Best Value Review of Out of Hours Services

1.1 The purpose of this report is to inform Members of the Advisory Panel of the performance of the Joint Registration and Inspection Unit from April 2001. This is the final report of the Head of Unit to the Advisory Panel prior to the transfer of the function together with the staff to the National Care Standards Commission on 1^st April 2002.

2.1 Since 1994 the Department of Health has required each Inspection Unit to produce an annual report detailing the work of the Unit in the preceding year. However, with the imminent transfer to the National Care Standards Commission together with the consequent increased workload the Department of Health removed the requirement for an annual report for 2001/02

2.2 The Annual Report has over the years provided valuable information not only with regard to the performance of the unit but also in a more general sense regarding the state of the care home market. This report aims to set out the position on 1 April 2001, detail the work of the Unit over the year and provide information showing the level and types of services to be transferred to the National Care Standards Commission.

2.3 The role and function of the Unit has been reviewed over recent years in line with government initiatives such as the creation of CAFCAS and the transfer of under eights services to OFSTED. In addition the reorganisation of the Social Services and Housing Directorate resulted in further changes to the Unit.

3.1 In April 2001 following a review of the staffing within the Unit the Head of Unit, Mrs Cousins was appointed to the Head of Central Support Service. Prior to April 2001 the Unit comprised the following staff:

3.2 Following the appointment of Mrs Cousins, the previous Head of Service to the Central Support Section, the transfer of other staff and one redundancy, the staffing within the Joint Registration and Inspection Unit was as follows:

Working methods and practices have been reviewed to ensure that all statutory duties are covered with no reduction in service to homes and agencies.

4.1 The range of homes and other services regulated by the Joint Registration and Inspection Unit on 1 April 2001 and 20 February 2002 is set out below.

	01/04/01	20/02/02
Residential Care Homes	108	102
Nursing Homes	10	9
Small Homes	26	27
Domiciliary Care Agencies	10	9
Boarding Schools	2	2
Health Trust Establishments	1	1
Local Authority Homes	3	3

4.2The most significant number of homes lost is within the residential sector. However in percentage terms the loss of nursing homes and nursing beds is by far the greater. The unit has processed a number of registrations during the year and with the exception of two small homes no other new developments have been registered.

4.3 The breakdown of the residential care and nursing homes is set out below based on the main category for which the home is registered.

Category of Registration by home	01/04/01	20/02/02
Older people and older people with physical disabilities	62	56
Older people - mental infirmity	10	10
People with mental health problems	6	6
People with learning disabilities	26	26
People with physical disabilities	1	1
Local Authority Homes	3	3
Nursing Homes	11	10
Mental Nursing Homes	1	1

Category of Registration by bed	01/04/01	20/02/02
Older people and older people with physical disabilities	1214	1142
Older people - mental infirmity	377	357
People with mental health problems	68	64
People with learning disabilities	271	283
People with physical disabilities	18	13

4.5 The tables above show that since 1 April 2001 there has been a net loss of 6 residential care homes and 89 beds within the residential sector.

4.6 The unit has also seen some change within the small home sector over the year and although a number of homes have ceased to operate the overall number of homes has not altered significantly.

4.7 The tables below show the number of homes and beds together with their location

Area	Residential Homes	Residential Homes	Residential Beds	Residential Beds
	01/04/01	20/02/02	01/04/01	20/02/02
Bembridge	3	3	81	81
Brading	1	1	13	13
Brighstone	1	1	23	23
Carisbrooke	1	1	25	25
Cowes	6	6	144	144
E Cowes	6	6	118	116
Freshwater	6	5	117	86
Ventnor	7	6	144	125
Newchurch	1	1	12	12
Newport	12	10	212	190
Northwood	1	1	4	4
Ryde	27	27	409	412
Sandown	10	10	200	200
Shanklin	15	13	203	174
Totland	8	8	183	183
Wootton	2	2	44	44
Havenstreet	1	1	27	27
	108	102	1959	1859

Area	Nursing Homes	Nursing Homes	Nursing Beds	Nursing Beds
	01/04/01	20/02/02	20/02/02	20/02/02
Newport	3	3	84	84
Ryde	1	1	26	26
Wootton	2	2	51	51
Bembridge	1	1	24	24
Sandown	1	1	37	37
Shanklin	1	1	40	40
Havenstreet	1	1	23	23
Ventnor	2	1	41	21
Totland	1	1	30	30
	13	12	356	336

4.8 For the past three years the Joint Registration and Inspection Unit has operated a voluntary accreditation scheme for domiciliary care agencies. This has focussed primarily on agencies that contract with the Isle of Wight Council. Since April 2001 only one agency has surrendered the certificate of accreditation and this was due to problems in recruiting and retaining staff.

4.9 There are now 9 agencies operating including the local authority service, all of which have been inspected at least twice during the past 11 months.

4.10 The Care Standards Act 2000 requires the registration of domiciliary care agencies with

the National Care Standards Commission and they have been advised of the process.

4.11 The Registered Homes Act 1984 requires that every nursing home and residential home for more than three residents which is registered with the same person in control for the full year must be inspected at least twice. There is no requirement to inspect small homes but it has been the policy of the Isle of Wight Council that all small homes are visited at least once a year and that the visit is announced.

4.12The table below shows the number of homes which have been operational since 1 April 2001 with the same person in control together with the total number of inspections. The panel should be reassured that all homes have been visited through the year but the figures in the table relate to the statutory requirement.

4.13 One of the targets set out in the Service Plan for the Joint Registration and Inspection Unit relates to meeting the statutory target and the table above shows that the target was met in full.

4.14 Another target set out in the Service Plan was to undertake 35% of unannounced visits to homes out of usual office hours. This target was not achieved and although this was disappointing in itself it is noted that a number of announced out of hours visits were undertaken. It was perhaps a little ambitious to step up this percentage from 25% in 2000/1 to 35% in this year.

5.1 The Joint Registration and Inspection Unit encourages the users of care services to raise concerns and complaints directly with the service provider. It has been shown that where complaints can be dealt with as close as possible to the service they can be dealt with quickly and efficiently.

5.2 However, for a variety of reasons a number of complainants raise concerns with the Joint Registration and Inspection Unit and ask the staff to investigate the complaint. In addition there are some issues which appear to be so serious that the suitability of the registered person, the manager or a staff member is brought into question, and these are always investigated. The Joint Registration and Inspection Unit has a well established and generally respected complaints procedures which is open and transparent, seeking to deal with complaints using established investigation techniques.

5.3 Since April 2001 the Joint Registration and Inspection Unit has been involved in the investigation of 29 complaints. The table below lists the types of complaints and the number which have been upheld.

Total Number	29
Number of Homes	20
Number of homes with 3 or more complaints	1
Poor care Practice	15
Poor facilities	5
Financial mismanagement	0
Potential abuse	0
Poor staff management	3
Staff levels /competency	2
Other	4
Fully upheld	2
Partially upheld	17

5.4In addition there were 1856 reportable incidents reported to the unit during this year up to 18 February 2002.

6.1 It has been the style and approach of the unit to work in collaboration with service providers seeking to secure agreement on compliance rather than resorting to statutory enforcement. Although this approach is generally successful there have been a number of occasions over the past year when a breach of the regulations has been either repeated on a number of occasions despite the interventions of the Registration and Inspection Officer or the matter has been so serious that a Regulation 20 Notice has been served.

6.2 Regulation 20 notices have been served on 5 establishments following “minded to serve notice” letters. The reasons for the notices included breach of regulations in respect of staffing levels, records relating to the care of residents, medication procedures and care practices.

6.3 The most serious action which the Joint Registration and Inspection Unit can take is a proposal to cancel the registration of a registered person and it is regrettable that one such proposal has been issued. The registered person in question has consistently failed to comply with the requirements of the legislation and this has resulted in the issue of a number of Regulation 20 Notices in recent years.

This process is subject to an established legal procedure and therefore cannot be discussed until that process is concluded.

7.1 As members of the panel will be aware the work of the unit has also involved much activity in respect of the transfer to the National Care Standards Commission on 1 April 2002.

7.2 In preparation for the transfer the inspection year was reduced from the full twelve months, April to March with the statutory work of inspections being concluded in 10 months. The statutory work has been concluded and this is in the main down to the staff of the unit responding to the request of the National Care Standards Commission.

7.3 Much of the work over recent months has been to prepare service providers for the transfer to the National Care Standards Commission and this has involved the transfer of services and the transfer of files.

7.4 The transfer of services has ben managed by the Joint Registration and Inspection Unit on behalf of the National Care Standards Commission and has necessitated the issue of Transfer of Registration Forms. This was a legal process with the primary aim of ensuring services could be registered with the National Care Standards Commission from 1 April 2002 with the current categories of registration.

7.5 This process has now concluded and from recent discussions with the National Care Standards Commission it would appear that only five providers have appealed against the decision of the Head of Unit. One of these is clearly based on a misunderstanding and should be resolved easily. The remaining four will be more difficult as they concern the category of registration in nursing homes. The process for representation rests with the National Care Standards Commission and if not resolved before 1 April 2002 will be dealt with soon after when the Commission is fully operational.

7.6 As reported to the previous meeting all staff employed in the Unit will transfer to the National Care Standards Commission on 1 April 2002 and they are all undertaking specific training and induction to assist with the process

8.1 This report shows another successful year for the Joint Registration and Inspection Unit in meeting specific targets set externally and internally. The staff team has worked in ways to ensure that the level of service has not been diminished while at the same time supporting the Department of Health and the National Care Standards Commission in preparation for the new Commission.

8.2 The legacy being transferred to the National Care Standards Commission is a positive one in which the partnership between the Joint Registration and Inspection Unit and services and agencies is described as generally positive and respectful.

8.3 In presenting the final report it is worth placing on record the thanks of the Joint Registration and Inspection Unit for the assistance, support and sometimes challenges of the Registered Care Homes Association and Registered Nursing Homes Association who both share the objective of providing high quality and safe services for vulnerable people. The partnership working has been instrumental in assisting with developing a model in which the Joint Registration and Inspection Unit regulates with the consent of those who are regulated.

8.4 The final recognition in this report must be given to the Isle of Wight Health Authority (and successor Authorities) Isle of Wight Council and the Social Services & Housing Directorate in particular which, since the creation of the Unit have provided full support in both practical terms and in budgetary resources. This support has played a significant part in the overall success of the Joint Registration and Inspection Unit.

9.1 The Report of the Head of Unit on the Performance of the Joint Registration and Inspection Unit is commended to the Advisory Panel for information and comment.

Type of Home	Number of Inspections required	Number of Inspections undertaken
Residential Homes	194	194
Nursing Homes	24	24
Small Homes	24	24