SOCIAL AND MEDICO-SOCIAL CHILDCARE INSTITUTIONS • 2015 saw the end of the process of deinstitutionalization, i.e. the closure of institutions for children with disabilities. The new social service facilities whereto the children have been moved fail to meet some of their needs. There is a shortage of specialized professional care and the approach to accommodating the different groups of children impedes the provision of adequate care. • The process of deinstitutionalization of children placed in HMSCC is still underway. In 2015, the NPM identified, once again, risks with regard to the relocation of the most severely disabled associated with the deficiency of sufficiently specialized residential medical and social services. DEINSTITUTIONALIZATION AND NEW RESIDENTIAL SOCIAL SERVICES In 2015, the NPM team continued to monitor the process of deinstitutionalization of children with disabilities, namely their removal from homes for children with mental retardation and homes for medical and social child care and their accommodation in family-type placement centres (FTPC). To this end, the National Preventive Mechanism inspected eleven FTPCs. This year’s findings of the NPM team were, for the most part, identical with last year’s recommendations. A most important recommendation made by the NPM was to avoid mixed accommodation of children and adults with disabilities in FTPC as this might result in serious difficulties associated with the quality of care, including issues with children’s sexual maturation and different types of needs. Nevertheless, the mixed accommodation of children and much older adults has continued. By way of example, the NPM team came across a case at a FTPC in the city of Plovdiv where the youngest child resident was seven years old and the oldest person was thirtythree. The NPM believes that such age gaps between FTPC residents is a negative condition for poor quality of the social care service and is at variance with the children’s best interest. In 2015, the NPM continued to receive concerns regarding insufficient project planning and lack of groundwork for the process of moving children from institutions into FTPCs. It seemed also that the need assessments of the children with disabilities made prior to moving them with a view to deciding on a most appropriate new accommodation underwent frequent changes. This resulted in a number of problems facing both the staff at the former institutions and the teams at the FTPC where children were moved to. Given that children with disabilities require longer preparation before making the move, this causes mental and health issues for them as well. While inspecting different FTPCs, the NPM team found that the quality of care for children with severe disabilities did not meet children's health needs, which posed an immediate threat to their health or lives. By way of example, there is no night-shift medical staff at the FTPCs, so it is the night-duty caregivers who administer medications to children whose treatment regimen requires taking strong medicines. Specialised training and resources for FTPC staff on caregiving for children with disabilities is inadequate. This in turn results in their inability to even identify crisis situations, let alone respond to them appropriately. The high staff turnover remains a major challenge as more than half of the new social service workforce has been replaced. In most of the municipalities offering this type of residential social service a number of advertised vacancies have remained unfilled for quite some time. Another problem identified by the NPM is the lack of clear criteria for recruiting staff to work at the new social service facilities. The NPM has, therefore, addressed a recommendation to the Sofia City Municipality to elaborate a clear 72