March 1996

Heads of Paid Service, New Councils

Copy to: Directors of Social Work, New Councils

Chief Social Work Officers, New Councils

Directors of Social Work, Regional and Island Councils

Directors of Housing, New Councils

Chief Housing Officers, New Councils

Chief Executive, Scottish Homes

Director, Scottish Federation of Housing Associations

Relevant Private and Voluntary Organisations

General Managers, Health Boards

Holders of SWSG Guidance Package

Dear Sir/Madam

LOCAL INSPECTION OF RESIDENTIAL AND DAY CARE SERVICES

1. Summary

1.1 The purpose of this circular is to provide the new councils with up-to-date guidance on discharging their responsibilities for the inspection of care services in homes for adults and children and day-care services for adults. This guidance does not apply to day-care services for children.

1.2 This circular

• reminds unitary authorities of the key requirements for local inspection ;

• underlines the principles which should be followed in managing local inspection;

• encourages the new authorities to establish consortia or other joint arrangements for carrying out their inspection functions;

• requires inspection reports on all establishments to be made available to the public;

• introduces changes relating to the content of Annual Reports and the composition and operation of Advisory Committees;

• encourages local authorities to make closer links with Health Board Inspection Units;

• offers advice on the development of standards statements, inspection methods and Units' links with Health Boards' Inspection units.

These changes should not impose significant additional burdens for local authorities.

2. Action required

2.1. The new unitary authorities must ensure that inspection units are in place to carry out regular inspections of homes for adults and children and registered day care services for adults.

2.2. Small authorities should consider whether joint arrangements would produce a more effective approach to inspection.

2.3. Inspection units must be established at arms length from the operational management of services.

2.4. Heads of Inspection should generally report directly to the Director of Social Work or the Chief Social Work Officer.

2.5. Inspection reports on all establishments must be easily available to members of the public from April 1996. Reports should be produced at least twice a year.

2.6. The standards used in inspection should be published and made easily available to the public and to providers of services.

2.7. The local authority must publish an annual report describing the work of the inspection unit and commenting on the quality of care services in homes for adults and children and day care services for adults. The report should be produced by the Director of Social Work or Chief Social Work Officer.

2.8. Advisory Committees should be established by October 1996 with 50% members being users, carers or people representing their interests. Advisory Committees should meet regularly and should contribute to the annual report on the work of the inspection unit.

2.9. By 30 October 1996, local authorities should send to the Social Work Services Inspectorate details of arrangements for inspection, the name of the Head of Inspection, information about the staffing of the inspection unit and about the composition and remit of Advisory Committees.

2.10. Local authorities should send to the Social Work Services Inspectorate a copy of the annual report on local inspection by 1 July 1997 and thereafter at 12 monthly intervals.

2.11. The training requirements of inspection staff should be reviewed regularly and access provided to relevant training and development.

3. Previous guidance

3.1 This guidance is issued under Section 5(1) of the Social Work (Scotland) Act 1968. It amends and updates guidance provided in Scottish Office circular SW/9/90 issued on 30 October 1990 (Inspection of Establishments: Organisation and Role of Inspection Units). The 1990 circular was followed in 1991 by a further document ''Inspection Units: Establishing Good Practice'' which provided guidance on good practice in conducting inspections.

4. Background

4.1 Circular SW9/90 set out the Government's policy on the organisation and role of local inspection units. From April 1991 local authorities were required to establish units operating at arms-length from service management in order to inspect the quality of care in all residential care homes. This was extended in 1992 to include the inspection of children’s homes.

4.2 The 1990 circular said that local authorities must operate in an even-handed manner in assessing the quality of care in homes run by local authorities as well as those run by private and voluntary organisations. Advisory Committees were set up to assist inspection units with their work and annual reports on the work of units were produced.

4.3 Regional and Island Councils and the unitary councils from 1st April 1996 are also responsible for the registration and inspection of residential and day-care establishments for adults and children which are operated by private and voluntary organisations.

4.4 Although registration and inspection are separate functions the majority of local authorities have combined them within the one unit of management and most inspectors fulfil a dual role. A large number of units have assumed responsibility for the inspection and registration of day-care services for children aged eight years and under.

4.5 The Scottish Office has established a working group to review the operation of the legislation relating to the registration of residential care homes and registered adult day-care establishments. The group includes representatives of local authorities, voluntary and private sector providers and local inspection units. The group is also examining links between the registration of residential homes (by local authorities) and the registration of nursing homes (by Health Boards). Revised guidance on registration matters will be issued to local authorities during 1996. The Scottish Office will also provide guidance on the new responsibilities arising from Section 34 of the Children (Scotland) Act 1995 which requires local authorities to register schools providing substantial personal care or support to children.

5. The Citizen's Charter

5.1 The publication of the Citizen's Charter in 1992 set out the Government's policy on the inspection of public services. The Charter said that the purpose of inspection in public services is ''to check that the professional services that the public receive are delivered in the most effective way possible and genuinely meet the needs of those whom they serve''.

5.2 The key principles which should underpin inspection are: independence and even-handedness, openness and lay participation. The consultation document ''Inspecting Social Work Services in Scotland'' was published by The Scottish Office in April 1993 and set out proposals for implementing these Charter principles in relation to the work of local authority inspection units. Eighty four responses were received to this document and have been taken into account in this circular.

5.3 In the light of the reorganisation of local government The Scottish Office will not implement major changes in local inspection at this stage. A review will be conducted in 1997.

6. Local Government Reorganisation

6.1 Many local authorities will only be able to allocate a small number of posts to inspection, in some cases one or two people. This is likely to have implications for the effective operation of inspection as units must have sufficient knowledgeable and experienced staff to meet their statutory responsibilities. In many instances it will be sensible for authorities to join together to carry out the inspection function and this approach is recommended. The advantages of one unit serving more than one authority include more cost-effective use of staff, consistency of approaches and standards, more support for staff, the availability of a wider range of skills and knowledge and a capacity to employ inspectors with experience and knowledge across all care groups.

6.2 In very small units inspectors can be drawn into other functions and their objectivity can be more easily compromised. It may be harder to keep at arms-length from service management. In addition staff training and development, which is necessary to ensure a satisfactory service is more difficult to sustain in a smaller unit. The advantages of a joint approach may also be achieved by local authorities and Health Boards combining their staff to work together in a joint unit and progress in this area is recommended.

6.3 If cross-authority arrangements are implemented it will be essential to have a clear reporting line and to make explicit the lines of accountability in respect of the registration function. Management responsibilities and day to day working arrangements will require to be clearly defined and the perspectives of the different authorities taken into account.

7. The Purpose of Inspection

7.1 The main purpose of inspection is to safeguard the well-being and interests of the users through an evaluation of the quality of life experienced by people using the service. This requires that inspectors normally meet service users face to face and discuss their views and feelings about the service. It also aims to promote good practice through examination of the procedures and processes that operate in the establishment as well as judging the resulting outcomes for users.

7.2 Different types of inspection should be carried out during the year depending on the objectives of the particular visit. These include comprehensive announced visits and unannounced inspections which focus on particular aspects of life in the establishment. There must be at least one annual comprehensive overview of the performance of each establishment. The length of inspections will vary according to the complexity and purpose of the inspection and this can range from more than a week to a few hours.

7.3 The circular SW/9/90 indicated that, while it was up to local authorities to determine the number of visits per establishment, 2 inspections per year would be the normal minimum requirement and that 1 of these should be unannounced. Additional visits are made as necessary to investigate concerns, monitor the implementation of urgent recommendations etc.

7.4 Inspection methods include the study of documentation, observation of care practices and interactions between staff and users, paying attention to the health needs of users, interviewing of staff, users and other interested parties e.g. relatives, carers, visiting professionals, and inspection of the physical aspects of the establishment. Most authorities obtain information prior to an inspection through questionnaires completed by managers and users. It is important to collect only necessary and new information which will be added to extant information in order not to impose burdens on those completing the questionnaires.

7.5 The views of users should be a major focus of all inspections. Many different methods can be used to obtain users’ views. Suitable approaches include:

• a preliminary meeting with users to prepare them for the forthcoming inspection, as this will give users an opportunity to clarify the process, and consider what they want to discuss with the inspector on the day of the inspection;

• surveys;

• focus groups of users which meet periodically and with a facilitator to discuss users’ views in some depth;

• detailed one to one interviews;

• involving advocates or even the person who knows the user best, who may be a care worker;

• obeservation, and during different times of the day and week;

• group interviews;

• sharing in users’ activities or outings;

• regular simple and confidential questionnaires;

• involving relatives on a regular basis as agreed with user.

It is also useful to attend users' committees but this should be supplemented by individual interviews. It can also be valuable to include users from other establishments in inspections and to have them seek residents' or members' views.

7.6 The activities and processes of inspection should not discriminate against any user with sensory, intellectual or communication difficulties inhibiting them from making their opinions known. Inspectors should ensure that they facilitate the users' expression of views. Inspectors should also be sensitive to issues concerning race, religion and gender as part of the normal inspection process.

7.7 Inspectors should keep a record of users interviewed and in what circumstances and the report should indicate clearly how many were interviewed.

8. Key Principles of Inspection

8.1 Whichever structure is chosen the key principles which must guide the work of local inspection units are independence and even-handedness, accessible inspection reports, and the involvement of users and lay people.

Independence and Even-handedness

8.2 Circular SW/9/90 ''Organisation and Role of Inspection Units’’ emphasised the need for an even-handed approach to the inspection of homes across all sectors and required that the management of inspection should be entirely separate and at arms-length from the management of the authority's own homes. Local authorities will need to continue to demonstrate that they have managed an effective separation and that inspection units are equally objective in their assessments of the quality of care in both statutory and independent homes. It is also essential that local authorities demonstrate to the general public and to service providers that the same standards are being applied to all places subject to inspection. Open reports, published standards, effective Advisory Committees and informative Annual Reports can all contribute to this.

8.3 From April 1996 local authorities will have a variety of different structures. Some will have Directors of Social Work heading a department; others may choose different management arrangements. All authorities will have Chief Social Work Officers but the role and responsibilities of that person may vary between different authorities. Some inspection units may be set up jointly by more than one authority and will require special management arrangements. Whatever the structure it is important that the inspection unit reports to a Chief Officer and generally this should be the Director of Social Work or the Chief Social Work Officer. It is open to local authorities to vary this arrangement if they wish.

8.4 It is also necessary to ensure that the grading of the Head of Inspection is at a sufficiently senior level to command the respect of senior service managers and council members.

Openness of Inspection Reports

8.5 From April 1996 local authorities must make inspection reports publicly available. The availability of reports will serve to increase the understanding of all who have an interest in the quality of care provided.

8.6 There are a number of audiences for reports - current and potential users of the establishments and their relatives, professionals who require knowledge of the establishments, the general public, local authority members, proprietors, service managers, staff, and advisory committees. Reports should give a clear picture of the quality of care provided in an establishment and the quality of life experienced by users so that it provides useful information for potential users, purchasers and providers alike.

8.7 Users, potential users and their families and friends should have easy access to reports and they need to know how they can get the opportunity to read the reports and receive a copy of the reports. The existence and purpose of inspection reports should be prominently advertised and an up-to-date list of reports should be displayed in public places with details of where reports are available. Reports should then be made available at suitable social work outlets where the interested person can read the report and receive a copy if they wish.

8.8 Summaries of reports can be produced with the aim of reaching a wider audience than full reports, for example, by placing them in public libraries or in a guide to care homes in a particular area. If summaries are prepared for the public it will be important to ensure that this does not result in a watering-down of content. The good aspects of the service as well as the limitations should be described. It will also be necessary to indicate where the full unedited report may be obtained.

8.9 Within the local authority reports should be disseminated down the line of operational management, particularly to care managers and contracts officers who need to keep abreast of conditions in homes.

8.10 Reports should be free from jargon and include comprehensive information on key areas. Fact should be separated from opinion and recommendations from requirements. Timescales should be included. Where charges are made for reports these should be kept to a reasonable level e.g. basic photocopying costs, so that people are not deterred from purchasing them.

8.11 It will be necessary to protect the privacy and confidentiality of residents and to ensure that disclosure of information revealing the location of their home does not threaten their quality of life. It will also be important to protect sensitive commercial information. It will only be in an exceptional circumstance that a report should be withheld from public access and that after legal advice.

8.12 It is a practice for some units to provide guides or profiles on all local homes detailing their facilities and specific features. This is an additional and often useful way of assisting future residents to find homes suitable for their needs as long as it is recognised that guides are limited in the amount of information that it is possible to provide.

8.13 In addition to the written material many potential users and their families may find it useful to speak to the inspectors in order to find out more about homes, particularly in regard to quality of life issues.

Lay Involvement and Advisory Committees

8.14 Authorities should ensure that by October 1996 they have in place Advisory Committees to provide a source of independent advice which will enhance the objectivity of the inspection unit. It is essential that the Committee is seen as strong and independent and that it represents a range of perspectives.

8.15 Annex A of circular SW/9/90 described the intended functions and membership of Advisory Committees. Paragraph 29 of that circular indicated that powers to appoint such committees as sub-committees of the social work committee are provided by Schedule 20 of the Local Government (Scotland) Act 1973. Legal advisers now indicate that this is incorrect. An Advisory Committee should in fact be appointed under section 57 (4) of the 1973 Act. This gives powers to a local authority to appoint a committee to advise the appointing authority on any matter relating to the discharge of their functions. Such committees can include persons whether or not they are members of the appointing authority.

8.16 Advisory Committees should include local authority members, service providers, service users and representatives of interested bodies. The combined numbers of local authority members and officers and voluntary and private providers should be no more than half of the total numbers. There should be an emphasis on having a high percentage of users who may be assisted by advocates as well as relatives, carers and representatives of users. Members of the committee should choose their own chairperson, for a fixed term, and this may be from the non-local authority members of the group as well as from council members. Advisory committees must meet at least twice a year and more often is desirable.

8.17 It is for the authority to decide on the exact terms of reference of the committee but the remit should include a consideration of inspection reports; discussion of the standards applied in inspection; commenting on the even-handedness of the unit's methods and the responses of the local authority and voluntary and private sector providers to inspection reports; making a contribution to the Annual Report; and making proposals to improve the unit's effectiveness.

8.18 Every effort should be made to enable users and others to participate as fully as possible. This can be facilitated by involving advocates, providing training in specific areas, holding pre-meetings or subgroups, and ensuring users are aware how they can claim expenses. It will be important to ensure that the committee is not too large as this will hinder effective discussion. Consideration should also be given to including lay members of the committee, such as service users, their representatives and carers and relatives, in inspection visits where their experience and insight can add value to the assessment. Where this happens it is essential that guidance and support are provided to the lay members.

9. Annual Reports

9.1 An annual written report must be provided by the Chief Officer to whom the Inspection Unit reports. This report on the work of the Inspection Unit should be presented to the relevant local authority committee. The report must be published and should be circulated widely.

9.2 At present a variety of formats are being used for Annual Reports, from lively newsletter style containing little detail or analysis to reports which are very detailed and informative but which require more imaginative presentation. It is important that authorities review their annual reports so that they reflect the essential principles of openness and even-handedness.

9.3 The annual report provides an important opportunity for the local authority to demonstrate the effectiveness of local inspection. Reports should be comprehensive and easy to read.

9.4 The minimum contents, as outlined in earlier guidance, are as follows :-

· description of the unit's work over the previous 12 months

· assessment of the unit's performance

· summary of the findings of inspections

· summary of action taken and action not taken

· detail of the numbers and types of homes visited

· frequency of visits

· details of staffing and training provided

· patterns and trends from inspections, and workload indicators

In addition these reports should describe

• the standards achieved by all sectors

· the methods of inspection

· the degree to which the service user had been involved in the inspection process

· arrangements to ensure the independence of the unit

· methods used to publicise reports and details of the take-up of reports

• the mechanisms implemented by the local authority to ensure effective follow up

action to reports on its own homes

· monitoring arrangements.

9.5 In the event of the recommended minimum two inspections of homes per year not being achieved the report should provide an explanation for this and an action plan to rectify this.

9.6 The report should be presented in draft form to the Advisory Committee and their comments and views recorded in the report before it goes to the committee dealing with social work matters.

9.7 The report should be circulated to all organisations and groups with a relevant interest and publicity given so that the general public is aware of its existence. A copy should be sent to the Social Work Services Inspectorate.

10. Follow up to Inspection Reports by Local Authorities

10.1 It is essential that local authorities demonstrate that they are being even-handed and committed to act on inspection recommendations about their own homes and other establishments. The guidance issued in 1991 ("Inspection Units: Establishing Good Practice") made clear the need for the follow-up to inspection reports to be the same for all sectors in order to demonstrate an open and fair approach to all providers of care.

10.2 Local Authorities should have guidelines regarding the follow-up to inspection reports about their own establishments. These should make clear who is responsible for implementing recommendations and the time limits on follow-up action. They should state who will monitor the response and that it will be reported in writing to the Director of Social Work or the Chief Social Work Officer if the response is not adequate. A similar system must be in place for the independent sector.

11. Inspection Standards

11.1 The Citizen's Charter states that ''the citizen must be told what service standards are and to be able to act where service is unacceptable....''. It also specifies that standards should be realistic, attainable, challenging and reflecting users' needs; in addition they should be regularly monitored and published, and progressively raised.

11.2 The responsibility for setting inspection standards lies with the local authority and not the Inspection Unit. The standards should be produced in consultation with all the key bodies and individuals who will be affected by them. Local authorities should make known these standards and should set out in detail what Inspectors will be looking for.

11.3 The standards should look particularly at the desired quality of life required in all residential homes and other establishments. There is significant material available on quality of life including national reports, research findings, published literature and local policy and practice. Standards are usually derived from a combination of these and they should be determined with reference to the resources available to achieve service improvements.

11.4 A great deal of progress has been made in relation to standard-setting and local authorities should share their achievements in this area with a view to developing a national framework. This would be helpful to small local authorities in particular and would provide users, carers and providers with a more consistent picture of local authority requirements and expectations. Some authorities are reviewing their standards in the light of experience and are involving users, carers and professional staff in this process.

11.5 Standard-setting and the monitoring of standards should not become mechanistic and inflexible and concentrate solely on the measurable. It should not be automatically assumed that quality of life will be determined by the application of criteria such as the size of the establishment or the qualifications of staff. Good homes may be of varying sizes. A wide range of qualifications and experience may equip managers to be fit to run a home. The fitness of each home and each manager should be assessed in its particular circumstances. An evaluation of the quality of life should take into account the total service provided, its responsiveness to individual users’ wishes and the meaning of the outcomes for users. It is also essential to co-operate with other regulatory or standard-setting bodies such as Building Control, Planning, Environmental Health and Fire Departments so that each is aware of the other's expectations and of the need to deliver a service sensitive to the user's needs.

11.6 In addition to inspection standards the local authority is also responsible for setting registration standards and standards for contracting purposes. Contracting, inspection and registration have different purposes and it is important that providers, users and the general public are not confused about the respective functions and roles. Too close a relationship between the management of contracts and inspection and registration risks compromising the objectivity of the inspection and registration functions. There will, however, need to be good communication between the Inspection Unit and contracts staff as both are concerned with the quality of establishments and can employ sanctions if quality standards are not being met. They will need to exchange information on, for example, new contracts, inspection reports, complaints about establishments.

12. Links with Health Board Inspection Units

12.1 Most Inspection Units have developed working relationships with Health Board Inspection Units. Many have regular meetings. Some are trying to agree joint registration guidelines while allowing for the difference in legislation and care requirements. Others are developing common standards of care for both residential care homes and nursing homes. In a few areas health and social work inspectors are doing joint visits in order to draw on different skills and contributions are made to each others inspection reports.

12.2 Some authorities are exploring the possibility of combining their inspectors into a joint unit. This will be particularly appropriate in areas where the Health Board and local authority are co-terminous and may also be sensible if a number of local authorities combine to take a joint approach to inspection.

12.3 It is essential that close working relationships are developed between local authority and health board inspectorates and that there is a regular exchange of relevant information. There should be a common agreement on the key elements of good standards of care and there should be common approaches to inspection. There is merit in sharing training and there may be opportunities to have joint projects e.g. researching relevant areas.

13. Contact Point

Enquiries about this circular may be addressed to Mrs Jean MacLellan, Social Work Services Inspectorate, James Craig Walk, Edinburgh EH1 3BA, telephone 0131 244 3617. [ To holders of the SWSG Circulars and Guidance Package :- This circular should be placed in Section F.18 of the volume containing "F. Community Care (sections 11-20)" circulars.]

Yours Faithfully

ANGUS SKINNER

Chief Inspector