CARE STANDARDS ACT 2000

Regulation 28 the Adult Placement Schemes (Wales) Regulations 2004
NOTIFICATION OF SERIOUS INJURY AND OTHER INCIDENTS
Mae'r ffurflen hon hefyd ar gael yn Gymraeg / This form is also available in Welsh

GUIDANCE - COMPLYING WITH NOTIFICATION 28 REQUIREMENTS
NOTIFICATION OF INCIDENTS 
Regulation 28 of the Adult Placement Schemes (Wales) Regulations 2004 places a duty on registered persons to notify Care Inspectorate Wales (CIW) of the occurrence of the following incidents. 

• any serious injury sustained by a relevant adult in the scheme premises or when in the care of an adult placement carer: 
any incident which- 
• i) occurs in the scheme premises or in connection with a placement, and 
• ii) is reported to, or investigated by, the police; and 
• any allegation of misconduct by the registered person, a member of staff or an adult placement carer. 

The registered person must notify CIW within 24 hours of the registered person being informed, or otherwise becoming aware, that such an incident has taken place. 

Any oral notification given in accordance with this regulation must be confirmed in writing to CIW. A contravention of Regulation 28 is a criminal offence. 

The registered person must ensure that members of staff and adult placement carers are required to inform the registered person without delay of any of the incidents described above. 

The aim of this guidance is to help registered persons comply with Regulation 28. It sets out the type of circumstances which CIW considers would fall within the events specified by the Regulation. The lists are however not exhaustive and registered persons are encouraged to notify their regional office of the Inspectorate of any incident which may appear to require notification. 

According to the nature of the incident registered persons are reminded of the need to consider notifying other authorities. Particularly, there is a requirement to report certain incidents under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 (RIDDOR) whose website can be found at http://www.hse.gov.uk/riddor/  Consideration will have to be given to notifying the Police or Local Authority in appropriate circumstances. 

Examples of serious injury 
• fractures 
• head injury 
• dislocation of the shoulder, hip, knee or spine 
• amputation 
• chemical or any penetrating injury to the eye 
• loss of sight (temporary or permanent) 
• injury resulting from an electric shock or electrical burn leading to unconsciousness or requiring resuscitation or treatment in hospital 
• any other injury leading to hypothermia, heat induced illness, burns, unconsciousness, requiring resuscitation or requiring treatment in hospital 
• unconsciousness caused by asphyxia or exposure to harmful substance or biological agent 
Examples of serious Incidents which should be reported to the police: 
• Burglary 
• Theft 
• Fraud 
• Assault 
• Fire/Arson 

Where there is any allegation of misconduct by a registered person, a member of staff or an adult placement carer this includes any allegation of inappropriate care or behaviour contrary to the Social Care Wales’ Code of Practice 
(Attached: Regulation 28 – Notification Form) 

Care Inspectorate Wales

The Adult Placement Schemes (Wales) Regulations 2004:
REGULATION 28 NOTIFICATION FORM

Please ensure that this form is completed clearly in block capitals.
An additional sheet is included for your use if required.

 Please indicate which of the following notification is relevant: 
   (PLEASE TICK)	
Serious injury sustained by a service user in the scheme premises or while in the care of an adult placement carer:		
An incident which has occurred in the scheme premises and has been reported to, or is, or has been investigated by the police:		
An incident which has occurred in connection with a placement which has been reported to, or is or has been investigated by, the police:		
An allegation of misconduct by the registered person, a member of the scheme staff or an adult placement carer:		

Name of service user: (if applicable)	     	
Placement address: 
	     	
Name and address of scheme: 
	     	
Name of registered provider:
	     	

Date of Injury/Incident:
	Time of Injury/Incident:
	
     	     	

Where did the incident take place?                                                                       (PLEASE TICK)	
Adult Placement:		
Scheme premises:		
Other location: (please specify)
     

	

Nature of incident being reported; location of incident within (or outside of) building; how and when registered persons became aware (date and time); action taken: (please use additional sheet if necessary)	
     

	

Name and designation of person reporting this incident: 
     	
Name and address of any witness to the event (where relevant): 
     

Did this result in:	
Treatment at A/E:		
Hospital admission:		
Who else has been notified of this injury/incident (e.g. Police, Local Authority, RIDDOR): 	
     
	
If allegation of misconduct - Name(s) and Professional Status of person(s):	State further action taken/to be taken:	
     
	     	

Name of Person completing this form:      
	Designation: 
     	
Date:      
	
Signature:*      

(*Please note: where the completed form is submitted electronically it is not necessary to provide an additional ‘hard copy’ of the signature sheet).

Care Inspectorate Wales
Declaration
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.
Completed forms will often contain personal information and require adequate protection. Therefore forms should only be submitted using one of the following methods:-
•	By secure email to CIW.Support@gov.wales

•	By Recorded Delivery to a CIW office:

Care Inspectorate Wales,    Government Buildings,
Sarn Mynach,
Llandudno Junction
LL31 9RZ                      Fax: 0872 437 7301	Care Inspectorate Wales, 
Welsh Government Building,
Rhydycar Business Park
Merthyr Tydfil
CF48 1UZ
Fax: 0872 437 7302	Care Inspectorate Wales
Government Buildings
Picton Terrace
Carmarthen
SA31 3BT
Fax: 0872 437 7303	
Important: Completed forms should not be sent directly to CIW staff.

Care Inspectorate Wales

REGULATION 28 NOTIFICATION FORM

(Please use this sheet if you need additional space to provide the information required):