CARE STANDARDS ACT 2000 
Application to register as an Adoption Support Agency
Mae’r ffurflen gais hon hefyd ar gael yn Gymraeg / This application form is also
available in Welsh
PART 2
Name of agency:	     	

Address of agency including post code:	     	

Name of provider:	     	

Name of proposed responsible individual:	     	

Name of proposed registered manager:	     	

Name and status of person completing this form: 	     	

This part of the application to register as an Adoption Support Agency (ASA) is your opportunity to demonstrate that you have understood the principles and requirements of the Regulations and National Minimum Standards that underpin the provision of an ASA.

To complete this application, you will need to obtain a copy of the relevant Regulations and National Minimum Standards.  These are:

(i)	The Adoption Support Agencies (Wales) Regulations 2005
(ii)	The National Minimum Standards for Adoption Support Agencies in Wales 2005

The Regulations can be obtained from HMSO; either down loaded from their website HMSO or, on payment of a fee, provided in hard copy 

The National Minimum Standards are available from Welsh Government, either the Child Health and Social Care Division or via Care Inspectorate Wales (CIW) website NMS 

At this stage CIW will be looking to be assured that the arrangements and resources that you are proposing to deploy in your adoption support agency will result in the regulations and standards being consistently met or exceeded.  The document requires you to provide evidence to demonstrate this and in some sections asks for specific information / evidence.  In other places it makes suggestions as to what evidence might be appropriate.  It is helpful if you provide this information but your application will not be disadvantaged if you use other sources of evidence.

A well thought out and clearly presented Statement of Purpose for the proposed agency is an essential starting point for working through all aspects of the agency’s operations.  It will also be the starting point for CIW's evaluation of your proposals.

It is essential that your application demonstrates that you are familiar with the Regulations and National Minimum Standards, including their appendices and the sources of information informing them (usually listed in the bibliography).  We will expect you to have considered the legal and best practice aspects of the service you propose. 

To help us to process your application as efficiently as possible, please list and mark each document you submit by reference to the Regulation and National Minimum Standard to which it relates.  Although not a requirement, CIW would find it helpful if you would submit your documents in a file with an index of sections and contents.  

We look forward to receiving your completed proposals. 

Section One - General matters
1.1	Statement of Purpose and Children's Guide

Relevant Regulations	
3, 4 & Schedule 1	

Linked NMS	
1	
This table links each regulation to the most relevant NMS, this does not preclude other National Minimum Standards being linked to each regulation	

Please describe the adoption support service that you are proposing to provide.
     

	

Please provide the following document/s, ensuring that they meet the full requirements of the Regulations and National Minimum Standards
Attached
(a)	Statement of Purpose	
(b)	Children’s Guide	
(c)	Copies of any other written information about the service 	

Please list any other documents that you feel demonstrate your compliance with the Regulations and National Minimum Standards listed above.
     

	
1.2	Staffing proposals

Relevant Regulations	
21 & Schedule 2	

Linked NMS	
10, 11	
This table links each regulation to the most relevant NMS, this does not preclude other National Minimum Standards being linked to each regulation	

Please outline how you propose the agency will be staffed
Posts (positions)	Number	Proposed hours per post	Level of qualification and experience	
     	     	     	     	
     	     	     	     	
     	     	     	     	
     	     	     	     	
     	     	     	     	
     	     	     	     	
     	     	     	     	
     	     	     	     	

Please provide the following documents: 
Attached
(a)	Organisational chart 	
(b)	Job descriptions for each grade of post	

Section Two - Management of the agency
2.1	Registered providers, responsible individuals and managers.

Relevant Regulations	
5, 6, 7, 8, 9 & Schedule1, 2	

Linked NMS	
5, 6, 7, 8	
This table links each regulation to the most relevant NMS, this does not preclude other National Minimum Standards being linked to each regulation	

N.B. Many aspects of this section are covered in part 1 of the application but please complete the following

Please confirm the persons who will fulfil the following roles 
Role	Name	
Responsible individual:	     	
Manager:	     	

Please describe how you intend to ensure that the service meets the requirements of the Regulations 6, 8 and 9 and the National Minimum Standards relevant to these regulations.
Please can you ensure you cover the following in your response
•	Links with appropriate training providers
•	Quality assurance processes
     

	

Please list below copies any other documents that you feel demonstrate your compliance with the Regulations and National Minimum Standards listed above
     

	

Section Three - Specific provisions for agencies providing services under part 3 of the Regulations (Access to Information and Contact for People over 18 and Relatives of Adopted Persons who have reached the age of 18)
N.B. This section may not apply to all adoption support agencies, please consider your Statement of Purpose and Regulations 2 (2) (e) & (f) to determine whether this applies to your application.  

Agencies not providing these services should not complete section 3 of this application form; please proceed to section 4. 
3.1	Decision to proceed

Relevant Regulations	
11

Linked NMS	
3, 4.3, 4.6	
This table links each regulation to the most relevant NMS, this does not preclude other National Minimum Standards being linked to each regulation	

Please describe how you intend to ensure that the service meets the requirements of the above Regulations and the National Minimum Standards relevant to these regulations.
Please can you ensure you cover the following in your response
•	How and who will determine whether requests for support should proceed 
•	Any systems or processes that will be in place to support this decision making including any review processes 
     

Please provide a copy of the following document/s, ensuring that the contents meet the full requirements of the Regulations and National Minimum Standards

(a)	Statement / policy and procedure for deciding whether to provide the support service as stated in Regulation 11.		Attached  

Please list any other documents that you feel demonstrate your compliance with the Regulations and National Minimum Standards listed above.
     	
3.2	Consents and vetoes in the provision of information

Relevant Regulations	
12, 13, 14

Linked NMS	
3	
This table links each regulation to the most relevant NMS, this does not preclude other National Minimum Standards being linked to each regulation	

Please describe how you intend to ensure that the service meets the requirements of the above Regulations and National Minimum Standards.
Please can you ensure you cover the following in your response
•	How you will operate within these regulations
•	Your arrangements for keeping and accessing records of vetoes
     	

Please provide a copy of the following document/s, ensuring that the contents meet the full requirements of the Regulations and National Minimum Standards

Attached
(a)	Staff guidance								
(b)	Information for service users						

Please list any other documents that you feel demonstrate your compliance with the Regulations and National Minimum Standards listed above.
     	
3.3	Counselling

Relevant Regulations	
15

Linked NMS	
3.3	
This table links each regulation to the most relevant NMS, this does not preclude other National Minimum Standards being linked to each regulation	

Please describe how you intend to ensure that the service meets the requirements of the above Regulations and National Minimum Standards.

Please can you ensure you cover the following in your response
•	Systems and processes for managing and monitoring requests for counselling
•	Arrangements for the provision of counselling whether within or outside of the agency
     

Please provide a copy of the following document/s, ensuring that the contents meet the full requirements of the Regulations and National Minimum Standards

(a)	Copies of written information provided to service users.  Attached  

Please list any other documents that you feel demonstrate your compliance with the Regulations and National Minimum Standards listed above.
     

	

Section Four - Conduct of the agency
4.1	Protection of children

Relevant Regulations	
16 	

Linked NMS	
2	
This table links each regulation to the most relevant NMS, this does not preclude other National Minimum Standards being linked to each regulation	

Please describe how you intend to ensure that the service meets the requirements of the above Regulations and National Minimum Standards.
Please can you ensure you cover the following in your response
•	The background / reference documents you used to write your policy
•	Dealing with historical allegations
•	Your links with local child protection agencies
•	How staff, volunteers and service users are made aware of the policy
•	The training you provide for staff and volunteers, at induction and ongoing
     

Please provide a copy of the following document/s, ensuring that the contents meet the full requirements of the Regulations and National Minimum Standards

	Attached
(a)	Child Protection Policy						
(b)	Child Protection Procedure						

Please list any other documents that you feel demonstrate your compliance with the Regulations and National Minimum Standards listed above.
     	
4.2	Provision of service

Relevant Regulations	
 3 (1), 17 & Schedule 1(8)	

Linked NMS	
3, 4, 12.3	
This table links each regulation to the most relevant NMS, this does not preclude other National Minimum Standards being linked to each regulation	

Please describe how you intend to ensure that the service meets the requirements of the above Regulations and National Minimum Standards.
Please can you ensure you cover the following in your response
•	How you plan to manage referrals for service, including links with any agencies that refer to you
•	How you plan to determine and monitor the appropriate service for individuals, including meeting a range of specific needs
•	Arrangements for service user input into quality assurance and continuous improvement 
     

Please provide a copy of the following document/s, ensuring that the contents meet the full requirements of the Regulations and National Minimum Standards
		Attached
(a)	The policies required by Standard 3	
(b)	Equal Opportunities Policy	

Please list any other documents that you feel demonstrate your compliance with the Regulations and National Minimum Standards listed above.
     	
4.3	Record keeping

Relevant Regulations	
18, 25 & Schedule 3	

Linked NMS	
16, 17, 18, in their entirety plus 2.3, 6.5, 9.6, 15.6	
This table links each regulation to the most relevant NMS, this does not preclude other National Minimum Standards being linked to each regulation	

Please describe how you intend to ensure that the service meets the requirements of the above Regulations and National Minimum Standards.
Please can you ensure you cover the following in your response
•	How records are to be maintained, managed and retained in accordance with the Data Protection Act (1998)
•	Safety and confidentiality of records including who can access them and how
•	How staff and volunteers will be advised about their role in the management of records
     

Please provide a copy of the following document/s if they are available, ensuring that the contents meet the full requirements of the Regulations and National Minimum Standards where that is appropriate

(a)	Any policies that demonstrate your compliance with the Regulations and National Minimum Standards e.g. file management policy, policy on service user access to their records			Attached  

Please list any other documents that you feel demonstrate your compliance with the Regulations and National Minimum Standards listed above.
     	
4.4	Complaints and representations

Relevant Regulations	
19, 20	

Linked NMS	
3.7, 15 	
This table links each regulation to the most relevant NMS, this does not preclude other National Minimum Standards being linked to each regulation	

Please describe how you intend to ensure that the service meets the requirements of the above Regulations and National Minimum Standards.
Please can you ensure you cover the following in your response
•	The background / reference documents you used to write your policy / procedure
•	How complaints are investigated and by whom
•	How staff, volunteers and service users are made aware of it
•	The training you provide for staff and volunteers, at induction and ongoing
•	Monitoring arrangements
     

	

Please provide a copy of the following document/s, ensuring that the contents meet the full requirements of the Regulations and National Minimum Standards where that is appropriate

(a)	Your Complaints Policy and Procedure			Attached  

Please list any other documents that you feel demonstrate your compliance with the Regulations and National Minimum Standards listed above.

     	
4.5	Staffing - employment, deployment and support

Relevant Regulations	
21, 22, 23, 24, 25 & Schedule 3	

Linked NMS	
10, 11, 12,13, 14	
This table links each regulation to the most relevant NMS, this does not preclude other National Minimum Standards being linked to each regulation	

Please describe how you intend to ensure that the service meets the requirements of the above Regulations and National Minimum Standards.
Please can you ensure you cover the following in your response
•	How you will manage workloads and adjust numbers of staff over time 
•	Links with appropriate training providers
     

Please provide a copy of the following document/s, ensuring that the contents meet the full requirements of the Regulations and National Minimum Standards where that is appropriate
Attached
(a)	Recruitment and selection procedures					

(b)	Disciplinary procedure							

(c)	Arrangements for induction, training, supervision, and 	
appraisal of staff								

(d)	Health and Safety policy							

(e)	Whistleblowing policy							

(f)	Public Liability and Professional Indemnity insurance			

Please list any other documents that you feel demonstrate your compliance with the Regulations and National Minimum Standards listed above.
     	
4. 6	Premises

Relevant Regulations	
26, 28(2)(e)	

Linked NMS	
19	
This table links each regulation to the most relevant NMS, this does not preclude other National Minimum Standards being linked to each regulation	

Please describe how you intend to ensure that the service meets the requirements of the above Regulations and National Minimum Standards.
Please can you ensure you cover the following in your response
•	Security of premises and records
•	Health and Safety arrangements
•	Insurance arrangements for equipment
     

Please provide a copy of the following document/s, ensuring that the contents meet the full requirements of the Regulations and National Minimum Standards where that is appropriate

(a)	Disaster Recovery Plan					Attached  
(b)	Insurance certificates (where available)			Attached  

Please list any other documents that you feel demonstrate your compliance with the Regulations and National Minimum Standards listed above.
     

	

Section 5 - Miscellaneous
5.1	Notifications

Relevant Regulations	
27, 29, 30, 31	

Linked NMS	
6.1, 9.1, 	
This table links each regulation to the most relevant NMS, this does not preclude other National Minimum Standards being linked to each regulation	

Please confirm that you have read and understood the range of notifications that you are required to make	Yes       No  	

Please outline the systems or processes that you plan to put in place to meet the requirements of the above Regulations and National Minimum Standards
     	

Declaration and Signature
Declaration
The information we/I have provided in this application form and in any attached documents is, to the best of our/my knowledge and belief, true and complete.  We/I understand that the discovery of any deliberate concealment or omission of information could lead to any registration which may be granted as a result of this application being cancelled and may also render us/me liable to prosecution.

Important: 
We process any personal and/or sensitive information we hold about you fairly and lawfully, and we only ask for such information where it is necessary for us to carry out our role. For more information about how we process your personal data, and your rights in relation to this, please see our Privacy Notice at https://careinspectorate.wales/how-we-use-your-information, or contact us for a paper copy.

Signature of person(s) completing this form

1) Name:	     	
Status:	     	

2) Name:	     	
Status: