New inspections that reflect the Health and Social Care Standards

Our new way of inspecting care services

The Care Inspectorate is rolling out new ways of inspecting the quality of care and support, to help support improved services for people experiencing care.

Click here to download a copy of our Quality Framework for Care Homes for Older People.

Chief Executive Karen Reid will write to care service providers and chief officers of local partnership to provide an update on our new and developing inspection approaches. Read Karen's letter here

New inspections - care homes for older people

We are starting by changing the way we inspect care homes for older people. These new inspections will reflect the new Health and Social Care Standards, which were published in 2017 and set out what people should experience from care and support in Scotland. Since then, we have consulted widely with people who provide and commission care home services, and people who experience care, about a new quality framework to use on our inspections.

We are starting this new approach in care homes for older people, in July 2018.

What is changing?

The new approach will still feel familiar to people who have experienced our recent inspections in recent years. However, it better reflects the Scottish Government’s new Health and Social Care Standards and provides more transparency about what we expect.

Our new Quality Framework for Care Homes for Older People sets out some key questions about the difference a care home is making to people’s wellbeing, and the quality of the elements that contribute to that. Care services can use the framework to evaluate their own performance. We will also use it our on our inspections and in our improvement advisory work.

Watch our new animation to find out how it will work. 

How did you develop the framework?

We involved people who experience and provide care and support. We tested versions of the framework in about 60 care homes for older people, between November 2017 and May 2018. These tests included listening to people experiencing care, their carers, and care providers. The tests and people’s experiences of them helped us refine the framework and the way we will use it.

How is the framework structured?

The framework is structured around five key questions.

  1. How well do we support people’s wellbeing?
  2. How good is our leadership?
  3. How good is our staff team?
  4. How good is our setting?
  5. How well is our care and support planned?

Our inspections will evaluate (grade) these using our six-point scale set out below.  (A sixth question, “what is our overall capacity for improvement?” is included in the framework to help care services in planning their improvement journey, but will not be used on inspections at this time.)

Under each key question, there are three or four quality indicators, covering specific areas of care practice. Each quality indicator has illustrations of what ‘very good’ quality would look like, and what ‘weak’ quality would look like. These illustrations are drawn from the Health and Social Care Standards, but are not checklists or definitive descriptions. They are designed to help people understand the quality level we are looking for.

Each quality indicator includes a scrutiny and improvement toolbox. This includes examples of how we might evidence the quality of provision. It also contains links to practice documents that will help care services in their own improvement journey.

How will the quality framework be used on inspections?

The framework replaces our previous practice of inspecting against themes and statements. Inspectors will look at a selection of the quality indicators. They will not look at all quality indicators on each inspection, but select a number of indicators from a number of key questions.

How many they look at will depend on the type of inspection, the quality of the service, the intelligence we hold about the service and risk factors that we may identify. We will always look at the quality indicators about people’s wellbeing and care planning (1.1, 1.2, 1.3, and 5.1 in the framework). 

What about evaluations (grades)?

We will provide a specific evaluation (grade) for each quality indicator that we inspect and show that in the inspection report. We will use the six-point scale: unsatisfactory; weak; adequate; good; very good; and excellent.

The evaluations for each set of quality indicators will inform an overall evaluation (using the same scale) for the key question the indicators sit under. Where we inspect just one of the quality indicators under a key question, the evaluation we give the indicator will automatically be the same for the key question. Where we inspect more than one quality indicator per key question, the overall evaluation for the key question will be the lower of the quality indicators for that specific key question. This is because if we evaluate a key question as being, for example, ‘very good’, we expect all the indicators in that key question to be ‘very good’.

Can you give me an example?

If we evaluate just one quality indicator, 2.2, as ‘very good’, the evaluation for key question 2 will be ‘very good’.

If we inspect quality indicators 2.1, 2.2, and 2.4, and find them to be ‘good’, ‘adequate’, and ‘good’ respectively, the overall evaluation for that key question will be ‘adequate’.

How will you use the six-point scale?

We use the six-point scale to describe the quality we see:

6          Excellent                   Outstanding or sector leading

5          Very good                  Major strengths

4          Good                          Important strengths, with some areas for improvement

3          Adequate                   Strengths just outweigh weaknesses

2          Weak                          Important weaknesses – priority action required

1          Unsatisfactory          Major weaknesses – urgent remedial action required

An evaluation of excellent describes performance which is sector leading and supports experiences and outcomes for people which are of outstandingly high quality. There is a demonstrable track record of innovative, effective practice and/or very high quality performance across a wide range of its activities and from which others could learn. We can be confident that excellent performance is sustainable and that it will be maintained.

An evaluation of very good will apply to performance that demonstrates major strengths in supporting positive outcomes for people. There are very few areas for improvement. Those that do exist will have minimal adverse impact on people’s experiences and outcomes. While opportunities are taken to strive for excellence within a culture of continuous improvement, performance evaluated as very good does not require significant adjustment.

An evaluation of good applies to performance where there is a number of important strengths which, taken together, clearly outweigh areas for improvement. The strengths will have a significant positive impact on people’s experiences and outcomes. However improvements are required to maximise wellbeing and ensure that people consistently have experiences and outcomes which are as positive as possible.

An evaluation of adequate applies where there are some strengths but these just outweigh weaknesses. Strengths may still have a positive impact but the likelihood of achieving positive experiences and outcomes for people is reduced significantly because key areas of performance need to improve. Performance which is evaluated as adequate may be tolerable in particular circumstances, such as where a service or partnership is not yet fully established, or in the midst of major transition. However, continued performance at adequate level is not acceptable. Improvements must be made by building on strengths while addressing those elements that are not contributing to positive experiences and outcomes for people.

An evaluation of weak will apply to performance in which strengths can be identified but these are outweighed or compromised by significant weaknesses. The weaknesses, either individually or when added together, substantially affect peoples’ experiences or outcomes.
Without improvement as a matter of priority, the welfare or safety of people may be compromised, or their critical needs not met. Weak performance requires action in the form of structured and planned improvement by the provider or partnership with a mechanism to demonstrate clearly that sustainable improvements have been made.

An evaluation of unsatisfactory will apply when there are major weaknesses in critical aspects of performance which require immediate remedial action to improve experiences and outcomes for people. It is likely that people’s welfare or safety will be compromised by risks which cannot be tolerated. Those accountable for carrying out the necessary actions for improvement must do so as a matter of urgency, to ensure that people are protected and their wellbeing improves without delay.

While we have clarified what we mean by each evaluation to ensure a better, shared understanding of these, our evaluation scale from 1-6 has not changed. During the 60 test inspections during the course of developing the framework, there were not significant changes to the evaluations. The Health and Social Care Standards, published by the Scottish Government in 2017, significantly modernise the expectations of what people should experience from their care and support. The Care Inspectorate must, by law, take these into account when making decisions on our inspections.

Where can I find out more?

The quality framework and our new inspection leaflet gives more information. Alternatively, you can contact your inspector, or call us on 0345 600 9527 or email This email address is being protected from spambots. You need JavaScript enabled to view it..