Monitoring Quality

Contents

1. Suitability of Premises (Regulation 46)
2. Review of Quality of Care
   
   Appendix 1: Regulation 45 Report on Review of Quality Care
   
   Further Information

1. Suitability of Premises (Regulation 46)

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 on their Care Plans/Placement Plans. The review should include the identification of any risks and opportunities presented by the Home’s location and strategies for managing these.

2. Review of Quality Care

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

• A process of regular monitoring of the activities within the Home by the registered manager or, in their absence, their appointed deputy;
• Reports prepared as part of Regulation 44 visits completed by an Independent Person;
• A formal Review of Quality of Care (Regulation 45) completed by the Registered Manager and submitted to HMCI (Ofsted) at least once every 6 months.

Regular Monitoring

Leaders and managers actively and regularly monitor the quality of care provided. They use learning from practice and feedback to improve the experiences and care of children, including direct testimony from children, parents, staff, other professionals and other stakeholders. They learn from complaints, staff feedback, placement successes and breakdowns, and any serious events. They identify strengths and areas for improvement and implement clear development plans that continually improve the experiences of children.

Regulation 44 Visits

The Home will receive monthly visits from an Independent Person. These visits are an on-going process to identify whether the Home is meeting the needs of the children and young people living there. This is only a small element of this process. 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 Services functions relating to children, and must have the necessary skills and experience. For more information on who can be appointed as an independent person, see Children's Homes Regulations Amendments 2014.

The visit will be for a minimum of one hour. The person should complete a written report of the visit. This may include recommendations for improvement, with timescales.

The report should be shared with the Registered Manager and Responsible Individual, with the opportunity to make comment e.g. if there is disagreement with the comments and recommendations.

The report should be lodged with the Home for the manager and staff to read and respond to.

A copy of this report is sent to the Regulatory Authority in the following month after the visit.

The independent person must provide a copy of the report, upon request, to the local authority for the area in which the Home is located.

The independent person, when carrying out a visit, shall:

• Interview, with their consent and in private, such of the children accommodated there, their parents, relatives and persons working at the children's Home as appears necessary in order to form an opinion as to whether:
  • Children accommodated at the Home are effectively safeguarded; and
  • The conduct of the Home promotes the wellbeing of the children accommodated there.
• Inspect the premises of the Home, and such of the Home's records, as the independent person requires (children's case records may only be inspected with the consent of the child and the child's Placing Authority).

This may include the following:

1. Meet and talk to children and staff of the Home to ascertain their views, comments and any complaints about the running of the Home;
2. Read the Daily Log, records of restraints, incidents, reports of notifiable events;
3. Read the records of Comments, Representations and Complaints and (Child Protection Referrals), commenting on the frequency and type made and whether they appear to have been dealt with adequately;
4. Read and comment on the record of Children's and Staff Meetings, or other methods used by the manager to consult the children and staff, held in the Home. The person should also check that staff supervision have taken place as required;
5. Check on the physical condition and decoration of the Home, including the children's bedrooms.

Regulation 45 Report – Review of Quality of Care

The formal Review of Quality of Care (Regulation 45) completed by the registered manager must be submitted to HMCI (Ofsted) at least once every 6 months which is sent within 28 days of the completion of the review.

It is the expectation of the Responsible Individual that these reviews are completed at least quarterly 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 helpful to review outside of these timescales.

In order to complete a review of the quality of care the registered manager must establish and maintain a system for monitoring, reviewing and evaluating:

1. The quality of care provided for children;
2. The feedback and opinions of the children about the Home, its facilities and the quality of care they receive in it; and
3. Any actions that the registered person considers necessary in order to improve or maintain the quality of care provided for children;
4. The feedback and opinions of the parents, placing authorities and other significant stakeholders in the care of the children and in the Home such as the staff working there.  

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

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 are monitored:

Minimum of weekly:

1. Incidents including:
   1. The use of restrictive physical interventions;
   2. Episodes of missing from Home;
   3. Accidents and injuries;
   4. Safeguarding or child protection;
   5. Notifications under Regulation 40.
2. Day notes;
3. Complaints log;
4. Fire log;
5. Day planner;
6. 1:1 consultations or debriefs following incidents;
7. Medication records;
8. Sanctions;
9. Staff signing in book.

Minimum of Termly (6 weekly):

1. Cleaning rota;
2. Fridge/freezer temps;
3. Menus (quality and evidence of child involvement);
4. Communications book;
5. Rotas and timesheets;
6. Visitor's book;
7. Staff supervision records;
8. 1:1 work/keyworker sessions;
9. Maintenance log;
10. Health records;
11. Monetary records;
12. Meetings – staff and children's;
13. WIP File 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.
14. Case management meetings;
15. Training matrix;
16. First aid boxes;
17. Contents of fire box.

Minimum of Quarterly

1. Children's contracts;
2. ILAC paperwork;
3. LAC Reviews;
4. Education paperwork (plans and targets).

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

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

Reports must also be provided on request to a placing authority, if the placing authority is not the parent of a child accommodated in the Home.

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

It is the responsibility of the registered manger to decide on what should be included in the review of the Home. The report should be 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 following headings and guidance are for reference to help inform a structure for reporting. The views and wishes of children and other key stakeholders should form an integrated 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 Home and the measures taken by the persons working at the Home to respond effectively to these to ensure the safeguarding and welfare of the child. What has been learnt from these incidents?
2. The arrangements for children coming to and leaving the Home. Impact on the Home?
3. The arrangements for monitoring the quality of care provided by the Home, including the actions taken in response to recommendations made by the independent person or, as the case may be, the reasons why the registered person did not consider it appropriate or necessary to take any such actions;
4. In respect of each child accommodated in the Home, compliance with the Placing Authority's Care Plans and Placement Plans;
5. The arrangements for:
   1. Consulting children about the quality of the Home's care and for acting on the results of such consultation;
   2. Involving children in decisions about:
      1. Their own care; and
      2. The day to day running of the Home.
6. Complaints in relation to the Home or children accommodated in it, 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).

The Education Standard

8. The effectiveness of the Home in promoting the educational attainment of children in its care and the quality of relationships between the children's Home and local schools.

The Positive Relationship Standard

9. The arrangements for promoting and supporting the positive behaviour of children accommodated in the Home;
10. The effectiveness of the Home's approach to behavioural support, including arrangements for commissioning training for staff in behaviour management and restraint;
11. The number of times that children accommodated at the Home are restrained and the steps taken by the Home to minimise the use of restraint
12. Whether there have been any occasions when children accommodated in the Home have been charged with a criminal offence.

The Health and Well-being Standard

13. The arrangements, if any, for commissioning therapeutic services appropriate to the needs of children accommodated by the Home and the effectiveness of any such arrangements in achieving health outcomes for the children accommodated by the Home;
14. The arrangements for children 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 children requiring accident and emergency treatment and other hospital services;
16. Illnesses of children accommodated in the Home.

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 incidents at the Home;
20. The arrangements for continuing professional development, recruitment and 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.
21. The arrangements for consultation with placing authorities, the local authority in whose area the Home is located and other community services used by children accommodated at the Home;
22. The effectiveness of the children's Home's guidance and procedures concerning police involvement in the children's Home.

On an annual basis, the managers 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

23. The number of reports of children accommodated at the Home being absent without permission;
24. The measures taken by staff:
    1. To prevent children from being absent from the Home without permission; and
    2. In response to a child being absent without permission from the Home.
25. 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 Home.

Further Information

Children's Homes Regulations Amendments 2014