The Quality and Purpose of Care Standard

The Statement of Purpose is of particular importance to this Standard (regulation 6(2)(a) and (b)(i)). Homes are required to develop and keep under review a "Statement of Purpose" (regulation 16 and schedule 1). The home's Statement of Purpose should be child-focused, indicating how the home provides individualised care to meet the Quality Standards for the children in their care.

The information set out in the Statement of Purpose is an essential part of the process of agreement between the registered person and placing authority that a placement in that home is the right one for that child, and that the home will be able to respond effectively to the child's assessed needs. Emergency admissions should not be taken unless the home's Statement of Purpose and its capacity and support systems mean that it has the capability to care for children admitted at very short notice while continuing to offer high quality care to children already living in the home.

Many children placed in homes 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. Homes must also meet children's basic day-to-day needs and physical necessities. 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.

The registered person should ensure that children are 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.

For children's homes to be nurturing and supportive environments that meet the needs of their children, they will, in most cases, be homely, domestic environments. Children's homes must comply with relevant health and safety legislations (alarms, food hygiene etc.); however, in doing so, homes should 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 (regulation 21(c)(i)). 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. Information on restraint and deprivation of liberty is contained in the protection of children section of the Guide - see Restraint.

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.

Children's home 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 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 children's homes 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). The care 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.

Any home using CCTV or other monitoring equipment should have a written policy describing how this will support the safeguarding and well-being of those living and working in the home in accordance with regulation 24. Homes must gain consent to any monitoring or surveillance by the placing authority in writing at the time of placement. The use of CCTV is regulated by the Protection of Freedoms Act 2012 and the Surveillance Camera Code of Conduct (Home Office 2013).

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.

Children should be provided with appropriate furniture, such as a lockable cabinet or drawers to securely store personal items, including any personal information. Children should have separate bedrooms and should not share a bedroom with an adult. It may be appropriate for siblings of the same sex to share. Children should be given a choice about how their personal space is decorated in accordance with regulation 7(2)(a)(i).

A child's bedroom should not generally be entered without their permission, though it may be necessary to establish routines to allow for rooms to be cleaned regularly. Usually, rooms should only be searched if the child has been informed or asked for their permission. Immediate searching may be necessary where there are reasonable grounds for believing that there is a risk to the child's or another person's safety or well-being.

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 and the setting in which they are cared for. 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.

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.

Staff must help each child to prepare for any moves from the home, whether they are returning home, moving to another placement or adult care, or to live independently. This includes supporting the child to develop emotional and mental resilience to cope without the home's support and, where the child is moving to live independently, practical skills such as cooking, housework, budgeting and personal self-care.

As the home will have a day-to-day understanding of young people's capabilities and needs, children's homes staff will have a valuable contribution to make to the pathway planning process. They should actively seek to make the fullest contribution, working with other relevant persons.

For further information, see Children Act 1989: Transition to adulthood for care leavers.

Where a placing authority commissions a children's home to deliver care to meet a specific health or developmental outcome outlined in a child's relevant plan (as set out in regulation 6 (2) (d)) and that care is provided or partially provided by a non NHS service, the registered person must ensure that such an arrangement meets the requirements in regulation 6 (3).

Any home offering the type of care outlined above, should have in place an assessment process for the child in advance of the placement whereby the child, the social worker and other relevant persons input is sought on the implementation and arrangements for the care.

Under regulation 6 (3) it is expected that in establishing whether the care meets the child's needs, the child will 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 a children's home involves the provision of a regulated activity, the registered person should check that the provider of the service is registered with the CQC. [6] The relevant regulated activities are listed in the CQC and Ofsted guidance below. 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 (as set out in 6 (3)) 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 outlines 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.

The CQC and Ofsted guidance, Registration of healthcare at children's homes, provides further information for children's homes that provide healthcare:

_{[6] In this context a "regulated activity" is as defined by the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.}

The Quality and Purpose of Care standard applies to secure children’s homes. However, regulation 6(2)(b)(vii) must be applied in such a way that the home can protect the safety of all children accommodated there and maintain the secure environment.

Secure children's homes should allow children appropriate freedom and choice but this may be limited dependent on each child’s risk assessment. The provision of personal items must be interpreted according to the nature of the secure setting.

Observation, monitoring or surveillance of children must not remove reasonable privacy, and should allow as much privacy as is possible, including in dressing, washing and using the toilet. A record must be kept of all observations in bedrooms to ensure that children are not subject to unnecessary invasions of their privacy.

A young person who reaches the age of 18 and is accommodated in a secure children's home because they were remanded or sentenced to youth detention may transition directly into the adult prison estate. Transition preparation for the change of environment will need to be planned in conjunction with the receiving prison, the youth offending team and other agencies involved with the young person.

Healthcare Standards for Children and Young People in Secure Settings are available from the Royal College of Paediatrics and Child Health. These standards include guidance on entry and assessment, healthcare planning, physical and mental health, transfer and continuity of care and multi-agency working. The relevant NHS England providers are expected to consider these standards when organising health care for those under 18 years old in secure settings.

When making a decision about arranging care (as described above) for children in secure children's homes, it is good practice for all the relevant people involved in the child's healthcare commissioned through NHS England to be informed so there is an integrated approach to health and wellbeing.

The Quality and Purpose of care standard applies to residential special schools registered as children's homes and short break settings. Some of the requirements of the standard must be applied in such a way that homes are able to protect and meet the needs of all children accommodated in them (particularly in relation to children's complex special educational needs and disabilities).

Children should have the appropriate level of freedom and choice granted to them, however, for some children, ensuring their safety and welfare means that this may be limited compared with other settings.