Personal Care and Physical Contact with Children

1. General

The home should provide a nurturing environment that is welcoming and supportive and provides appropriate boundaries. This environment should support a child's physical, mental and emotional health, in line with the approach set out in the home's Statement of Purpose.

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 their 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.

Suitable arrangements should be in place in all homes for matters relating to physical contact, intimate care, menstruation, enuresis, encopresis and other aspects of children's personal care. These arrangements should take into account the child's gender, religion, ethnicity, cultural and linguistic background, sexual identity, mental health, any disability, their assessed needs, previous experiences and any relevant plans e.g. Placement Plan and Care Plan.

WORKING WITH CHILDREN WHO HAVE BEEN ABUSED

Each individual who has suffered abuse may behave differently, as no two cases will be the same. Building relationships and seeking appropriate advice can assist the children in moving on, and receiving support in relation to their experiences;
Staff must be aware of services for children who have been abused e.g. CYPS, counselling services via their GP etc.;
Staff who work with children who have been abused must complete relevant child protection and other training on methods and tools to use with children who have been abused. Staff should take advice whenever they feel it is required, whether it be from a co-Worker or outside Agency;
Additional professional supervision may also be accessed from the LAC Psychologist or similar. Staff must use supervision for their own support and emotional well-being.

SUPERVISING CHILDREN AT NIGHT

A minimum of two members of staff will be on duty each night. Staff bedrooms are separate and are within the vicinity of the children’s bedrooms to enable assistance to be offered during the night if necessary;
If staff are required (re: safety issues), to enter a child’s bedroom during the night, they must;
- Do this in pairs;
- Record this in the Daily Log Book including the reasons (e.g. suspicion that a child has misused alcohol, so nightly checks may be required in respect of the child’s health and safety);
- Note if it has been agreed that a child is to be monitored during the night, then it will be undertaken by two members of staff and a monitoring record must be kept and placed in the child’s file.

PREVENTION OF ABUSE OF TRUST

Rules and boundaries have to be clear, understood and adhered to. If not, staff are left open to allegations of abuse and unprofessional conduct;
Relationships that go beyond what may be considered professional can result in distress, disciplinary action or job loss;
Staff represent the powers and duties of the Council and are in a position of trust in the delivery of the service to vulnerable and needy children. The objective of staff is to meet the assessed needs of children within the prevailing Council Policies;
Staff’s own needs must not take precedence over a Child’s needs. Behaviour that may be seen to be primarily in Staff’s own interests is unprofessional;
Staff are responsible for not abusing their position of trust in the conduct of relationships with children and their families;
Unless there is a sound reason to do so, (which has the approval of Managers and is recorded), staff must not:
- Arrange to meet children or members of their families when off duty;
- Take children or members of their families to their home;
- Give their home telephone number or address to children or their families;
- Enter into any financial transaction with children or their families.

Examples of specifically prohibited behaviours are:

Sexual contact;
Borrowing/lending money or belongings;
Entering into or witnessing any financial or legal contract;
Giving or receiving gifts, other than at times when this is accepted practice e.g. birthdays and Christmas and not exceeding an agreed value.
Arranging extra help for a fee.

The Council undertakes to:

Respect the confidentiality of staff raising concerns;
Provide the opportunity for concerns to be raised other than through line management;
Discipline or reprimand those found to have made a malicious or false allegation.

2. Physical Contact

Staff must provide a level of care, including physical contact, which is designed to demonstrate warmth, respect, and positive regard for children.

Physical contact should be given in a manner that is safe and protective and promotes positive relationships with adults.

PHYSICAL CONTACT BETWEEN STAFF AND CHILDREN

Relationships between staff and children must be based on mutual respect and understanding and clear professional and personal boundaries, which are effective for both the individuals and the group;
It must be noted that horseplay with children such as tickling, arm wrestling and fun fighting is not allowed in Children’s Homes under any circumstances;
A child who is being cared for may seek physical comfort from staff when, for example, they are distressed and in such circumstances this may be appropriate. Care must be taken, however, to ensure that such contact is not prolonged or repetitive with the same member of staff over a period of time;
When a member of staff has concerns within this area, they should seek the advice of their Manager;
Physical contact may be misinterpreted by a child or observer. This might include well-intentioned gestures;
Following instances where staff feel that an action may have been open to question, then they must discuss this with their colleague or Manager;
In situations where any concerns are felt or highlighted by colleagues, it would be prudent to detail these in the logbook and discuss the issue in supervision;
There may be occasions where it is necessary and important for staff to restrain a child or physically intervene such as guiding a child to prevent injury to themselves or others. In such circumstances staff should be familiar with the Guidance on Control and Restraint and have received Team Teach training;
Staff should discuss physical contact regularly in Team Meetings as this will achieve a shared awareness of the issues and measures to achieve best practice in differing situations.

3. One to One Time Alone With Children

Also see: Lone Working Procedure.

Where a staff members daily work brings them into a one to one situation they should inform other staff why this is necessary and where this will be taking place.

Where one to one work is delivered as part of a specialist service or direct work programme this should be identified in the Placement Plan.

Managers will, where it is deemed necessary, ensure a risk assessment is carried out for the delivery of any piece of work that is consistent with the Placement Plan.

Staff should always try to keep doors open unless this constitutes a breach of privacy for the child. In these instances it may be necessary to undertake a risk assessment of the situation.

No volunteer working in the home should ever be in a one to one situation with a child.

If an accident happens whilst in this situation as with any other situation make sure an accident report form is filled in and signed by all parties.

Giving first aid or personal care (where deemed necessary on the Placement Plan), should be recorded on the relevant format.

If any member of staff is uneasy about the behaviour of others who are putting himself or herself or the child at risk they must inform the manager of the home.

Where a member of staff feels that the unease is centred on the registered manager they must report this to a manager outside of the line management of the home, or to the child's social worker.

Any allegations, suspicions and/or disclosures of abuse should be reported as per Safeguarding Children and Young People and Referring Safeguarding Concerns Procedure.

STAFF ONE TO ONE TIME WITH CHILDREN

Good childcare practice dictates that confidential interviews and meetings e.g. Link Worker discussions, will need to take place to discuss progress, concerns etc. with children. Staff should ensure that colleagues are aware when these are happening and that a record of the meeting is made on the child’s file;
The approval of the Lead Person on duty must be given for any proposed contact outside of the Home e.g. for clothes shopping or accompanying to appointments. If staff have an unplanned meeting with a child away from the Home either in their duty or off duty time this must be reported to a Manager as soon as possible after the event and recorded appropriately;
Discussions between staff and children will, on occasions, need to cover sensitive subjects such as sexual health, relationships and personal hygiene;
In these circumstances staff should be sensitive in relation to balancing the need to help children with these issues against intruding into personal information/action.
Non-care staff e.g. domestic staff, may be approached for advice by children, they must, therefore, be advised as part of their induction process/probationary period in safe care appropriate to their role. This would need to include reference to the type of information that cannot be kept confidential and their obligation to pass it on to care staff;
Staff should not be alone with children in their bedrooms with the door closed. As a rule of general good practice this serves to protect all concerned from actual or alleged abuse;
This may, however, not be practicable when caring for children, where personal care tasks such as applying topical medication are necessary. When this is the case, it should be detailed in the child’s Placement Plan and undertaken by staff of the same gender where possible.

4. Intimate Care

Children must be supported and encouraged to undertake bathing, showers and other intimate care of themselves without relying on staff.

If a child need helps with intimate care, arrangements must emphasise the child's dignity. Where necessary staff will be provided with specialist training and support.

GUIDANCE FOR STAFF WHEN UNDERTAKING INTIMATE CARE

Whenever possible, children should be offered the option of a carer of the same sex;
- When this cannot happen, it must always be with the agreement of the Registered Manager of the Home and the reason recorded e.g. the member of staff’s skills/experience/knowledge of the child;
- Where there is any doubt that a child is able to make an informed choice in this regard, parents are in the best position to act as advocates.
Ideally children should be able to choose the member of staff they wish to conduct their personal care;
Staff must ensure that the child’s parents and social workers provide information re: intimate care requirements during the referral and pre-admission process;
Staff must ensure all intimate care requirements are written in the child’s Placement Plan and must:
- Take full account of the religious views and cultural values attached to aspects of intimate care related to the child;
- Be sensitive to their needs and preferences;
- Maximise safety and comfort;
- Respect the child’s right to give or withdraw consent.

STAFF RESPONSIBILITIES

To work in partnership with the child, parents and their named Care Team members;
To try and encourage a child’s independence as far as possible and encourage them to do as much as they can for themselves;
To respect the diversity of the child and treat every child with dignity and respect;
To ensure that the intimate care given is consistent with the child’s Placement Plan and Care plan;
To be aware of the communication levels of the child and use all methods to gain their understanding and agreement of personal care actions;
To get to know the child in a range of contexts to gain an appreciation of his/her moods and verbal/non-verbal communication;
To have positive, clear and understood communication with the child and parents to ensure and maintain consistent practice. The children’s review meetings can be used to agree any changes or amendments;
To be aware of their own limitations. They should only conduct intimate care that they are suitably trained for. If a member of staff is in doubt they should speak to a member of the Management team;
To record and report any unusual emotional or behavioural responses by the child;
To maintain high standards of hygiene by washing hands both prior to and after carrying out a personal care task using hot water and soap and paper towels for drying hands;
To use fresh disposable gloves while whilst carrying out intimate care tasks;
To follow Health and Safety Procedures;
To promote the good health of children in the Home and take necessary steps to prevent the spread of infection, and take appropriate action if children are ill or infectious;
To follow Blaydon’s Procedures for dealing with spillages of bodily fluids such as the process to be followed when a Child accidentally wets or soils themselves, or is sick whilst on the premises;
To comply with the Children’s Homes Regulations and Standards 2015 regarding privacy.

ALSO TO SAFEGUARD CHILDREN STAFF MUST;

Report any concerns about a colleague’s practice to the Registered Manager, who is the designated Safeguarding Officer. This is an obligation which provides a safeguard for children and staff. If abuse is suspected and not reported, then this is a breach of staff’s duty of care;
Report immediately to a Manager if they observe a child with any unusual marks, discolouration or swelling to their body;
Report immediately to a Manager if the child becomes or appears to be sexually aroused during intimate care duties. This observation must be recorded in the confidential section of the children’s case notes/file;
Report if a child becomes upset during any form of intimate care to a Manager. This should also be recorded in the child’s daily notes. The member of staff must call for assistance to safeguard the child and themselves;
Parents and staff should be aware that matters concerning intimate care will be dealt with confidentially and sensitively and that the child’s right to privacy and dignity is maintained at all times;
Liaise with parents, child where appropriate, Social Care Team and school to ensure consistency of care;
Information concerning intimate care procedures should not be recorded in a Home School Diary, as the diary is not a confidential document and could be accessed by people other than the parents and member of staff. It is recommended that communication relating to intimate care should be made through one of the following:
- Sealed letter;
- Personal contact (and recorded in a log);
- Telephone call – between member of staff and parents.
Staff must ensure that they follow the Code of Conduct Procedure in all respects. Part of this will include not having their own mobile phone on with them in person while caring for children inside the Home. It should be noted also that the taking of photographs of children with personal mobiles is not permissible under any circumstances;
Secrecy and exclusivity in relationships should be challenged for the protection of all concerned. Staff must not, for example, take children to their own home;
Staff need to understand Council Policy regarding boundaries on sexual relationships for children. This should include knowledge of who is responsible for Policy implementation and what support there will be when conflict arises.

MANAGEMENT RESPONSIBILITIES

To ensure Induction Procedures and training and continued CPD is in place within the Home to support staff in dealing appropriately with issues of intimate care;
To provide staff with ongoing support and direction on this practice requirement;
To ensure staff have Child Protection training and are aware of the signs and symptoms of abuse and the Child Protection Referral Procedures;
To monitor where there are intimate and personal care arrangements in place to ensure these are child-centred and safe;
To monitor the arrangements for visitors to the Home to ensure safety for the children and staff, ensuring that the Policy is being implemented in daily practice.

5. Menstruation

Young women should be supported and encouraged to keep their own supply of sanitary protection without having to request it from staff.

There should also be adequate provision for the private disposal of used sanitary protection.

6. Enuresis and Encopresis

If it is known or suspected that a child is likely to experience enuresis (involuntary urination) and/or, encopresis (soiling) or may be prone to smearing it should be discussed openly, with the child if possible, and strategies adopted for managing it. These strategies should be outlined in the child's Placement Plan.

It may be appropriate to consult a Continence Nurse or other specialist, who will provide advice on the most appropriate strategy to adopt. In the absence of such advice, the following should be adopted:

Talk to the child in private, openly but sympathetically;
Do not treat it as the fault of the child, or apply any form of sanction;
Do not require the child to clear up; arrange for the child to be cleaned and remove then wash any soiled bedding and clothes;
Keep a record, either on a dedicated form or in the child's Daily Record;
Consider making arrangements for the child to have any supper in good time before retiring, and arranging for the child to use the toilet before retiring; also consider arranging for the child to be woken to use the toilet during the night;
Consider using mattresses or bedding that can withstand being soiled or wet.