LD - Opportunity for a provider to work with Durham for a bespoke residential children’s home.

Tender description

Durham County Council require a solo placement for a 14 year old male, LD, For providers with proven experience of delivering CQC registered Children’s Social Care Services for young people with complex needs and presentation. We are interested in having discussions with those providers who are experienced in managing young people with neurodevelopmental conditions and challenging behaviour and are willing to work towards setting up a new bespoke solo arrangement around an individual young person and registering the setting with CQC. Type of Service Required L would benefit from a robust specialist placement upon discharge in order to allow for a period of social, emotional and psychological stability and growth. The provider should be a long-standing service, which has experience working with people who demonstrate risks toward themselves and others. The provider should also have experience of Autism and associated co-morbid diagnosis. The placement needs to have Care Quality Commission (CQC) registration. In essence, L requires the following from a provider 1. A provider who can either offer established accommodation with an area of retreat from staff or work with Social Care to develop a bespoke, purpose-built CQC registered dwelling. 2. Solo placement - L could not currently reside with other young people. 3. Long-standing, robust provider with evidence of successful community packages with children with Autism needing restrictions. 4. Staff working with L to be appropriately trained in Autism Spectrum Disorder and associated rigidity of thought. 5. A boundaried and consistent staff team, who understand his antecedents/warning signs and can follow his management plans. This staff team need to actively monitor L’s presentation and know when they should retreat from his area of living, document this and continually review its usage. 6. A safe and supportive environment that provides for his physical and developmental needs; it needs to be nurturing and one that can meet L’s needs for stability, routine and consistency in approach and support techniques. 7. Support and encouragement to access appropriate education and meaningful age-appropriate activities, which he can enjoy and achieve at his pace. Education will initially be needed in house. 8. The placement needs to be robust enough to cope with L’s fluctuating psychological and associated emotional presentations and be able to respond in a way that is not risk adverse, but also ensures his welfare. 9. The placement will need to store and administer routine medication at specified times. Staff who can also gently support, listen and explain when L has views on increasing/stopping medication. There is a subjectively marked difference when he is not on prescribed medication, but objectively he reports a different opinion. 10. The placement needs to be able to ensure that L has regular contact with the local Community Mental Health Services to optimise his continued recovery and wellbeing. He will also require a community psychiatrist to regularly review his prescribed medication. Accommodation and Environmental Factors • A rural location. • High walls rather than fences, consideration about gates/areas that could be used to climb. Anti-climb and boxed in guttering. • Consideration of single story property. • Ability to have an area to which staff can retreat. L does not like physical intervention. It is his preference to walk to or be in a restricted environment than restraint be utilised. He feels safer this way and it also reduces risk to staff. • Consideration needs to be given about how he would continue to be observed safely. Some examples of this which community providers have used are CCTV are, firstly, that it only records during periods of retreat and, secondly, this footage being deleted after an agreed period. Equally, observation windows can be utilised with the ability to frost glass. Consideration of L’s privacy and dignity must be paramount whilst safely managing challenging behaviour. • Reinforced windows. • Safe/weighted furniture. • Television/radiators/electronics blocked in to reduce risk of breaking items. • Shower facilities rather than bath. • A separate kitchen area outside of the area where L resides or staff can retreat from. The kitchen should have an area sharp items can be locked away. • Access to an area for exercise to support his emotional and sensory needs. L will likely request free weights though this safely needs assessing. Expected values of the Therapeutic Residential Placement • Evidence of the model of care provided (for example, PACE, Therapeutic, Trauma- informed). • L be treated and respected as an individual. • L be supported and enabled to lead as normal a life as possible. • L be supported and encouraged to achieve his optimum potential. • L has his voice listened to and acted upon. • Be afforded privacy, dignity and confidentiality. • Be provided with a safe, secure ‘homely’ living environment whilst maintaining safety and required restrictions. • Support to continue to review restrictions and reduce these safely with time as he becomes settled into the placement. Staffing Required The staff who support L in this Therapeutic Residential Placement will be ‘key’ in terms of how successful the placement is for him. He requires: • Staff who are able to meet the needs of young people with emotional and psychological challenges and difficulties and who have an awareness of young people’s social and developmental needs. • Staff who have experience of transition from secure environments to community placements and robust planning of this. • Staff who are experienced in supporting young adults with emotionally impulsive behaviours and managing risks which these kinds of behaviours pose. • Staff who are experienced in working with young adults who have a diagnosis of Autism. • L would benefit from being supported by staff who are experienced at supporting young people with issues pertaining to rigidity of thought and emotional dysregulation and who can be flexible in their approach in accordance with his fluctuating mental health. • Staff with enthusiasm and a genuine commitment to working on engagement with young people as L can struggle to form new relationships. • L will require staff who can support him to develop acceptance and tolerance of others • In particular, L needs staff who are resilient and tolerant as he can display some difficult behaviours - for example, verbal aggression and racial language when he perceives his needs are not met to his expectations. • Staff must be able to work in collaboration with Health and Social Care professionals for the benefit of L. • Staffing ratio initially would need to be minimum of two-to-one with an ability to increase this and call upon support if required, with waking night shift. This could be reviewed with time dependent upon his • Presentation and risk profile. • Predominantly male staff team but contact with females who are boundaried but nurturing. L’s contact and behaviour around females should be observed and safely undertaken to. At present, he would not be left on his own in the company of females. • Staff with use of reflective practice skills, with appropriately trained staff to deliver this. Keywords: Bespoke placement, Durham County Council, Residential childrens care