The Guide - introduction

A. Background

The Guide is aimed at community planning partners (CPP) and staff participating in joint inspections.  It is complementary to a quality framework for children and young people in need of care and protection (QIF) which supports joint self-evaluation and continuous improvement.

Joint inspections include representatives from Healthcare Improvement Scotland (HIS), Education Scotland (ES) and His Majesty’s Inspectorate of Constabulary in Scotland (HMICS), as well as young inspection volunteers.  They take account of the full range of work within a CPP area including services provided by social workers, health visitors, police officers, teachers and the third sector.

Whilst details of the approach to each joint inspection may vary in response to local circumstances, the core elements of the process remain consistent and comparable.

Embedded in our approach is a strong emphasis on listening to, and taking account of, the views of children and young people as well as their parents and carers.  The young inspection volunteers, who have relevant experience of services and are trained and supported to be members of joint inspection teams, play a key role in this.  These inspections provide public assurance on the quality and effectiveness of services for children and young people and seek to assist partnerships in continuous improvement.

The methodology for joint inspections, as well as our quality framework, is informed by the European Foundation of Quality Management (EFQM) Excellence Model. It looks at:

  • key outcomes
  • stakeholder’s needs
  • delivery of services
  • management
  • leadership
  • capacity for improvement.

Our quality framework outlined in the diagram below contains 22 quality indicators.

DIAGRAM B

B. Joint inspection focus

Since July 2021, the remit of the joint inspections is to consider the effectiveness of services for children and young people at risk of harm.  The inspections take account of the difference community planning partnerships are making to the lives of children and young people at risk of harm.

Looking ahead to the implementation of The Promise and the changes that will be required in both practice and scrutiny, the intention of these inspections is to achieve assurance about how children and young people at risk of harm are being kept safe.  We are keen to establish how well protection processes to identify, assess and plan for the management of risk are enabling children and young people to experience sustained loving and nurturing relationships, to keep them safe from further harm and promote their wellbeing.

Evidence gathered under the quality indicators of our quality framework for children and young people in need of care and protection (QIF) will enable inspectors to address the four following aims:

  • Children and young people are safer because risks have been identified early and responded to effectively.
  • Children and young people’s lives improve with high quality planning and support, ensuring they experience sustained loving and nurturing relationships to keep them safe from further harm.  
  • Children, young people, and families are meaningfully and appropriately involved in decisions about their lives. They influence service planning, delivery and improvement.
  • Collaborative strategic leadership, planning and operational management ensure high standards of service delivery.

These will, in turn, form the basis of the published report, which will include key messages, strengths and areas for development for the partnership.

In addition, we will evaluate Indicator 2.1 (Impact on children and young people) using the six point scale.

C. Joint inspection process

Our inspection activity is divided into two phases, followed by a reporting phase. 

Key inspection tasks include: 

  • A review of children’s records 
  • A staff survey 
  • Children, young people and parent/kinship carer surveys 
  • Review of position statement and written evidence 
  • Focus groups for staff 
  • Meetings with children, young people and families 
  • Three meetings with service leaders (partnership discussions) 

We then publish a report on our website and produce a video report. 

For more information refer to resources and documents section. 

Our joint inspections last for around 25 weeks from the point of notification to publication.  The actual timespan may be longer if the period of the inspection includes school or public holidays.  

There are two phases to the inspection, followed by a reporting phase, outlined in the chart below. 

Phases of joint inspections

D. Children and young people’s participation and involvement

During the inspection it is important that we hear as much as possible from children and young people using services.  Consequently, we have developed our methodology to enable their views to be prominent.  We have produced a survey specifically to hear feedback from children and young people, as well as a separate survey for parents and carers.

We want to hear about how children and young people are involved in all the stages of protection process and the impact that this has had.  We are interested to see how children and young people are enabled to take part in discussions about service delivery and improvement and how partners respond to their views.  We want to know about information sharing and complaints processes and will be seeking assurance that these are accessible and actively promoted.  We will be looking at how partners comply with the broader remit of the UNCRC and their response to children’s rights issues.

We will work closely with trained young inspection volunteers who themselves have had experience of services for children and young people.  They will lead much of our direct contact with children and young people during the inspection.

We are particularly keen to hear the views of children and young people about:

  • Their personal well-being and outcomes.  Perceived well-being is increasingly viewed as the most important element of feedback from service users and can be used for: identifying the needs of groups; evaluating the impact of a specific intervention; or obtaining a snapshot of needs and strengths in communities.
  • The staff working with them and their families.  We know the importance of children and young people being enabled to experience sincere human contact and enduring relationships. We will therefore explore the extent to which they have confidence in the people who support and care for them.
  • Their experiences of the processes that they have encountered – assessment, planning, intervention, review.  We are interested in the experience that children and young people have of the processes which are designed to recognise and respond to child protection concerns and keep them safe and well.
  • How well services have involved them.  We are not only interested in the headline care standard “I am involved in all decisions about my care and support”, but also in the ways that services are involving children and young people in reviewing and improving the work that they do.  We want to know how services have sought their views and hear how these views have been used to make changes as necessary.

 


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The Guide

The Guide provides information for community planning partnerships (CPP) about the process for the joint inspection of services for children and young people at risk of harm.  This includes services for children under the age of 18 years at the point of involvement with services. It should be read in conjunction with the quality framework for children and young people in need of care and protection (QIF).

The Guide contains a number of hyperlinks. These may be to references within the guide itself or to external sources. If partnerships being inspected have any queries about any part of The Guide they should consult with their inspection lead, or with their link inspector if not being currently inspected.


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Staffing schedules

The Care Inspectorate has traditionally issued a staffing schedule to relevant service types at the point of registration.  This is a historical practice that has continued from previous regulatory bodies.  The issuing of staffing schedules has been reviewed over the years, but the practice of some service types having a staffing schedule remains.  We have recognised that the majority of staffing schedules in place do not reflect the changing needs of people who currently use the service. In a time of great change across the care sector, we want to promote innovation and also ensure people experience high-quality care and support that is tailored to their needs, rights and choices.  High-quality staffing that responds dynamically to people’s needs is essential for this.

We recognise that staffing schedules are prescriptive and that they merely set a minimum standard based on numbers and general assumptions around the needs of the residents at the point of registration, which may have changed significantly since then.  The staffing schedules are based on the assumption that services operating at full occupancy.  They do not take account of changes in residents’ dependency and capabilities, either among long-standing residents or new people coming to live in the home.

Consequently, we have taken the decision to move away from issuing staffing schedules to enable providers to apply judgement and flexibility in demonstrating how they meet the requirements of the relevant regulation (SSI 210 (15) Staffing) which states that:

‘A provider must, having regard to the size and nature of the care services, the statement of aims and objectives and the number and needs of service users…ensure that at all times suitably qualified and competent persons are working in the care service in such numbers as are appropriate for the health, welfare and safety of service users.’

We will however retain the discretion to impose conditions about staffing, or any other matter, on any individual care service where that is necessary to ensure people experience high quality care.

The legal framework under which services operate is quite clear that the responsibility for assessing staffing according to need lies with the provider of a care service.  The Scottish Regulators’ Strategic Code of Practice requires us to be proportionate in our approach and we believe that the safety, health and wellbeing of people who experience care can be enhanced without the issuing of fixed staffing notices at the point of registration.

The removal of staffing schedules will also remove reference to the management arrangements, however Scottish Statutory Instrument (SSI) 210: Regulation 17 (1) (c) – Appointment of Manager states: “A provider who is not, or does not intend to be, in full time day-to-day charge of the care service must appoint an individual to manage the service”.  We expect this regulation to be complied with and to see the management arrangements detailed in the aims and objectives for each individual service.

With the removal of staffing schedules, our scrutiny methodology will help provide assurance that the provider has systems in place to assess people’s dependency, regularly and as their needs change.  Providers will be required to maintain a daily record of the staffing level and skill mix which results from a dynamic process in relation to the assessment of need and capability.

Quality Indicator 3.3 in the new quality framework for care homes for older people states: ‘Staffing levels are right and staff work well together’.  Inspectors can and will evaluate providers systems and processes against this indicator to ensure that there are positive outcomes for people who receive services.  We strongly encourage providers to ensure this is part of their self-evaluation and quality assurance systems also.

This approach reflects the Care Inspectorate’s broader shift towards outcomes-focused regulation which seeks to ensure that care and support is responsive to people’s individual needs.  Providers of care and support have a clear responsibility to provide effective staffing, and we will continue to ensure through our scrutiny work that this is happening.

From 1 September 2018 we will no longer issue staffing schedules for new registrations.  A letter and variation template will be sent to all existing providers for services who have staffing schedules.  Between January and 31 March 2019 we will process variations for all providers who return a completed variation template.

It may take some time to complete variations for all relevant registered services.  We are therefore unable to give a timescale for completion of individual applications; however, we will endeavour to complete variations as quickly as possible.


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Care surveys: How good is your care?

We are developing care surveys that reflect the Health and Social Care Standards. These will replace the old care standards questionnaires (CSQs) and link to our quality frameworks for care services.

We want to include the views of people who experience care, as well as their relatives, friends and carers in our scrutiny and improvement work and these will surveys help us do that.

They have a stronger emphasis on hearing about people’s experiences and outcomes and we hope this will enable more people to tell us about their care. We want people to be able to engage much more meaningfully with our inspections, in the way that suits them best. We designed these surveys to support this in a flexible way. 


Online surveys (Microsoft Forms)

Throughout the year, we will send electronic survey links directly to managers of care services. We ask that these links are sent to the relevant key people within your service who use and support you to deliver care. We anticipate this will be an annual request. 

There are four different electronic surveys:

  • people who experience care
  • service staff
  • relatives and carers
  • and, where appropriate, external professionals such as district nurses and G.P.s.

We appreciate some people, especially those experiencing care and some relatives and carers, may need support to provide their feedback and we appreciate any support you can provide to enable them to participate. Advocacy services in your local area may be able to support this. 

Please email these survey links to the appropriate groups of people. If your staff are supporting people to complete the surveys, then please give them the most appropriate link for the person giving the feedback.

People who experience care

People who experience care can complete the survey by:  

  • completing the form that will be issued to the service and then returning this in the freepost envelope provided.
  • completing the survey online.

We have also produced sentiment and response cards to support people in care homes to complete the survey. The images on the sentiment cards mirror the first section and the response cards help people to be clearer in their answers to the questions in the survey.

People can choose to do as much of the survey as they are able to. Some people may wish to focus on the first page with images that describe how they feel, and others may be happy to complete the whole survey.

How all services will receive batch surveys

We will send a batch of care surveys and freepost envelopes.  

For care homes, there will also be a set of sentiment and response cards sent to your service with the first batch of surveys.  

Downloadable version  

Services can also download a copy of the survey from the links below. Please make sure you quote the services registration number (CS number) and name of service on the front page of the document so we can send this to the correct inspector. The CS number will be on the services registration certificate which is displayed in the service. 

Once completed please return these to:

                Care Inspectorate
                Compass House
                11 Riverside Drive
                Dundee
                DD1 4NY

If you need the survey in an alternative format, such as a different language or easy read, please give us a call on 0345 600 9527 or email This email address is being protected from spambots. You need JavaScript enabled to view it.

 

 


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Medicine waste in care homes

The Care Inspectorate worked with colleagues in NHS Tayside, Scottish Care, Community Pharmacy Tayside and other Pharmacy organisations to reduce inappropriate medicine waste in care homes. Co-production between these organisations resulted in all agreeing a new protocol to ensure only appropriate waste was collected. The project has been successful and we have received positive qualitative feedback from care home managers and pharmacy staff. 

Medicine Waste Protocol

Letter sent to care homes in September 2016

Watch our clip below to find out more.

If you need any help or advice in relation to this project please feel free to contact either your community pharmacist or any one of the following individuals:

Dr David Marshall
Care Inspectorate - Health Improvement Adviser (Pharmacy)
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Diane Robertson
NHS Tayside - Community Pharmacy Development
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Ivan Cornford
Scottish Care - Local Integration Lead (Angus)
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