Care and Social Services Inspectorate Wales (CSSIW) Supporting the improvement of social care, child care and social services in Wales

Deliver efficient, effective regulation and inspection of social care services. Improve care, services and outcomes for people. Provide independent assurance about the quality and availability of social care in Wales. Safeguard adults and children, making sure that their rights are protected. Provide advice to inform the development of policy and service improvement to meet people’s needs. Work with other public service audit, regulation and inspection bodies, including workforce regulators, across the UK to support effective scrutiny of public services. Our role:

Register, regulate and inspect regulated care settings – over 6000 settings Produce inspection reports – at least 4000 inspections each year. Respond to concerns from the public, service users, relatives or professionals about care settings. Take enforcement action when we find poor care. Inspect and report on the work of local authority social services. Review local authority social services performance. Engage with local authorities. Engage with providers and service user groups (National Advisory Board and regional boards Provide information and advice to ministers. What we do:

Inspect and review local authority social services functions to see how they: Meet the needs of people, improve their quality of life and promote their rights and well-being; –protect adults and children who are at risk of harm, neglect or abuse, and –improve the way social services are delivered. Evaluation of the performance of social services informed by: –a self-assessment of services completed by the directors of social services, –performance data, and –regular engagement meetings with senior managers to discuss progress and service developments. Local authority social services

We also carry out a range of activities including: –national and thematic reviews; –focused local authority inspections and improvement activity in response to specific issues arising, i.e. risk and intelligence led, and When serious failings are identified we put in place our serious concerns protocol which involves regular monitoring, visits and inspections to the authority in question to work with them to make the necessary improvements. Emphasis is on outcomes for people. Local authority social services

We register regulated services to ensure that only people and organisations who will provide a safe and high quality service are registered. We undertake an inspection programme and produce inspection reports which set out the quality of care in regulated settings. Respond to concerns from the public, service users, relatives or professionals about care settings. Take enforcement action when services do not adhere to regulations/deliver poor care – civil and criminal enforcement. Regulation and inspection of care services

Our approach to regulatory inspection Unannounced Greater emphasis placed on outcomes and people’s experiences of care - use of SOFI 2 Baseline and focused Inspections. Frequency of Inspections. Focus on four themes: –Quality of life –Quality of staff –Quality of leadership and management –Quality of environment

Registration We registered 407 new services; processed 58 applications which were either refused or withdrawn; closed or deregistered 459 services. Inspection We completed 4,416 inspections; 304 inspections in response to concerns from others exceeding our inspection programme for regulated services by 7.4%; carried out 319 inspections that included two or more inspectors 197 inspections were outside normal office working hours, with 20 of these at weekends. Improving regulated care Our work

enforcement Qualit y of leader ship and mana gemen t Quality of life Quality of staffing Quality of environment Undetermined Total 14/15 Total 13/14 Adult residential Domiciliary care Nurses agency1 1 Qualit y of leader ship and mana gemen t Quality of life Quality of staffing Quality of environment Undetermined Total 14/15 Total 13/14 Adult residential Domiciliary care Nurses agency1 1 Enforcement and service improvement Inspection: Highlighting good practice Identifying areas for improvement Identifying non compliance with regulation Publicly available reports include non compliance notices Open reporting process-transparency and openness to challenge

enforcement Qualit y of leader ship and mana gemen t Quality of life Quality of staffing Quality of environment Undetermined Total 14/15 Total 13/14 Adult residential Domiciliary care Nurses agency1 1 Qualit y of leader ship and mana gemen t Quality of life Quality of staffing Quality of environment Undetermined Total 14/15 Total 13/14 Adult residential Domiciliary care Nurses agency1 1 Enforcement and service improvement Quality of leadership and management Quality of life Quality of staffing Quality of environment Undetermi ned Total 14/15 Total 13/14 Adult residential Domiciliary care Nurses agency1 1

Enforcement and service improvement Enforcement pathway: defined process where there is significant serious non compliance or continued non compliance Service of concern: register of services where there are significant failings which impact on vulnerable persons Commenced with 26 SOC with further 52 identified Action concluded in 57 of these services 20 services subsequently became compliant with regulations and achieved improvement following action taken by us. 11 services had their registration cancelled by us. 10 services voluntarily cancelled their registration 5 related to unregistered services, of which two registered and became compliant.

We actively encourage people to raise concerns with us and where appropriate take prompt action to: –refer safeguarding concerns to the local authority’s safeguarding team, and/or –undertake an inspection if there are concerns about people’s welfare. We have seen a significant increase in the number of concerns being referred to us largely from people who visit or use regulated services Responding to concerns: using information from people

2012/132013/142014/15 Total number of concerns 1,0852,1702,870 Adult services1,8532,446 Responding to concerns: using information from people In as a result of concerns raised, we carried out an additional 304 inspections largely in adult care homes.

Safeguarding: the role of the regulator Integral to CSSIW’s role: Safe and robust registration process Inspection- opportunity for early identification of risks and failings Concerns- referral through formal safeguarding processes Considerations: Could this affect provision of care to individuals? Is there potential breach of regulation? Focussed inspection Pathways: civil (urgent and ordinary)/ criminal …different burdens of proof, public interest test. Problems of demonstrating a breach. Undermined by improvement and support activity by LA/ LHB

Safeguarding: the role of the regulator Five dilemmas: When is enough enough. Should we allow providers time to improve/ if so how long? How much should we be constrained by the needs and impact of those currently in placement? Given the resources is it ever in the public interest for CSSIW to pursue prosecution? Primacy; When does the regulator put the interests of public safety above the need to pursue a prosecution How do we empower, involve and inform families and users in the process? Enforcement pathway to ensure clear process for decision making

Next steps: The future of regulation Legislation and our work: Well-being of Future Generations (Wales) Act 2015 Social Services and Well-being (Wales) Act 2014 Public Health (Wales) Bill More than Just Words strategy for strengthening the Welsh Language Human Rights Regulation and Inspection of Social Care (Wales) Act 2016 Implementation timetable Workforce regulation – April 2017 Service regulation and inspection – April 2018 with full implementation by April 2019

HIW WAO ESTYN LAs Sector Inspections Greater Accountability Improvement notices Market Oversight Fit & Proper test Penalties & Offences Annual Reporting WELLBEING OUTCOMES FOR PEOPLE