Blog: New inspections for care homes for older people

By Gordon Paterson, Chief Inspector for Adult Services

The Scottish Government’s new health and social care standards were published in 2017, and set out what people should experience from care. They are really focused on supporting people’s power, control, human rights and wellbeing. At the Care Inspectorate, we have been committed to reflecting these in our inspections, but promised there would be no big bang approach to our implementation. We promised to consult and engage widely to ensure any changes are well understood and informed by a wide range of people, including from people experiencing care. This builds on the very extensive consultation during the development of the care standards themselves.

So over the last year, we have been working with people who experience, provide and commission care to develop new ways of inspecting care homes for older people. This is the first setting to move over to our new model of inspections, although plans for other settings are now in train. The new inspections will start in care homes for older people from 30 July.

The development work for this started almost a year ago, when we arranged a series of round-table consultation events with providers of care, with very important input from Scottish Care, CCPS, and Cosla. With the new standards being relevant across all care and health settings, and in commissioning, planning and assessment too, these events were helping in discussing how the standards could be ‘made real’ in care homes for older people. We know that people moving into a care home for older people now often require more support than would have been common twenty years ago when the old national care standards were developed. At the same time, our collective understanding of how to support older people best has changed a lot in that time too, with a growing focus on the need for a homely environment with care that is tailored to people’s needs, choices and wishes. We recognise too the importance of seeing older people as people, with experience, hopes, ambitions and talents and of moving away from a deficit-based model of older age that defines people by what they may lack. Increasingly, very good care homes are demonstrating such an approach. They are re-imagining and challenging the perceptions of ‘older people’ as well as the perceived boundaries of what a care home can do to support older people – there are great examples of the CAPA programme supporting residents to be much more physically independent and in some cases even leaving residential care to return to their own home.

As we took the standards and developed them into a framework for inspections for care homes for older people, we wanted to be clear that we would use the same framework for self-evaluation, inspection and improvement support. Between November 2017 and March 2018, we tested the new framework and approaches in over 60 care homes. The views of residents, families, care staff, care providers and inspectors were all carefully captured, along with detailed feedback from a national consultation. The evaluations were consistently positive, with providers overwhelmingly saying that the framework set out clearly what the Care Inspectorate is looking for. Residents were positive about the inspections too, with many telling us that they had met the inspector, spoken to them, and were able to share their views about the care home and their own personal experience of care.

The new inspections will not be unfamiliar to people who have experienced recent inspections, but there will be a growing emphasis on evaluating the impact of care and support on people’s experiences and outcomes. We will also be focusing heavily on the importance of assessment, care planning and reviews as we know this is fundamental in understanding people’s choices, needs and wishes – and in helping to meet them. We will also consider how effectively staff are being deployed, with the correct skill-mix, numbers and competency to support residents to achieve better outcomes. We want to move away from prescribing staffing numbers, but will be looking for evidence that service providers have arrangements in place for changing the composition and numbers in order to meet residents’ changing needs and deliver effective care and support.

At the core of the approach is a quality framework which sets out the types of questions we will be asking and provides illustrations of the quality we expect to see. It is an important document for anyone providing or working in a care home for older people.

You can keep up to date with the changes and find more details about them on our dedicated webpage.