Guidance on Visits to Children in Residential Homes

The principles and tools outlined in this guidance apply for all residential visits to Looked After Children. However, there are further considerations for children who have disabilities and complex health needs. Children with disabilities in residential care often face unique challenges and may have difficulty communicating with social workers and Independent Reviewing Officers (IROs). It is crucial for social care staff to understand these challenges and approach visits with sensitivity, thorough preparation, and attention to detail. The voice of the child is central in this approach, as highlighted by the Doncaster Review, which emphasises the need for visibility and understanding of the child’s perspective.

Before the visit, review the child's care plan, minutes of the last Looked After Child Review, the child’s placement plan and any notes relating to the last visit. For children with disabilities and complex health needs, also review the child's communication passport, health passport, and regular educational communication aids such as Eyegaze or the Picture Exchange Communication System (PECS). Schedule the visit to allow for a full day's engagement, dividing the time between information gathering and direct interaction with the child. Seek feedback from parents and other professionals in touch with the child to understand their communication style and daily experiences. Find out if the child requires an interpreter (e.g. BSL) and arrange for one accordingly. Do not only rely on staff at the residential home to interpret for the child.

1. Information Gathering (see Annex A: Guidance for Information Gathering)
   • Review daily logs and handovers, restraint and significant incident reports, medication records, risk assessments, family time logs, staff rotas, and reports from the child’s independent visitor;
   • Focus on understanding the child's daily life and any incidents or changes since your last visit;
   • Formulate a list which you can use to cross reference to other documents.
2. Observation
   • Inspect accessible areas to the child for safety and suitability, including bedrooms, bathrooms, kitchens, and common areas;
   • Observe the child in various settings, including their transition between these settings.
3. Interaction with the Child
   • Engage with the child in informal activities to assess their behaviour, communication methods, and interactions with peers and staff;
   • Include a ‘Day in the Life’ montage (video or photo) in the Child Looked After (CLA) review to represent the child's activities, achievements, and interests.

Record all your observations carefully, focusing on the child’s voice and experience. Note any concerns or irregularities in the environment, the child's behaviour, and interactions. Ensure that the child’s perspective is accurately represented in your findings and report anything that requires immediate attention or follow-up.

After the visit, update the child’s records with your observations and plan any necessary follow-up actions, with timescales. Communicate your findings with other professionals involved in the child's care to ensure you are working collaboratively.

This guidance assists in identifying key areas of focus for information gathering, ensuring a comprehensive understanding of the child’s daily life and experience.

As you go through the information gathering process, it helps to make lists and a chronology. You can use this to cross reference different pieces of information and get a good overview.

Daily Logs/Handovers:

Staff in residential placements are expected to record a summary of their shift. This information is crucial for understanding the child's daily experiences and any specific incidents that might require additional assessment and exploration.

• What is the child's daily life like?
• What activities do they participate in?
• How are their relationships with family, peers, and staff?
• What is their experience with transitions, such as school transfers?

Restraint/Significant Incidents:

This refers to both physical restraints and calming medications, which are forms of restraint. Review the incident documents and determine which ones were communicated to the social worker.

• How many incidents have occurred?
• What was the severity of these incidents?
• Were there follow-up actions? Have they been implemented?
• Was medical treatment required? If so, request to see the report.
• Which incidents were reported to the social worker and which were not?
• Do the procedures for notifying social workers effectively support collaborative working for the child's best interest?

If the child is subject to restraint, this will require a discussion with your manager and/or the Independent Reviewing Officer (IRO) regarding Deprivation of Liberty. Consider a review if restraint is frequent.

Medication Recording and Appointments:

The residential placement should maintain Medicine Administration Records (MAR), which detail all administered medication. Cross-reference these with the medication summary from the last CLA review or medical appointment.

• What medications are being administered and what are their effects?
• Are the child's medical appointments clearly scheduled?
• Are there designated contacts for these appointments?
• How are medication errors documented?
• In cases of PRN (as needed) medication, how often is it administered? Has prolonged use been reviewed by a GP or clinician?
• Are there any unaddressed health needs? How are they managed?
• If the child has a medical condition that is enduring, is there a clear and up-to-date plan? Who is updating this?
  A copy should be available for the CLA health check.

Risk Assessments:

• What risk assessments are in place?
• Have they been regularly reviewed? Is there a clear timeframe for these reviews?
• Was the social worker involved in the risk assessments?
• Are staff members aware of these assessments?

Family Time:

• When does the child spend time with their family?
• Which family members visit them?
• How frequently do these visits occur?
• What are the conditions and nature of these visits?
• Are there any changes in behaviour noted for the child in the lead up to and/or following the visit?
• Are any family visits conducted virtually?
• How are family members included in special occasions and celebrations?

Staff Rota:

The presence of adequate staff is crucial for providing appropriate care and can help in preventing incidents. The care plan should set out the assessed level of staffing, such as 2:1 in the community and 1:1 in the home.

• Is the assessed level of staffing set out in the care plan being delivered?
• Are there sufficient staff members available to support this child in their placement?
• How are staff rotas organised for events or activities, such as community visits?
• Have there been incidents related to restraint or behaviour that were influenced by staffing levels?
  
  If the child is subject to restraint, this will require a discussion with your manager and/or the Independent Reviewing Officer (IRO) regarding Deprivation of Liberty. 

Independent Visitor:

An independent visitor should be assigned. Ensure they have your contact information. Allocate time to speak with them and/or review the reports from their visits.