This study aims to describe secure institutional youth care homes in Sweden in terms of the conditions of their spatial environment (i.e. physical design and objects) and the individual characteristics of the youths placed there. Data were collected through a survey and from the Swedish National Board of Institutional Care. The study population consisted of 18 units and 1,859 youths in secure institutions in Sweden from 2006 to the end of 2016. The results showed that 74.1% of the youths were enrolled under acute circumstances. They often present with physical and mental health problems, such as sleep disturbance and lack of impulse control; the young people are placed in a restricted environment with little possibility to maintain a sense of security. Due to their previous traumatic experiences, this can be problematic in terms of care and treatment. The results show a tension between different aspects of control, highlighting the importance of offering care environments that both offer the staff “control functions” (i.e. functions facilitating observation and control over the environment) and offer the youths “control opportunities.” Such environments need to be as homelike as possible, while simultaneously maintaining safe care for young people and a safe working environment for staff.