Inspection during Covid-19

Covid-19 inspection safety precautions for early learning and childcare services including childminders (Added 29 April 2021)

We are committed to carrying out our inspections safely, and we take our responsibility to the welfare of children and staff in your service very seriously.  We have worked with Public Health Scotland to ensure our inspection process is as safe as it possibly can be. 

All our staff have had infection prevention and control training that includes minimising the risk of contact and the safe use of personal protective equipment (PPE).  Our inspectors are undertaking twice weekly testing and are required to have a negative lateral flow test before visiting a service. If the test is positive, they self-isolate and arrange to undertake a polymerase chain reaction (PCR) test.   No inspector will visit a service if they have any of the recognised symptoms of Covid-19.

We have amended our processes to minimise the time we need to spend in your service carrying out key tasks.  We will carry out some activities remotely, such as interviews with staff or parents.

When our inspectors are in your service, they will maintain physical distancing from your staff and each other and wear moisture resistance face masks.  You may see your inspector change these across the time they are in your service.  They will wash their hands regularly and carry supplies of hand sanitiser where hand washing may be more difficult, such as in outdoor areas.

Inspectors will limit the items they bring into your service and will use their tablets to record and photograph information rather than taking paper copies.

Inspections of services for children and young people (except childminders) (Added 27 April 2021)

We suspended our normal inspection programme in March 2020 in response to Scottish Government national restrictions on movement put in place to help suppress the spread of Covid-19. We maintained close contact with services across the country, providing advice and guidance to help providers continue to deliver services through a time of unprecedented challenge.

During the autumn and winter we recommenced our inspection programme on a revised basis. We carried out as much activity as possible remotely, using digital and other means. We undertook assurance activity to respond proportionately to any concerns and continued to make visits to services wherever we judged it was necessary to gain assurance about children’s wellbeing.

We have now revised our inspection priorities for 2021-22. They will be determined taking into account a number of factors including:

• intelligence which gives us cause for concern or suggests there are areas requiring further exploration. Intelligence may come from notifications or from a failure to comply with the notification system, and from complaints or relevant information provided by other bodies;
• inspection history, particularly where the last inspection identified significant areas for improvement and where we now need to assess the extent to which improvements have been made;
• services which have not been inspected since registration with the Care Inspectorate;
• inspection frequency timescales.

For all high and medium risk services, we aim to carry out on-site visits to engage in fieldwork, gain assurance about the wellbeing of children and young people and assess how their needs are being met. We will work sensitively with services to ensure this is done safely, in a way which reduces risks for everyone. Inspection feedback will continue to be provided through a virtual meeting.

For all other services, we will continue to carry out as much activity as possible remotely, using digital and other means. We are asking services for continued cooperation and support in providing documentary evidence timeously and facilitating conversations between inspectors and children, families, staff and other stakeholders. This helps us to complete inspections without undue delays.  We will continue to make visits to services wherever we judge it is necessary to gain assurance about children’s wellbeing.

All of our inspectors have received Covid training to help keep everyone in the service and themselves as safe as possible. They undertake regular lateral flow tests and make appropriate use of PPE and face masks.

We will be flexible and will amend plans as necessary in the light of changing circumstances locally and nationally.

Operating an early learning and childcare setting (including out of school care and childminders) during Covid-19 (Updated 12 August 2020)

We have developed ‘Key Question 5’, a self-evaluation resource and tool which asks you to evaluate how well you are supporting children and families during Covid-19. The aim of this resource is to enable settings to gather information and continually evaluate their progress in supporting staff, children and families to have confidence in the provision of ELC by specifically evidencing how they have implemented the national guidance for Covid-19, while ensuring positive outcomes for children. This is the only Key Question we expect ELC providers (including out of school care and childminders) to compete. This key question will sit alongside our Quality Framework for Early Learning and Childcare when this is published later this year (which will include Key Questions 1-4).

We encourage you to complete the ‘self-evaluation tool’. The tool asks you to take account of performance data when evaluating your service.  This will be individual to your service.  It may include how you communicate with families or other settings where there are blended placements. It may also be some examples of evidence which you wish to include within the tool e.g. Supporting evidence of how you have implemented and reviewed the national guidance relevant to your service:

• Guidance for early learning and childcare services
• Guidance for childminding services
• Guidance for school age childcare services
• Guidance for fully outdoor childcare services

Inspectors will request the completed self-evaluation from providers on a risk and sampling basis. Please do not send this to us until requested. This will not be before 10 August 2020.  However, we may undertake other scrutiny activities in settings before this date. Read more about this here. 

Covid-19 Scrutiny Assessment Tool (SAT) (Added 30 July 2020)

The Covid-19 Scrutiny Assessment Tool (SAT) is a trigger tool developed by the Care Inspectorate to identify indicators of potential concerns in care homes.

From 14 August this will replace the current Risk Assessment Rating (RAD) for all Care Homes (Adults, Older People, Children and Young People). Inspectors will begin this process from 30 July.

A list of questions that the inspectors will answer when completing the SAT in the RMS system can be found here.

This is for service provider’s information only.

The SAT is not a risk assessment in the same way that the RAD was but will support us to identify what level of support and scrutiny is appropriate for a service taking account their current circumstances.

In developing the Covid-19 SAT we considered specific information relevant to the current Covid-19 pandemic. It is based on what our intelligence has so far identified as being key indicators or concerns within services to allow us to consider where additional support and/or scrutiny may be required. 

The Covid-19 SAT is based on a Scrutiny Assessment Tool we have developed and tested that included information from our enforcement review.  The release of the new tool was delayed due to the pandemic, we are planning to release the full SAT for all service types later in the year. 

Key question 7 for children and young people residential services (Added 6 July 2020)

We have developed key question 7 for children and young people residential services.

Where there are concerns relating to Covid-19 in a residential childcare setting this key question is to be used as part of our scrutiny.

Where there are concerns not relating to Covid-19, areas from the existing quality framework will be used as a basis of our scrutiny work.

New key question for care home inspections (Added 10 June 2020) 

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.  

Inspection questions

Joint inspections of services for children and young people at risk of harm aim to provide assurance about the extent to which services, working together, can demonstrate that:

1. Children and young people are safer because risks have been identified early and responded to effectively
2. Children and young people’s lives improve with high quality planning and support, ensuring they experience sustained loving and nurturing relationships to keep them safe from further harm
3. Children and young people and families are meaningfully and appropriately involved in decisions about their lives. They influence service planning, delivery and improvement
4. Collaborative strategic leadership, planning and operational management ensure high standards of service delivery.

Our findings in relation to the four statements, together with our evaluation of Indicator 2.1 (Impact on children and young people) and our assessment of the impact of Covid-19 on the continuation of practice to keep children and young people safe will, in turn, form the basis of the published report. This will include key messages, strengths and areas for development for the partnership.

We will be looking at how well systems are organised to ensure that children and young people can experience continuity in their care and develop lasting relationships. We will also look at how well staff are supported and equipped for their task.

We want to learn how well children and young people understand and have been involved in decision making and plans about their care and support, as well as how well they think professionals work together to promote their well-being.

We will be looking at the extent to which performance in assessment and planning, supported by robust quality assurance and high-quality reflective supervision, is in place to ensure the safety of, and improve outcomes for, children and young people.

The child protection systems review identified the need for a clearer collective understanding of when child protection concerns should give rise to consideration of compulsory measures of care. Our inspections will consider the appropriate use of legal measures to achieve security and stability in the lives of children and young people at risk of harm.

We will continue to assess how well leaders work together and how they can demonstrate the difference that they are making to the lives of children and young people at risk of harm.

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Inspection team - roles and responsibilities

Inspection lead

The inspection lead will be a strategic inspector from the Care Inspectorate. They are responsible for the successful conduct of the joint inspection and as such leads on all aspects and phases of the inspection. Responsibilities include leading the inspection team; ensuring the effective gathering and analysis of complex data and evidence across the range of relevant services; and reaching sound conclusions about how well services work together to ensure good outcomes for children.

The inspection lead plays a key role in setting the tone of the inspection by establishing credibility and confidence of chief officers, community planning partners, senior managers and key staff in the range of services involved throughout the joint inspection.

Depute inspection lead

The depute inspection lead is responsible for supporting the inspection lead in the preparation, planning and management of all phases throughout the joint inspection. The role includes deputising for the inspection lead for aspects of the inspection as directed, as well as assuming responsibility for the conduct and completion of the inspection in the absence, or withdrawal, of the inspection lead due to unforeseen circumstances.

Strategic support officer

The strategic support officer (SSO) project manages each inspection. They work closely with the Care Inspectorate's inspection lead and depute inspection lead in supporting the inspection. They provide a key link for the partnership and will work alongside a co-ordinator identified by the CPP. The SSO co-ordinates a wide range of activities to ensure that the inspection runs efficiently, and they are the first point of contact for the CPP for logistical aspects of the inspection.

Relationship manager

The Care Inspectorate has a regulatory relationship manager linked to each local authority area and they will provide a “profile of performance” about care services operating within the area. This helps to build a picture and contribute to the inspectors analysis of the partnership’s self-evaluation.

Link inspector

A strategic inspector within the Care Inspectorate has a link role with each local authority in Scotland. They provide support and challenge to the local authority social work service and the Child Protection Committee, as well as participating in the Shared Risk Assessment/Local Scrutiny Plan development. As part of the inspection team, their responsibilities include preparing and submitting an analysis of relevant data and intelligence in respect of services in the area. The link inspector also has the key role in subsequently monitoring progress of any action plan resulting from the joint inspection.

Inspection team members

Other inspection team members include:

• Other Care Inspectorate strategic inspectors
• His Majesty's Inspectorate of Constabulary in Scotland (HMICS) Associate Inspector
• Inspectors from Healthcare Improvement Scotland (HIS) and Education Scotland
• Associate assessors - drawn from a pool of experienced professionals who have been nominated by CPPs and their employer to take part in strategic inspection teams
• Young inspection volunteers aged 18 to 26 who are supported by a voluntary organisation and have relevant experience of care services.

The role of all inspection team members throughout the inspection is to:

• gather, record and analyse evidence across services and from a range of sources including a review of multi-agency practice by reading children’s records;
• interview children, young people, parents and carers sensitively to obtain evidence of their experiences, the impact of the services that they receive, and the outcomes achieved;
• facilitate and record focus groups on key themes or with particular groups of staff; and
• produce clear and concise written reports within the inspection timeline to assist the inspection team to reach conclusions about the quality of services provided.

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Inspections overview

• Inspection types
  
• Inspection teams 
• Inspection methodology
• Inspection activities
• Inspection reports  
• Quality assurance 
• Inspection governance  
• Covid-19

Inspection types

Our specific inspection focus and programme at any one time is agreed with the Scottish Government and published in the Care Inspectorate’s Scrutiny, Assurance and Improvement Plan. We take a number of different approaches to inspection, designed to meet different scrutiny objectives. These include, but are not limited to:

Inspections and joint Inspections: inspections of individual local authorities or partnerships in relation to key priority areas. Local authorities are identified for inspection based on a combination of risk assessment and rotation of scrutiny activity.

Progress reviews: return visits to a local authority or partnership to check progress following a previous inspection and set of recommendations. Progress reviews are usually (but not always) carried out where the original inspection identified significant areas for improvement.

Thematic reviews/inspections: inspections carried out in a limited number of local authority or partnership areas to explore a particular area of policy or practice that is of national interest. These reviews may or may not evaluate the performance of individual authorities or partnerships but are primarily designed to explore the national picture relating to a given theme and make national recommendations.

Supported self-evaluations: we are always keen to support and encourage self-evaluation. We may at times work proactively with identified local authorities and partnerships to support and validate their self-evaluation of particular areas of activity.

Inquiries: this approach uses an abbreviated approach to explore a particular theme or issue across the country. It is usually designed as a discrete piece of work, carried out over a relatively short time to produce a quick report that provides insight into the key issues relating to the theme.

Inspection teams

Our inspection teams have an inspection lead with responsibility for effectively delivering and concluding the individual inspection. The lead is supported by a deputy lead and a team of inspectors drawn from the Care Inspectorate and relevant partner scrutiny bodies. Our inspections may be supported by associate assessors and people with lived experience (inspection volunteers). The administration and organisation of inspection activities is managed by a team of strategic support officers.

The size of an inspection team will be determined by the scope, methodology and planned length of the inspection. Sometimes, additional resources may be allocated for specific parts of the inspection. However, most inspections will have a core team of between six and 10 members.

How resources are deployed across the different activities of the inspection, and the timing of activities, is captured on a plan that we call the inspection footprint.

Inspection methodology

For each set of inspections, we develop a quality framework (QIF). The quality framework outlines what we expect the quality of the service provided to be. The frameworks we use in our strategic inspection work are based on the EFQM (European Foundation for Quality Management) excellence model, widely used by organisations for managing change and improving performance. The Health and Social Care Standards are woven throughout the quality indicators.

Overall, the QIF provides a model to support inspection. We examine:

• performance and the outcomes that services achieve for the children and adults who use them
• the processes that support service delivery
• the vision, leadership, management and planning of services.

The quality frameworks are also available to local authorities & partnerships for them to use for self-evaluation purposes.

 Inspection activities

The activities carried out by inspection teams to gather information can differ across inspections. However, there are some activities which have been proven to consistently provide good information and are therefore used regularly as part of inspections. These include:

Information and communication

The local authority or partnership can expect to receive full information about the inspection.

Most inspections provide a written guidance document of some sort, explaining the various stages and activities of the inspection, along with timescales.

In most inspections, we ask the local authority or partnership to nominate a local co-ordinator to manage and co-ordinate the various activities for them.

Throughout the course of the inspection, there are pre-planned meetings between key members of the inspection team and the local authority or partnership. These may be called professional or partnership discussions. Their key functions are: for the inspection team to feedback on findings so far; for the local authority or partnership to reflect on those findings; for the parties to discuss arrangements and plans for the next phase of the inspection.

Self-evaluation

It is a priority for the Care Inspectorate to support local authorities and partnerships to evaluate their own progress. Most of our inspections ask the local authority or partnership to provide a position statement and supporting evidence at the beginning of the inspection to help inform the inspection team’s understanding and formulate lines of enquiry.

Talking to children and adults who use services

Understanding the experience of people who use social work and social care services is fundamental to inspection, and we use a range of methods to gather the views of both people and unpaid carers. These are likely to include surveys, interviews, events, focus groups, and a range of activities developed to support specific inspections.

Reviewing records

Reading the records of children and adults who use services (also known as file reading) is a rich source of evidence for the inspection teams and is a part of many inspections. It provides understanding of how processes work and gives a picture of how staff interact with people using services.

Support networks

As well as reading records, many inspections include further examination of the care and support journeys experienced by children and adults by meeting with the staff and other significant people who have been part of that journey. This means that inspectors are able to further explore questions that have arisen from reading case records.

Staff surveys

Many inspections include surveys issued to staff. The inspection team often requests the help of the local authority or partnership in distributing the survey and encouraging staff to respond. The arrangements for issuing the survey, and which staff should receive it, will be discussed with the inspection co-ordinator by the inspection lead and strategic support officer.

Interviews and focus groups with key stakeholders

Most inspections involve focus groups or interviews with key stakeholders, including staff, managers, senior leaders, representatives of other statutory and third sector organisations. Often this takes place towards the end of an inspection as it gives the inspection team a good opportunity to discuss themes and issues that have emerged during other inspection activities.

Inspection reports

Inspection teams use regular team meetings to identify and explore themes that emerge from inspection activities. We make sure that potential findings are triangulated and corroborated through a range of activities before accepting them.

Inspection reports for each strand of inspection activity are tailored to the requirements of that inspection, so there are differences between the reports produced by each strategic inspection team. There will also be differences in the reports produced by each team when they are working on different inspection themes.

However, in general, strategic inspection reports can be expected to contain:

• a summary of key findings and/or strengths and areas for improvement
• an analysis of the inspection findings based on the relevant quality framework
• some form of evaluation of the local authority or partnership’s performance – which may or may not have grades attached
• recommendations for action and/or improvement.

Quality Assurance

We aim to achieve a high quality for all our work and want it to have maximum value for all our stakeholders and help to improve the experience of people who use services. To help us achieve this, each inspection programme has a range of quality assurance arrangements:

Each programme has arrangements for review of the inspection approach and methodology which take account of the learning from each inspection while balancing the need for consistency. A key source of learning is from post inspection questionnaires and feedback from inspection leads and team members. All strategic scrutiny teams are represented on a forum to discuss potential improvements to inspection methodology from experiences across the different workstreams and promote consistency wherever possible. When reading the records of people who use services during inspection, a proportion of the sample is double read to ensure consistency of evaluations and we provide training for all record readers.

At the reporting stage of our inspections, inspection leads present their inspection team’s findings and draft report to a ‘quality and consistency’ panel with representation from each partner scrutiny body for discussion and comment. Reports are then issued to the area inspected for an accuracy check before final editing and publication.

Information governance

Our approach to processing personal data is set out in full in our organisational privacy notice.

Covid-19

The Covid-19 pandemic has had a huge impact on social work and social care services across the country. Because of this, most of our strategic inspection work was paused between March 2020 and spring 2021. Since then, strategic inspections have recommenced with some adjustments to reflect the ongoing risks posed by covid-19 and the pressure on local authority and partnership services.

We continue to be responsive to the trends of the pandemic as we plan for and deliver inspection activities. We have also incorporated learning from the pandemic period in relation to our use of technology, and expect to be using a blend of onsite and distance approaches to carry out inspections moving forward.