Application to Register

Application to register as a Child MinderIt is essential in preparing your application that you are familiar with the following legislation: Part 2 of the Children and Families (Wales) Measure 2010  The Child Minding and Day Care (Wales) Regulations 2010  The Child Minding and Day Care (Disqualification) (Wales) Regulations 2010  National Minimum Standards for Regulated Child CarePlease refer to the Guidance for Applicants, to assist you in completing your application to become a registered child minder.The above documents can be found at ww w .cssi w .org.uk.The application form is divided into two distinct parts. Both parts must be completed in full.A checklist of additional documents that must be submitted with the application is included at the end of the application form.Please tick preferred language of communication:Welsh English BothPage 1 of 53 08/2013 About you, the care you want to Part 1 provide, your premises and people who work/live with youSection 1 - Information about you (the applicant)Details requested in this section are required under the Child Minding and Day Care (Wales) Regulations 2010 Schedule 1, Part 1, Paragraphs 2-7 and Schedule 2, Part 1, Paragraph 2(1) - (6)Title Surname First names Date of birth Any aliases and former names Home address Address where child minding is to take place, if different from your home address Email address Telephone number Mobile number Page 2 of 53 08/2013 Qualifications and experiencePlease provide details of your professional/technical qualifications that are relevant to looking after children under the age of 8:Please tell us here about any experience relevant to looking after children under the age of 8 that will support your application to be a registered child minder:Please provide details below of any business you are carrying on at present or that you have carried on in the past:Details of business Dates you carried on this businessPage 3 of 53 08/2013 Your work historyPlease provide details of your work history covering the period between leaving school and now, including the year and month of each change of occupation. Remember to include periods of study and volunteering.Where there are gaps in employment please explain, giving enough detail of the circumstances, to enable checks to be made if necessary. Please be sure to include any experience you consider to be relevant to the present application including any previous work with children, whether paid or not.If any of your previous duties involved working with children, give the full reasons why your employment or position ended with the details of how this can be confirmed.Reason for Name, address and Occupation From To month leaving, telephone number of month and and year including any person/company we year disciplinary may contact to confirm actionPage 4 of 53 08/2013 Please use this space to explain any gaps in your employment record above (include dates).Page 5 of 53 08/2013 ReferencesPlease supply the names and addresses of two individuals from whom we will take up references. The people you name must not be related to you. Both of these referees must be able to comment on your competence to look after children under the age of 8. Where possible, one of the referees should be your most recent employer. You should give the name of your most recent employer as the first.Reference 1 Name Address (including post code) Occupation Telephone number In what capacity are you known to them? e.g. employee, friend, colleague and how long have they known you.Reference 2 Name Address including post code Occupation Telephone number In what capacity are you known to them? e.g. employee, friend, colleague and how long have they known you.Page 6 of 53 08/2013 Medical practitioner reportYou are required to provide a report by a registered medical practitioner as to your physical and mental fitness to look after children under the age of 8.This must be submitted as part of your application. A template for this reference is attached. (Appendix 1).If you are unable to obtain this report please explain why and provide a statement on a separate sheet as to the state of your physical and mental health.Disclosure and Barring Service (DBS) checkYou are required to provide a completed DBS application form when you file your application to register with CSSIW. (This must be countersigned by CSSIW on behalf of the Welsh Ministers.)Additional Personal InformationThe following information is requested under the Children and Families (Wales) Measure 2010 and the Child Minding and Day Care (Disqualification) (Wales) Regulations 2010.Please note: You are disqualified from registration as a child minder if you or any person living or working in your household is disqualified under the Child Minding and Day Care (Disqualification) (Wales) Regulations 2010. CSSIW will carry out various checks, including the DBS criminal record check, local authority social services departments, and its own records.A person is able to apply for a waiver from disqualification in certain circumstances. Have you ever: been refused registration in respect of a children’s home or voluntary home? Yes No had your registration in respect of a children’s home or voluntary home cancelled? Yes No been concerned in the management of, or had any financial interest in a children’s home or voluntary home in respect of which another person has had their registration cancelled? Yes NoPage 7 of 53 08/2013 If you answered yes to any of the above please provide details including details of the registration authority, name and address of the home, nature of your connection with the home, type of action taken against you and the date.Have you ever:- been refused registration in respect of the provision Yes No of nurseries, day care, child minding or other provision of day care?- been disqualified from registration in respect Yes No of the provision of nurseries, day care, child minding or other provision of day care?- had registration cancelled in respect of the provision Yes No of nurseries, day care, child minding or other provision of day care?If you answered yes to any of the above please provide details including details of the registration authority, name and address of the provision, nature of your connection with the provision, type of action taken against you and the date.Page 8 of 53 08/2013 Do you know of any other reason why you may be disqualified from registration as a child minder under the Child Minding and Day Care (Disqualification) (Wales) Regulations 2010? Yes No A copy can be found at ww w .cssi w .org.ukIf you answered yes, please provide details here:Please be aware that a failure to disclose a matter which would disqualify you from registration as a child minder may affect your ability to be granted a waiver.Social services checkPlease complete the attached consent form which authorises CSSIW to contact social services departments for information. (Appendix 2)Page 9 of 53 08/2013 Section 2 - Information about the care providedDetails requested in this section are required under the Child Minding and Day Care (Wales) Regulations 2010 Schedule 2, Part 1, Paragraphs 3-9 Information on premisesPlease provide the details requested below about the premises you intend to use to look after children.Name and address of premises (including postcode)Email address Telephone number Fax (if applicable) Please describe the area in which the premises are located and details of access to the premises:Please attach a plan of the premises with this application showing the dimensions of each room in metres and centimetres. It will help if it is drawn to scale, but should show accurately the sizes and positions of windows, internal doors, stairs and external exits.Do you:- own the premises? Yes No- lease the premises? Yes No- rent the premises? Yes NoIf leasing or renting, how much notice to vacate would have to be given?Page 10 of 53 08/2013 If you rent or lease the premises, please provide a letter of confirmation from your landlord that they agree to your child minding from these premises.Please provide a statement regarding the security arrangements at the premises including arrangements for the purpose of: a) safeguarding access to information held at the premises b) restricting access from adjacent premises, or when the premises form part of a building, from other parts of the building.Will any business or activity be carried on in the premises at the same time as children are looked after there? Yes NoIf yes, please give details.Do you have any pets? Yes NoIf yes, please give details.Have you consulted with the Local Planning Authority? Yes No(Please refer to the guidance provided)Page 11 of 53 08/2013 Hours of OperationPlease indicate below what hours you intend to operate as a registered child minder.AM PMMondayTuesdayWednesdayThursdayFridaySaturdaySundayDo you intend caring for a minded child overnight? Yes NoPage 12 of 53 08/2013 Section 3 - Information about other personsDetails requested in this section are required under the Child Minding and Day Care (Wales) Regulations 2010 Schedule 2, Part 1, Paragraphs 10 - 14 You will need to provide information about your own children and any others for whom you are responsible, any other person who is going to mind children with you, and anyone else (over the age of 16 years) who is likely to have regular contact with the minded children and/or lives or works on the same premises where the child minding service is to be provided.3A Information about your own children and any others for whom you are responsibleThe maximum number of children for whom a child minder may care is as follows (this includes your own children and any other children you may be caring for e.g. grandchildren, foster children): Six children under 8 years of age  Of those six children, no more than three may be under five years of age  Of those three children, normally no more than two may be under 18 months of age, although exceptions can be made for siblingsThe space available for children on the premises may also affect the numbers for which provision can be registered.Please provide details below about your own children and any others for whom you are responsible, aged under 16 years (including any children who are in full time education and those you will be looking after at the same time as you are child minding)Full Name Date of Birth Relationship to you Tick here if this child will be present while you care for minded childrenPage 13 of 53 08/2013 Please provide the number and ages of children you propose to look after if you are registered as a child minder.Number of children in total 0-18 months: 19 months - under 5 years 5 - 8 years 3B Information about any assistants you intend to employ Do you plan to have someone assist you with your child minding? Yes NoIf no, please go to Section 3C.If yes, please provide the details requested in the table below.If you intend employing more than one assistant you must provide all of the details below for each assistant.Full name of assistant: Any alias and former names Date of birth Please give details of the person’s duties and responsibilities in relation to their work with you:Will the person be resident on the premises? Yes NoIs the person a relative of yours? Yes NoPage 14 of 53 08/2013 If yes, please state what the relationship is Number of hours person will work per week Date on which the person commenced work/is intended to commence work with youDetails of the person’s qualifications to look after children under the age of 8.Details of the person’s skills and experience to look after children under the age of 8.I confirm that I am satisfied with the authenticity of the above person’s qualifications Yes NoI confirm that I have verified the experience and skills of the above person Yes NoI am satisfied that the person’s qualifications are suitable for the work they are to perform Yes NoI am satisfied that the person has the necessary skills for such work Yes NoI am satisfied that the person is fit to work and have regular contact with children under the age of 8 Yes NoI have received a statement from the person as to the state of their physical and mental health Yes NoI am satisfied that the person is physically and mentally fit to perform their work Yes NoI am satisfied with the identity of this person Yes NoPage 15 of 53 08/2013 Please tell us what documents you have seen to confirm the person’s identity:I have obtained a copy of this person’s birth certificate for my records Yes NoI have a recent photograph of this person for my records Yes NoI have obtained two references relating to the person Yes NoI am satisfied with the authenticity of the above references Yes NoI have obtained a full employment history, together with a written explanation of any gaps in the person’s employment Yes NoWhere the person’s previous employment or position has Involved work with children, I have verified the reason why the employment or position ended Yes NoIf you answered no, please explain why.Please tick to confirm that you understand your responsibilities as a child minder and will ensure that every person who looks after or is intended to look after the children for whom child minding is provided, is issued with a DBS certificate allowing them to work with children.The registered provider needs to be able to demonstrate they have seen DBS Certificates of staff they employ and that a record is maintained for inspection by CSSIW.Page 16 of 53 08/2013 3C Information about any other persons (over 16 years) who work, live, or are otherwise present on the premises and who are likely to have regular contact with the minded children (other than any assistants named above)A registered child minder must ensure that every person who has attained the age of 16 and who lives or works on the premises or who is likely to have regular contact with the children who are to be minded must be suitable to have such contact.Please complete the table below in respect of all persons over the age of 16 who live or work on the premises or who visit the premises and are likely to have regular contact with the children who are minded.You do not need to include any persons who you intend employing as an assistant if you have already provided their details above:Please specify if this person is Any alias and Date of living, working or a Full name former name Birth Address regular visitor to the premisesPage 17 of 53 08/2013 The following section must be completed in respect of all the people who live and/or work at the premises (listed above) who are over the age of 16 years of age. This information is requested under the Children and Families (Wales) Measure 2010 and the Child Minding and Day Care (Disqualification) (Wales) Regulations 2010. A copy can be found at www.cssiw.org.ukPlease note: You are disqualified from registration as a child minder if any person living or working in your household is disqualified under the Child Minding and Day Care (Disqualification) (Wales) Regulations 2010.Has anyone who lives or works in your household ever- been refused registration in respect of a children’s home or voluntary home? Yes No Don’t know- had their registration in respect of a children’s home or voluntary Yes No Don’t know home cancelled?- been concerned in the management of, or had any financial interest in a children’s home or voluntary home in respect of which another person has had their registration cancelled?YesNoDon’t knowIf you answered yes to any of the above, please provide details including details of the registration authority, name and address of the home, nature of their connection with the home, type of action taken against them and the date.Has anyone who lives or works in your household ever- been refused registration in respect of the provision of nurseries, day care, Yes No Don’t know child minding or other provision of day care? - been disqualified from registration in respect of the provision of nurseries, Page 18 of 53 08/2013 day care, child minding or other provision Yes No Don’t know of day care? - had registration cancelled in respect of the provision of nurseries, day care, Yes No Don’t know child minding or other provision of day care?Page 19 of 53 08/2013 If you answered yes to any of the above please provide details including name of the person, details of the registration authority, name and address of the provision, nature of your connection with the provision, type of action taken against them and the date.Has anyone who lives or works in your household ever been the subject of a care or supervision order? Yes No Don’t know had a care or supervision order made with respect to a child in their care? Yes No Don’t know been disqualified from fostering a child privately? Yes No Don’t knowIf you answered yes to any of the above please provide details.Do you know of any other reason why any person who lives or works in your household may be disqualified from registration as a child minder under the Child Minding and Day Care (Disqualification) (Wales) Regulations 2010? Yes NoIf you answered yes please provide details here.Please be aware that a failure to disclose a matter which would disqualify you from registration as a child minder may affect your ability to be granted a waiver.Page 20 of 53 08/2013 Social services check All persons over the age of 16 who live or work in your household must complete the attached consent form which authorises CSSIW to contact social services departments for information. (Appendix 2)Disclosure and Barring Service (DBS) check All persons over 16 who live or work in your household must provide a completed DBS application form which should be submitted when you file your application to register with CSSIW. (These forms are available from your regional CSSIW office.)(Refer to Guidance for Applicants)Page 21 of 53 08/2013 Section 4 - Additional InformationIs there anything else you want to tell us to inform our assessment of your suitability (this includes any additional information about the premises and/or other people who are working or living at the premises.) Yes NoIf you answered yes please provide the information here.Notification of changesPlease note that you are required to notify CSSIW of a change in any person looking after the children on the premises and any person living or employed on those premises. The information to be provided is the new person’s date of birth, full name, former names and aliases and home address. Where reasonably practicable this information should be provided in advance of the event occurring, otherwise it must be provided as soon as reasonably practicable and, not later than 14 days after the change has occurred.The Child Minding and Day Care (Wales) Regulations 2010 also require you to notify CSSIW of other specific changes to your service and significant events as prescribed in Schedule 4 of the Regulations. A ‘Notification’ form is available on the CSSIW Internet site or from your CSSIW regional office.This form includes a list of all the information you must tell CSSIW about.Page 22 of 53 08/2013 Part 2 Meeting the regulations and standardsIntroductionThis section of your application is your opportunity to show that you have understood the principles and requirements expressed in the Regulations (The Child Minding and Day Care (Wales) Regulations 2010), and the National Minimum Standards for Regulated Child Care (NMS). You must use this part of the application form to describe the arrangements and resources you will use as a child minder to comply with the Regulations and improve your service over time.There are eight sections to the National Minimum Standards:Information on service Planning for individual needs and preferences Empowering service users and encouraging life style choices Quality of care Staffing Conduct and management of the service Complaints, protection and other significant events The physical environmentYou need to consider how you will promote equality and diversity under each of the headings above.Each section identifies which regulations and NMS you need to meet and what information you must provide to CSSIW to demonstrate that you are prepared for registration as a child minder. The outcome statements under each heading should assist you to complete each section. There is also reference to additional standards shown in Annex A (Overnight care) of the NMS which you need to take account of if you intend to provide overnight care to minded children. Throughout the form where the term ‘parent’ is used it also means the ‘main carer’ of a minded child.Guidance is given here, and you may also want to contact your local Family Information Service (FIS) to find out if any additional support is available in your area. FIS can be contacted on 0300 1237777.Page 23 of 53 08/2013 Section One - Information on serviceInformation and written contractLinked NMS Relevant Regulations 15 (For overnight 1 & 2 care see Annex A) Parents have all the information they need to make an informed choice about the child care service they require Outcomes  Parents have a written contract they have agreed with the child minder You must provide a written Statement of Purpose which describes your child minding business and how it will operate, providing information for anyone wishing to use your service. The content of your Statement of Purpose is prescribed in Regulation 15 and NMS 1 You must also provide a written contract that sets out the expectations of both child minder and parents about the care of the child, activities provided and business arrangements. You can produce your own or buy contracts from the National Child Minding Association. Make sure your contract covers all the information listed in NMS 2. An agreed and signed contract with the parent/carer for every minded child must be in place Please tell us below how you will provide parents with this information (Statement of Purpose and contract) and how often you intend reviewing / updating this information:Page 24 of 53 08/2013 Please provide a copy of your Statement of PurposeInspector’s comment boxInspector’s Date signaturePage 25 of 53 08/2013 Section Two - Planning for individual needs and preferences Assessment, meeting individual needs and keeping records15, 20, 21, 22, 23, 24, 26, 29, 30, 31, Relevant Regulations 32, 37 and Linked NMS 3, 4 & 5 Schedule 3 All children have their needs and preferences identified and their parents know how these will be met Each child’s individual needs, including any special educational Outcomes needs and disabilities, are planned for and provided for Parents and CSSIW have access as appropriate to a full range of records maintained by the registered child minder for the smooth running of the child minding service The assessment: you must develop a form to use with parents that will make sure you understand each minded child’’s needs, what parents expect from you and confirmation that you are able to meet these needs and expectations  You must prepare a policy that describes how you will assess, plan for and meet any special or additional needs minded children may have and include how you will make sure that any assistant you employ will also meet this standard  You must ensure that you keep records as required by Regulation 30 and Schedule 3 of the Child Minding and Day Care (Wales) Regulations 2010Please tell us below: what you would assess with parents to ensure that you will be able to meet each child’s individual needs and preferences  how you will ensure information about each child is kept up-to-date  how you will store these confidential recordsPage 26 of 53 08/2013 Please provide a copy of your special needs policyInspector’s comment boxInspector’s Date signaturePage 27 of 53 08/2013 Section Three - Empowering service users, encouraging life style choiceWorking in partnership with parents and opportunities for play and learning6 & 7 including Annex A Relevant Regulations 16, 20, 27, 32, 37 Linked NMS a.9 & a.10 if appropriate Parents are kept fully involved in and informed about their child’s activities, achievement and progress Outcomes  Children have a range of experiences - including freely chosen, unstructured and self directed play - that contribute to their emotional, physical, social, intellectual, language and creative developmentParent’s primary responsibility for their children must be recognised and respected. They must be kept fully informed about the child minder’s routines and child care practices.Please tell us below how you will:  keep parents informed and involved in the care of their child  seek feedback from parents about the service you are providing  listen to children and value their contribution  help children to cope with new situations; help them to explore and use their imagination  manage riskAlso describe what resources, play opportunities and activities you intend to provide.Page 28 of 53 08/2013 Please provide a copy of your confidentiality policyInspector’s comment boxInspector’s Date signaturePage 29 of 53 08/2013 Section Four - Quality of careNurture and wellbeing, behaviour, health care, medication and food and drink20, 21, 23, 24, 25, 8, 9, 10, 11 & 12 Relevant Regulations 26, 27, 29, 30, Linked NMS including Annex A 31 37 a.8 and a.9 if appropriate  Children feel secure, happy and comfortable with their carers and in their environment and their rights are respected The behaviour of children is managed in a way that respects their rights and promotes their welfare and developmentOutcomes  The health care needs of each child are identified and addressed as appropriate and children benefit from the way in which good health is promoted Children are safeguarded by the setting’s policies and procedures about medication, and receive the medication they need Children are provided with regular drinks and food in adequate quantities for their needsYou must prepare the following:  a written behaviour management policy stating the methods used to manage children’s behaviour: this should include a statement on how you will deal with bullying  a written policy describing your procedure and management for storing and administering medication  a written procedure that describes what action you will take if a child becomes lost/missing or is not collected.You must: hold and maintain a first aid certificate and keep a first aid box  keep a record of any medicine administered to a child  prepare a form for parents to give their consent for you to give medicine to their child  contact the Food Standards Agency in order to register with them, if you are providing food for minded children  contact your local authority Family Information Service to arrange training in basic food hygiene; this is good practice.We advise that you plan a healthy eating menu for the children in your care taking account of NMS 4.Page 30 of 53 08/2013 Please tell us in the box below how you would -  manage children’s unacceptable behaviour and tackle any instances of bullying  raise any concerns with parents about a child’s behaviour  promote good health of the children you look after and prevent the spread of infection and what you would do if any child is ill and/or has to be excluded due to illness  record a child’s health needs and any observations or concerns you may have and how these will be raised with parents  identify the risks around the administering of medication and how you would seek advice and training if required  respond to any medical emergencies  manage mealtimes, provide a balanced and nutritious diet that takes account of individual needs, preferences and any food allergiesPage 31 of 53 08/2013 Please provide copies of your:  Behaviour management policy  Medication policy  Lost/missing/not collected procedure  First aid certificateInspector’s comment boxInspector’s Date signaturePage 32 of 53 08/2013 Section Five - StaffingSuitable PersonRelevant Regulations 6, 9, 27, 28, 29 Linked NMS 13 (CM)Outcomes Children’s needs are fully met by those who look after them. The child minder must be suitable to look after children under the age of 8: you are asked to provide evidence of this in Part 1 of this application  You must notify CSSIW should you wish to employ an assistant to look after children. CSSIW undertakes the DBS check for any assistants but you are responsible for checking and providing additional information about them. Child minders are always responsible for supervising assistants during working time: you should be aware of any relevant employment law that applies to this part of your business  If you employ any assistants you must prepare a written policy and procedure for staff discipline.Please provide information below about: your knowledge of child development and how you propose to keep up-to-date with any changes in this area  your arrangements for supervising/training any assistants (if applicable).Page 33 of 53 08/2013 Please provide the following: a copy of your pre-registration qualification certificate  written policy and procedure for staff discipline (if applicable)Inspector’s comment boxInspector’s Date signaturePage 34 of 53 08/2013 Section Six - Conduct and management of the serviceOrganisation, staffing ratios, equal opportunities, financial procedures and quality assurance6, 9, 15, 16, 17, 18, Relevant Regulations Linked NMS 14, 15, 16, 17, 18 20, 27, 28, 32, 33 Parents and children benefit from a well organised and planned child minding service Outcomes  Children benefit because the ratio of adults to children conforms to best practice  All children are treated with equal concern and respect  Children and their parents are safeguarded by the registered person operating sound financial procedures  Children and their parents benefit from a quality service that is effectively monitored.You must: have appropriate public liability insurance. (Schedule 2 Part 1 Paragraph 18)  set up and keep a system for monitoring, reviewing and improving the quality of care given to children (Regulation 16). The quality of care must be reviewed annually and you must obtain the views of children, parents and other significant persons. You will be required to complete a Self Assessment of Service Statement (Statement (SASS) form, which is issued by CSSIW every year (Regulation 17). This will be accepted as your annual review of quality of care providing it meets the requirements of Regulation 16 and is in such a format that can be understood by parents and other significant persons.CSSIW may make requirements about your service - you must let CSSIW know that you have completed them by the given date (Regulation 18).You should: prepare a written policy that explains how you promote equality of opportunity and anti- discriminatory practice (NMS 16.2)  develop and periodically review an operational plan which indicates the number of children you will care for and your emergency cover arrangements (NMS 14.1)  ensure that your car is roadworthy and that you have appropriate car insurance which includes business use, if you intend to use your car for child minding  keep a record of all financial transactions for your business. It is good practice to make enquiries with your local Tax Office to check what records they will expect you to keep.Page 35 of 53 08/2013 Please tell us below about the activities and resources you will develop and use to help children understand and learn about a wide range of people and cultures in our society  how you will monitor the quality of your service and seek the views of minded children, parents and other interested parties on the quality of care you provide.Page 36 of 53 08/2013 Please provide a copy of the following:  your operational plan  your equal opportunities policyInspector’s comment boxInspector’s Date signaturePage 37 of 53 08/2013 Section Seven -Complaints, protection and other significant eventsComplaints, safeguarding, child protection, notifying CSSIW of changes/significant events10, 11, 15, 22, 23, Relevant Regulations 28, 31, 32, 33, 34, Linked NMS 19, 20 & 21 35, 36 Children and their parents are confident that their complaints will be listened to, taken seriously and acted on Outcomes  Children are protected from harm and abuse and parents are confident that all reasonable steps to protect children from abuse are taken.You must: have a written complaints procedure in line with the Regulations which informs parents how you will deal with any concerns they have and what you will do if they are not satisfied (Regulation 32)  keep a record of all complaints. (Regulation 33(5))  ensure parents are aware that CSSIW is the organisation that registers and inspects your service and give parents the contact details for the local CSSIW office. (Regulation 32(6))  provide a written child protection policy that links into the arrangements of the Local Safeguarding Children Board (LSCB) and identifies how to access the All Wales Child Protection Procedures. The policy must include local contact telephone numbers for reporting concerns you might have about a child in your care. (Regulation 22)  notify CSSIW of the occurrence of any of the events listed in Schedule 4 of the Child Minding and Day Care (Wales) Regulations 2010 and other requirements for notification e.g. if you as a child minder are convicted of a criminal offence. A notification form which lists all notification requirements is available on the CSSIW Internet site.Please tell us below how would you deal with a concern or complaint from a parent  how would you deal with a potential child protection issue, including allegations made against yourself or a family member.Page 38 of 53 08/2013 Please provide the following:  a copy of your complaints procedure  a copy of your child protection policy.Inspector’s comment boxInspector’s Date signaturePage 39 of 53 08/2013 Section Eight - The physical environmentEnvironment, equipment and safetyRelevant Regulation 20, 25, 37, 38 Linked NMS 21, 22 & 23 Children are cared for in an environment that is safe, secure and suitable for their purpose Outcomes  Children have access to furniture, equipment, toys and children are cared for and have their needs met in a safe environment.You must ensure:  that safety is promoted and all precautions are taken to prevent accidents  hazards for children are kept to a minimum and Health and Safety Regulations are complied with  an up to date risk assessment of the premises is in place  premises you use are compliant with fire safety requirements. A checklist is available in Appendix 3  that local planning requirements are met.You must develop an emergency evacuation procedure for the premises.Please describe below  the safety measures you have put in place for each area of the premises (indoor and outdoor space) to be used for child minding  how you will ensure children are adequately supervised at all times (this includes trips away from the premises)  how you will ensure that furniture, equipment and toys are well maintained and conform to BS EN safety standards or relevant Toys (Safety) Regulations.Page 40 of 53 08/2013 Please provide copies of your:  risk assessment of the premises  annual safety check for gas/electrical/oil burning appliances  statement of the procedure to be followed in the event of a fire or accidentInspector’s comment boxInspector’s Date signaturePage 41 of 53 08/2013 Checklist of documents to be submitted with your application Please tick to confirm that you have attached a copy of the following:Your birth certificateProof of identityA recent photographCertificates of your qualifications that are relevant to looking after children under the age of 8, or other suitable evidenceCopy of your pre-registration qualification (Introduction to Child Minding Practice) Copy of your first aid qualificationMedical practitioner report or, if unobtainable, a statement from you as to the state of your physical and mental healthYour completed enhanced Disclosure and Barring Service (DBS) application formCompleted DBS disclosure application form for all persons over 16 who live or work in the applicant’s householdPlan of the home where you will be child mindingLetter from your landlord confirming consent to mind at the premises (if applicable) Social Services enquiry consent formPlease also provide copies of the following policy documents:Your Statement of PurposeYour child protection policyYour behaviour management policyYour staff disciplinary procedure, if applicableStatement of the procedure to be followed in the event of a fire or accidentYour procedure for dealing with a child who is lost/missing/not collectedPage 42 of 53 08/2013 Your complaints procedureYour special needs policyYour medication policy and procedureYour equal opportunities policyYour confidentiality policyRisk assessment for your premisesAnnual safety checks gas/electric/oilPlease ensure you have signed and dated the application.Failure to provide all the required items and a fully completed application form will lead to your application being returned or refused..Page 43 of 53 08/2013 DeclarationI am applying for registration as a child minder and certify that the information given in this application is true and accurate to the best of my knowledge and belief. I understand that it is an offence knowingly to make a statement which is false or misleading and to do so may lead to prosecution and/or the refusal or subsequent cancellation of my registration.In making this application for Registration under the provisions of the Children and Families (Wales) Measure 2010 I agree to comply with the Child Minding and Day Care (Wales) Regulations 2010 taking into account the National Minimum Standards for Regulated Child Care.I agree to Care and Social Services Inspectorate Wales undertaking whatever checks it deems necessary to verify my suitability.Applicant’s Signature: Date: When you have completed this form please contact CSSIW to make an appointment to submit your application and present your documents for the DBS checks.You are advised to keep a copy of this form for ongoing reference and guidance.Page 44 of 53 08/2013 Appendix 1 Medical reference:Medical reference for Care and Social Services Inspectorate (Wales) in respect of a person applying to be a Child Minder or Day Care providerThis section to be completed by the applicant: Name and address Post code Tel No E-mail Date of birth Place of birth Maiden name Any other surname This section to be completed by the applicant’s GP: Name Address Post code Tel No Page 45 of 53 08/2013 Note to GPBefore completing the declaration below, please consider any existing medical condition for which the applicant is being treated at the moment and any hospital admissions over the last five years which may be relevant.It is my opinion that after reading the medical notes of:The applicant is physically and mentally fit to look after children under the age of 8.ORThe applicant has a condition or disability (including mental disability) which may affect his/her ability to look after children under the age of 8.GP Signature Date Surgery Stamp:Page 46 of 53 08/2013 Appendix 2 Social Service check consent formDeclaration and consent for CSSIW to contact Social Services DepartmentsCare and Social Services Inspectorate WalesRegulation and InspectionChildren and Families (Wales) Measure 2010 and the Child Minding and Day Care (Disqualification) (Wales) Regulations 2010 A copy of this form must be completed by the applicant and every person over 16 who lives/works in the applicant’s household. Full name and address of applicant/person over 16 who lives/works in the householdAny alias and former names Post code Date of birth Previous full addresses in the last five years Address Address Post code Post code From Until From Until Address Address Post code Post code From Until From Until Page 47 of 53 08/2013 Address Post code From Until Have you ever been the subject of a care or supervision order? Yes NoHave you had a care or supervision order made with respect to a child in your care? Yes NoHave you ever been disqualified from fostering a child privately? Yes NoIf yes to any of the above, please provide details including dates and the local authority involved:Page 48 of 53 08/2013 Please give the following details of children who currently live with you and of those who may now live elsewhere (including those of your partner).Full name of child Date of birth Relationship to youI confirm that the information provided above is correct and I give my consent to Care and Social Services Inspectorate Wales contacting my local or any relevant Social Services Department so that the above statements may be verified and to share any other information relevant to my suitability to care for children under the age of 8 years.Name Date Signature Please return this to your CSSIW office with your application form.Page 49 of 53 08/2013 Appendix 3 Child Minder Fire Safety checklistFire safety checklist1. The following information is intended to help you to make sure that fire safety matters have been dealt with by you before the CSSIW inspector visits your home. Please have this form available when the inspector visits your home. 2. Applications for the registration of a child minder will not normally be referred to the fire service unless overnight care is to be provided. 3. All the boxes below should be completed and this will help the inspector make a judgement as to whether they need to make contact with the fire service. 4. Should an inspection reveal matters of concern regarding fire safety, CSSIW will contact the local fire service for discussion. If it is decided that the fire service need to inspect the premises, a request will be put in writing by CSSIW.Please complete the following checklist:Is any overnight care to be provided for minded children? Yes NoIs there a smoke alarm on each floor to be used for child minding? Yes NoCan the sound of any one smoke alarm be heard in all areas used for child minding? Yes NoIs any accommodation provided for child minding above the ground floor? Yes NoIf yes, how many floors above ground level do you intend using? Do the stairs come down to a passageway that leads to an exit door? Yes No(If for example the stairs come down into a living room then it will probably not be acceptable and a referral may need to be made to the fire service by CSSIW or you may need to consider restricting the use of certain rooms.)Is a basement to be used for child minding? Yes NoIf so has it got an alternative way out? Yes NoIs the way out easily used in the event of an emergency? Yes NoIs there anything unusual about the layout of the home? Yes NoDo you have a BS Kite mark fire blanket? Yes NoWhere is this fire blanket located? Page 50 of 53 08/2013 Are all forms of heating guarded as appropriate? Yes NoAre there adequate arrangements to control risk from cooking areas? (Consider use of kitchen while child minding.) Yes NoAre adequate arrangements in place to separate children from smokers’ materials? Yes NoDoes the furniture comply with the Furniture and Furnishings Regulations 1989 and is it in good condition? Yes No (Check there are labels underneath sofa cushions, no foam/filling visible) Make a note here if you have any fire safety concerns or wish to discuss this further with an inspector.Page 51 of 53 08/2013 Appendix 4 - Child Minder - consent to their details being made publically availableChild Minder consent for a local authority to provide their details to persons enquiring about child care provision in the area Children and Families (Wales) Measure 2010The Child Minding and Day Care (Inspection and Information for Local Authorities) (Wales) Regulations 2010 When a person is registered by CSSIW as a child minder, CSSIW must supply certain information to the relevant local authority’s Family Information Service. This will be used to provide up to date information to the public about child care provision in the area. On the granting of registration, this would routinely include: 5. Your name. 6. Your address and the address of the premises if this is different. 7. Other contact details e.g. telephone number or email address. 8. Any unique reference number used by CSSIW in respect of your registration. 9. Details of the times and duration of your service, (e.g. opening hours and total number of weeks you are open / closed). 10.The number of places you offer and the age range of children that you are registered to provide a service for. 11.Any conditions attached to your registration. 12.How parents can obtain copies of your CSSIW inspection report. 13.In the case of a child minder, whether or not you agree for your details to be made available to persons seeking child care provision in the relevant local authority area. Additional information may also be provided if this is relevant to the local authority’s duty under Section 27 of the Childcare Act 2006 to provide information about child minding services in their area. When your registration is ended or suspended, CSSIW must supply to the relevant local authority’s Family Information Service the following information: 14.Your name. 15.Your address. 16.Any unique reference number used by CSSIW in respect of your registration. 17.Which of the following steps have been taken:  Notice of intention given to cancel your registration  Cancellation of your registration by CSSIW  Suspension of your registration, including at your own request  Removal of your name from the register at your own request  Emergency cancellation of your registration by a justice of the peace on the application of CSSIW. 18.Details of any other relevant enforcement action which has been taken, or may be taken, against you and the reasons for that action. [Paragraph 7 of Schedule 2 to the above Regulations]Page 52 of 53 08/2013 Please complete the following:*I wish my details to be included in information made available to persons seeking child care provision in my local authority area*I do NOT wish my details to be included in information made available to persons seeking child care provision in my local authority area*Please tick whichever statement is applicableSigned Date Name Please note that in addition to the above CSSIW is required to maintain a register of all registered services which will include details of your registration, your name and the name of the town where you live.Page 53 of 53 08/2013

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