation to the law.

Staff are trained, using Management of Actual or Potential Aggression (MAPA), which are accredited by the British Institute of Learning Disabilities. You may want to check with staff that they are attending practice sessions, so that in the eventuality of needing to use the techniques they can do so safely.

There should be a record of any incidents where physical intervention has been used, this should include a clear debriefing of staff involved and note of actions being taken to limit the likelihood of such a situation arising in future. Within Disability services there should be a Physical Intervention Protocol which assesses the risk associated with the supportive holding and circumstances in which restraint might be considered appropriate.

2.3 Safety Issues

Safeguarding Issues

You may wish to check with staff that they can access the local safeguarding board's procedures, and what training within this area they have recently completed. In relation to bullying you may want to check staff awareness of the procedures on managing bullying within the home, and discuss how a recent incident of bullying was dealt with. Do think to ask a young person if she/he thinks there is any bullying in the home.

Note whether anyone who has gone missing or is absent without permission from the home, and read the records relating to this incident. Staff should be active in looking for patterns or trends in incidents of young people who do go missing. Check the notes of the interview following the return of the young person, and if staff were able to ascertain the reason for the young person being missing. There should be evidence of a plan being put into place to engage in safe and appropriate behaviours to keep the young person safe.

You may wish to ask staff if they know the procedure that is followed when a child is missing or absent without permission;
You may wish to ask staff if they know the procedure that is followed when a child is absent without permission;
Try to find out whether there are any patterns to individuals or groups running away or failing to return on time. Why has a particular young person been missing? Were they running to escape the home or something in the home or were they running to do something or see someone?

Notifiable Events

The Children's Homes Regulations 2015, Regulation 40 identifies a list of items which the Manager of the Home should notify OFSTED. These items should be kept within a discrete log, together with notes of any further action agreed.

These include notification of: the death of a child / Referrals to POCA list / Serious accident or illness of a child / outbreak of infectious disease / involvement in Child Sexual Exploitation / police involvement in serious incidents / serious complaint about the home or person working there/ investigation and outcome of any child protection enquiry.

Health and Safety

The Department has a clear commitment to ensuring that the Home provides both a safe living and work environment. In reviewing incident reports you may wish to note any significant incidents or any patterns of events. Thresholds for recording do vary across different homes and teams. The Visiting Officer needs be clear that Managers and staff are proactive in reviewing accidents and incidents, and are identifying remedial action appropriately.

2.4 People and Practice

Customer Relations Records

Our expectation is that our homes operate in an open manner where young people feel free to express their opinions, and that staff take seriously what they say. Most issues should be dealt with informally and without the need to use the formal complaints system. However, there are times when the young person needs to make a complaint and see that it is responded to in a fair and just way.

Areas you may need to consider / evidence are:

Have young people had a leaflet explaining how to make a complaint and time to discuss it? Ask them how any recent complaints have been resolved. For young people with communication difficulties is this in an accessible format;
Do the young people all have telephone numbers and addresses of people they can contact for help and advice? Do children have access to a telephone which they can use without being overheard by other young people or staff?
Have parents been informed in writing of the complaints procedure?
What compliments have been received?
Ask the young people whom they would talk to if they were unhappy or worried, do they feel 'safe' in the home.

Discussion with Young People

One of the benefits of arranging a planned visit is to provide better opportunity for young people to decide if they wish to meet with the Visiting Officer to comment on their support arrangements.

The Visiting Officer should arrange to visit at times of day when young people are likely to be present and more willing to engage in discussion.

Most children with disabilities do have significant difficulties in communication - and the Visiting Officer should discuss with the Registered Manager about arranging for one of their visits to be when young people with better verbal communication skills can be present. Otherwise the Visiting Officer should spend time reading the young person`s communication profile and check with staff present the most useful ways of communicating. (Jenny Morris - "A Lot to Say" provides useful guidance).

The Visiting Officer may need to make a judgement as to whether it is appropriate to talk to a young person displaying anxious or challenging behaviour. It may be appropriate to seek advice from staff on duty.

The Visiting Officer should leave a contact number for young people to ring them if they have not had opportunity to talk during visits.

The Visiting Officer may also wish to check with colleagues for any issues which the young person has raised either within the CLA review or with Children`s Involvement Officer / Complaints Officer.

Discussion with Parents of Young People

One of the benefits of arranging for a planned visit is to provide better opportunity for parents to decide if they wish to talk to the Visiting Officer to comment on their child`s support arrangements. Discussion with the manager during the planned visit should enable for this contact to be made in a supportive manner, and to establish a clear context to comments received. The manager will also within their own Regulation 46 checks be looking to ascertain parents views, and it would be appropriate to discuss issues raised by staff members contacts, meetings and home visits.

Discussion with Staff and Observations of Staff Practice

Caring for children is a continuous learning process for parents as well as for people who look after other people's children in a residential setting. Staff need to learn individually and as a group from experience, training and from one another. Caring for other people's children can require enormous emotional as well as physical energy. It can challenge personal values about families, gender sexuality, race, religion and morality. In addition to this, children who have been seriously damaged by the adults in their lives may target staff members to express their anger and pain through physical or verbal abuse. Therefore, staff may need to understand about attachment disorder, and the issues of caring for young people whose experiences of adult care are far from positive. Staff, need support to deal with the complexity of reactions that these factors cause for them individually and as a group.

Similarly a number of young people with disabilities have over time developed a range of challenging behaviours - which staff equally need time and opportunity to explore the most effective approaches to tackling learned behaviours which may for instance include self harm, physical aggression or other equally anti-social behaviours.

There are a range of areas you may to evidence including:

Check the minutes of the last few staff meetings to get an idea of issues discussed and the level of staff attendance. Check with staff that they are briefed on issues relating to young people and are using communication logs;
Ask staff to confirm that individual supervision is structured and valued within the home, and are supervision audits being done. Are issues of performance, conduct, training and safeguarding children from abuse a routine part of supervision sessions? Visiting Officers can ask these questions of staff, but should not expect to have access to individual supervision records;
How are staff finding Key Issues discussions - and what feedback they might offer on their recent training and how they have used their learning in practice?
If there is a new staff member on duty, check how they have found their induction. For other staff check what new guidance have they seen, or have reviewed in the last month;
You may wish to check with staff have they had recent access to:
- The local safeguarding board's procedures;
- The home procedure/staff guidelines manual;
- The residential service policies;
- Health and safety Policy;
- Children's Homes Regulations 2015 including Quality Standards;
- Department of Health Guidance on Permissible Forms of Control, April 1993.
Are staff aware of counselling support service if they wish?
Are all staff aware of the whistle-blowing Policy?

(The above checks link in with Standard 8 of the Quality Standards in relation to staffing and support).

3. Personal Files

The Children's Homes Regulations require that the responsible authority should arrange that an individual case record be maintained in each children's home on each child in the home. The case record in the children's home is particularly important because it contains information about a time of their lives when family relationships are under pressure and may need to take the place of memories and knowledge that are usually held within the family.

The case record can be a significant and positive feature of the young person's life. You may want to check that they are aware of their case file, how they have access to it and can contribute to the record. The Visiting Officer should look at two case files on each visit choosing files where consent for an independent person to view files has been given by either parents or Social Worker where appropriate.

Particular areas to check include:

Are files kept in a secure and locked cabinet?
Are written entries legible and signed and dated clearly? Is the information factual, accurate and clear? Is fact separated from opinion? Are stigmatising terms avoided?
Does the home have a record of where the files have been transferred to when they leave the home?

4. Placement Plans

When checking the case file you will want to check CLA documentation and ensure that they contain up to date copies of the relevant documentation (Medical Consent, CLA Health Assessment, ICS Referral & Information Record, ICS Chronology, ICS Pathway Plan etc) for each child, and that there is a copy of the last review meeting. You may also wish to check with staff how they encourage young people to participate in their review meetings in whatever way they feel most able.

If the case file is for a non-CLA young person receiving a short-break service then the file should contain up to date copy of CIN Care Plan / Transition Plan.

Young people living away from home need to have contact with the people who are important to them - parents, siblings, relatives and friends. Supporting important relationships helps to maintain a young person's sense of stability and continuity and helps them feel valued. Where young people live with us you may want to talk to staff to confirm how they support them in maintaining family relationships. (This links in with The Care Planning Standard).

Where young people have short breaks with us - it is equally important to maintain frequent contact with parents, at a level agreed between the parent(s) and the key-worker, both to ensure consistency of support for the child, and to support parenting.

The Children's Homes (England)Regulations 2015 requires that each child should, as far as practicable, have an opportunity to attend such religious services and receive such instruction as is appropriate to the religious persuasion to which the child belongs. The child must also be provided with facilities for religious observance such as special diets and clothing. You should check what steps are currently being taken to allow children and young people to practice their religion in a manner appropriate to their age, and check this information is recorded on the case file.

(The above checks links in with Regulation 6 of the Children's Homes Regulations (2015) whereby the visitor assesses Placement Plan and Review).

5. Health Care Planning

Each CLA young person should have full health record and a health Care Plan; we want to be confident that staff are taking a proactive approach to promoting the health of each child and young person. Monitoring and promoting the health of children looked after is particularly important as changes of carers and possibly doctors, dentists and opticians can lead to gaps in knowledge about the child's health needs and medical history. You may want confirm dental checks and medicals have been done.

For young people using short breaks health needs should be noted in the young person`s profile. Where the young person has complex health needs there should be additional protocols and evidence of staff training packages.

What advice/education about sexual matters, including contraception and safe sex is provided?
What advice/education about smoking and the use of alcohol and other drugs is provided?
How is regular exercise and healthy eating being promoted as a part of a normal lifestyle?
How is emotional health monitored and promoted?
Are there any links with health professionals outside the home who can offer advice, support or guidance?

(The above links in with The Health and Well-being Standard in relation to promoting good health and well being).

6. Education and Employment

Children Looked After can be disadvantaged educationally. Changes of carer may have led to changes of school and a disrupted school career. Emotional distress can make concentration on schoolwork difficult and low self-esteem can prevent children achieving their full academic potential.

Low expectations of educational standards by adults for children in care will add to these difficulties. Staff in children's homes can promote confidence and achievement at school and can help with the transition to further study or employment.

Particular questions to consider are:

Is a copy of the personal education plan on file at the home, and is it clear how the key worker is supporting communication with school?
If a child or young person is not attending school for any reason, what arrangements have been made to ensure the child receives some continuity of education?
What practical arrangements are made for private study and homework?
Is there evidence of staff arranging resources and trips out to support course or school work?
How is good performance at school encouraged and rewarded in the home?
For Young People receiving Short-breaks, how does the home evidence its links with school

(The above links in with The Education Standard in relation to promoting educational achievement).

7. Preparation for Leaving Care and Transition

Young people may leave the home to live with their families, to join a foster or Adoptive Family or to go into semi or fully independent living arrangements. However much the child or young person welcomes the move, it will be a significant change for them and will usually cause anxiety. Staff at the home can support them by preparing them for the move as much as possible and being available after the move to offer advice or more practical help to them and their carers.

How are young people helped to gain practical skills while living in the home (e.g. shopping, budgeting, filling in benefit or job application forms, using a bank, using public transport, cooking, changing a fuse, registering with a GP)?
How are parents and/or family members involved in supporting the plan?
In the case of disabled young people what support is being provided to visit other homes - develop their person centred profile - meet new people;
In the case of Disabled young people is the Skills Analysis undertaken to identify areas for development of independent living skills;
What links does the home have with other relevant agencies such as education, fostering and Adoption teams and housing in developing plans for young people to move on?
Are contingency plans made to cope with a breakdown in the plan after the young people has left? Are young people aware of where to go for help and support after leaving the home?
Are young people encouraged to go on to further education? Do staff explore ideas about what individuals would like to do when they leave school well before they reach school leaving age?

(The above links in with The Care Planning Standard in relation to leaving care).

8. Daily Life

Food and mealtimes

We would want to be confident that young people like the food and are involved in planning the menus. Young people often need guiding to eat a varied and balanced diet, and at regular intervals. Menus should reflect young people`s lifestyle rather than those which might be more traditional.

Taking part in the preparation of food or snacks, and in food shopping should be things staff should be able to explain how they are actively encouraging.

Other things you might want to consider:

Do staff and young people eat together?
How are specific dietary needs catered for;
Are meals used to mark special occasions such as birthdays, achievements, festivals or surprises? Is it possible for friends to stay for a meal?
Is food, including fruit, always available as in most people's homes?
For disabled young people are staff able to explain how they are promoting their self-help skills.

Recreational activities and links with the community

Occupying time productively along with having fun and learning new skills is a good basis for self respect and feeling that life can be enjoyable. Activities do not need to be highly structured or expensive.

Particular issues to consider might include:

The activities available to young people both within and outside the home. Does the range of activities on offer reflect the gender, age and ethnic balance of the home?
Are young people being encouraged to buy their own clothes and personal belongings and develop trust in using money and budgeting;
Are disabled children out and about using their local community? Using public transport?
Is there evidence that disabled youngsters are being encouraged to take exercise - go swimming - walking - engage in other sports activities;
Are disabled young people being engaged in playing... and not watching videos... are activities age appropriate;
Are staff able to explain the outcomes they are working on with young people in promoting their independence, communication and or social skills.

9. Government Guidance, Regulations & National Minimum Standards for Children's Homes

For further information on Government Guidance and Regulations and the Quality Standards for Children's Homes, please access the links below: