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Improvements to health authority registration, inspection and compliance units for nursing homes are urgently required to ensure that the services are safe, a review has found.

Some of the current procedural arrangements are haphazard and fail to adequately protect residents, says the review based on standards used for social services inspections.

"In most units, safeguarding of patients through ensuring that appropriate standards were met had been inconsistent and sometimes poor," it adds.

The review was carried out by the Social Services Inspectorate (SSI) assisted by nursing inspector managers. It used social services standards adapted for health authority units.

The review found that overall management procedures were not coherently managed in five of the six units.

Inspectors focused on the responsibilities for nursing homes providing care for ill, frail and disabled people and for mental nursing homes for people with a mental disorder. The authorities inspected were Avon, Dorset, Enfield, Haringey, Kent and Liverpool.

Registration of nursing home providers was described as "significantly flawed" at most units and there were some "critical gaps" in vetting checks on applicants.

This meant there were questions over whether some homes had always been legally registered and if units were always clear about the current status of all homes.

"There was a general need for units to ensure that the full range of vetting checks on staff caring for children and on agency nurses had been carried out," said the review.

Units usually met the required statutory minimum frequency for inspections and they sometimes visited outside normal office hours, but not at weekends. But units lacked policies and procedures for follow-up and enforcement of requirements.

The SSI said procedures at health authority registration units must improve before the National Care Standards Commission (NCSC) assumes responsibility for both social services and nursing home inspections and registrations in April next year.

Staff from the inspection units at local authority social services departments and health authorities will join the new standards commission.

Averil Knottage, deputy chief inspector of the SSI, said the report was generally positive about the professional judgments made in the health authority units but was concerned that some of the systems were not operating properly.

Social services registration units had faced similar criticism when they were first inspected eight years ago but many of the problems had been resolved following guidance from SSI.

"There are some things that must be done by March such as getting records straight and making sure that checks are done systematically to ensure they are able to transfer the NCSC on a safe basis," said Ms Knottage.

"It will be much easier if the people working with the records now can make sure they are in good order so that the status of the homes will be clear to the new commission."