Quality framework for care homes for children and young people and special residential schools
This framework has been developed to help services understand, and improve, the experiences and outcomes of the children and young people they care for. It provides a single point of information to assist staff, managers, external managers and providers with self-evaluation, keeping the promise and inspection preparation.
It is most effective when used as a working tool, to help guide where your strengths as a service lie and where improvement may be needed. The framework covers every aspect of a service’s activity but can be used flexibly to examine specific outcomes or particular aspects of care practice.
The promise is clear that if children and young people are removed from their families, the focus of their care must be on nurturing childhoods that are underpinned by loving relationships, fun, play and opportunity. It describes the fundamentals of this care as including children and young people’s right to:
be cared for by a workforce which respects, champions and defends their rights
be supported to continue relationships that are important to them where it is safe to do so
continuity of care and carers, limiting the number of changes and moves they experience.
The quality framework is based on these fundamentals and mirrors the promise’s expectations that what must be prioritised are the quality of relationships that children and young people experience in residential settings. It sets out the elements that help services answer how well they are keeping the promise and ensuring children and young people grow up loved, safe and respected – so that they realise their full potential.
The quality framework reflects the expectations of the promise, the Health and Social Care Standards, Public Services Reform (Scotland) Act 2010 and the Health and Care (Staffing) (Scotland) Act 2019 regulations. It is designed to help to develop a shared understanding of what very good outcomes for children and young people look like, what services need to do to achieve these very good outcomes and what inspectors will look for at inspection.
The framework can therefore be used for:
self-evaluation and improvement
helping keep the promise to children and young people
preparing for inspection.
It uses the European Foundation for Quality Management approach, 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 promise and the Health and Social Care Standards to illustrate the quality we expect to see.
It is framed around seven key questions.
The purpose of key questions 1 to 5 is to support services to understand their own performance against the expectations of the promise and the Health and Social Care Standards. Using key question 6 then enables services to evaluate their performance against both.
Answering key question 6 helps services find out how good the care and support that children and young people are experiencing really is. It also assists in developing ways of improving these experiences and outcomes - with advice, guidance and practical tools for both self-evaluation and producing a development and improvement plan.
Key question 7 then consolidates the outcomes set out in questions 1 to 5 and is used proportionately by inspectors to structure their evidence gathering at inspection. This supports the transparency of evaluations at inspection because services using the framework for self-evaluation know they are benchmarking themselves in a similar way, and to the same standards, as the Care Inspectorate.
The first question is:
How well do we support children and young people’s wellbeing?
To try and understand what contributes to wellbeing, there are four further key questions:
How good is our leadership?
How good is our staff team?
How good is our setting?
How well is care and support planned?
Under each key question, there are a small number of quality indicators. These have been developed to help services understand how best to answer the key questions. Each quality indicator has a small number of key areas, which are short bullet points which make clear the areas of practice covered.
Under each quality indicator, we have provided quality illustrations at two levels on the six-point scale used in inspections. They describe what children and young people would expect to experience in a care service that is operating at a ‘very good’ level of quality, and what they 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 services evaluate the quality indicators, using the framework.
In each quality indicator, we have also included a ‘Self-evaluation and improvement support toolbox’. This includes examples of actions that services might find helpful to undertake when evaluating the experiences and outcomes for children and young people. It also contains links to key practice documents that underpin good care and support, which services should use as part of their own improvement journey.
Key question 6
Key question 6 is ‘What is our capacity to keep the promise and ensure children and young people grow up loved, safe and respected – so that they realise their full potential?’ This is the most important key question to answer. The guidance and tools in this section can be matched against the quality illustrations, core assurances and self-evaluation toolboxes in key questions 1 to 5. This will allow services to more confidently evidence the quality of outcomes children and young people are experiencing. Equally important, the process of self-evaluation will also enable any improvements to be identified. A further benefit is a shared understanding of expected outcomes, and the practice that underpins these outcomes, when key question 7 is inspected against.
Key question 7
This key question is divided into two quality indicators and is used by inspectors to structure their evaluations at inspection. Quality indicator 7.1 covers the same experiences and outcomes for children and young people as key question 1 and also includes key experiences and outcomes that are matched against key question 4 and key question 5. Quality indicator 7.2 covers the broad outcomes illustrated in key question 2 and key question 3 and is mapped against those key questions.
We use key question 7 to structure our activity at inspections where an evaluation on our grading scale is to be given.
The question is comprised of a single key question with two quality indicators. The key question is ‘How well do we support children and young people’s rights and wellbeing?’ and the quality indicators are:
7.1 Children and young people are safe, feel loved and get the most out of life.
7.2 Leaders and staff have the capacity and resources to meet and champion children and young people’s needs and rights.
Inspectors will always look at 7.1 and will also look at 7.2 in some services depending on the current evaluations (grades) for the service, the intelligence we hold about the service and risk factors that we may identify. In some circumstances we may also look at specific quality indicators from key questions 1 to 5, should this be needed to offer further assurance on outcomes for children and young people.
The core assurances span the entire framework, covering elements of several different quality indicators, so will always be proportionately examined.
We will use the quality illustrations in our professional evaluations of the care and support we see. We will provide an overall evaluation (grade) for each of the quality indicators we inspect, using the six-point scale, from ‘unsatisfactory’ (1) to ‘excellent’ (6).
Where we inspect one quality indicator, the evaluation for that quality indicator will be the evaluation (grade) for the key question overall. Where we inspect more than one quality indicator per key question, the overall evaluation (grade) for the key question will be the lowest evaluation (grade) of the quality indicators for that specific key question. This recognises 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.
Key question 1: How well do we support children and young people’s wellbeing?
1.1. Children and young people experience compassion, dignity and respect
1.2. Children and young people get the most out of life
1.3. Children and young people’s health and development benefit from the care and support they experience
1.4. Children and young people get the service that is right for them
Key question 2: How good is our leadership?
2.1. Vision and values positively inform practice
2.2. Quality assurance and improvement are led well
2.3. Leaders collaborate to support children and young people
2.4. Staff are led well
Key question 3: How good is our staff team?
3.1. Staff are recruited well
3.2. Staff have the right values, skills and knowledge to care for children and young people
3.3. Staffing levels are right and meet children and young people’s needs, with staff working well together
Key question 4: How good is our setting?
4.1. Children and young people experience high quality facilities
4.2. The setting enables children and young people to thrive and develop their independence
4.3. Children and young people can be connected with and involved in the wider community
Key question 5: How well is our care and support planned?
5.1. Assessment and care planning reflects children and young people’s needs, outcomes and wishes
5.2. Parents, carers and family members are involved
Key question 6: What is our capacity to keep the promise and ensure children and young people grow up loved, safe and respected – so that they realise their full potential?
Key question 7: How well do we support children and young people’s rights and wellbeing?
7.1. Children and young people are safe, feel loved and get the most out of life
7.2. Leaders and staff have the capacity and resources to meet and champion children and young people’s needs and rights