Section 4. Outcomes for children Children at risk of suicide or self-harm 4.28 If a child is at risk of self-harm or suicide and subject to assessment, care in custody and teamwork (ACCT)19 casework monitoring at the point of separation, or is placed on an ACCT during a period of separation, this must be recorded and the exceptional circumstances for the separation must be clearly set out in a decision log completed by the authorising manager. The health care professional who completes the risk assessment must note the ACCT and complete the assessment accordingly. 4.29 We found two instances at Werrington where no decision log had been completed when it was decided to separate the children in crisis, and this had not been picked up at the review 72 hours later. We found two further examples at Cookham Wood where the recordings were so poor they were meaningless. At Feltham, we found four children on ACCTs who were separated when we first arrived. We could not be assured that these children were seen daily by managers or health care staff as the daily logs were not completed or signed by anyone. In one case at Feltham, a child judged to be at such a risk of self-harm as to require constant supervision20 in unfurnished accommodation with a severely restricted regime (see paragraph 4.27) had an out-of-date care plan and staff had not completed the last written actions that had been noted, which included providing some clothing and bedding as he was cold; it was indefensible that staff had not carried this out. At Cookham Wood, the paperwork for three children on ACCTs that had been opened while they were separated was so poorly completed that we could not be assured that adequate safeguards were in place from managers or health care staff. Safeguards 4.30 When a child is separated a manager (normally the duty governor) and the chaplain should see the child every day. In addition, a health care professional must see a separated child daily and a doctor should visit the child every three days. The IMB and the governor must see all separated children every week. All of these visits should be recorded. 4.31 We found these visits regularly did not happen. Although the situation was generally better for children on designated units, even here many daily visits did not take place. Of the 57 log sheets for separated children that we reviewed across the five sites, only 15 children had seen health care and 33 had seen a manager daily. Feltham did not have records of any daily visits to some of the separated children it held. Many children at Parc and those on normal location at Cookham Wood did not receive these visits either. 4.32 At Parc, health care and chaplaincy staff were unaware of their obligation to see separated children every day. Documentation at Parc showed that these visits never occurred at the weekend. More concerningly, at one site we saw completed records of health care visits to a separated child but when we viewed the CCTV footage it was evident that the visit had not taken place at the recorded time, if at all. At all sites we found that nurses, chaplains and the IMB often carried out these welfare checks from outside locked cell doors, which fundamentally undermined these safeguards and put children at risk. Visits by the doctor did not happen at the required three-day intervals across all sites. Even at sites where the daily checks were more meaningful, they were undermined by the establishment’s inability to identify effectively who was separated, and their irregularity eroded its ability to safeguard these children effectively. 4.33 Daily rounds by the duty governor did not always take place and most governing governors did not make weekly rounds of segregation units. Even where these did take place, the 19 20 Assessment, care in custody and teamwork case management of children at risk of suicide or self-harm. A child will be constantly supervised if they are deemed to be at the most risk of attempting suicide or self-harm. Separation of children in young offender institutions 27