New key question for care home inspections (Added 10 June) 

In order to robustly assess care home arrangements to respond to the COVID-19 pandemic, our inspections are placing particular focus on infection prevention and control, personal protective equipment and staffing in care settings. 

We have developed Key Question 7 to augment  our quality framework for care homes for older people and our quality framework for care homes for adults.  We have done this to meet the duties placed on us by the Coronavirus (Scotland) (No. 2) Act and subsequent guidance that we must evaluate (grade) infection prevention and control and staffing.  

This means we will carry out targeted inspections that are short, focused and carried out with colleagues from Health Improvement Scotland and Health Protection Scotland, to assess care and support for people experiencing care and support during the COVID-19 pandemic. We will continue to put the wellbeing for people experiencing care at the heart of our inspections.  

We routinely carry out our inspections unannounced, unless there are practical reasons why we need to announce it.  Inspections can take place at any time while a care service is operational. For some services, we may inspect at any time of the day or night including weekends.  Unannounced inspections provide members of the public with a greater reassurance that we are looking at the experiences and outcomes for people in services that are operating as they usually would. It is important to remember that all Care Inspectorate staff carry identification and you should ask to see this.  If you are unsure whether the person who has called or visited your service is genuinely from the Care Inspectorate, you should call us on 0345 600 9527 to verify their identity.

Our new approach to inspection

In consultation with the social care sector, we have developed a self-evaluation and quality framework model based on the Scottish Government’s Health and Social Care Standards.  We have used this model to develop a suite of quality frameworks for different service types.

Our inspectors use quality frameworks to evaluate the quality of care during inspections and improvement planning. So far, we have published quality frameworks for:

We are currently developing quality frameworks for:

  • care at home and housing support services
  • childcare and nurse agencies
  • secure and offender accommodation
  • fostering and adoption and adult placement services.

What has changed?

This approach may feel familiar however, it better reflects the 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 service makes to people’s wellbeing, and the quality of the elements that contribute to that. 

Framework structure

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?

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 level of quality we are looking for.

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

Inspections

The frameworks replace our previous practice of inspecting against themes and statements.  Inspectors will look select a number of quality indicators from a number of key questions to look at.

How many and which ones 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.  However, 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).

There are some service types that will continue to use themes and statements until they are replaced – these are:

  • care at home and housing support services
  • childcare and nurse agencies
  • fostering and adoption and adult placement services
  • secure care and offender accommodation.

Care at home and housing support services, secure care and offender accommodation will be published in April 2020. An agencies framework, which will include childcare and nurse agencies, fostering and adoption and adult placement services will be published in June 2020.

Self-evaluation

The quality frameworks help services evaluate themselves. Self-evaluation is central to continuous improvement.  It enables care settings to reflect on what they are doing so they can recognise what they do well and identify what they need to do better.  We have published a guide to self-evaluation to support services in their improvement journey. 

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.