Funded Provider Inspection and Compliance Procedure

Purpose. This procedure sets out how compliance officers plan and conduct inspections of funded providers, assess compliance with the funded service standards and the service agreement, and take proportionate action on non-compliance.

1.Scope and powers

Compliance officers inspect providers under the terms of the service agreement and the funded service standards. Officers must carry their authorisation, must identify themselves, must explain the purpose of the visit and must act within the powers in the agreement. Entry to private premises or the use of statutory powers must be authorised by the Director in advance.

2.Planning an inspection

Scheduled inspections are drawn from the annual risk-based program; triggered inspections follow a complaint, an incident report or a data indicator. Before a visit the officer must review the provider's file, the previous inspection, open cases and acquittal status, prepare the inspection checklist and record the plan in the compliance register. A conflict of interest declaration must be completed for every provider inspected.

3.Conducting the inspection

The officer must conduct the opening meeting, observe the service, review the records listed in the checklist, interview staff and, with consent, service users, and take copies or photographs of evidence with the provider's knowledge. Findings must be based on evidence recorded in the inspection notes. The officer must hold a closing meeting to explain the preliminary findings and the next steps.

• Confirm identity, authorisation and purpose at the opening meeting
• Record evidence for every finding: document reference, observation or interview note
• Treat service users with respect and protect their privacy
• Do not offer opinions on outcomes before the assessment is complete
• Report immediate risks to service users to the Director on the day

4.Assessing compliance

The officer must assess each standard as met, partly met or not met against the evidence and must rate the risk of each non-compliance using the compliance risk matrix. The inspection report must be completed within ten business days and reviewed by the team leader before it is issued to the provider.

5.Acting on non-compliance

Action must be proportionate to the risk and the provider's history. Options are, in increasing order, a written advice with a remediation plan, a formal notice to comply with a deadline, conditions on funding, suspension of payments and termination of the agreement. Notices and conditions must be approved by the Director and recorded in the compliance register. Suspected fraud must be referred to the fraud control officer.

6.Monitoring and closure

The officer must monitor the remediation plan to its due dates, verify evidence of completion and close the case in the register with a summary. Repeat or unresolved non-compliance must be escalated to the Director for stronger action.