3.1 Residential homes are expected to provide the level of care one would expect from a competent and caring relative - covering, for example, security and the provision of such day-to-day services as laundry and meals, as well as the stimulation of company, encouraging individuals to remain as alert and independent as possible. Residents may require assistance with some aspects of personal care. Nursing homes cater for more dependent older people requiring nursing care. In nursing homes there will always be a qualified nurse on duty and 24-hour nursing care is provided.

3.2 Residential homes are run by local authorities, by voluntary organisations (registered charities or religious bodies), or privately, by individuals or companies on a commercial basis. Nursing homes are usually run privately or by voluntary organisations. Homes that are run by voluntary organisations may have special rules about whom they can admit. In some areas there are homes especially for people who have served in the armed forces, or for people from particular ethnic groups or religions.

3.4 The primary legislation relating to nursing homes and residential care homes is the Registered Homes Act 1984. Under the Act, the providers of nursing homes and of residential care homes in the private and voluntary sectors must be registered. Although directly managed local authority residential homes for adults do not fall within the scope of the Act, they do have to be regularly inspected. Residential care homes are monitored by inspection units within local authority social services departments, while nursing homes are monitored by inspectors of the relevant health authority. Failure to register with the appropriate local or health authority is a criminal offence.

3.5 Different criteria apply to residential homes and to nursing homes: consequently those registering such accommodation need to define the services that they offer to ensure they register correctly. Care-home owners can ‘dual-register’ their homes, making it possible for them to provide both categories of care. Such homes will be registered with both the local authority and the health authority. The Registered Homes (Amendment) Act 1991 removed a previous exemption from the registration requirements for ‘small homes’ - those providing residential care for fewer than four people.

3.6 Social services inspectorates are constituted under the auspices of local authorities, while health authorities appoint officers to inspect nursing homes. In some areas there are joint inspection units, covering both residential homes and nursing homes. Elsewhere, health and local authorities have less formal arrangements but do liaise closely. The legislation requires that the registering authority inspects each home - except small residential care homes - at least twice a year. One of these inspections should be unannounced. Nevertheless, inspectors are authorised to enter homes unannounced at any other time, day or night. Inspections are also carried out by health and safety inspectorates, environmental health officers, and fire brigades in respect of their specific duties.

3.7 The National Health Service and Community Care Act 1990 requires that local authorities inspect (but not register) their own in-house residential care provision on an even-handed basis with provision in the private and voluntary sector. Local authorities are required to make their inspection reports openly available and to make arrangements to ensure that any requirements and recommendations made in the reports are carried out. In addition they have to set up advisory panels and include lay assessors in inspections.

3.8 The registration and inspection of both residential homes and nursing homes in Northern Ireland is governed by the Registered Homes (Northern Ireland) Order 1992 and associated regulations. Many of the provisions of this Order are similar to the regulations which apply to England and Wales. Residential homes must be registered, as must nursing homes in the private and voluntary sectors. While homes provided by Health and Social Services Trusts do not require to be registered, they are expected to provide the same standards of accommodation and care as those in the independent sector. In appropriate circumstances, individual homes can be registered as both residential care homes and nursing homes. Statutory regulations on how a home should be run are supplemented by guides to developing good practice.

3.9 In Northern Ireland the organisational structure for health and social services differs from that elsewhere in the United Kingdom, with local and health authority functions carried out by four health and social services boards. Authorised personnel of the boards or the Department of Health and Social Services have the right of entry to inspect homes at all times. Each board is required to inspect every registered home in its area at least twice a year. But this is regarded as a minimum requirement and the boards are encouraged to carry out inspections more frequently if the situation in a particular home appears to warrant it. To register and inspect residential care homes and nursing homes (and also children’s homes) every board has its own integrated registration and inspection unit, with staff drawn from both nursing and social work backgrounds. Each unit operates at arms’ length from the day-to-day management of its parent board, reporting directly to the board’s Chief Executive, and producing its own annual report. The inspection units include lay assessors. A circular from the Department of Health and Social Services in Northern Ireland requires that, as in England and Wales, inspection reports are open to the public and that follow-up arrangements are made to address action points from inspections. Practice guidance was issued by the Social Services Inspectorate in 1994.

3.10 The primary legislation governing the inspection of all nursing homes in Scotland is the Nursing Homes Registration (Scotland) Act 1938. Secondary Regulations from 1990, 1991, 1992, and 1998 are also relevant. The Act requires each Health Board to inspect all nursing homes in its area at least twice a year - but there is no upper limit. All nursing homes in Scotland must comply with certain ‘core standards’ that were published in 1997.

3.11 The primary legislation governing the registration of residential care in Scotland is the Social Work (Scotland) Act 1968, as amended by the Registered Establishments (Scotland) Acts of 1987 and 1995. Under the legislation, ‘any establishment controlled by a government department or by a local authority’ is excluded from the need for registration. With the transfer of all NHS hospitals - bar one - to NHS Trusts, this category has diminished. In addition, some local authorities are currently in the process of transferring their homes to the private sector - so that they will no longer be exempt from registration. Pending the introduction of new legislation, authorities have been directed by the Scottish Office to treat their own direct provision, as far as possible, in the same way as the independent sector. The National Health Service and Community Care Act 1990 applies in Scotland and introduced the requirement for local authorities to establish arms’-length inspection services. Many authorities integrated their registration responsibilities with these services. No specific provision needed to be made for small homes as residential care for even one person had previously been possible. Although there is provision for ‘joint’ registration of homes providing both residential and nursing care (known as ‘dual’ registration elsewhere in the United Kingdom), the owners of such homes have to pay two sets of registration fees and are required to achieve the standard of care appropriate to each service.

3.12 Nursing home registration and inspection teams throughout Scotland have to apply the criteria set out in the core standards issued by the Scottish Office (see paragraph 3.10).The procedures for residential care homes were reviewed in 1996. One of the recommendations made was that nationally recommended guidelines and quality-of care standards should be produced, and the Scottish Office is setting up a National Consultative Committee to take that recommendation and related issues forward.

3.13 While checking that homes meet the demands of the statutory regulations, inspectors in all parts of the United Kingdom increasingly seek to ensure that they comply with standards of good practice beyond these basic requirements. The OFT has seen a number of specimen inspection guidelines that have been issued by local authorities in England and Wales, and which indicate that inspectors look into a very wide range of matters. These include: the facilities offered by individual homes; occupancy rates; charges; the availability of descriptive brochures; complaints procedures; catering; staffing; health and safety; management records; access to, and recording of, medication; records of residents’ money held; arrangements for safeguarding residents’ valuables; access to telephones and a private place; care plans; and leisure activities. The inspection process also includes discussions with residents.

3.14 The Residential Care Homes Regulations 1984 require that home owners inform every resident, in writing, of the person to whom, and the manner in which, they should make any request or complaint that relates to the home. Home owners must also ensure that any complaint made by a resident, or a person acting on their behalf, is fully investigated. In addition, they must tell every resident, in writing, of the name and address of the registration authority to whom complaints about the home can be made. The Nursing Homes and Mental Nursing Homes Regulations 1984 provide no equivalent requirement to provide nursing-home residents with similar information. Nevertheless, those in nursing-home care in Scotland, whose care is paid for in full by the NHS, do have access to the NHS complaints procedure.