Section Four National Preventive Mechanism member profiles enforcement action to ensure the regulations and the standards are met. In extreme cases, enforcement action may include closing down a service. In 2008, the Care Commission introduced a grading system to its inspections. Services are graded on a scale of 1 (unsatisfactory) to 6 (excellent) across five themes. The themes are quality of care and support; environment; staffing; management and leadership; and information. A report of each inspection is published. Before the report is finalised, the provider of the service is given the opportunity to comment on the draft. The Care Commission also publishes an annual report of all its activities. Summary of activities During 2009–10, the Care Commission carried out 14 inspections of the seven secure accommodation services for children and 15 inspections of the eight private psychiatric hospitals in Scotland. It also investigated seven complaints relating to four of the services. A further investigation was carried out in relation to the suicide of a young man in secure accommodation. Although OPCAT does not require complaints handling to be part of an NPM’s mandate, the Care Commission is nevertheless able to use its complaints handling function to contribute to its preventive mandate. Investigations of complaints often raise issues that are relevant not just to the individual complainant, but to other people in secure care. This year, the Care Commission also published guidance for care service providers to help them actively involve people who use their services, as well as their carers.60 The involvement of service users is seen as a central element of service delivery and service improvement. The extent to which users are involved informs the Care Commission’s grading of a service. Following publication of a government strategy for looked after children, the Care Commission published a series of bulletins which considered the quality of through care and after care, and the mental and physical health and wellbeing of young people living in residential settings, including secure accommodation.61 Key issues In 2008, the Care Commission published a report which, in part, reviewed the use of physical restraint against young people in secure accommodation, as well as other residential settings.62 Since then, the Care Commission has continued to work with service providers and others, including nongovernmental organisations and the Scottish government, to improve guidance on and practice of the use of physical restraint. Looking forward In the coming year, the Care Commission will maintain its inspection programme and will continue its work on suicide prevention and promoting the use of appropriate methods of physical restraint for children. In April 2011, the Care Commission will cease to exist and its functions will be transferred to a new organisation – Social Care and Social Work Improvement Scotland. It is anticipated that the new organisation will be OPCATcompliant and will be designated as a member of the UK’s NPM in place of the Care Commission. 60 Care Commission, Involving people who use care services and their families, friends and supporters: guidance for care service providers (2009). 61 These bulletins are available on the Care Commission website. 62 Care Commission, Protecting children and young people in residential care: are we doing enough? (2008). 51