SCHEDULE 1INFORMATION TO BE INCLUDED IN THE STATEMENT OF PURPOSE

Regulation 3(1)

1

The aims and objectives of the agency.

2

The name and address of the registered provider, the responsible individual and the registered manager.

3

Any conditions for the time being in force in relation to the registration under Part 2 of the 2000 Act of the registered persons.

4

The relevant qualifications and experience of the registered manager.

5

The number, relevant qualifications and experience of the staff working for the purposes of the agency.

6

The organisational structure of the agency.

7

A description of the services offered by the agency.

8

The system in place to monitor and evaluate the provision of services to ensure that the services provided by the agency are effective and the quality of those services is of an appropriate standard.

9

A summary of the complaints procedure.

10

The name, address and telephone number of the registration authority.

SCHEDULE 2INFORMATION REQUIRED IN RESPECT OF THE RESPONSIBLE INDIVIDUAL OR PERSONS SEEKING TO MANAGE OR WORK FOR THE PURPOSES OF AN AGENCY

Regulations 5(3)(c), 7(2)(c), 22(2)(d)

1

Proof of identity including a recent photograph.

2

Either —

a

where the certificate is required for a purpose relating to section 115(5)(ea) of the Police Act 1997 (registration under Part 2 of the 2000 Act)10, or the position falls within section 115(3) or (4) of the Police Act 199711, an enhanced criminal record certificate issued under section 115 of that Act in respect of which less than 3 years has elapsed since it was issued; or

b

in any other case, a criminal record certificate issued under sections 113 of that Act, in respect of which less than 3 years have elapsed since it was issued,

including, to the extent permitted under the Police Act 1997 the matters specified in sections 113(3A) or (3C) or 115(6A) or (6B)of that Act12.

3

Two written references, including a reference from the person’s most recent employer, if any.

4

Where a person has previously worked in a position whose duties included work with children or vulnerable adults, so far as reasonably practicable, verification of the reason why the employment or position ended.

5

Documentary evidence of any relevant qualification.

6

A full employment history, together with a satisfactory written explanation of any gaps in employment.

SCHEDULE 3RECORDS TO BE KEPT IN RELATION TO EACH PERSON WORKING FOR THE PURPOSES OF AN AGENCY

Regulation 25(1)

A record indicating in respect of each person working for the purposes of the agency —

1

Full name.

2

Sex.

3

Date of birth.

4

Home address.

5

Qualifications relevant to, and experience of, working with persons receiving adoption support services and (in relation to an agency which provides adoption support services to children) qualifications relevant to and experience of work involving children.

6

The dates on which he or she commences and ceases to be so employed by the agency.

7

Whether he or she is employed by the registered provider under a contract of service or a contract for services, or is employed by someone other than the registered provider.

8

His or her job description and whether he or she works full-time or part-time and the number of hours for which he or she is employed by, or contracted to work for, the registered provider each week.

9

Training undertaken by him or her, supervision, appraisal, disciplinary action (if any) taken against him or her, complaints (if any) made against or concerning him or her and the outcome of such complaints and any other matters in relation to his or her employment for the purposes of the agency.

SCHEDULE 4EVENTS AND NOTIFICATIONS

Regulation 27(1)

Column 1

Column 2

Event

To be notified to:

Registration authority

Local Health Board/ Primary Care Trusts

Relevant authority

Referral to Secretary of State or the Assembly pursuant to section 2(1)(a) of the Protection of Children Act 1999 of an individual working for the agency

Yes

Death or serious injury of an adult or child in the course of receiving adoption support services from the agency

Yes

Yes

Yes (where death or serious injury of a child)