Care surveys

We are developing care surveys that reflect the Health and Social Care Standards

Scotland’s Health and Social Care Standards are rights-based and written from the perspectives of people experiencing care.  Since they came into use in April 2018, we have been changing how we inspect so our work closely aligns with and supports the standards. 

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 surveys help us do that. Over time, we will develop new care surveys for all service types which will include online surveys. These new surveys will replace the old care standards questionnaires. 

So far, we have developed new care surveys for care homes for older people, that link to the new quality framework for inspecting care homes for older people.

These new care surveys have a stronger emphasis on hearing about people’s experiences and outcomes.

The surveys are designed around the key questions in the new quality framework.

  • How well do we support people’s wellbeing?
  • How good is our leadership?
  • How good is our staff team?
  • How good is our setting?
  • How well is our care and support planned?

We hope the survey will enable more people to tell us about their care.

We offer two surveys: one for residents and one for relatives, friends and carers. The survey for residents includes a series of sentiments, shown in words and pictures that people can select. This may be all that some people can fill out but will still contain valuable information for the inspector.

Care survey – resident

Care survey – relatives/carers

We have produced a printable poster promoting the new care surveys for you to download and display in your service. You can download this here.

How services will receive the new care surveys

Care homes for older people will receive their care surveys in the same way that they used to receive the older style care standards questionnaires. They will also receive a set of sentiment and response cards together with guidance on using the cards and an inspection poster. If you have already received the older style care standards questionnaire, please continue to use them.

Sentiment and response cards

To support people to take part in inspections we have produced sets of sentiment and response cards. The images on the sentiment cards will mirror the first section of the survey and the response cards will help people to be clearer in their answers to the questions in the survey.

Guidance on supporting people with the survey (service version)

Sentiment card

Response card

Testing online surveys

Up to now we have used paper questionnaires only. We have now developed online surveys which are being tested in a small number of services. As well as using the paper surveys, which all care homes for older people will receive, the sample services will be asked to pilot the online versions.

If you are in the test sample, we will write to you and let you know. Once the testing is complete, we will roll the online surveys out to all care homes for older people.  We will tell services when this happens.

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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 experiencs 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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New inspections that reflect the Health and Social Care Standards

The Care Inspectorate has, following extensive consultation with the sector, developed a self evaluation framework which is based on the Health and Social Care Standards. You should use the framework to evaluate how well you are delivering services and to identify where improvements can be made for people who use your service.

We are using the framework to inform our scrutiny actions.

We launched the self evaluation framework for care homes for older people in July 2018 and will be introducing similar self evaluation frameworks for inspections for care homes for adults on 20 May 2019, followed in June by the new self evaluation framework for care homes for children and young people and school care accommodation (special residential schools).

We launched the quality framework for care homes for adults in May 2019. 

Frameworks for other service types will be introduced during 2019 including: 

  • support services (not care at home);
  • mainstream school care accommodation and school hostels;
  • offender and secure accommodation;
  • care at home and housing support services;
  • childcare and nurse agencies and
  • fostering and adoption and adult placement services.

We will provide regular updates on our progress.

What has changed?

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

The new quality frameworks set 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 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 frameworks?

We involved people who experience and provide care and support. We tested the frameworks in 19 care homes for adults and 21 care homes for children and young people and special residential schools. These tests involved 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 are the frameworks structured?

The frameworks are 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 frameworks be used on inspections?

The frameworks replace 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. This is because in the 100 test inspections we carried out, there were no significant issues that indicated change was needed.

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 frameworks and our 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..

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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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Early learning and childcare profiles

Early learning and childcare profiles, by local authority

We have created early learning and childcare local profiles to assist local authority planning for the expansion of early learning and childcare in Scotland. 

These profiles are a valuable source of information about daycare of children services in local authority areas. They include information about: number of services and capacity; funded places; trends in children registered; registered children by age; service quality; sessions and opening times; SIMD and urban/rural classification; staffing and vacancies; population estimates and projections; and an early learning and childcare service list of the area.

The profiles focus on those services that provide early learning and childcare (children and family centres, nurseries and playgroups) while our early learning and childcare statistics publication also provides information about out of school care, holiday playschemes and creches.

We welcome any feedback, queries and ideas for improvement for these profiles; please email This email address is being protected from spambots. You need JavaScript enabled to view it..

 

Early Learning and Childcare Profiles, as at 31 December 2016

Early Learning and Childcare Profiles, as at 31 December 2017

 

  

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