The Care Standards Act was passed 7 years ago and is something that all care professionals should be familiar with and, whilst standards have improved, some care homes are still not meeting the standards initially hoped for. This article aims to help care home managers and owners to consider whether the Act is applicable to them, what should be done to comply with it , and what to consider when making alterations or looking to acquire a new property.


The Purpose of the Act

The Care Standards Act 2000 (the Act) established the National Care Standards Commission, to make provision for the registration and regulation of care homes, independent hospitals, independent clinics, residential family centres, care agencies and nursing agencies.

Classification of a care home

For the purposes of the Act, an establishment is classed as a care home if it provides accommodation together with nursing or personal care for the following class of people:

• those who are or have been ill.
• those who have or have had a mental disorder.
• those who are disabled or infirm.
• those who are or have been dependent on alcohol or drugs.

However, it is not a care home if it is:

• a hospital
• an independent clinic
• a children's home or
• is excepted by the Care Homes Regulations 2001 (these exceptions are beyond the scope of this article).

Registration authorities

The requirements of the Act are assessed and effectively policed by the Commission for Social Care Inspection (CSCI). It is their duty to keep the Secretary of State informed about the provision of registered social care services and the availability and quality of these services. To do so they make information about the services available to the public and give advice and information to the Secretary of State.

Regulations and standards

The Act provides that regulations may be made to regulate the fitness of premises to be used as a care home as well as in relation to the fitness of the individuals managing and working at the home.

Fitness of Premises under the Care Homes Regulations 2001 ("the Regulations")

The Regulations provide that a registered person shall not use any premises for a care home unless:

• the premises are suitable for the purpose of achieving the aims and objectives set out in a statement of purpose;
• the location of the premises is appropriate to the needs of service users.

The registered person

The registered person should ensure that:

1. the design and layout of the premises meets the needs of the service users;
2. the premises are of sound construction and kept in a good state of repair externally and internally;
3. equipment is maintained in good working order;
4. all parts of the care home are kept clean and reasonably decorated;
5. adequate private and communal accommodation is provided;
6. the size and layout of the rooms are suitable for their use;
7. there is adequate sitting and dining space;
8. the communal space provided is suitable for the provision of social, cultural and religious activities;
9. suitable facilities are provided to meet visitors in communal accommodation and in private accommodation, separate from bedrooms;
10. there are appropriate numbers of lavatories and washing facilities with hot and cold water;
11. sluice facilities are provided if necessary;
12. suitable storage is available for the service users and the care home;
13. suitable adaptation is made for service users who are old, infirm or physically disabled;
14. external grounds are suitable for and safe for use by the service users;
15. ventilation, heating and lighting is suitable.

These regulations are all subjective and mean that each home can be judged on its own merits. In running your own home, you will know whether these standards are being met. When viewing a prospective home to be bought however, it is sensible to use this check list.

Making alterations

Planning permission

Before any alterations are made to the premises, you should check that the Local Authority's consent is obtained. This should be in the form of planning permission and when applying for planning permission, assistance may be sought from your architect or contractor. You should ensure that any planning permissions do not contain terms or conditions which adversely affect the use of the extension or alteration. Conditions may be imposed on a planning permission such as the hours of use and where access may be obtained. You will also need building regulation consent before starting work.

Completing work

A Completion Certificate must be obtained when the works are completed. If these are not obtained the local authority can take enforcement action and potentially require the works to be amended.

When asking a contractor to do works for you, as much detail as possible should be included in the contract to do the works. This means if works are not completed to a satisfactory standard as you thought you had agreed, you have evidence of this. The quality of the construction depends on three main areas:

1. the architect designing the drawings correctly.
2. the structural engineer specifying the materials to construct the building correctly.
3. the contractor following the architect and structural engineer's instructions and using good quality materials.

If a design and build contract is entered into with the contractor he will take responsibility for all of these elements.

Water and drainage search

You cannot construct a property over an adopted main drain or sewer without the consent of the statutory authority. This is given in the form of a build over agreement. This can be difficult to be obtain and usually you cannot build within 3 metres of a drain to ensure that the drain can be accessed for repair and maintenance. Each situation may differ and it is always advisable to talk to the appropriate water authority.

Ground conditions

Contractor's advice should be taken as to the stability of the ground. In particular, if mining operations used to take place in the area then subsidence may be an issue and your contractor's advice should be taken as to the form of foundations to be laid.

A solicitor can conduct a mining search which should reveal any previous subsidence claims and show previous coal seams and mine shafts. The report will confirm if ground movement is likely to have ceased.

A desktop environmental survey can also be done to check previous uses of the property and other industrial uses in the area.

Official title of the property

You should ensure that there are no issues in relation to ownership of the land that is being built upon. The title may also contain restrictions as to the use of the property, for example it may specifically state on the title that the area should only be used for car parking. In such a case indemnity insurance or a deed of release may need to be entered into to ensure that you can construct an extension on the land. If this matter is not addressed, a third party may object to the fact the property is not being used as a car park, seek an injunction and stop the extension being used.

This is a worst case scenario as significant money would have been spent on obtaining the planning consent and building the extension. You should also ensure that services can be taken to supply the extension from existing supplies.

Buying a property with an extension

When buying a property that has an existing extension, many of the considerations discussed above will apply, and include the following:

1. Checking the local authority search to ensure that the planning consent has been obtained for the property, that the number of bedrooms reflects the number of rooms that were constructed and that consent was obtained for any additions that have been made. Building regulations consent is also required. Completion Certificates should be checked to ensure that the property has been constructed soundly.
   
   If such works have been done within the last 12 years, thought should also be given as to whether warranties are available from the construction team which constructed the property
   
   
2. Drainage Search - to check that no mains drains or sewers have been constructed over without consent.
   
   
3. Any ground investigation report, mining search and environmental search should be checked to ensure that ground stability is not an issue
   
   
4. Title should be checked to make sure that there are no restrictions on the title that prohibit the use of the property.

Conclusion

It is important for care homes to ensure that their construction complies with the Care Standards Act 2000.The requirements of the Act are policed by CSCI which is able to make information about care homes available to the public.

The registered person at a care home has a number of responsibilities in terms of ensuring that the home meets the regulations of the Act, though the requirements are individual to each home.

When planning an alteration to a premises, or buying a home that has had alterations made, it is crucial that the correct permission has been granted and that other searches including a water and drainage search have been made and are satisfactory. It is important for the registered person to ensure that building construction complies to CSCI and the Care Standards Act 2000 to avoid problems with CSCI or with a third party who may contest the building work.

A version of this article, written by Sarah Temple, first appeared in "Nursing and Residential Care", November 2007, Vol 9, No 11.

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