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ANNEX A - PROPOSALS TO REDUCE THE MINIMUM FREQUENCY OF INSPECTIONS OF CERTAIN CARE SERVICES FROM 1 APRIL 2009

Mainstream school care accommodation and school hostels

1. Currently these services are inspected at least twice a year with one of the inspections being unannounced. The proposal is to reduce this to:

• At least one unannounced inspection per year for services in the first two years following registration
• At least one unannounced inspection every two years for those services which have been registered for more than two years (joint inspections with HMIE will continue to be announced.)

Legal requirements

2. The legal requirement would be amended to require services to be inspected at least twice in the period of 24 months following registration and thereafter at least twice in each subsequent period of 48 months. It would still be a legal requirement that at least one of the two inspections in the 24 and 48 month periods be unannounced.

Care Commission Operational Policy

3. It would be for the Care Commission to determine in practice the frequency of inspections within that framework. The requirement that all 2 yearly inspections are to be unannounced would not be set down in law. However, the Care Commission will make this its policy from 1 April 2009. The HMIE joint inspections point would also be covered by the Care Commission's policy rather than regulations.

4. This reduction in the minimum frequency of inspection to one unannounced inspection every two years would apply in practice to individual services where:

• Regulatory Support Assessment ( RSA) scores are low
• there is no current enforcement action
• Quality Theme grades are high ( i.e. grades 4, 5 or 6).

5. The remaining services would continue to be inspected more frequently than the minimum depending on their RSA score, grades and enforcement action.

Evidence

6. In 2007-08 there were 21 mainstream schools and 7 school hostels. These services were first registered in 2005. Evidence from subsequent inspections shows that mainstream school care accommodation services perform well. The general quality of school hostels can be variable, and in some isolated cases poor. The following gives a summary of the Care Commision's findings from regulatory activity:

7. The Care Commission has received no complaints about mainstream school care accommodation or school hostel services.

8. Enforcement action has been taken against only one school hostel. An Improvement Notice was issued to this service in connection with matters relating to safety and the environment.

9. Mainstream schools have a low level of requirements made following inspection. The reason for the slight increase in requirements in 2007-08 relates to the specific focus area for that year. School hostels had more requirements and these were mainly in those services which had enforcement action taken against them.

10. The Care Commission is required to collaborate with HMIE on the inspection and regulation of these services. This will be achieved by conducting one joint inspection, with one inspection team producing one jointly badged report. Under current arrangements, these inspections are announced. Any change to this arrangement will need to be agreed between the Care Commission and HMIE. Under the proposed revised minimum frequency, a joint inspection of the service could take place every four or six years, depending on assessed need.

11. Mainstream school care accommodation services and school hostels cater for children and young people of primary and secondary school age. A sizeable proportion of young people come to these schools from abroad and the parents of a number of more local young people work abroad. There can, therefore, be a lack of direct parental contact with the schools. However, in these situations, a system of "guardianship" has been established through which authorised adults take an interest in the welfare and wellbeing of the young person on the parents' behalf.

HSS (that are not provided by a registered social and which provide only HSS)

12. Currently these services are inspected at least once a year. The proposal is:

• To reduce this to a minimum of one inspection every 3 years

Legal requirements

13. The legal requirement would be amended to at least once in the period of 36 months following registration and thereafter inspections at intervals of not more that 36 months.

Care Commission Operational Policy

14. This reduction in the minimum frequency of inspection to one inspection every three years would apply in practice to individual services where:

• Regulatory Support Assessment ( RSA) scores are low
• there is no current enforcement action
• Quality Theme grades are high (i.e grades 4, 5, or 6)

15. The remaining services would continue to be inspected more frequently than the minimum depending on their RSA score, grades and enforcement action. The legislative changes will allow the Care Commission the flexibility to continue to inspect some housing support services shortly following registration. The vulnerability of the service users who are using the services will form part of the consideration of more frequent inspections being required.

Evidence

• Housing Support Services

16. RSA levels for all housing support services at 31 May 2008.

17. There are 988 housing support services ( HSS) that are not registered as Registered Social Landlords ( RSLs), of these 465 provide HSS only. (The remaining 523 HSS are also registered to provide a support service - care at home. These services will continue to be inspected at the current minimum frequencies i.e. at least once a year). The Care Commission has considered whether we should support the proposal to reduce the frequency of inspection to bring it into line with housing support services provided by Registered Social Landlords (minimum inspection frequency for these services was reduced to at least once every 3 years from 1 April 2007).

18. In relation to HSS provided by local authorities, the SHR has advised that after a round of foundation inspections that they will only be intervening through the Concordat and will be moving away from cyclical inspections to a themed/targeted approach, with little input to local authority services. This decision was partly based on the fact that the Care Commission would still be inspecting these services.

19. These services are provided to a wide range of vulnerable individuals, from support to older people in sheltered housing developments to intensive support for people with alcohol and drug support needs, and those who are at risk of homelessness. However, many of these 465 services perform consistently well with a high proportion having a low RSA.

Independent Hospitals and Hospices

20. These services are currently inspected at least twice a year with one inspection being unannounced. The proposal is:

• To reduce this to a minimum of one inspection every year

Legal requirements

21. The legal requirement would be amended to at least twice in the period of 24 months following registration and thereafter at least twice in each subsequent period of 24 months with at least one unannounced inspection in each of those periods.

Care Commission Operational Policy

22. It would be for the Care Commission to determine in practice the frequency of inspections within that framework. The requirement would be for one of the inspections within the 24 month periods to be unannounced. The Care Commission would determine whether or not the other inspection in that period was to be announced or unannounced according to its policy from 1 April 2009.

23. The Care Commission will use its RSA and grading levels to make decisions on the need for more frequent visits to individual services. This reduction in the minimum frequency of inspection to one unannounced inspection every year would apply in practice to individual services where:

• Regulatory Support Assessment ( RSA) scores are low
• there is no current enforcement action
• Quality Theme grades are high ( i.e. grades 4, 5 or 6).

Evidence

Independent Hospitals (10) and Private Psychiatric Hospitals (4)

24. Overall, the Care Commission has found that the majority of independent hospitals provide safe and effective care that centred on the needs of the people using the services and their carers. The Care Commission Report ' The Quality of Care in Private Hospitals and Voluntary Hospices in Scotland 2006-07' provides evidence which should be taken into account. This report highlights the findings from the services' announced inspections which focused particularly on three main areas of healthcare governance: staffing; standards of care; and provision of information.

25. The Commission identified in the report, 19 requirements across five services, of which 14 requirements related to one service. However, overall most private hospitals received no requirements, while some received only one or two, mainly to improve areas of recruiting, supervising or training and developing staff. Generally the independent hospitals' requirements have been reducing in number and those for Private Psychiatric Hospitals remain unchanged.

26. In 2004-05, five services had a total of six complaints made against them, of which two were upheld regarding provision of service and information, four were partially upheld regarding provision of information/making choices, record keeping, general food quality, inadequate activities, financial issues, inadequate medical or healthcare treatment, provider's complaints procedure. In 2005-06, three services had a total of four complaints made against them, of which all were partially upheld regarding provider's complaints procedures, provider's policies, general health and welfare, potential abuse. In 2006-07: two services had a total of three complaints made against them, of which all were partially upheld regarding general health and welfare, staffing levels, fitness of provider/management/staff, medication issues, fitness of premises/environment, personal plans/agreements. This shows relatively low level activity and an improving trend.

27. There has been enforcement activity against one independent hospital and one private psychiatric hospital in 2005-06. However, there has been no further enforcement action against this service type to date.

28. Private psychiatric hospitals are services where people can be detained under the Mental Health (Care and Treatment) (Scotland) Act 2003. This is to protect and safeguard people, both from injury and harm to themselves, or because they may be a danger to others. These services are providing care for vulnerable adults and from time to time notify us of critical incidents. Therefore, some of these services will need to be inspected at more frequent levels based on a proportionate risk based approach which takes account of critical incidents and events.

Hospices (15)

29. Overall the report demonstrates that the majority of hospices provided safe and effective care that centred on the needs of the people using the services and their carers.

30. 20 requirements were identified across nine services of which ten requirements related to one service. Six hospices received no requirements in any of the focus areas, while the rest received one or two, to improve areas of recruiting, supervising or training and developing staff.

31. Two hospices cater for children and young people. It has been assessed that these services perform well. There have been no known child protection issues connected with these services and parents and families have a high level of involvement in the service.

32. There has been one complaint made against a hospice in 2005-06. This complaint was partially upheld and highlighted issues regarding provision of service, staff behaviour, including failure to respond. Formal enforcement procedures have not been taken against any hospice.

Childminders

33. These services are currently inspected at least once a year. The proposal is to reduce that to:

• At least one inspection a year for those services in the first two years following registration
• At least one inspection every two years for those services which have been registered for more than two years.

Legal requirements

34. The current legal requirement for childminders to be inspected at least once in the 12 months following registration would remain. Thereafter the requirement would be amended to at least once in each subsequent 24 months.

Care Commission Operational Policy

35. The Care Commission policy would be to always inspect new childminders at least once a year in the two years following registration.

The further reduction in the minimum frequency of inspection to at least one inspection every subsequent two year period would apply in practice to individual services where:

• Regulatory Support Assessment ( RSA) scores are low
• there is no current enforcement action
• Quality Theme grades are high ( i.e. grades 5 and 6).

36. The remaining services would continue to be inspected at least once a year.

37. The Care Commission will also consider whether within its existing powers it can require individual childminders benefiting from the reduction in minimum frequency to inform the parents of the children using their service of the reduction. This reflects the Commission evidence that parents greatly value the assurance they derive from the Commission inspections.

Evidence

38. There are just over 6000 registered childminders in Scotland. This is the largest group of care service providers that the Care Commission regulates. Childminders work and provide their service in their own homes. Most work with children alone, although a few work with assistants or with their partners, and in many cases family members can be present after school, after work or during holiday periods. Childminded children range from babies to children in secondary education.

39. The evidence supports the case for reducing the frequency of these inspections. However, our proposals here are modest bearing in mind the potential isolation of childminders and the potential vulnerability of the children using the service.

40. In 2006 the Care Commission published a "Review of the quality of childminding". This report demonstrated that overall the quality of childminding services was good, with 78% having no requirements made during inspections. The Commission found that 97.4% of parents were either "happy" or "very happy" and only 1.6% were "very unhappy" with the service provided. These high levels of satisfaction and the good levels of performance have been consistent year on year. Because of the high numbers of these services, and the inspections completed to date using the quality grading scheme, the Commission has begun to identify trends in the grades of childminding services.

41. At 3 June 2008, the reports on 432 graded inspections of childminders had been finalised. Childminders scored very highly as noted below:

42. While the 432 inspections may not be fully representative of the 6000 childminders in Scotland, the grading results to 3 June correlate well with other information available. For example, around 80% of childminders have low RSAs and formal legal enforcement action has been taken against less than 1% of childminders in any year. This evidence supports the case for reducing the frequency of these inspections, bearing in mind the potential isolation of childminders and the potential vulnerability of the children using the service.

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