raising standards improving lives

Application to voluntarily cancel registration from a social

care provider or manager 1

You must complete and return this form to apply to cancel your registration as a provider or a manager.

There are two sections to this form. Part A is an application to cancel registration as a provider; part B is an application to cancel registration as a manager.

You must send the applicable part of the form to Ofsted at the address given below at least three months' before the date you want the cancellation to take effect. We may agree to a shorter period of notice in exceptional circumstances.2

If we have served you with a notice of proposal to cancel your registration as a provider or a manager,3 or a notice of decision,4 you cannot apply to voluntarily cancel your registration.5

We will not be able to process your application for cancellation unless all the required information is provided to us. We may contact you to ask for further information. If you do not provide the required information, this may cause delays in processing your application and may result in the need to revise your proposed cancellation date.

If this is an application to cancel a registered provider, then this form must be signed by someone who makes up the registered provider and any application without the appropriate signature(s) will need to be resubmitted.

If this is an application to cancel the registration of a manager, then this form must be signed by the manager who is applying to cancel their registration.

We cannot process forms that are not signed by the correct person(s) and any application without the appropriate signature(s) will need to be resubmitted

The provider must return the certificate of registration on the agreed cancellation date.

If you have questions on completing this form, please contact our contact centre on 0300 123 1231.

1 Section 15 (1)(6) of the Care Standards Act 2000 and regulation 13 of the Care Standards Act 2000 (Registration)(England) Regulations 2010. 2 Regulation 13(2)(6) of the Care Standards Act 2000 (Registration)(England) Regulations 2010. 3 Section 17( 4)(a) of the Care Standards Act 2000. 4 Section 19(3) of the Act. 5 Section 15(2) of the Act.

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Part A

Notice of application from a registered provider to voluntarily cancel their registration under

section lS{l){b) of the Care Standards Act 2000

Information about the establishment or agency

Section 1a

Name of registered provider

Name of establishment or

agency

Address

Postcode

Telephone number

Email

Date of registration

Ofsted reference number

Proposed date of voluntary cancellation

Description of the establishment or agency

Section 2a

Please tick as appropriate

Children's home

Independent fostering agency

Voluntary adoption agency

Adoption support agency

Residential family centre

Residential holiday scheme for disabled children

I I I

I I I

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S e cti o n 3 a

W h at ar e y o ur r e a s o n s f or a p pl yi n g t o c a n c el y o ur r e gi str ati o n ?

S e cti o n 4 a

If y o ur pr o p o s e d d at e f or c a n c ell ati o n i s l e s s t h a n t hr e e m o nt h s fr o m t h e d at e of

t hi s a p pli c ati o n, w h at ar e t h e r e a s o n s f or t hi s ? Pl e a s e al s o pr o vi d e a r e p ort a b o ut

w h et h er y o ur e st a bli s h m e nt or a g e n c y h a s c e a s e d t o b e fi n a n ci al vi a bl e, or i s li k el y

t o c e a s e t o b e fi n a n ci all y vi a bl e, wit hi n t h e n e xt 1 2 m o nt h s .

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S e cti o n 5 a

W h at arr a n g e m e nt s h a v e y o u m a d e t o e n s ur e t h at c hil dr e n, y o u n g p e o pl e a n d

w h er e a p pr o pri at e, a d ult s er vi c e u s er s , will c o nti n u e t o b e pr o vi d e d wit h si mil ar

a c c o m m o d ati o n a n d s er vi c e s t o t h e t y p e t h at y o u c urr e ntl y pr o vi d e aft er t h e

p r o p o s e d c a n c ell ati o n d at e ? (Pl e a s e c o nti n u e o n a s e p ar at e s h e et if n e c e s s ar y)

S e cti o n 6 a

W h at arr a n g e m e nt s h a v e y o u m a d e f or t h e r et e nti o n a n d s e c ur e st or a g e of r e c or d s

aft er t h e pr o p o s e d c a n c ell ati o n d at e ?

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(ii) representatives of the people listed in (i), including placing authorities

Section 7a

What notice or information have you given to the following people about your

application to cancel your registration?

(i) the people who use your service, including children and young people, foster

carers, adoptive parents and families

(iii) the local authority in the area where the establishment or agency operates

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S e cti o n 8 a If y o u h a v e n ot gi v e n i nf or m ati o n t o a n y of t h e p e o pl e li st e d i n s e cti o n 7 a , w h at ar e t h e cir c u m st a n c e s t h at h a v e pr e v e nt e d y o u fr o m gi vi n g t h e m i nf or m ati o n a b o ut y o ur n oti c e t o c a n c el ?

(i) t h e p e o pl e w h o u s e y o ur s er vi c e, i n cl u di n g c hil dr e n a n d y o u n g p e o pl e, f o st er

c ar er s, a d o pti v e p ar e nt s a n d f a mili e s

(ii) r e pr e s e nt ati v e s of t h e p e o pl e li st e d i n (i ), i n cl u di n g pl a ci n g a ut h oriti e s

(iii) t h e l o c al a ut h orit y i n t h e ar e a w h er e t h e e st a bli s hm e nt or a g e n c y o p er at e s

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S e cti o n 9 a

If y o u h a v e n ot alr e a d y gi v e n n oti c e or i nf or m ati o n a b o ut y o ur a p pli c ati o n t o c a n c el

y o ur r e gi str ati o n t o t h e p e o pl e i n S e cti o n 7a , t h e l a w r e q uir e s t h at y o u d o s o wit hi n

s e v e n d a y s of m a ki n g t h i s a p pli c ati o n t o c a n c el. Will y o u pr o vi d e t h e s e

n otifi c ati o n s ? Pl e a s e writ e eit h er y e s or n o n e xt t o e a c h gr o u p b el o w.

S p e cifi e d P e r s o n s Y e s / N o

E a c h p er s o n w h o u s e s y o ur s er vi c e (i n cl u di n g c hil dr e n a n d y o u n gp e o pl e, f o st er c ar er s, a d o pti v e p ar e nt s a n d f a mili e s)

T h eir r e pr e s e nt ati v e , i n cl u di n g pl a ci n g a ut h oriti e s (thi s i n cl u d e sa n y o n e w h o h a s p ar e nt al r e s p o n si bilit y f or a c hil d/ y o u n g p er s o n)

T h e l o c al a ut h orit y i n t h e ar e a w h er e t h e e st a bli s h m e nt ora g e n c y o p er at e s

S e cti o n 1 0 a

If y o u h a v e r e s p o n d e d ‘n o ’ t o a n y a n s w er i n S e cti o n 9 a , w h at ar e t h e r e a s o n s t h atwill pr e v e nt y o u fr o m d oi n g t hi s ?

Section 11a

What notice or information have you given to staff of your service (including paid and volunteer staff) about your application to cancel registration?

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Declaration by the registered provider ( organisation and individual)

I declare that, to the best of my knowledge, the information given in support of this application to cancel my registration as detailed above is accurate.

Name:

Signed: .............................................................. .

Details of your role within the registered provider:

Date:

Declaration by the registered provider (partnership)

If partnership, all partners to sign.

We declare that, to the best of our knowledge, the information given in support of this application to cancel our registration as detailed above is accurate.

Signature Print name Date

Please continue on a separate sheet if necessary.

Please send your completed voluntary cancellation application form to:

Ofsted Piccadilly Gate Store Street Manchester M12WD

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N o ti c e of a p pli c a ti o n f r o m a r e gi s t e r e d m a n a g e r t o v ol u n t a ril y c a n c el t h e i r r e gi s t r a ti o n u n d e r

s e c ti o n 1 5 ( 1 ) ( b ) of t h e C a r e S t a n d a r d s A c t 2 0 0 0

1 0

P a r t B

I nf o r m a ti o n a b o u t t h e e s t a bli s h m e n t o r a g e n c y

S e cti o n 1 b

N a m e of r e gi st er e d m a n a g er

N a m e of r e gi st er e d pr o vi d er

N a m e of e st a bli s h m e nt or

a g e n c y

A d dr e s s

P o st c o d e

T el e p h o n e n u m b er

E m ail

Of st e d r ef er e n c e n u m b er

Pr o p o s e d d at e of v ol u nt ar y c a n c ell ati o n

D e s c ri p ti o n of t h e e s t a bli s h m e n t o r a g e n c y

S e cti o n 2 b

Pl e a s e ti c k a s a p p r o p ri a t e

C hil dr e n’ s h o m e

I n d e p e n d e nt f o st eri n g a g e n c y

V ol u nt ar y a d o pti o n a g e n c y

A d o pti o n s u p p ort a g e n c y

R e si d e nti al f a mil y c e ntr e

R e si d e nti al h oli d a y s c h e m e f or di s a bl e d c hil dr e n

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✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

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S e cti o n 3 b

W h at ar e y o ur r e a s o n s f or a p pl yi n g t o c a n c el y o ur r e gi str ati o n ?

S e cti o n 4 b

If y o ur pr o p o s e d d at e f or c a n c ell ati o n i s l e s s t h a n t hr e e m o nt h s fr o m t h e d at e oft hi s a p pli c ati o n, w h at ar e t h e r e a s o n s f or t hi s?

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S e cti o n 5 b

W h at n oti c e or i nf or m ati o n h a v e y o u gi v e n t o t h e f oll o wi n g p e o pl e a b o ut y o ur

a p pli c ati o n t o c a n c el y o ur r e gi str ati o n ?

(i) t h e p e o pl e w h o u s e y o ur s er vi c e, i n cl u di n g c hil dr e n a n d y o u n g p e o pl e, f o st er

c ar er s, a d o pti v e p ar e nt s a n d f a mili e s

(ii) r e pr e s e nt ati v e s of t h e p e o pl e li st e d i n (i ), i n cl u di n g pl a ci n g a ut h oriti e s

(iii) t h e l o c al a ut h orit y i n t h e ar e a w h ere t h e e st a bli s h m e nt or a g e n c y o p er at e s

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S e cti o n 6 b

If y o u h a v e n ot gi v e n i nf or m ati o n t o a n y o f t h e p e o pl e li st e d i n s e cti o n 5 b, w h at ar e t h e cir c u m st a n c e s t h at h a v e pr e v e nt e d y o u fr o m gi vi n g t h e m i nf or m ati o n a b o ut y o ur n oti c e t o c a n c el ?

(i) t h e p e o pl e w h o u s e y o ur s er vi c e, i n cl u di n g c hil dr e n a n d y o u n g p e o pl e, f o st er

c ar er s, a d o pti v e p ar e nt s a n d f a mili e s

(ii) r e pr e s e nt ati v e s of t h e p e o pl e li st e d i n (i ), i n cl u di n g pl a ci n g a ut h oriti e s

(iii) t h e l o c al a ut h orit y i n t h e ar e a w h er e t h e e st a bli s h m e nt or a g e n c y o p er at e s

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S e cti o n 7 b

If y o u h a v e n ot alr e a d y gi v e n n oti c e or i nf or m ati o n a b o ut y o ur a p pli c ati o n t o c a n c el

y o ur r e gi str ati o n t o t h e p e o pl e i n S e cti o n 5 b, t h e l aw r e q uir e s t h at y o u d o s o wit hi n

s e v e n d a y s of m a ki n g t hi s a p pli c ati o n t o c a n c el. Will y o u pr o vi d e t h e s e

n otifi c ati o n s ? Pl e a s e writ e eit h er y e s or n o n e xt t o e a c h gr o u p b el o w.

S p e cifi e d P e r s o n s Y e s / N o

E a c h p er s o n w h o u s e s y o ur s er vi c e (i n cl u di n g c hil dr e n a n d y o u n gp e o pl e, f o st er c ar er s, a d o pti v e p ar e nt s a n d f a mili e s)

T h eir r e pr e s e nt ati v e , i n cl u di n g pl a ci n g a ut h oriti e s (thi s i n cl u d e sa n y o n e w h o h a s p ar e nt al r e s p o n si bilit y f or a c hil d/ y o u n g p er s o n)

T h e l o c al a ut h o rit y i n t h e ar e a w h er e t h e e st a bli s h m e nt ora g e n c y o p er at e s

S e cti o n 8 b

If y o u h a v e r e s p o n d e d ‘ n o’ t o a n y a n s w er i n S e cti o n 7 b , w h at ar e t h e r e a s o n s t h atwill pr e v e nt y o u fr o m d oi n g t hi s ?

Section 9b

What notice or information have you given to staff of your service (including paid and volunteer staff) about your application to cancel registration?

Declaration by the registered manager

I declare that, to the best of my knowledge, the information given in support of this application to cancel my registration as manager as detailed above is accurate.

Name:

Signed: .............................................................. .

Date:

Please continue on a separate sheet if necessary.

Please send your completed voluntary cancellation application form to:

Ofsted Piccadilly Gate Store Street Manchester Ml 2WD

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