Falls and Fractures
The 'Managing Falls and Fractures in Care Homes for Older People good practice resource' is a revised and improved edition of the resource pack launched in 2011.
This resource pack will help staff in care homes to assess how well falls prevention and management and the prevention of fractures is being addressed in their service.
It aims to provide the answers to many of the questions care home managers have, and can also act as an educational tool for new or existing care home staff. It provides practical help, guidance and tools and signposts to resources available online.
There are a number of changes and additions in the 2016 edition.
The self assessment is still your starting point when using the resource pack; you will notice it has a few additional ‘good practice statements’ in line with the updated practice. It will help you identify what improvements, if any, you need to make in your care home to prevent falls.
Section 5 - 'Learning from falls' emphasises the importance and value of learning from the information you gather about falls. Section 2 'Guidance for improving the quality of care’ is a new section which has been added to support you to identify, plan, test and implement lasting improvements in your care home. Section 4 ‘Keeping well’ is another new section, focusing on 10 common risk areas and includes guidance, points to consider, tools and links to useful websites.
Care home stories have been added throughout the resource pack to give examples of new ways of working. To emphasise the importance of working with the wider health and social care team Section 6, ‘Working together’ has been added, which suggests ways to develop and improve links.
And finally, some tools in the toolkit have been updated and new tools added including a falls data spreadsheet to gather and analyse information about falls in your care home (this is accessible on the internet along with instructions for its use) and a DVD education pack that goes with the falls awareness DVD that came out with the original pack.
Please make use of the revised resource in a way that fits with the needs of the staff and residents in your care home. We hope you find it useful, comprehensive and easy to use. Most importantly we hope it supports you to improve the care and lives of older people at risk of falling.
The resource can be downloaded here or by clicking on the image above.
Resource Tools
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Tool 1a The Model for Improvement
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Tool 1b The Model for Improvement and PDSA cycle planning and progress proforma
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Tool 2a Improvement log
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Tool 2b Action plan
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Tool 4a Multifactorial Falls Risk Screen (MFRS) and falls care plan
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Tool 4b Care home resident falls and fracture risk/intervention tool
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Tool 6 Falls management checklist
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Tool 10 Protocol for measuring lying/standing blood pressure (BP) (checking for Orthostatic Hypotension)
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Tool 13 Bedrail risk assessment
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Tool 14 Seating matters
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Tool 15 Post fall pathway for managing a resident who has fallen or has been found on the floor
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Tool 16 Telecare matters: A quick guide to technology enabled care and support
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Tool 17a Guidelines for completing a post falls/incident report form
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Tool 17b Post fall/incident report form
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Tool 18b Care home monthly falls diary
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Tool 19 Fall data spreadsheet
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Tool 20a Procedure for the use of measles chart/falls plotting
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Tool 20b Measles chart example
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Tool 21b Falls safety cross
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Tool 22 Training database
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Tool 23 Managing falls and fractures in care homes for older people: DVD education pack (This links with the falls awareness DVD which is available below)
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Tool 24 Service directory
Watch the falls awareness educational video here.
We first published the resource in 2011 and carried out and evaluation in 2012. You can read the full evaluation report here.
For more information please contact Fiona Currie, Improvement Adviser at This email address is being protected from spambots. You need JavaScript enabled to view it..
Strength and Balance DVD to prevent falls and keep well
A DVD has been produced by Active Fife in partnership with Paths for All and is accompanied by their 'Walk Your Way to Better Strength and Balance' leaflet. Anyone outside of Fife who wishes to get copies of the DVD or leaflet can get them directly from Paths For All or through their local health walking group.
The videos contained within the DVD are also available through Paths for All on YouTube.
Useful information
Fees
Services must pay fees to be registered with us. The maximum limit is set by Scottish Ministers. The fees we collect contribute to our operating costs.
We charge a fee for registering a new service and an annual continuation fee. The annual continuation fee licenses a care service to operate.
Download our fees table here.
Annual continuation of registration fee
We will send an invoice each year for all your registered services. The date of when we send the invoice depends on the date you first registered. The table below helps you work out when your continuation fee will be due each following year:
| Date of first registration | Annual continuation fee due from |
| Between 1 April and 30 June | 1 April |
| Between 1 July and 30 September | 1 July |
| Between 1 October and 31 December | 1 October |
| Between 1 January and 31 March | 1 January |
If a service cancels part way through its fee year, we do not give a refund or discount.
Combined service discount
Separately registered services that operate from the same premises, sharing staff, management, policies and so on, are often referred to as ‘combined services’. Combined services can be cheaper for us to administer. If they are, we give a 15% discount on the smaller of their continuation fees.
The discount isn’t automatic and we must be confident that we can make a saving on their administration. Combined service discounts will show on the smaller service’s continuation fee invoice. If you think you may be entitled to a combined service discount, but there is no discount shown on your smaller service’s invoice, please contact your inspector.
We don’t normally give combined service discounts to fostering and adoption services. We don’t give discounts to services where the continuation fee is less than £500.
Variation, addition or removal of condition(s) – No fees charged
Although we have set this fee at zero, you must still complete an application to add, vary or remove a condition of registration. You can apply online through the digital portal. If this is not possible, call our Contact Centre on 0345 600 9527 for an application form.
New certificate fees – no charge
If we grant a variation to your registration, we will issue you with a new certificate of registration. There is no charge for sending your certificate.
Cancellations – no charge
Like variation fees, we have set the cancellation fee at zero. You can apply to cancel online through the digital portal. If this is not possible, call our Contact Centre on 0345 600 9527.
Unless we agree a shorter timescale, you must give us 3 months’ notice of your proposed cancellation. We will consider your cancellation completed when you have returned all the necessary documentation and we have confirmed your cancellation. If you are voluntarily cancelling a service in the period leading up to your annual continuation fee due date, make sure you don’t delay the process unnecessarily.
If you do not cancel your service before the annual continuation fee is due then it becomes payable in full. The annual continuation fee is not discounted for services that only operate for part of a year.
How to pay Care Inspectorate fees
Credit/Debit Card
You can pay by credit or debit card online through the following link: https://www.gov.uk/payments/care-inspectorate/continuation-fee
Direct Debit
You can pay by direct debit, either as a single payment or by 10 equal monthly instalments (only available if the fee is more than £100).
Direct Debits are normally collected at these times:
|
Annual continuation due date |
Single payment by |
10 equal instalments |
| 1 April | 31 May | from 31 May to 28 Feb |
| 1 July | 31 August | from 31 Aug to 31 May |
| 1 October | 30 November | from 30 Nov to 31 Aug |
| 1 January | 28 February | from 28 Feb to 30 Nov |
We do not fully control when the fees are set. We decide this in consultation with Scottish Government. Because of this, collection dates and number of instalments may change. If they do, we will let you know.
If you wish to pay by Direct Debit, please download, print and complete the Direct Debit instruction adding your customer number and return it to us.
BACS
Royal Bank of Scotland, St Andrew Square, Edinburgh
Sort Code: 83-06-08
Account Number: 11580052
Account Name: Social Care and Social Work Improvement Scotland
Cheque/Postal Order
You may pay by either cheque or postal order, made payable to The Care Inspectorate, including the remittance advice on the foot of your invoice, by posting to:
Care Inspectorate, Finance – Income Section, Compass House,
11 Riverside Drive, Dundee, DD1 4NY.
Contact us
Please contact us if you have an enquiry about your invoice. Call us on 0345 603 6979 Monday to Friday 9am – 4pm, or write to us at: Care Inspectorate, Finance – Income Section, Compass House, 11 Riverside Drive, Dundee, DD1 4NY or This email address is being protected from spambots. You need JavaScript enabled to view it.
Fee Information
This can be found within the fee section of our website
Inactive services
Please note that although your service may be inactive, you will still be due to pay annual continuation fees.
Frequently Asked Questions
Frequently asked questions from the briefing sessions to community justice strategic groups to the Care Inspectorate.
| Questions/Points raised | Response |
| Will the model use a 6 or 4-point evaluation scale? | From on-going discussion, we recognised that a 4-point scale might simplify the model and allow for different language but overall, it was felt a 6-point scale would be more helpful in being able to evaluate and see improvement over time. Using improvement language was viewed as being beneficial. |
| As different partnerships are at different stages in development, there was some reservation about capacity to undertake this work and what the expectations were to undertake self-evaluation. | A second phase of the project has been proposed which would focus on building capacity and confidence in partnerships in undertaking meaningful self-evaluation. Partners thought this was required and as well as support locally, there may be benefits for specific support for some partners on a national basis. The OPI Framework does not specify requirements specifically about undertaking self-evaluation. However, embarking on this work will be externally valuable for partnerships in helping strive for continuous improvement and excellence and establishing a strong sense of performance and key priority areas for action. It will also enable partners to identify key strengths. When Community Justice Scotland comes into being, they may wish to offer further views on this. |
| We sent the initial correspondence for the briefing to chairs of Community Planning Partnerships; this has not always resulted in it being passed on. | We took this approach at the end of March 2016 as we recognised strategic partnerships were at different stages in development and CPP chairs were the one constant. We then followed this up by ensuring we copied all transitions leads in to subsequent correspondence about the briefings and this proved more successful. Subsequent dialogue with local areas has resulted in the decision that we will make all chairs of strategic groups the main contact point with the transition leads copied in to all communication. This should make communication flow easier and more consistent. |
| Partners felt strongly that the language should have an improvement tone. | We agree and will endeavour to ensure the model reflects this. |
| Partners had some reservations about expectations of performance against the quality indicators within the self-evaluation model. This was based on the transition stage and the timing required to embed community justice and how this may reflect performance evaluations. |
We understand there are reservations and there are a couple of elements to consider.
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| Are you speaking to other groups as well as statutory partners? | Yes, we have an extensive approach to engagement and involvement, which will be happening during summer 2016. This will involve a staff survey, service user focus groups and stakeholder focus groups/meetings. |
| Some partners were slightly apprehensive that the staff survey would ask questions about community justice that may still be new or unknown to many staff and were unsure how this would be interpreted and used. | The staff survey is for us to develop the self-evaluation model only. This will be to ensure that a wide range of staff have an opportunity to give their views and influence what the self-evaluation model looks like. The survey is confidential and we will not use it for any other purpose |
| Will partners be able to use the survey questions for their own use? | There is no reason why partners can’t use the content of the Care Inspectorate survey with their staff locally to help gather views and opinions about community justice. They may want to consider amending some or all of the questions to meet local needs |
| Has there been any research done in developing the model? | The proposed model is based on the EFQM framework which is widely known and used and highly regarded across a very wide range of public and private sector organisations. Frameworks based on EFQM have been used to inform scrutiny models in Scotland for many years. In developing this model we are also drawing on existing research, policy and strategy including ‘Reducing reoffending in Scotland’ and ‘Commission on Women Offenders’. |
| Whilst a self-evaluation model is helpful the demand on time was highlighted in respect of evidence. Is there any way to reduce this? | We will consider this when developing the model and plan to include some tips about approaches to gathering evidence. In all of the models we have developed, we encourage partners to use evidence they need to gather anyway, either for the purposes of routine reporting or for ongoing service improvement, rather than undertaking self-evaluation for its own sake. |
| Some partners were slightly concerned about the plans for future inspection of community justice and them being over scrutinised. | The OPI Framework states the intentions for any future inspection of community justice. The Care Inspectorate recognises the need for any scrutiny work to be proportionate, risk-based, targeted and firmly directed at supporting improvement in outcomes for people. |
Getting involved
What you think really matters. If we are inspecting your area, and you have experience of services, you may want to speak to us about the help that you have been getting.
We will offer a range of ways for you to give us feedback. As well as a survey we will arrange one-to-one discussions and group meetings. Our one-to-one discussions can take place in person, or we can contact you by phone or other ways such as Facetime or MS Teams.
If you give us information anonymously, we may not be able to get in contact with you if you raise concerns about your own safety or the safety of anyone else. If you have such concerns, we would encourage you to contact your local authority and ask for their child protection or adult protection service. You can also contact Childline on 0800 1111. If we have any concerns about the safety of individuals, we will share this with protection agencies in the relevant area.
Our inspection team also includes young inspection volunteers. These are young people aged 18 – 26 with experience of care services who help us with our inspections. If you are a young person, you can choose to speak with one of them and you can have someone to support you when you meet them. If you are a young person and want to know more about becoming a young inspection volunteer or how to get involved, click here to find out more.
Guidance and good practice
We expect services to be self-aware and able to evaluate their own performance effectively and openly.
To support this, we aim to:
- act as a catalyst for change and innovation
- support improvement and signpost good practice.
For general information for registered care services, read our guide.
Choose from the menu items on the left to find the information you need to deliver care and social work services.
We support nurseries, childminders and other early years care services that take a positive approach to risk.
Read our position statement here.
Read our improvement strategy here.
Read our Policy position on the use of restrictive practices.
We regularly publish resources to support services to keep up to date with best practice and improve. Click on the resources below to find out more.
- My World Outdoors
- My Childminding Experience
- Our Creative Journey
- Care... about physical activity
- Make every moment count
- Managing falls and fractures in care homes for older people
- Promoting continence for people living with dementia
- Medicine waste in care homes
Our other website The Hub provides ‘one-stop-shop’ access to a wide range of resources aimed at supporting improvement in social care and social work by sharing intelligence and research-led practice.
Open to everyone, The Hub includes:
- a library of good practice guidance
- information on the latest developments in policy and legislation
- video based examples of innovative practice
- guidance to help users carry out their own research
- toolkits and resources aimed at supporting improvement.
Guide to using the portal
Creating an account
To register for an online account and link your current service information to the portal please read:
To create your online portal account visit: https://portal.careinspectorate.gov.scot/Account/Register
Managing access to your service or provider
You can also grant additional user access to the service information. For example, a provider may want to allow a service manager access to a service, in order for them to view service information, submit applications and update service details.
Find out how to add a new user with service access.
Find out how to add a user with provider access.
If you have access to a service on the eForms system, you can also use this to grant access on the digital portal. Please read our guidance on granting access to a service or provider.
Registering a new care service
You can apply to register a new care service using the digital portal. If you are an individual applicant, please see our guidance for contents of the application form for an individual applicant. If you are an organisation, please see our guidance for contents of the application form for an organisation.
We also have guidance to support you with accepting your conditions and becoming registered, and how to withdraw an application to register a care service.
If you need to add or amend a service managers details while you are in the process of registering a care service, please see our guidance for adding and amending managers details.
You can request advice from our registration team before you submit your application form using the portal. To do this, you must create an application to register a care service and fill in some details first. If you need support with this please see our guide for requesting advice.
Viewing and changing your service and provider details
For support with seeing your service details, please read our guides to viewing your service and provider details.
You can apply to change your service details such as change of manager or change the service address. These changes will require Care Inspectorate approval.
You can also update (without the need for approval) your contact details – email address and phone numbers and these will be updated on your record immediately.
Please see our guidance for changing service details and changing provider details for support with this.
Apply to become inactive
You can apply online to become inactive. Registered services must operate within the legal framework laid out within the Public Services Reform (Scotland) Act 2010, (the “Act”). We have policy where any service can make an application to stop operating for up to 12 months, without having to cancel their registration. Where such an application is granted, a service will be referred to as ‘inactive’.
Reasons for a service to be treated as inactive would be limited to:
- refurbishment of premises
- provider has caring responsibilities for a limited period of time
- provider maternity leave
- provider health issues.
There may be, on occasion, other exceptional circumstances, which we may consider on an individual basis.
If you need help with this form, please read our guide to becoming inactive.
Apply to cancel a service
Any registered service can voluntarily apply to cancel their registration, giving a minimum of three months’ notice.
If you want to cancel your registration, you can now complete the application to cancel a care service form through your portal account. This must be completed before we can progress with your cancellation.
If you need help with this form, please read our guide to cancelling a service
Apply to vary conditions of registration
If you need to vary, (add, amend or remove) the conditions of registration of your service, you should in the first instance discuss this with the inspector responsible for your service. You will now be able to make an application to vary the conditions of your registration on the portal. Note, you are currently only able to have one application for variation in progress at a time.
Unless otherwise agreed with us, the date the variation is to take effect from must not be less than three months after the date of application. We can only grant or refuse an application to vary a condition – we cannot change the detail of the variation that you have originally requested. However, whilst the application is still in progress you can update/amend the application yourself within the portal. Where you subsequently decide that you no longer wish the variation request to be progressed, for instance, if it is no longer necessary due to a change of circumstances, then you should discuss this with whoever has been dealing with your application. You must then withdraw the application via the portal, and we will receive automatic notification of this.
If you need help with this form, please read our If you need help with this form, please read our guide to a variation for a premises based service and guide a variation for a non-premises based service.
Health and Social Care Standards
On 1 April 2018, Scotland's Health and Social Care Standards came into effect, replacing the National Care Standards. The Care Inspectorate is required, by law, to consider the Health and Social Care Standards when making decisions during our inspections and other scrutiny and improvement work.
We encourage services to refer to these when planning and delivering care.
Over time, the Care Inspectorate is testing and evaluating different ways to carry out its inspections of care services against the new Standards, starting with care homes for older people in summer 2018.
As part of implementing the new Health and Social Care Standards, the Care Inspectorate reviewed the adult to child ratios in early learning and childcare (ELC) settings and issued guidance. This reflects the ratios that existed under the previous National Care Standards, with some additional advice included within the guidance. The guidance will be reviewed in May 2019.
Care Inspectorate report on Health and Social Care Standards implementation
How the framework links to How good is our early learning and childcare
The following table shows how our quality framework for children, childminding and school-aged childcare link to Education Scotland’s ‘How good is our early learning and childcare’ quality indicators.
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Care Inspectorate quality framework for daycare of children, childminding and school aged childcare |
Links to How Good Is Our Early Learning & Childcare |
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Quality indicator 1.1 Nurturing Care and Support |
2.4 Personalised support 2.6 Transitions 2.7 Partnerships 3.1 Ensuring wellbeing, equality and inclusion |
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Quality indicator 1.2 Children are safe and protected |
2.1 Safeguarding and child protection |
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Quality indicator 1.3 Play and learning |
2.2 Curriculum 2.3 Learning, teaching and assessment 2.6 Transitions 3.2 Securing children’s progress 3.3 Developing creativity and skills for life and learning |
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Quality indicator 1.4 Family engagement |
2.5 Family learning 2.6 Transitions 2.7 Partnerships 3.1 Ensuring wellbeing, equality and inclusion |
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Quality indicator 1.5 Effective transitions |
2.5 Family learning 2.6 Transitions 2.7 Partnerships 3.1 Ensuring wellbeing, equality and inclusion |
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Quality indicator 2.1 Quality of the setting for care, play and learning |
1.5 Management of resources to promote equity. |
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Quality indicator 2.2: Children experience high quality facilities |
1.1 Self-evaluation for self-improvement 1.4 Leadership of management and practitioners 1.5 Management of resources to promote equity |
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Quality indicator 3.1 Quality assurance and improvement are led well |
1.1 Self-evaluation for self-improvement 1.3 Leadership of change 1.5 Management of resources to promote equity |
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Quality indicator 3.2 Leadership of play and learning |
1.2 Leadership of learning 1.3 Leadership of change 1.4 Leadership and management of practitioners |
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Quality indicator 3.3 Leadership and management of staff and resources |
1.5 Management of resources to promote equity |
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Quality indicator 4.1 Staff skills, knowledge, and values |
1.3 Leadership of change 1.4 Leadership and management of practitioners |
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Quality indicator 4.2 Staff recruitment |
1.3 Leadership of change 1.4 Leadership and management of practitioners |
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Quality indicator 4.3 Staff deployment |
1.3 Leadership of change 1.4 Leadership and management of practitioners |