A quality framework for support services (care at home, including supported living models of support)

Last updated: 17 August 2026

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PDF A quality framework for support services (care at home, including supported living models of support) Published: 1 June 2022

A quality framework for support services (care at home, including supported living models of support). For use in self-evaluation, scrutiny and improvement support

Changes to our inspection

We are developing new approaches to scrutiny. We want to make sure that inspections and our other scrutiny work are strongly focused on assessing the extent to which people experience wellbeing, and on understanding the difference care and support makes to their lives. Since 1 April 2018, the Health and Social Care Standards have been used across Scotland. They have been developed by Scottish Government to describe what people should experience from a wide range of care and support services. They are relevant not just for individual care services, but across local partnerships. The Care Inspectorate’s expectation is that they will be used in planning, commissioning, assessment and in delivering care and support. We will use them to inform the decisions we make about care quality. This means that we are changing how we inspect care and support. From 2018, on an incremental basis, we have been rolling out a revised methodology for inspecting care and support services.

The changes build on approaches we have introduced in the past three years: an emphasis on experiences and outcomes; proportionate approaches in services that perform well; shorter inspection reports; and a focus on supporting improvement in quality. The core of the new approach is a quality framework that sets out the elements that will help us answer key questions about the difference care is making to people and the quality and effectiveness of the things that contribute to those differences. The primary purpose of a quality framework is to support services to evaluate their own performance. The same framework is then used by inspectors to provide independent assurance about the quality of care and support. By setting out what we expect to see in high-quality care and support provision, we can also help support improvement. Using a framework in this way develops a shared understanding of what constitutes good care and support.

It also supports openness and transparency in the inspection process. In developing this framework, we have involved both people who experience or have experienced care and those who provide care and support. It is based on the approach used by the European Foundation for Quality Management, specifically the EFQM Excellence Model, which is a quality tool widely used across sectors and countries. We have adapted the model for use in care settings and have used the new Health and Social Care Standards to illustrate the quality we expect to see. Our frameworks are tested and evaluated to hear the views of people experiencing care, their carers and care providers. This helps us refine the framework and the way we will use it.

The quality framework is framed around key questions. The first of these is:

How well do we support people’s wellbeing?

To try and understand what contributes to that, there are four further key questions:

How good is our leadership?
How good is our staff team?
How good is our setting? (not currently assessed for this service type)
How well is our care planned?

Under each key question, there are up to five quality indicators. These have been developed to help answer the key questions. Each quality indicator has key areas, short bullet points which make clear the areas of practice covered by it.

Under each quality indicator, we have provided quality illustrations of these key areas at two levels on the six point scale that we use in inspections. The illustrations are the link to the Health and Social Care Standards and are drawn from the expectations set out in these. They are also aligned to the appropriate legislation and relevant national good practice. They describe what we may expect to see in a care service that is operating at a ‘very good’ level of quality, and what we might see in a service that is operating at a ‘weak’ level of quality. These illustrations are not a definitive description of care and support provision but are designed to help care and support services and inspectors evaluate the quality indicators using the framework.

The final key question is:

What is our overall capacity for improvement?

This requires a global judgement based on evidence and evaluations from all other key areas. The judgement is a forward-looking assessment, but also takes account of contextual factors which might influence the capacity of an organisation to improve the quality of services in the future. Such factors might include changes of senior staff, plans to restructure, or significant changes in funding. We think this an important question to ask as part of a self-evaluation of care.

During the Covid-19 pandemic we introduced an additional key question to the framework. Key question 7 focused on ‘How good is our care and support during the Covid-19 pandemic?’. This key question is no longer a part of the framework, however quality indicators 1.5 has been developed to ensure that where there are outbreaks of any infectious diseases, people’s health and wellbeing continues to be supported and safeguarded by infection, prevention and control practices. This reflects our learning from issues relating to infection, prevention and control that arose during the pandemic, and takes account of good practice guidance from Antimicrobial Resistance and Healthcare Associated Infections (ARHAI) Public Health Scotland and Scottish Government.

In each quality indicator, we have included a scrutiny and improvement toolbox. This includes examples of the scrutiny actions that we may use in evaluating the quality of provision. It also contains links to key practice documents that we think will help care services in their own improvement journey.

The quality framework will be used by inspectors in place of the older approach of ‘inspecting against themes and statements’. Inspectors will look at a selection of the quality indicators.

Which and how many quality indicators 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, but it is likely that we will always inspect Quality Indicators 1.1, 1.2, 1.3. We will use the quality illustrations, which are based on the Health and Social Care Standards, in our professional evaluations about the care and support we see.

One of the quality indicators, 1.4, looks beyond the practice of an individual care service and introduces elements about the impact of planning, assessment and commissioning on people experiencing care. This is important because these practices impact on people’s experiences and the extent to which they experience wellbeing. This quality indicator may help us during an inspection to find information or intelligence that is relevant to practices in commissioning partnerships, but our overall inspection evaluations (grades) will reflect the impact and practice of the care service itself.

We will provide an overall evaluation for each of the key questions we inspect, using the six-point scale from unsatisfactory (1) to excellent (6). This will be derived from the specific quality indicators that we inspect. Where we inspect one quality indicator per key question, the evaluation for that quality indicator will be the evaluation 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, recognising that there is a key element of practice that makes the overall key question no better than this evaluation.

The six-point scale is used when evaluating the quality of performance across quality indicators.

6 - Excellent: Outstanding or sector leading

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.

5 - Very good: Major strengths

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.

4 - Good: Important strengths, within some areas for improvement

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.

3 - Adequate: Strengths just outweigh weaknesses

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.

2 - Weak: Important weaknesses, priority action required

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 people’s 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.

1 - Unsatisfactory: Major weaknesses, urgent remedial action required

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.

The framework is primarily designed to support care services in self-evaluation. We are working with care services and sector-wide bodies to build the capacity for self-evaluation, based on this framework. We have published Self-evaluation for improvement – your guide.

Self-evaluation is a core part of assuring quality and supporting improvement. The process of self-evaluation, as part of a wider quality assurance approach, requires a cycle of activity based round answering three questions:

• How are we doing?

This is the key to knowing whether you are doing the right things and that, as result, people are experiencing high quality, safe and compassionate care and support that meets their needs, rights and choices.

• How do we know?

Answering the question ‘how we are doing’ must be done based on robust evidence. The quality indicators in this document, along with the views of people experiencing care and support and their carers, can help you to evaluate how you are doing. You should also take into account performance data collected nationally or by your service.

• What are we going to do now?

Understanding how well your service is performing should help you see what is working well and what needs to be improved. From that, you should be able to develop plans for improvement based on effective practice, guidance, research, testing, and available improvement support.

Using this quality framework can help provide an effective structure around self-evaluation.

The diagram below summarises the approach:

The approach to use for self-evaluation — Approach to self-evaluation

Irrespective of our role as the national scrutiny and improvement body, care providers will want to satisfy themselves, their stakeholders, funders, boards and committees that they are providing high quality services. We believe this quality framework is a helpful way of supporting care and support services to assess their performance against our expectations of outcomes for people, outwith an inspection and as part your own quality assurance. We are promoting this approach as we believe it adds value and we consider it important that care and support providers do not take actions merely to satisfy the inspection process.

Key question 1: How well do we support people’s wellbeing?

1.1. People experience compassion, dignity and respect

1.2. People get the most out of life.

1.3. People’s health and wellbeing benefits from their care and support

1.4. People are getting the right service for them

1.5. People’s health and wellbeing benefits from safe infection prevention and control practices and procedures

Key question 2: How good is our leadership?

2.1. Vision and values positively inform practice

2.2. Quality assurance and improvement is led well

2.3. Leaders collaborate to support people

2.4. Staff are led well

Key question 3: How good is our staff team?

3.1. Staff have been recruited well

3.2. Staff have the right knowledge, competence and development to care for and support people

3.3. Staffing arrangements are right and staff work well together

Key question 4: How good is our setting?

Not currently assessed for this service type

Key question 5: How well is our care and support planned?

5.1. Assessment and personal planning reflects people’s outcomes and wishes

5.2. Carers, friends and family members are encouraged to be involved

Key question 6: What is the overall capacity for improvement

This registration category covers a variety of service types providing a range of different supports, including support provided to children and young people.

This framework covers outcomes for people across the whole range of registered support services that provide care at home. It includes outcomes for people who receive support from services which operate a ‘supported living’ model. This often involves social support or longer periods of support, including 24-hour support. This is usually provided by a combined registration of care at home and housing support services, which enables people to maintain their wellbeing, home and tenancy.

Reference made only to ‘supported living services’ is identified in bold text, which reflects the additional elements of support provided within this model of service

Stand-alone housing support services have a separate quality framework.

In order to identify outcomes that are relevant to the service, you should consider the aims and objectives of the service when looking at the quality illustrations and evaluating it using the quality indicators and key questions.

The term ‘people’ has been used throughout this document to include children and young people as well as adults.

Key improvement resources

Quality indicator 1.1: People experience compassion, dignity and respect

Charter for Involvement – ARC Scotland

Children’s human rights – Children and Young People’s Commissioner Scotland: Seven golden rules for participation and other rights information

Good practice guides: Information from the Scottish Human Rights Commission

Guidance document on human rights charter for technology and digital in social care

Guidance for care providers in Scotland using CCTV (closed circuit television) in their services

Health and Social Care Standards

Information from the Scottish Human Rights Commission: Good practice guides

Mental Welfare Commission:

Rights, risks and limits to freedom
Human rights in mental health services
Covert medication
Working with the AWI Act,
Decisions about technology.

Practice guide: Involving children and young people in improving services

Scottish Recovery Consortium

World Health Organisation – Quality rights:  promoting the rights of people with mental health conditions, psychosocial, intellectual, and cognitive disabilities

Quality Indicator 1.2: People get the most out of life

Autism strategy for Scotland

General standards for neurological care and support 2019

Indicators of good practice in drug and alcohol services

Information on supporting people with complex needs and sight loss

Let's get active, connected and included resource - SCLD

National guidance for child protection in Scotland (Scottish Government)

Promoting excellence in dementia care (includes people with a learning disability and dementia)

Quality Principles - Standard expectations of care and support in drug and alcohol services

Scottish recovery network – peer support resources

See Hear – framework for meeting the needs of people with a sensory impairment

Supporting personal relationships 

The keys to life

Wellness recovery action plan

Quality indicator 1.3: People’s health and wellbeing benefits from their care and support

Accessible health information

Alcohol related brain damage

Care of people living with HIV

Hospital Passports:

Autism: My health passport
Royal Free: Hospital passport - Patients with a learning disability

Intermediate care including reablement

Maximising Recovery, Promoting Independence: An Intermediate Care Framework for Scotland

Medication management procedures for care at home services

Mental Health Strategy for Scotland

Mental Welfare Commission: Good practice guide - covert medication 

Notifications about controlled drugs: guidance for providers (2015)

Palliative and end of life care resources

Reset and rebuild: sexual health and blood borne virus services - recovery plan

Resources - Eat Well Age Well: Resources about the prevention, detection and treatment of malnutrition and dehydration amongst older adults living at home in Scotland.

Rights, respect and recovery: alcohol and drug treatment strategy

Safe administration of medication: Modules 1-3 (SSSC)

SCLD Healthy Eating Healthy Living Pack

Sexual health and blood borne virus framework 2015-2020

Standards for prevention and management of pressure ulcers

Supporting psychological wellbeing in adults with learning disabilities – an educational framework

Tissue viability toolkit

Trauma informed practice – National trauma training plan and resources

You are our eyes and ears: Pocket guide supporting consistent monitoring and identifying changes in wellbeing.