SI415 Nursing Home Provider Registration 0
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Registration
Registration: A guide to your registration
Registration explained 001
The purpose of regulation 001
The purpose of registration 001
The role of the registered provider 002
The role of the person in charge 002
What centres will be subject to registration? 002
When should you apply for registration? 003
Registration of more than one designated centre 003
How long does your registration last? 003
How do you become registered? 003
Fees 004
What happens next? 004
Fit-person Entry Programme 005
Assessing the tness of other people involved in the
management of the centre 006
Registration for new providers 006
The registration panel 007
Notices of proposal 007
Notices of decision 008
Registration decisions - your right to appeal 008
Registration conditions 009
Can registration conditions be changed at the
request of the provider? 009
The registration certicate 010
The register 010
Removal from the register 010
Key points on registration 011
Table of Contents
A guide to your registration
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Registration and Inspection of Residential Care Settings for Older People in Ireland
1. Registration explained
The Health Information and Quality
Authority’s Social Services Inspectorate
(SSI), referred to in the Health Act 2007,
as the Office of the Chief Inspector, was
established to regulate the quality of
residential care in designated centres
for children, older people, and people
with disabilities.
This guide leads you, the provider, through
the registration process, and informs you
of your responsibilities in relation to the
registration of a designated centre.
2. The purpose of regulation
The purpose of regulation is to protect
vulnerable individuals of any age who
are receiving residential care services.
Regulation gives confidence that the
people being looked after in a designated
centre are receiving a standard of service,
which ensures that their wellbeing and
safety is being properly promoted and
protected.
3. The purpose of registration
The process and fact of registration
confirms publicly and openly that, as
the registered provider, you are fit and
legally permitted to provide that service.
In controlling entry to service provision,
the registration authority is fulfilling an
important regulatory duty delegated to the
Chief Inspector of Social Services under
section 40 of the Health Act 2007. Part of
this duty is a statutory discretion to refuse
registration if the Chief Inspector is not
satisfied about your fitness to provide
services, or the fitness of any other
person involved in the management of
the centre.
Registration:
• informsapplicantstheyareinvolved
in a regulated sector, governed by a
legal process
• makesitclearthattheregistration
authority carries out a gate keeping
role which vets individuals and
services for fitness
• communicatesthisisanongoing
process which checks that providers
continue to be fit by complying with
regulations and guidance to deliver
an appropriate standard of service as
prescribed by Government and the
registration authority.
Section 46(1) of the Health Act 2007
states:
“a person shall not carry on the business
of a designated centre unless the centre is
registered under this Act and the person is
its registered provider”.
Section 50(1) of the Health Act 2007
states:
“where an application is made for the
registration or renewal of the registration
of a designated centre, the Chief
Inspector, if satisfied that the person who
is the registered provider, or intended
registered provider, and each other person
who will participate in the management of
the designated centre—
(a) is a fit person to be the registered
provider of the designated centre
and to participate in its management,
and
(b) if the application is for registration,
will comply with, or, if for renewal, is
in compliance with—
(i) standards set by the Authority
under section 8(1)(b),
(ii) regulations under section 101, and
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Registration and Inspection of Residential Care Settings for Older People in Ireland
(iii) any other enactment which appears to
the Chief Inspector to be relevant, and
is cited to the applicant in writing by
the Chief Inspector,
shall grant the application and if not so
satisfied shall refuse it”.
In July 2009, two statutory instruments
were enacted to give effect to the
regulation of designated centres.
These are Statutory Instrument S.I. No.
236 of 2009 Health Act 2007 (Care and
Welfare of Residents in Designated
Centres for Older People) Regulations
2009 and Statutory Instrument S.I. No.
245 Health Act 2007 (Registration of
Designated Centres for Older People)
Regulations 20091.
4. The role of the registered
provider
As the registered provider referred
to in the Health Act 2007 you have
overall responsibility for the designated
centre. The registered provider is legally
responsible for the designated centre and
will be held accountable for any faults with
the services.
Your role as the registered provider is to
ensure that the centre is suitable for its
purpose and function and is in compliance
with the requirements as set out by the
Health Act 2007, the Health Act 2007
(Registration of Designated Centres for
Older People) Regulations 2009, the
Health Act 2007 (Care and Welfare of
Residents in Designated Centres for
Older People) Regulations 2009 and the
National Quality Standards for Residential
Care Settings for Older People in Ireland.
You must be able to demonstrate that you
understand the requirements of operating
a designated centre and ensure that the
people employed have the necessary skills
to manage and deliver the service. You
are accountable and responsible for the
delivery of the service and as such will be
held accountable for any deficit in
the services.
5. The role of the person in
charge
The person in charge of the designated
centre must be a suitably qualified and
experienced registered nurse with
authority, accountability and responsibility
for the provision of the service. He/she is
the person with responsibility for the day-
to-day operation of the designated centre.
The registered provider may also be the
person in charge, provided he/she has
the appropriate skills and qualifications.
6. What centres will be subject
to registration?
There are three categories of designated
centres for older people, all of which must
apply to be registered:
• existingcentresforolderpeople
which have been previously
registered by the HSE
• existingcentresforolderpeople
which have not been registered by
the HSE
• newcentresapplyingforrsttime
registration.
‘designated centre’ is defined in section
2(1) of the Health Act 2007.
Irrespective of which category your centre
belongs to, you must notify us of your
existence within six months of the July 1
2009 commencement date (in accordance
with section 69(3) of the Health Act 2007).
1 These regulations are referred to in this document as Health Act 2007 (Care and Welfare of Residents in
Designated Centres for Older People) Regulations 2009 and Health Act 2007 (Registration of Designated
Centres for Older People) Regulations 2009.
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Registration and Inspection of Residential Care Settings for Older People in Ireland
7. When should you apply for
registration?
From 1 July 2009, all existing centres
(whether public, private or voluntary) are
deemed by law to be registered “for a
period not exceeding three years or such
shorter period as the Chief Inspector
may determine.” See section 69(2)
Health Act 2007.
The Social Services Inspectorate has
a phased three-year programme of
registration. Our registration schedule is
based on a number of factors including
(but not exclusively), for the private and
voluntary centres, the expiry date of
current registration certificates. When
you are due to apply for registration SSI
will contact you to submit an application.
Once registered by SSI you will be
required to apply for your next and all
subsequent registrations “at least 6
months, or a lesser period that the Chief
Inspector may specify, before the expiry
date of the current registration.”
See section 48(3) Health Act 2007.
The only exception to this is if you are
a new provider applying for first time
registration, which you must do six
months prior to the time you wish to
commence (see section on “registration
for new providers”).
8. Registration of more than
one designated centre
If you operate or intend to operate more
than one designated centre a separate
application for registration, or the renewal
of the registration, must be made for
each centre. See section 48(5) Health
Act 2007. The registration application
form requests information on any other
designated centre(s) that you operate.
9. How long does your
registration last?
Subject to sections 48 and 51 of the
Health Act 2007, the registration of a
designated centre is for three years.
After that you must make an application
for registration renewal at least six
months before the expiration date of the
current registration. See section 48(3)
Health Act 2007.
10. How do you become
registered?
The first step in the registration process
is to complete an application form. You
will need to complete different parts of
the form, depending on whether you are
an existing registered provider or you
intend to become a registered provider,
and whether you are an individual, a
partnership, a company, an unincorporated
body, or a statutory body. Included with
the application form will be the Fit-person
Entry Programme self-assessment
(see section on Fit-person Entry
Programme below).
The registration application form in
the first instance seeks information
about the provider, person in charge
and other key personnel involved in
the management of the centre. This
information is required by the Health
Act 2007 and the 2009 regulations and
includes: evidence of identification;
references; Garda vetting; medical
fitness; qualifications and employment
history accounting for any gaps in
employment. Information is also
required about the service provided
including the purpose and function of
the centre, the profile of the residents,
details of premises, staffing details,
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Registration and Inspection of Residential Care Settings for Older People in Ireland
and information on governance and
management.
The application form has guidelines to
aid completion and there is a checklist
at the back of the form to identify the
required information and documentation.
You must:
• completetheapplicationformin
full and return within four weeks
of receipt
• attachthenecessarydocuments
as set out in the registration
application form
• arrangepaymentoftheregistration
application fee.
• completetheFit-personEntry
Programme self-assessment and
return within eight weeks
of receipt
It is important that you complete the
form correctly and that the additional
information is enclosed as requested
(as per section 48(2) of the Health Act
2007). If any information is missing
the Social Services Inspectorate will
consider the application incomplete and
return the incomplete documentation
to you. This will delay the registration
process.
11. Fees
Fees are payable:
• toregisterorrenewyourcentre’s
registration. The registration fee is
€500.
• ifyouwanttoapplytovarya
condition of your registration.
(The amount will depend on the variation
applied for and the complexity of the
method of assessment required in
respect of the variation).
There is also an annual fee for each
centre. The fees are set by the
Department of Health and Children and
the fee structure is encompassed in
the Health Act 2007 (Registration of
Designated Centres for Older People)
Regulations 2009.
12. What happens next?
Once the fully completed application and
the nominated fee have been received,
a letter will be sent to you confirming
receipt of your application from our
national registration office in Cork.
The registration office will:
1. Review your application and all
the enclosed information. If any
information is missing, the Social
Services Inspectorate will return your
incomplete application to you with a
cover sheet setting out what aspects
of the application are incomplete.
2. Confirm receipt of the registration
fee (if your application and supporting
information is complete). If you do not
pay the correct fee in full, SSI will
not process the application.
3. Review all of the information you
provide and check your references.
It is your responsibility to make sure
that your referees are contactable
and that they understand the context
in which they are providing the
reference.
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Registration and Inspection of Residential Care Settings for Older People in Ireland
The regional inspection office will then:
1. Contact you to arrange an inspection
of your centre.
2. Send you a poster to display in your
centre informing residents, relatives
and staff of the inspection date and
offering them an opportunity to meet
with an inspector.
3. Send out questionnaires to be
completed by residents and relatives
to be returned to the regional office or
to be collected by the inspectors on
the inspection.
An inspector will:
1. Carry out a fit-person interview with
you. The interview is designed to
assess your fitness. Some aspects
of your fitness will already have been
assessed by the documentation
you have provided as part of your
application. The fit-person interview
will assess your understanding of,
and capacity to comply with, the
requirements of the regulations
and the Standards. In forming a
judgement in relation to your fitness
the Authority’s Social Services
Inspectorate will take into account the
size of the service you provide, the
statement of purpose and function
and the number and needs of the
people who will use your service.
2. Conduct an inspection of your
centre. (See Are you ready for your
inspection?)
13. Fit-person Entry Programme
Under section 50(1)(a) of the Health Act
2007 registered providers and others
who participate in the management
of the designated centre must be
fit to do so. As a provider you must
demonstrate to the satisfaction of the
Chief Inspector that you are suitable
or fit for the role. The Fit-person Entry
Programme is based on the National
Quality Standards for Residential Care
Settings for Older People in Ireland
and is a tool for you to self-assess your
fitness to provide the service. The Fit-
person Entry Programme is in the format
of a programme with defined learning
outcomes and self-assessment activities
and is designed to be used without
the need for any specialist training or
additional resources.
The Fit-person Entry Programme takes
a participative approach by encouraging
you to reflect on and consider
your experience, competence and
knowledge, together with your staff and
residents. Its purpose is to prompt you,
the provider, to:
• considertheNational Quality
Standards for Residential Care
Settings for Older People in Ireland
as a guide on how to provide, and
continually improve care services
• assessthewayyouoperateyour
centre
• identifygapsinyourservicesor
areas of learning
• increaseyourawarenessof
changes that need to be made to
some areas of practice.
By assessing the standard of care being
delivered at your designated centre,
and where necessary, developing your
practice further, the expected outcome
is that each resident in your centre will
be enabled and supported to live as
full, safe and as independent a life as
possible.
If you are the registered provider of
more than one designated centre
you should use the Fit-person Entry
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Registration and Inspection of Residential Care Settings for Older People in Ireland
Programme in each of your centres,
together with your staff. You will,
however, only be assessed on it once.
14. Assessing the fitness of
other people involved in the
management of the centre
As part of the registration application
process you will be required to provide
information about your person in charge
and others involved in the management
of the centre, in relation to their
qualifications, employment history and
evidence of vetting. Part of your test
of “fitness” as the registered provider
is that you can demonstrate that the
people you have employed to manage
your centre are fit to do this. That means
that you have satisfied yourself, and can
demonstrate to us that you have done
so, that these people are appropriately
qualified, have the necessary skills to
manage the centre, have no convictions
under the Health Act 2007, and are
people of good character and integrity.
As the registered provider you are also
accountable to ensure that there are
effective management systems in place
that support and promote the delivery
of a good quality service. This involves
being able to demonstrate to us that
there is a clearly defined management
structure in place that identifies lines
of accountability and authority and
the roles and responsibilities of your
management team.
15. Registration for new
providers
› Enquiry stage
If you are considering building a new
designated centre you should contact
our registration office in Cork. This is an
opportunity for you to inform the SSI of
your intentions and to make preliminary
enquiries about your statutory
obligations and requirements in respect
of the service you intend to provide.
› Advisory visit
If you decide to apply to register a
designated centre the SSI can discuss
the intended purpose and function of the
centre and offer you advice in relation to
the services and facilities required. This
will assist you to become as prepared as
possible before you progress your plans
and ensure you are fully informed before
applying to register.
As part of this advisory process, an
inspector may review the architectural
plans and in addition, may conduct a visit
to the premises to ensure that:
• theplanningpermissionandthe
architectural plans accurately reflect
the service to be registered
• thedesignandlayoutofthecentre
reflect the needs of residents
• therearetherequiredfacilitiesfor
the proposed number of places and
proposed resident profile
• allgeneralareasareaccessible.
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Registration and Inspection of Residential Care Settings for Older People in Ireland
› Registration inspection
As all new providers must apply for
registration prior to operating, part of
the formal registration process involves
an inspection of the physical premises.
The inspection also includes: a fit-person
assessment, a review of the centre’s
statement of purpose and function,
relevant policies and procedures,
arrangements for staffing, management
structures and plans in relation to the
services and facilities you intend to
provide. It is important therefore that
as a new provider you do not apply
for registration until six months before
you are ready to operate. For more
information on inspections see the
guidance on Are you ready for
your inspection?
› First inspection following registration
The first post-registration inspection
takes place three to six months
following registration when the first
residents are living in the designated
centre. This inspection is to ensure that
what was intended prior to registration
is happening in practice.
16. The registration panel
All applications related to registration are
submitted to a national registration panel
for decision. The purpose of having a
national registration panel is to ensure
that our decision making is open and
transparent and to provide consistency
of approach across the Authority’s Social
Services Inspectorate. The registration
panel is made up of senior staff with
expertise in the area of registration,
inspection and enforcement. The Deputy
Director of Operations chairs the panel.
The national panel considers:
• applicationsforregistrationor
registration renewal
• applicationsbytheprovidertovary
or remove conditions (see section
on registration conditions below)
• applicationsrelatingtocompliance
and enforcement issues (see Guide
for Providers on Compliance).
When the registration inspection
is completed the inspector will
compile a summary report based on
your application documentation, the
inspection event, and, where relevant,
your action plan (see Are you ready
for your inspection?). The report will
include a recommendation to the
national registration panel relating to
your centre’s registration status based
on your compliance with the regulations
and standards, and the extent to which
your service is managed by people who
are fit to do so, and your fitness as
a provider.
17. Notices of proposal
Under section 53 of the Health Act
2007 when your application has been
considered you will be sent a written
“Notice of Proposal” to:
• grantanapplicationforregistration
or registration renewal setting
out the operating conditions (see
section on registration conditions
below)
• refuseanapplicationfor
registration or registration renewal
• changetheconditionsofan
existing registration (attach
additional conditions, or vary or
remove existing ones)
• cancelaprovider’sregistration.
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Registration and Inspection of Residential Care Settings for Older People in Ireland
Under section 54(1) of the Health Act
2007 you have 28 days in which you
“may make written representations
to the chief inspector concerning the
matter which is the subject matter of
the proposal”.
18. Notices of decision
Under Section 55(3) of the Health Act
2007 a final decision will not be made
until you have:
• madewrittenrepresentationsto
the Chief Inspector concerning the
proposal, or
• notiedtheChiefInspectorin
writing that you do not intend to
make representations, or
• thetimelimitof28dayshas
elapsed.
Where written representations are
made, the representation should specify
the reasons why you disagree with
the proposal. A representation allows
the Chief Inspector to adhere to the
principles of natural justice, to examine
whether SSI has acted fairly, taking into
account all the information available
and any additional information provided,
before a final decision is made.
You will be informed of the registration
panel’s decision in writing.
• ifthepanelagreeswiththe
representations made by you, you
will be sent a “Notice of Decision”
to that effect
• ifthepaneldoesnotagreewith
the representations it will send you
a “Notice of Decision” confirming
that it will be proceeding with the
original proposal.
19. Registration decisions - your
right to appeal
Under section 57 of the Health Act 2007
the registered provider has the right of
appeal against the panel’s decision to
the District Court. The appeal must be
made within 28 days after service of
the “Notice of Decision” and you must
notify the Chief Inspector of the appeal
at the same time as it is made to the
District Court.
The decision will take effect if no appeal
is brought within 28 days or longer as
determined by the Chief Inspector. The
decision will not take effect if an appeal
is brought by the registered provider
until the determination or withdrawal of
that appeal. See section 57(2)(a) Health
Act 2007.
If you appeal to the District Court under
section 57 of the Health Act 2007, you
may continue to operate your designated
centre until a determination is made, the
appeal is withdrawn or a further appeal
to the Circuit Court is lodged.
The District Court may:
• conrmthedecisionoftheChief
Inspector or
• directtheChiefInspectorto:
(a) register or renew the registration of
the designated centre
(b) restore the registration of the
designated centre
(c) vary or remove a condition of the
registration, or
(d) attach an additional condition to the
registration. See section 57(4).
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Registration and Inspection of Residential Care Settings for Older People in Ireland
20. Registration conditions
The registration application form requires
you to provide information on the
purpose and function of your centre i.e.
the type of service you provide, who you
provide it for and the manner in which
you provide it.
As part of the registration process
the Health Information and Quality
Authority’s SSI will assess your capacity
to provide the type of service you
currently provide, or intend to provide.
This will inform the decisions of the
registration panel and the operating
conditions for which the centre will be
registered.
All designated centres will be registered
with conditions. These conditions
are called registration conditions.
Conditions are used to describe and
define the service which the centre
provides. They ensure that you the
registered provider, residents, staff and
members of the public are clear about
the total service provided in the centre.
These conditions mean that every
designated centre will be registered
for a total number of beds, and one or
more service user categories. These
categories are:
• OlderPersonsover65
• Dementia
• PhysicalDisability
• IntellectualDisability
• AcquiredBrainInjury
• Children
• Other
Once a centre has been registered with
conditions, you will be inspected against
them and you cannot operate outside
of them. To do so is likely to initiate
enforcement activity.
All existing conditions are reviewed at
each registration renewal and during
inspections.
21. Can registration conditions
be changed at request of the
provider?
A situation may arise where you might
want to offer a service for which your
centre is not registered. Equally you
may wish to increase the number of
places you are registered to provide.
In such cases, where you wish to vary
or remove a condition of registration
within the three years for which your
centre is registered, under section 52
of the Health Act 2007 you must make
an application to SSI by completing an
application to vary or remove a condition.
Forms are available on the Authority’s
website at www.hiqa.ie. Fees are
payable to apply for the variations or
removal of a condition and the amount
will depend on the variation applied for.
Under section 52(2) of the Health Act
2007 the Chief Inspector may grant an
application “if satisfied that the variation
or removal of the condition is
(a) appropriate in the circumstances,
and
(b) will not adversely affect the persons
who are resident in the designated
centre,
and if not so satisfied shall refuse the
application”.
Depending on the type of change applied
for, an inspector may visit the centre
to make an assessment. When the
assessment is complete and SSI has
determined whether or not the variation
of a condition is appropriate in your
particular circumstances, SSI will write
to you with a “Notice of Proposal”. (See
earlier section on Notice of Proposal).
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Registration and Inspection of Residential Care Settings for Older People in Ireland
The next step is that SSI will issue
you with a Notice of Decision. The
Notice of Decision will state whether
your application for a variation of a
condition(s) has been accepted and, if
so, it formalises the new condition(s).
If your application to vary conditions is
successful you will be issued with a
new registration certificate listing the
new conditions. This does not affect
your obligation to apply to renew your
registration within three years.
22. The registration certificate
After the registration process is
complete, a centre that meets the
criteria for registration is issued with
a certificate. Details listed on the
certificate include:
• thename,addressandtelephone
number of the designated centre
• thename,addressandtelephone
number of the registered provider
• thenameandtelephonenumber
of the person in charge of the
designated centre
• theregistrationconditionsattached
to the designated centre
• thedateandexpirydateof
registration
• theregistrationnumberofthe
centre.
The certificate is valid for three years.
Under section 56 (1) of the Health
Act 2007 you “must ensure that the
certificate of registration issued for
the designated centre is affixed in a
conspicuous place at the centre”.
If any changes are subsequently
made to the operating conditions of
your centre an amended certificate of
registration will be issued to you.
Where a centre’s registration is
cancelled or if you cease to carry on the
business of a designated centre you
must return the certificate to Health
Information and Quality Authority’s
Social Services Inspectorate by
registered post not later than the day on
which the decision or order, cancelling
the registration takes effect.
23. The register
Under section 49 of the Health Act
2007 the Chief Inspector will maintain
a register of designated centres, which
will be available to the public and will
be placed on the Authority’s website.
The register will hold the following
information on each centre:
• nameofthecentre
• addressofthecentre
• nameoftheregisteredprovider
• nameofthepersoninchargeof
the centre, whether that is the
registered provider or another
• thenumberofresidentswhocan
be accommodated in the centre
• thedateofregistration
• anyconditionsattachedto
registration.
24. Removal from the register
Under section 66 of the Health Act 2007
you cannot close the designated centre
until you give the Chief Inspector six
months written notice of your intention
to do so. The date of closure must be
specified in the notice. This can be done
by completing an “NF35” form which
can be found on the Authority’s website
at www.hiqa.ie.
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RG01 ©Health Information and Quality Authority 2009
Key points on registration
1. The registered provider referred
to in the Health Act 2007 is the
person with overall responsibility
for the designated centre.
2. You must notify the Health
Information and Quality Authority’s
Social Services Inspectorate of
your existence within six months
of 1 July 2009 commencement.
3. When you are due for registration
or re-registration SSI will contact
you to apply to register or
re-register.
4. If you are a new provider applying
for first time registration you must
apply six months prior to the time
you wish to operate.
5. You must complete the
registration application form in full
and return it within four weeks of
receipt.
6. If you operate or intend to operate
more than one designated
centre a separate application for
registration must be made for
each centre.
7. You must complete the self-
assessment section of the Fit
person Entry Programme within
eight weeks of receipt.
8. All designated centres will be
registered with conditions. These
conditions are called registration
conditions.
9. Once you are registered with SSI
your registration certificate lasts
for three years.
