A quality framework for care homes for adults and older people
Key question 3: How good is our staff team
This key question has three quality indicators associated with it.
They are:
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
Quality indicator 3.1
Staff have been recruited well
Key areas include the extent to which:
people benefit from safer recruitment principles being used
recruitment and induction reflects the needs of people experiencing care
induction is tailored to the training needs of the individual staff member and role.
Very good
People can be confident that staff are recruited in a way which has been informed by all aspects of safer recruitment guidance, including a strong emphasis on values-based recruitment. The process is well organised and documented so that core elements of the procedure are followed consistently. People living in the care home have opportunities and the necessary support to be involved in the process in a meaningful way, which takes their views into account, including in recruitment decisions.
To ensure people are kept safe, staff do not start work until all pre-employment checks have been concluded and relevant mandatory training has been completed. There is a clear link between the needs of people and the skill and experience of the staff being recruited. There are a range of supports in place to encourage staff retention.
Weak
There is insufficient attention to understanding why safer recruitment is important, which may put people at risk. Key elements of processes may be ignored, for example exploring gaps in employment records or checking that references come from a previous employer.
Even where good recruitment policies are written, they may not be implemented consistently, for example only one reference is obtained, and staff start to work alone before their membership of the Protection of Vulnerable Groups scheme has been confirmed.
The care home may not fully understand the skill set and experience it needs within its staff team in order to provide high quality care and support for the people living in the service
Very good
The induction is thorough and has been developed to enable staff to support the needs and outcomes of people in the particular setting. This includes an emphasis on implementing the Health and Social Care Standards as underpinning values for all care and support. There is a clear plan as to what is included and how this will be delivered with sufficient time to ensure that staff can understand all the information and what is expected of them.
During the induction period, feedback is sought from people living in the service, family members and colleagues, so that they contribute to the evaluation of staff values, communication and further development needs.
Weak
The values and motivation of potential staff may not have been explored as part of the recruitment process and may not inform recruitment decisions.
Staff start work before they have sufficient knowledge and skills. They may have had no induction; it may be brief and patchy, or there may be too much covered too quickly for it to be effective. New staff may only have the opportunity for a minimum period of shadowing and there is limited structure for additional discussions about their learning needs, either through supervision or a mentor.
Very good
Throughout the recruitment and induction process, the learning needs and styles of individual staff members are taken into account to help ensure they are well prepared for their role. There is likely to be a range of learning styles, for example, the opportunity for face-to-face discussion and shadowing of more experienced staff. Staff are clear about their roles and responsibilities, with written information they can refer to, and a named member of staff for support.
Staff are clear about their conditions of employment and the arrangements for ongoing supervision and appraisal. As a result, they feel well supported and confident in carrying out their role. There is additional supervision in the first few months to discuss any learning needs or issues.
Weak
The induction may be generic, have not been reviewed recently, or may not include effective input about the Health and Social Care Standards.
Staff lack confidence in, or have limited understanding of, their role in providing care and support and how they contribute to the work of the organisation because their induction has not adequately prepared them for their job role.
Observation of:
experiences of people in the service
staff practices
communication and interactions.
Discussions with:
people living in the care home
staff, including manager
visitors, such as relatives, friends and carers of people living in the service
visiting professionals.
Sampling of:
recruitment policy and procedure
staff job descriptions and roles quality assurance policy, procedure, practice and outcomes
the induction policy, procedure and practice
relevant HR or personnel files
how fitness checks are undertaken
interview records.
Consideration of:
the analysis of staff skills required to meet the outcomes of those using the service
how induction is tailored to individuals
how those living in the service, or where appropriate, relatives, and carers can be involved in the recruitment process.
National health and social care workforce plan: part two
Knowledge and skills framework for Health and Care staffing in Scotland
Scottish Code of Practice for the international recruitment of health and social care personnel
SSSC / Care Inspectorate - safer recruitment through better recruitment
Quality indicator 3.2
Staff have the right knowledge, competence and development to care for and support people
Key areas include the extent to which:
staff competence and practice support improving outcomes for people
staff development supports improving outcomes for people
staff practice is supported and improved through effective supervision and appraisal.
Very good
Staff competence is regularly assessed to ensure that learning and development supports better outcomes for people. This means that people are being cared for by staff who understand, and are sensitive to their needs and wishes because there are a number of learning and support measures in place.
People are confident that staff have the necessary skills and competence to support them. There is a clear staff assurance framework that provides a structure of training for each role within the care home. This includes values, the Health and Social Care Standards and any applicable codes of practice and conduct, as well as specific areas of practice.
Weak
Arrangements for assessing ongoing competencies are sporadic and with little encouragement for reflection on how learning needs will be met or how this might improve practice and outcomes for people.
Staff may be registered with relevant professional bodies but do not fully understand their responsibilities for continuous professional development or how they can fulfil this. They may lack confidence or support in taking responsibility for their own learning and development.
Very good
Learning opportunities are developed to meet the needs of people who live in the care home based on evidence and good practice guidance. This is regularly analysed, with new training planned as people’s needs change. People who live in the service are involved in staff development and learning, if this is what they want.
Staff are supported to keep up to date with current and changing practice, with easy access to a range of good practice guidance.
There are a range of approaches to suit different learning styles and it is evident that all staff have access to training and have their own plan which identifies gaps and how these will be met. Staff are confident about where to find good practice and advice on how they can support people.
There is a learning culture embedded within the care home, which includes reflective practice. Staff are comfortable acknowledging their learning needs, as well as challenging poor practice and are confident these will be addressed.
Weak
Training is basic and restricted to set topics, often with little mention of values and codes and their importance to inform good care and support. Training does not reflect the changing needs of people being supported in the service.
Training is regarded as an event rather than ongoing learning. There is little access to good practice guidance or opportunity for further discussions to ensure knowledge is consolidated and embedded into practice.
There is no effective training analysis for the care home or individual staff. The training plan and records are incomplete or held in a format which does not allow the identification of priorities.
Very good
Regular supervision and appraisal are used constructively and staff value them because they support personal and professional development. There are clear records of learning being undertaken and planned, which inform what is provided for each member of staff. Staff are aware of their responsibilities for continuous professional development to meet any registration requirements, keep a record of this and have support to achieve this from their employer.
The views of people who are supported by staff are used to give staff feedback and are included in supervision and appraisal.
Staff benefit from personal and professional wellbeing support that includes debriefing on the management of difficult situations, personal safety, assessment of workload and bereavement support.
Weak
Supervision may not take place regularly or may be so limited that there is no opportunity to reflect on skills, knowledge and learning. Staff may consider that if they have completed all the available training, they need nothing else. Where learning needs are identified, the systems for ensuring these are provided are not robust, resulting in gaps in knowledge remaining unfilled.
Observation of:
experiences of people in the service
staff practices
communication and interactions
formal SOFI 2 observation
availability of staff to support people throughout the day.
Discussions with:
people living in the care home
staff
visitors, such as relatives, friends and carers of people living in the service
visiting professionals.
Sampling of:
staff rota and deployment
tools for assessing staffing.
Consideration of:
staff roles and duties
how information in care and support plans informs staffing
how the manager monitors staffing levels and skill mix, and when adjustments are made
the use of agency or sessional staff and how this is managed.
Quality indicator 3.3
Staffing arrangements are right, and staff work well together
Key areas include the extent to which:
the skill mix, numbers and deployment of staff meet the needs of people
there is an effective process for assessing how many staff hours are needed
staff are flexible and support each other to work as a team to benefit people.
Very good
The right number of staff with the right skills are working at all times to meet people’s needs because providers and leaders in the care home understand the needs and wishes of the people living there.
Staffing arrangements allow for more than basic care needs to be met and support people to get the most out of life. Staff have time to provide care and support with compassion and engage in meaningful conversations and interactions with people.
Staff are clear about their roles and are deployed effectively. Staff help each other by being flexible in response to changing situations to ensure care and support is consistent and stable. People can have a say in who provides their care and support.
People can have confidence in their support because any redeployed, temporary or new staff have ready access to the right information about the service and the individual’s specific needs and outcomes
Weak
The numbers of staff are minimal and sometimes insufficient to fully meet the needs of people living in the service. Staff work under pressure and some aspects of care and support may be skipped or missed, affecting outcomes for people. People living in, or visiting the service, perceive staff to be ‘rushed’.
When matching staff to work with individuals living in the care home, limited importance is placed on staff skills, experience and personality to help people build successful relationships and work well together.
Very good
The numbers and skill mix of staff are determined by a process of continuous assessment featuring a range of measures, and is linked to quality assurance. This includes taking account of the complexity of people’s care and support.
Feedback from all parties contributes to this and any dependency assessment takes account of the premise’s layout where applicable. This includes how best to deploy staff to support key-working, high quality care and small group living with good continuity of care and support.
Staffing assessments are transparent with decisions about staffing arrangements shared with both staff and those living in the service.
Robust methods to assess staffing are informed by the latest guidance and research which utilise available tools, data and professional judgement. This assessment includes the needs of people, as well as their views and that of their families and carers.
Staffing assessments are informed by an overall evaluation of the care service, its physical environment and local context. The views and well-being of staff are key factors when assessing staffing. Relevant professionals have been consulted on staffing arrangements where appropriate.
Staff are deployed effectively and efficiently whilst respecting the rights of people. In relation to staffing arrangements, there is a culture of shared assessment which involves a range of professional disciplines.
Weak
Staffing arrangements are relatively static with infrequent reviews and not adjusted to meet people’s changing needs. Current staffing levels and vacancies are not considered. There may be a dependency assessment, but this is not translated into staff hours and no other measures or feedback are used to determine what staff time is required.
The service does not have a staffing contingency plan in the event that a number of staff are absent at the same time.
There may be an over-reliance on agency or short term/temporary staff, which leads to people experiencing a lack of consistency and stability in how their care and support is provided and limits their ability to build a trusting relationship with staff members. There are no protocols in place to support the use of agency, sessional or bank staff.
Methods to assess staffing are limited and do not take a structured approach or consider the wellbeing of staff. Approaches are not informed by the latest guidance and the views of staff, people, their families and carers are not considered.
Assessment of staffing arrangements are narrow in focus and do not consult relevant health and social care professionals.
Very good
People living in the care home and staff benefit from a warm atmosphere because there are good working relationships. There is effective communication between staff, with opportunities for discussion about their work and how best to improve outcomes for people.
Motivated staff, effective deployment and good team working mean that staff spend as much time as possible with people. Staff are confident in building positive interactions and relationships.
There is a strong emphasis on the responsibilities of staff who are not involved in providing direct care and support to people, recognising that they play an important role in building a staff team.
Weak
The pressure on staff leads them to stick to their designated tasks as there is no capacity to respond to other demands. Despite the best efforts of staff, care and support is basic with little time for speaking with people or supporting them to maintain interests.
Communication and team building may suffer due to lack of time, and this affects staff wellbeing and motivation. Important information is not shared or passed on accurately leading to a negative impact on people.
Observation of:
experiences of people in the service
staff practices
communication and interactions.
Discussions with:
people living in the care home
staff, including manager
visitors, such as relatives, friends and carers of people living in the service
visiting professionals.
Sampling of:
mandatory training records for different grades of staff
staff supervision and appraisal records
staff’s training and development plan and outcome, including any training needs analysis
minutes of staff and team meetings.
Consideration of:
how on overview is maintained of staff’s professional registration status and requirements
how staff wellbeing is supported
whether training provided reflects the needs and outcomes of people living in the service
how competency issues are managed.
Achieving effective supervision – IRISS insight
Codes of practice for social service workers and employers (SSSC)
Common core skills and national occupational standards (SSSC)
Employer responsibilities–supporting staff with registration
Framework for continuous learning (SSSC)
Frequently asked questions about SSSC registration
Prepping for practice – induction guidance 3.2
Professional standards of practice and behaviour for nurses, midwives and nursing associates