PART 1 ITEM NO (OPEN TO THE PUBLIC) REPORT OF THE LEAD MEMBER FOR COMMUNITY & SOCIAL SERVICES DIRECTORATE TO THE HEALTH AND SOCIAL ISSUES COMMITTEE ON 9 JANUARY 2002 TITLE: REPORT ON THE OPERATION OF SALFORD COMMUNITY & SOCIAL SERVICES DIRECTORATE INSPECTION UNIT 2000-2001 RECOMMENDATIONS: Members to note the report. EXECUTIVE SUMMARY: Each year, Local Authority Inspection Units are required to produce an Annual Report outlining their activities over the previous twelve months. This is the final year in which such a report will be produced, as responsibility for regulating children’s day care moved to Ofsted in September 2001, and responsibility for regulating adult and children’s residential care, and domiciliary care will move to the National Care Standards Commission in April 2002. The report outlines the work of the Unit in 2000-2001 in accordance with national and local performance indicators, and reports on regulatory issues in respect of the relevant service sectors. This includes registration work, inspections, and enforcement activity. The work of the two Advisory Panels is also detailed. The report concludes with the targets for 2001-2002. BACKGROUND DOCUMENTS (Available for public inspection) None CONTACT OFFICER: MRS VIVIENNE HARE 0161 793 2233 WARD(S) TO WHICH REPORT RELATE(S) ALL KEY COUNCIL POLICIES DETAILS (continued overleaf) 2 City of Salford Community and Social Services Directorate Inspection and Registration Unit Annual Report April 2000 to March 2001 Contents Introduction 1 The Work of the Unit 2 Unit’s Performance 2000-2001 3 Unit Resources 5 Regulatory Issues Care Homes for Adults 7 Care Homes for Children 11 Adult Domiciliary Care 14 Children’s Day Care 16 Complaints and Enforcement 19 Advisory Panels 20 Targets for 2001-2002 21 Introduction Each year, Local Authority Inspection Units are required to produce an Annual Report outlining their activities over the previous twelve months. This is to enable the Registration Authority, service providers and users, and the general public to evaluate the performance of the Unit, and to receive information on the development of the care sector. This is the final year in which such an Annual Report will be made since, in accordance with the Care Standards Act 2000 the task of regulating certain care services is to be transferred from health and local authorities to other agencies over the next twelve months. Ofsted will take responsibility for the regulation of children’s day care services after September 2001. On 1 April 2002, the newly created National Care Standards Commission will take over responsibility for regulating existing adult and children’s care homes, and adult domiciliary care, and will extend the scope of regulation. For the first time residential family centres, voluntary adoption agencies, fostering agencies, private and voluntary hospitals and clinics, nurses agencies, and day centres will be regulated (the latter not until 2004 approximately). In addition, local authority adoption and fostering practices will be inspected along with FE colleges who have residential provision. Although throughout 2001-2 the Unit will continue to carry out the full range of its regulatory responsibilities, as at 1 April 2002 it will no longer exist in its present form and would not therefore be in a position to report on the previous years activities. This report is therefore somewhat different in nature from previous ones, and it has seemed only right to indicate the changes that will be taking place throughout the year as well as reflecting on the activities of the past year. 1 The Work of the Unit The Inspection and Registration Unit is responsible for ensuring that the local authority’s responsibilities for regulating care, as set out in the Registered Homes Act 1984, the Amendment Act 1991, and the Children Act 1989, are fully discharged. The purpose of the regulating function is to ensure that vulnerable people who receive care services are protected from harm. The Unit regulates the following services: Residential care homes for adults and children, but not nursing homes Domiciliary Care or Home Care (through a voluntary registration system) Children’s Day Care Services. This includes child minders, nurseries, crèches, playgroups, playschemes, and out of school provision. Regulation involves a number of processes. Those wishing to set up a care service must first be registered by the Unit. This involves a thorough vetting of the proposed service, and those intended to run it, to ensure it meets minimum standards. Once registered, the service is subject to regular inspections to ensure the standards are still being met. These inspections occur twice a year for care homes (once announced and once unannounced), and once a year for children’s day care and domiciliary agencies. The Unit also investigates any complaints made about registered care services and is responsible for taking whatever enforcement action is necessary to ensure that minimum standards are achieved at all times. Number of Care Services Regulated 2000-2001 Adult Residential Care Homes Children’s Homes Domiciliary Care Agencies Children’s Nurseries Child Minders Playgroups Other Children’s Day Care 90 14 52 23 244 39 60 2 Unit’s Performance 2000-2001 1. National Targets The Personal Social Services Performance Assessment Framework has 50 key indicators providing a statistical overview of social services performance. Two of these indicators relate directly to the work of the Unit - C25, inspections of children’s homes, and C34, inspections of residential care for adults and older people. The Unit’s work in relation to the regulation of children’s day care, or adult domiciliary services is not included within the current PAF performance indicators. As the 2000-2001 statistics are not yet available, a comparison has been made against the 1999-2000 indicators. As can be seen below, Salford meets the expected level of the indicators. Area England All Metropolitan Districts Salford (2000-2001) % of children’s homes inspections completed 99.95% 100% 100% % of adult homes inspections completed 99.59% 99.43% 100% 3 2. Unit Targets In addition to the national targets, each year the Unit sets itself a series of targets and objectives for the forthcoming year. The targets set for 2000-2001 are set out below, with details of their outcomes: Target Outcome Comments To continue work on a care planning model To undertake benchmarking activities against other inspection units Inspection staff to develop more IT skills To consider new ways of publicising open reports To develop new ways of obtaining feedback To allocate time within business meetings for policy/strategy issues To continue to increase the percentage of inspection reports sent out within six weeks To ensure good communication links within the Unit, in respect of Ofsted/NCSC changes To complete outstanding tasks from previous year Achieved This multi-agency development is now in operation in many homes. A benchmarking club was established and did some initial work, but has since been overtaken by other events. Arrangements made for identified staff to obtain further training. There has been little action on this matter in the past year. New methodology developed but not yet implemented. Realistically, however the policy/strategy issues have mainly concerned the new regulatory bodies. The figure has increased from 91% to 94% in respect of reports sent out by the Unit Partly achieved Achieved Not achieved Partly achieved Partly achieved Achieved Achieved Staff in the Unit have all information received from Ofsted/NCSC. Not achieved The tasks outstanding from the previous year related to new systems and methodologies. In the light of the forthcoming changes, a decision was taken not to undertake further work on existing systems. 4 Unit Resources As in previous years, the main and most important asset at the disposal of the Inspection Unit is its staff. At present the Unit has two operational teams and an administrative team under the leadership of the Chief Inspector, although this situation will change as moves to the National Care Standards Commission and Ofsted occur throughout the coming year. The Adult’s Residential/Domiciliary and Children’s Residential Team consists of 3.5 Senior Inspectors and 1 Inspector. This is the team that is expected to transfer to the National Care Standards Commission in April 2002. The Children’s Day Care Team consists of a Senior Inspector and 5 Inspectors. This Team is expected to transfer to Ofsted’s Early Years Directorate in September 2001. The Administrative Team of an Administrative Assistant, a Senior Clerk/Typist, and 3.5 Clerk/Typists is headed by an Administrative Officer. Staff within the Administrative Team have the option of transferring to either Ofsted or the Commission. At the present time a majority of administrative staff have indicated a preference to go to Ofsted. If this occurs, it is likely to have administrative implications for the remaining part of the Unit post September 2001. This year, on the children’s day care front, there has been increased provision to regulate, given the promotional work of the Early Years Development and Childcare Partnership. The secondment of two Early Years Officers has provided part-time support for the increased work, although in reality it needed the equivalent of at least an additional full time Inspector. Given all this, it is to the great credit of staff that they have managed to organise their workloads to enable their 2000-2001 inspection schedules to be completed, and to continue to keep on track with their inspections in 2001-2002. In terms of training in 2000-2001, two Senior Inspectors in the Adult/Children’s Residential Team are in the process of completing their 5 BA/PQ qualifications in Regulation, organised through the University of Salford. A further Inspector commenced the course in September 2000. Those staff transferring to the Commission have been advised that there will be a new national training award for regulators introduced in 2002 based on the NVQ system. Those who have completed the BA/PQ will be supported to convert their qualification to the new award. There has however been no further information on the introduction of a new NVQ qualification for Children’s Day Care Inspectors, originally talked about in early 1999. Issues for 2001-2002 At the present time staff are involved in the preparations for moving to the two new organisations. In addition to dealing with employment issues and potential changes – contractual terms, pension rights etc – staff are preparing themselves for the new ways of working in the future. Ofsted will be managed regionally from an office in Manchester, but Inspectors and Senior Inspectors will be home based. The National Care Standards Commission will have a regional base, but will also create ‘local’ area offices. In Salford’s case the current Unit and those at Trafford and Manchester Social Services, and Salford and Trafford Health Authority will merge to form a new area team based at Old Trafford. Home based working will be an option but not a requirement for Inspectors. In the meantime, both Ofsted and the NCSC are setting out their requirements in respect of the service files that will be transferred to them. Staff are therefore involved in checking and preparing all such files for the transfers, working to a transition plan as set out by the NCSC, and to guidance documents sent out by Ofsted. As a final point, although staff are clear which organisation they are expected to join, for a variety of reasons they may not wish to do this, and may seek other posts outside of the Unit in the forthcoming months. This is a situation currently being experienced in many Units and one which could result in serious management problems, since it is unlikely that vacant posts will be able to be filled in the time leading up to the moves. 6 Regulatory Issues 2000-2001 CARE HOMES FOR ADULTS As at 31 March 2001 the Unit regulated 90 residential care homes caring for adults in Salford. This is 6 fewer than at the end of March 2000. 3 of the closures involved large local authority homes, 1 involved a private care home. The majority of the care homes (75) are in the private sector. Most of the homes (66) are large, ie catered for more than 3 people. 11 of the homes also provide nursing care . As at 31 March 2001 there are 47 homes for older people, 18 homes for people with a mental health problem, 24 homes for people with a learning disability, and 1 home for people with a physical disability. Adult Care Homes - March 2001 40 35 30 25 20 15 10 5 0 D is. M en ta lH ea lth Ph y. D is ab ilit y Le ar ni ng O ld er P eo pl e Indep LA Vol Numbers of Beds The total number of beds provided for adult residential care at the end of March 2001 was 1274. This is 108 fewer than at the end of March 2000. The private and voluntary sector together provide four times more adult residential beds than the local authority. 7 The figure below shows the number of adult residential beds available in the City at the end of March 2001: Activity During the Year The Market The most significant ‘activity’ in the year was the closure of a number of care homes. 3 large local authority homes which catered for a total of 61 older people closed, and 6 private homes closed. These 6 provided 20 beds for older people, 9 beds for those with a mental health problem, and 3 beds for those with a learning disability. 5 ‘new’ private residential homes opened in 2000/1 including 3 in existing nursing homes. All bar one were small homes so only provided a total of 21 new beds - 15 for older people, 3 for mental health, and 3 for learning disability. Variations 9 homes had their registration conditions varied to increase the number of beds they were providing. This resulted in 66 additional beds, 37 of these being in existing nursing homes. 1 home reduced the number of residents catered for by 3. 10 homes had variations to managers or owners. 8 homes had variations to the category or age of resident accommodated. 8 Exceptions 2 exceptions have been granted in 2000/1, both concerning maximum occupancy levels. One involved a local authority home and the other concerned a voluntary sector home. Inspections A total of 126 inspections have been undertaken to large residential care homes for adults in 2000/1. This included 64 announced and 62 unannounced inspections. Over 151 hours were spent inspecting ‘out of normal hours’. 94% of inspection reports were sent out in draft within 6 weeks. Outcome of Inspections Altogether, 292 requirements were made after inspections to large adult care homes. Most inspections resulted in between 1 and 6 requirements, although some received more. In 9 inspections, no requirements were made at all. In 15 cases, the requirement had to be repeated at the subsequent inspection. The types of requirement made are shown below: Requirements Made - Adult Care Homes 2000/1 Records 10% Repairs 12% Health & Safety 22% Care Practices 33% Staffing 23% 9 The greatest number of requirements made concerned care practices, and within this the need for homes to undertake adequate risk assessments on all aspects of care featured most strongly. Staffing matters represented the next major area of requirements. Most of these concerned inadequate staffing levels, although some were about shortcomings in staff recruitment practices. Within the category of ‘Health and Safety’ requirements are matters relating to fire and accident prevention, the need for gas and electricity check certification, and non-compliance with COSHH. The final two categories identify requirements made in respect of physical defects with the homes themselves, and those concerning the need to keep and maintain specified records. Issues for 2001-2002 As from 1 April 2002 all local authority care homes will need to seek registration with the National Care Standards Commission. Registration will also be required for managers of local authority homes, and managers/matrons in nursing homes. This will ensure that all services are regulated in exactly the same way. The National Minimum Standards, Care Homes for Older People was published in March 2001. This includes 38 core requirements which will apply to all care and nursing homes for older people from April 2002, covering staffing, health and personal care, daily life and activities, and the physical environment. Some of the detailed requirements concerning the physical environment ie room sizes will not now be applied until either 2002 or 2007. National Minimum Standards for homes catering for other adult groups have not yet been published. 10 CARE HOMES FOR CHILDREN As at 31 March 2001, the Unit regulated 14 children’s homes in Salford, three more than at 31 March 2000. 12 of the 14 homes are owned and managed by the City Council. Within the 12 City Council homes, there is 1 respite care unit, and a secure unit. A further 3 homes operate as voluntary children’s homes. Although not currently regulated by the Unit, they will come within the remit of the National Care Standards Commission after April 2002. There are currently no ‘small’ 3 bed children’s homes in Salford. These will be regulated after April 2002 by the Commission, but in the meantime are being regulated by local authorities under interim legislation. Numbers of beds There are 78 beds provided by the local authority, and 9 by the private sector. Residential Beds (Children) - March 2001 Private 10% Local Authority 90% Activity During the Year In 2000, the second private children’s home opened in Salford. Two further small local authority homes also opened. There were no closures of children’s homes in 2000-2001. Inspections A total of 20 Inspections were made to children’s homes in the year ending March 2001. Half of these were unannounced. 11 100% of inspection reports were completed and sent to providers in draft within 6 weeks. A total of 14 hours have been spent inspecting ‘out of normal working hours’. Outcome of Inspections As a result of the 20 inspections, a total of 114 requirements were made on children’s homes in the independent and public sector. Requirements Made - Children's Homes Health and Safety 8% Staffing 10% Procedures 4% Care Practices 35% Repairs 17% Documentation 26% The most frequently made requirements dealt with care practice issues. These included requirements about admission practices, reviewing practices, medication handling, meals etc. A number of inspections indicated that admissions were often unplanned and gave young people little say as to which children’s home they were sent to. In terms of medication handling, this is not a task that is regularly undertaken in children’s homes. As a result it appears that staff are less conversant with the process. Documentation problems continued to be a major factor during inspections. Visits found that standards were often not met in respect of the accuracy of the Statement of Purpose of the home, and in terms of documentation required to follow the young person to a home. It is essential that a new home has all the necessary background information about a young person to ensure that their care is consistent and effective. Timescales are set for the transfer of this information – timescales that were not always met. 12 Approximately 10% of requirements concerned staffing issues. A number of these were about the number of staff on duty, but also reflected the problems that can occur, when from necessity, a high level of temporary staff are used in children’s homes. Of the 114 requirements made, 25 had still not been met at the time of the next inspection. Most of these were about the lack of necessary documentation, the planning of placements, and repairs to premises. Issues for 2001-2002 At the present time the new standards for children’s homes that will apply under the National Care Standards Commission have not yet been issued. 13 ADULT DOMICILIARY CARE AGENCIES As at 31 March 2001 there are 52 registered domiciliary care agencies in Salford, as well as the local authority home care service. The majority of the agencies cater for older people. 13 agencies cater specifically for the needs of those with mental health problems, whilst 5 cater for those people with learning disabilities. Less than half of the agencies registered are ‘active’ at the present time in terms of caring for Salford clients. Activity During Year Four new agencies opened during the year, none de-registered. Four agencies had new managers registered. Inspections/Outcome of Inspections Sixteen announced inspections took place during 2000-1. Sixty-three recommendations were made following inspections, as shown below: Recommendations Made - Domiciliary Agencies QA/Complaint 14% Staffing/Trng 21% Care Practices 39% Records/Info 26% As can be seen from this chart, the largest number of recommendations made concerned care practices at agencies. This included recommendations about medication practices, continuity of carers, the need to introduce carers to clients, and the need to have adequate key holding/authorisation systems. 14 As domiciliary agencies have a dispersed staff group, supervision is by its very nature more ‘at arms length’. It is therefore crucial that policies and procedures are clear in terms of the expectations placed on staff. The second major area of recommendations concerned such recording and information systems. Suggestions were made about the need for explicit policies on handling monies, the importance of recording carer visits, and the need for service users to be given clear information about the type of service they should receive. Fourteen per cent of the recommendations concerned staffing matters. These were often about the need for managers to take up written references, to have suitable staff induction procedures, and to engage in more staff training. The final area of recommendations concerned the need for agencies to have clear complaints procedures that were available to service users. Issues for 2001-2002 One of the major changes incorporated into the Care Standards Act is the requirement that from April 2002, domiciliary care agencies will be statutorily regulated. There is however no information yet available as to the national minimum standards for such agencies, nor concerning the registration and inspection methodologies to be used. The Department of Health has studied those systems used by local authorities who already have voluntary ‘registration’ systems, as in the case of Salford. It is therefore hoped that any new system of regulation will be broadly similar to these. 15 CHILDREN’S DAY CARE SERVICES As at 31 March 2001 the Unit regulated a total of 366 children’s day care providers in the City as outlined below: Children's Day Care Services 300 250 200 150 100 50 0 ild Ch ers nd i M es eri s r Nu Pla ps rou g y Pla m he c s y es r he Ot During the year the number of child minders, playschemes and playgroups has decreased, but only marginally. There was also a decrease in the number of local authority nurseries, due to a reconfiguration of the service. The most significant area of change however has again been in the provision of full day care, and sessional provision in the form of out of school clubs, much of the growth being generated by New Opportunities Funding and Start-Up Grants for child minders. Activity During Year 43 new child minders registered, but 49 de-registered. Three new playgroups opened, whilst four closed. There was a slight decrease in the overall number of playschemes, with eight opening but seven closing during the year. Two private day nurseries opened, replacing two that closed. Six local authority nurseries closed due to a reconfiguration of the service into a reduced number of nursery centres. 13 new out of school/other sessional services opened, whilst four closed. 16 Inspections/Outcome of Inspections A total of 306 inspections were undertaken by the Unit during 2000-1. Although there is no PAF performance indicator relating to this area of work, it should be noted that 100% of expected children’s day care inspections were carried out. 93 requirements were made of full day care providers. These requirements fall into the categories shown below: Requirements Made - Full Day Care Providers Repairs 9% Care Practices 9% Records 15% Health & Safety 44% Staffing 23% The requirements shown above relate to full day care providers, but are broadly indicative of the types of requirement made of other day care providers. The most frequently made requirements in 2000-2001 related to health and safety issues. They included requirements about fire drills and fire precautions, the need for risk assessments, secure fencing and secure equipment, through to fire aid requirements. Staffing issues made up the second largest group of requirements. This generally involved the need to ensure that all staff employed to care for children were properly referenced and police checked, but also reflected the need for adequate staffing levels and staff training in some establishments. 17 Record keeping requirements related to the need to keep up to date information on children being cared for, through to the need for appropriate medication and accident records. Other than repairs, the final group of requirements concerned care practices. These requirements concerned the way in which children were accommodated and cared for in day care establishments, and the way in which the establishments involved parents in the care of the children. Issues for 2001-2002 Ofsted have now published five sets of national standards for ‘Under Eights Day Care and Childminding’ – for full day care, childminding, crèches, out-of-school care, and sessional care. Guidance on the detail of these standards is expected shortly. In terms of transitional arrangements, these come into action from 2 July 2001 when Ofsted takes over responsibility for any new registrations that come in after that date. Ofsted will then take over all the remaining regulatory functions as from 1 September 2001. Between July and the end of August, the Unit will remain responsible for processing applications for registration already made, and for inspections and enforcement activity. It is Ofsted’s intention to inspect all existing providers at least once between 1 September 2001 and 31 March 2003. The local authority will however retain certain functions currently carried out by the Inspection Unit. These include the provision of information and guidance to prospective providers, and some aspects of training not already carried out by the Early Years Team. There are at present no proposals concerning the continuation of the existing Children’s Advisory Panel under Ofsted. Given that there will be no local area offices, and that Inspectors will be working from home, it is unfortunate that the additional benefit of local dialogue with Advisory Panel members may also be lost in the new structure. 18 Complaints And Enforcement Action The Inspection Unit is responsible for handling complaints that are made in respect of registered independent sector care. The Unit does not handle complaints about local authority provision as these are dealt with through Salford’s own Complaints Procedure. No.Received No.Upheld Substantial Investigations Regulation 20 Notices Enforcement Notices (CM) Cancellations of Regn. Large Homes Small Homes Children’s Homes 3 3 1 Children’s Day Care 44 16 4 20 11 3 0 0 0 1 0 0 N/A N/A N/A N/A 0 0 0 0 1 Only one statutory (Regulation 20) notice was issued in 2000-2001. This was against a dually registered home and was issued jointly with colleagues from Salford and Trafford Health Authority. The notice required the home to address a number of deficiencies in relation to staffing, furniture and bedding, the cleanliness of the home, the laundry arrangements, and recreational activities for residents. It was necessary in this instance to undertake a high level of monitoring of the home following the notice. Work was however undertaken to address the issues within the given timescales. No Enforcement Notices were issued against child minders in 2000-2001, although in January 2001 the registration of a child minder was cancelled. The minder did not appeal against the decision. 19 Advisory Panels There are currently two Advisory Panels operating – one considers issues relating to the regulation of adult services, and the other considers matters relating to the regulation of children’s services. The role of the Advisory Panels is to assist the registration authority in the effective discharge of its regulatory functions. In 2000-2001, the Adult Advisory Panel found itself concerned with the emerging arrangements for regulation post April 2002, as well as the ongoing work of the Unit. A variety of issues were discussed at meetings including the Care Standards Act (then a Bill), the ‘No Secrets’ guidance on protecting vulnerable people, the new role of the Criminal Records Bureau, the new Registered Manager qualification, and issues around the National Care Standards Commission. The Panel was also advised of the work of the Care Planning Working Group, an inter-agency working party set up to devise a model of care planning for use in care homes. In addition to these issues, the Panel at each meeting routinely scrutinised a variety of anonymised inspection reports. The Children’s Advisory Panel also discussed a mixture of local and national issues through 2000-2001. As well as discussing anonymised inspection reports, the Panel considered changes to registration standards, were advised of Salford’s Children’s Information Project, and discussed the proposed standards for children’s day care that will be applied under Ofsted. In more recent meetings, the Panel has discussed the arrangements covering the transition from local authority regulation to Ofsted regulation. Within Salford, the contribution of providers and carers to the work of the Unit through Advisory Panels has been much appreciated. It is therefore disappointing to note that as yet Ofsted has given no indication that it intends to replicate the Children’s Services Advisory Panel in any form in the future. The National Care Standards Commission has indicated that there will be some form of provider and service user consultation process within regions, but it is not yet known how localised this will be. 20 Targets for 2001-2002 Given the significant changes which will be taking place over the next twelve months, and the new regulatory regimes, it would not be realistic to suggest that further work is undertaken on the systems already in place at the Unit. The main targets then for the next twelve months are therefore in relation to the transition and are as follows: 1. 2. 3. 4. To ensure that as far as possible the Unit continues to operate on a ‘business as usual’ basis. To ensure that inspection schedules are completed for those services transferring to the Commission, and up to date at the point of transfer for those going to Ofsted. To ensure that all files and documentation are up to date at the point of transfer. To support staff during the transitional and transfer process. 21