Move to snap inspections as the onus is placed on users’ views

A volunteer with a service that gives breaks to informal carers
has to send out for a neighbour to take her charge to the toilet
because she is not registered as a personal care provider.

Is this regulatory correctness gone mad? The Commission for Social
Care Inspection’s chief inspector David Behan believes so. “It
strikes me as barmy,” he says.

Cases like this explain why the inspectorate plans a radical review
of its inspection, regulation and registration regimes, which it
set out in a consultation paper this week.

Within three years, the CSCI aims to transform the way it carries
out inspections, giving less attention to care providers’ policies
on paper and more to the experiences of service users.

More time is to be devoted to stamping out bad practice. To help,
the CSCI proposes recruiting paid informants, from mystery shoppers
who pose as prospective customers to hairdressers and podiatrists
who visit care homes regularly.

“We are clear we are not going to be able to deliver our vision and
values by tinkering – we needed to hold a radical review,” says
Behan.

“People who are using services tell us they want inspectors to
visit more often and unannounced. Just because inspectors are known
to be coming, children in residential care don’t want the meals to
suddenly improve, and older people don’t want flowers
introduced.”

By cutting back on announced inspections, the CSCI hopes to spring
more unannounced visits on providers it regards as high risk. That
means fewer visits to care homes regarded on past form to be of
good quality.

Inspectors would spend less time “ticking boxes” and more on
interviewing service users, while self-assessment would replace
many of the paperwork checks. Behan hopes that the changes will
free up 20 to 25 per cent more time to focus on taking enforcement
action against bad providers.

To this end they also need to get more sources of intelligence.
This is where the mystery shoppers come in. “We have closed six
homes this year on emergency orders,” says Behan. “A lot of our
enforcement action is taken on the back of complaints and
whistleblowing.

“If we get a complaint, one way to check the quality is to get a
trained person to visit saying they are looking to place their
elderly mother there. Mystery shoppers are used a lot in the retail
industry.”

Behan adds: “Where I came from, Blackburn, we had a view about what
is a good pub, what is a good care home. We need to tap into that
community knowledge. But it’s not about replacing our
judgement.”

As residential care gives way to home-based services and local
authorities devise or commission innovative services that cross
service boundaries, the CSCI is increasingly aware that its
registration categories are becoming outdated.

A particular issue is that there is no distinction made between
paid workers and volunteers.

“A number of sitting services have stopped operating because they
don’t want to be registered to provide personal care,” says Behan.
“Many sitters are volunteers in their sixties, who have had
criminal record checks and some training, but don’t want to become
paid carers or take NVQ2 in social care. It strikes me as barmy
that they are not able to provide that support and care.”

The CSCI also wants to do away with unnecessary repeats of “fit
person” interviews every time a manager switches roles, develops a
new service or opens a new branch.

It aims to develop a set of regulations and standards based on what
clients want from a service, such as choice, independence,
consistent and competent services and safety.

The growth in commissioned services and direct payments has left
many people not knowing where to complain to, so the CSCI still has
a long way to go to raise its profile.

“It’s important that people know who we are and what we stand for,
that they know they have some redress and there’s somebody on their
side,” says Behan.

Inspecting for Better Lives: Modernising the Regulation
of Social Care, CSCI consultation document, 2005-8. Available from
www.csci.org.uk