SCHEDULE 1INFORMATION TO BE INCLUDED IN THE STATEMENT OF PURPOSE
I11
A statement of the overall aims and objectives of the adult placement agency.
I22
The name and address of the registered provider and of any registered manager.
I33
If the registered provider is not an organisation, his relevant qualifications and experience.
I44
If the registered provider is an organisation the name and address and qualifications and experience of the responsible individual.
I55
The relevant qualifications and experience of any registered manager.
I66
The number, relevant qualifications and experience of the staff working for the purposes of the agency.
I77
The status, constitution and organisational structure of the agency, which identify the lines of accountability, specific roles and responsibilities for areas of activity.
I88
The age-range and sex of the service users in respect of whom the agency may make placements.
I99
The range of needs that the agency is intended to meet through the making of placements.
I1010
The arrangements made for consultation with service users about the operation of the agency.
I1111
The arrangements made for contact between placements and their relatives, friends, representatives and the local community where practicable.
I1212
The arrangements for dealing with complaints.
I1313
The arrangements made for dealing with reviews of the service users plan referred to in regulation 19.
SCHEDULE 2INFORMATION AND DOCUMENTS IN RESPECT OF PERSONS CARRYING ON, MANAGING OR WORKING FOR THE PURPOSES OF AN ADULT PLACEMENT AGENCY [EXCLUDING ADULT PLACEMENT CARERS]
I141
Proof of the person’s identity, including a recent photograph.
I152
When Part V of the Police Act 1997 is commenced in Northern Ireland, either—
a
where a certificate is required for a purpose which is prescribed by regulations under section 113B of the Police Act 1997 an enhanced criminal record certificate issued under that section; or
b
in any other case, a criminal record certificate issued under section 113A of that Act .
I163
Two written references relating to the person, including a reference from the person’s present or most recent employer, if any.
I174
Where a person has previously worked in a position whose duties involved work with children or vulnerable adults, so far as is reasonably practicable, verification of the reason why the employment or position ended.
I185
Documentary evidence of any relevant qualifications or accredited training of the person and if applicable, registration with an appropriate professional regulatory body.
I196
A full employment history, together with a satisfactory written explanation of any gaps in employment.
I207
Evidence that the person is physically and mentally fit for the purposes of the work which he is to perform or, where it is impracticable for the person to obtain such evidence, a declaration signed by the person that he is so fit.
SCHEDULE 3INFORMATION AND DOCUMENTS IN RESPECT OF ADULT PLACEMENT CARERS
I211
Proof of the person’s identity, including a recent photograph.
I222
When Part V of the Police Act 1997 is commenced in Northern Ireland either—
a
where a certificate is required for a purpose which is prescribed by regulations under section 113B the Police Act 1997, an enhanced criminal record certificate issued under that section; or
b
in any other case, a criminal record certificate issued under section 113A of that Act.
I233
Two written personal references from persons (not being relatives of the adult placement carer) who have known the adult placement carer for at least 2 years.
I244
A written reference from the person’s present or most recent employer if any.
I255
Details of health record.
I266
Details of a check with the HSS trust in whose area the adult placement carer resides.
I277
Where a person has previously worked in a position whose duties involved work with children or vulnerable adults, so far as reasonably practicable, verification of the reason why the position ended.
I288
Documentary evidence of any relevant qualification, including where appropriate a valid driving licence.
I299
A full employment history, together with a satisfactory written explanation of any gaps in employment.
I3010
A letter from a mortgage lender or landlord (as the case may be) confirming—
a
that the adult placement carer has sought and obtained permission to undertake placements where such permission is required by the terms of any mortgage, lease or tenancy agreement; and
b
that the adult placement carer is not in arrears with his mortgage payments, rent or (where applicable) service charges and that he is not in breach of the terms of his mortgage, lease or tenancy agreement.
I3111
A copy of the assessment report in respect of the adult placement carer prepared on behalf of an adult placement agency.
I3212
A written statement as to the suitability of a person for the role and responsibilities of an adult placement carer signed by the chair of the approval panel.
SCHEDULE 4RECORDS TO BE KEPT BY AN AGENCY
Records
I331
The following information or documents in the form of an alphabetical index in respect of each adult whom the agency has placed—
a
full name, address and telephone number;
b
date of birth;
c
sex;
d
marital status;
e
next of kin including address and telephone number;
f
ethnic origin where the person agrees to provide that information;
g
the assessment referred to in regulation 19(1);
h
the service user’s plan;
i
the placement agreement;
j
the date that the placement commenced and, where applicable, ceased;
k
details of placing authority and contact, details, including emergency out of hours contact details.
I342
An alphabetical index of all persons working for the purposes of the agency, which shall include the following matters—
a
full name;
b
sex;
c
ethnic origin where the person agrees to provide that information;
d
date of birth;
e
home address;
f
qualifications and accredited training relevant to, and experience of, work involving vulnerable adults;
g
written confirmation that the information referred to in Schedule 2 is available in relation to the person.
I353
An alphabetical index of all adult placement carers with whom the agency has placed an adult including—
a
full name;
b
sex;
c
ethnic origin where the person agrees to provide that information;
d
date of birth;
e
where relevant, the address of the premises to which the placement relates;
f
qualifications and accredited training relevant to, and experience of, work involving vulnerable adults;
g
a copy of the placement agreement;
h
a record of the monitoring undertaken in respect of the placement under regulation 13;
i
written confirmation that the information referred to in Schedule 3 is available in relation to the adult placement carer;
j
a copy of the carer agreement.
Other RecordsI364
A record of—
a
all accidents that have occurred during the course of placements made by the agency involving service users;
b
any use of physical restraint upon a relevant adult placed by the agency;
c
any allegation of abuse, neglect or other harm made by or in relation to a relevant adult whom the scheme has placed; and
d
any complaint made in relation to the agency, or to an adult placement carer working for the purposes of the agency.