The Commission for Social Care Inspection (CSCI) is responsible for all aspects of regulation and inspection of care homes in England, including those providing nursing care. CSCI employs inspectors with a range of professional skills for dealing with a mixed caseload, including approximately 300 inspectors who are registered nurses. Where possible, CSCI will assign inspectors with a nursing background to inspect nursing homes.
CSCI expects non-nurse inspectors to discuss any clinical issues arising at inspection with nursing colleagues in their team. As part of this process, CSCI has good practice guidance, known as “clinical triggers”, for inspectors in respect of several areas such as nutrition, continence management and medication. These triggers alert inspectors as to when it would be appropriate to instruct the service provider to contact local health services to arrange specialist nursing assessment for a resident or, to seek advice from a clinical colleague within CSCI to ascertain whether enforcement action may be necessary.
CSCI has a source of specialist nursing advice in its Head of Health Policy and Quality. CSCI also has a head pharmacist; where there are concerns around medication, a pharmacist inspector will inspect the service. All inspectors receive training in all methodologies and tools.
The Commission for Social Care Inspection (CSCI) is responsible, under the Care Standards Act 2000 and associated Regulations, for all aspects of regulation and inspection of care homes providing nursing care.
Up until April 2005, all care and nursing homes were required to be inspected twice yearly. From April 2005, CSCI's inspectors started using new ways of inspecting social care providers, based on the aims set out in the consultation document, “Inspecting for Better Lives”. The new inspection methodology is designed to place the people who use social care services and their experiences at the heart of the way CSCI inspects and regulates care services.
From April 2005, CSCI has carried out key inspections for care and nursing homes at a frequency determined by the quality of the service. A key inspection is a thorough, detailed inspection, under which CSCI will assess all of the key national minimum standards. For example, a “poor” quality service will receive a minimum of two key inspections a year, an “adequate” service will receive a minimum of one key inspection a year, a “good” service will receive a minimum of one key inspection every two years, and an “excellent” service will receive a key inspection a minimum of once every three years.
CSCI also carries out “random” and “thematic” inspections, which are short, focused inspections on a specific theme or area.
The Healthcare Commission is responsible for inspecting hospitals. The Healthcare Commission checks annually that core standards are in place across each national health service trust. If inspected, a trust is required to provide evidence that standards are in place in each part of the organisation. This includes wards for older patients. About 20 per cent. of trusts are selected for a core standards inspection each year.
In addition, in February 2007, the Healthcare Commission carried out a more in-depth review of dignity and care arrangements for older patients in hospital. Twenty-three hospitals were visited and a range of observations and interviews of ward staff were undertaken. The report of the findings can be found on the Healthcare Commission website at:
www.healthcarecommission.org.uk.