The Health Information and Quality Authority has called for legislation to improve the safeguarding of vulnerable people in care.
The watchdog's plea is made in a review of its regulation activities last year which says it is beginning to sustainably improve services.
However the statutory authority also warned that residential centres for people with disabilities and foster care services must take stronger measures to protect vulnerable people in their care against abuse, harm and exploitation.
As well as residential centres for people with disabilities and foster care services, HIQA's overview also covers inspections of nursing homes, residential services for children and targeted themed inspections of hospital practice.
Last year, HIQA issued 11 notices proposing to refuse registration applications and to cancel the current registration of centres for people with disabilities.
Three had their registrations cancelled after making representations at District Court level and the HSE arranged for alternative providers to run those services.
One proposal is under consideration by the court while the remaining seven did not have their registrations cancelled.
Separately, 38 nursing homes had restrictions applied to their registrations, for example a ban on accepting new residents.
The independent watchdog encountered much good work in all services and says a culture of regulation is now embedded and influencing improvements.
However, it said some services must take safeguarding more seriously, particularly by having garda vetting in place for all staff and volunteers.
In an accompanying statement HIQA's Director of Regulation, Mary Dunnion, said those particular services are failing in their legal responsibility to safeguard adults and children.
She also said that, in the leadership of a range of disability services, inspectors found deficiencies in recognising, preventing and protecting people from harm.
She added that HIQA believes safeguarding needs to be further strengthened by introducing new legislation to better protect those who may be at risk.
The watchdog also said those who fund services - in particular the State - need to take a greater role in holding them to account.
It notes that, despite distributing large sums to organisations to provide services on its behalf, the State often exercises insufficient oversight of how its money is spent or of the outcomes it achieves for service users.
HIQA acknowledged the preliminary work done by the Health Service Executive on developing a framework for improving accountability.
Ms Dunnion urged that the concept of "commissioning" should be further considered here.
She explains that it is a strategic process of identifying a population, community or individual service need; and designing, sourcing and delivering those necessary services.
She added that it is a well-established practice in other countries.
The review identified clear links between good governance of services and better outcomes for people using them.
Ms Dunnion said the overview report shows there is a requirement for clear national policy direction, policy implementation and timely decision-making in terms of health and social care services.
She underlined that this was a key finding in both reviews conducted by the healthcare team last year of the State's ambulance services and the services at Midlands Regional Hospital, Portlaoise.
Separately, the Joint Committee on Health will meet tomorrow to discuss concerns that some residential centres for people with disabilities are not in compliance with regulations laid down in the Health Acts.
The committee will hear from representatives from HIQA and others.
