Positive approach to risk in play
The Care Inspectorate is showing its support for nurseries, childminders and other early years care services that take a positive approach to risk, by setting out its position on regulating for risk in play. We launched our position statement with the support of Play Scotland at their event Playing with risk: embracing the benefits with positive regulation, held in January 2016.
The Care Inspectorate’s position statement
“The Care Inspectorate supports care service providers taking a positive approach to risk in order to achieve the best outcomes for children. This means moving away from a traditional deficit model that takes a risk-averse approach, which can unnecessarily restrict children’s experiences attending registered services, to a more holistic risk-benefit model. For example, we encourage services to use risk assessment to support children to enjoy potentially hazardous activities such as woodwork using real tools, exploring nature and playing in the mud and rain. We do not expect written risk assessments to be carried out for daily play activities.”
Context
Embracing a risk-benefit approach is part of changing our regulatory culture. For example, when we inspect we now assess the experience of the children attending and try to help services to improve. Traditionally the regulator would have just measured inputs and ensured that all services complied with the expected standards.
A positive approach to risk in play is being taken by specialist outdoor-based services for children. Since the UK’s first full-time forest nursery was registered in Fife in 2008, outdoor-based services have flourished in Scotland. At this event, the Care Inspectorate celebrated the growth of these services and their contribution to developing a proportionate approach to risk.
Play Scotland support
Cherie Morgan, Play Development Officer, Play Scotland says: “We want to see a common sense approach to risk in play, where practitioners weigh up the benefits, as well as the risks involved with activities. The opportunity to face challenges in a supportive environment helps children and young people learn to assess and manage risk for themselves, and this is vitally important for their development. We’re delighted to work with the Care Inspectorate to highlight this message to those who are responsible for the day to day care of children.”
Ministerial support
Aileen Campbell MSP and Minister for Children and Young People supports this new approach with the following statement.
“In June 2013 the Scottish Government published the Play Strategy for Scotland, which seeks to improve the play experiences of all children and young people, including those with disabilities or from disadvantaged backgrounds. The Strategy aims to ensure all children and young people can access play opportunities in a range of settings which offer variety, adventure and challenge. They must be able to play freely and safely while learning to manage risks and make choices about where, how and when they play according to their age, stage, ability and preference.
“A huge part of this is giving regulated services the confidence to provide good quality, challenging play opportunities for children in their care. Real life experiences for children cannot be free of risk; from the very beginning children learn from trial and error, falling and getting up, testing their own boundaries and this enables them to develop their own coping strategies and resilience.
“It is important too that children with additional support needs also have the chance to experience challenging play – and that quality play opportunities are offered to all children, according to their needs and preferences.
“Myth busting in terms of what ‘safe care’ is for our children is also important. Scotland’s children deserve to be cared for in a loving, nurturing environment that includes hugs and the comfort of touch, which is even more important now that children are in care environments from a younger age and for longer periods of time.
“I am delighted that the Care Inspectorate is supporting care service providers to adopt a more holistic risk-benefit model to help them achieve the best outcomes for children. This positive approach to risk emphasises confidence in providers using their professional judgement to support, nurture and challenge the children and young people in their care.”
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eForms: Information for providers about extensions
The eForms system is now available for providers. We are sorry for any inconvenience caused.
In order to help providers, we have extended submission dates for annual returns and some providers' self assessments. The table below shows the new deadlines.
| Process/forms | New submission date | Information for providers |
| Annual returns | 29 February 2016 | The final submission date has been extended to reflect the system being unavailable. |
| Self assessment | 18 February 2016 | Those services that were closed over the festive period and were given an extension to the end of January have another two weeks from 4 February. |
| Draft inspection reports and error response forms | 25 February 2016 | If you have been unable to view your draft report and/or submit your error response form you now have an additional fifteen working days from 4 February. |
| Final inspection reports and actions plans | 25 February 2016 |
If you have been unable to view your final report and/or submit your action plan you now have an additional 15 working days from 4 February. If you are waiting for you report to be finalised, we shall do so once the date for the error response form has passed. |
| Notifications | 25 February 2016 |
Please use our eForms to log all notifications that occured whilst the systems were not available including any you have already contacted your inspector about. Any notifications you have already submitted online will not be lost. You will be able to see what you have previously submitted to your account.
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| Any other eForms documents | For any other eForms documents (such as an application to inactive/active or vary your registration), we shall process your forms as quickly as possible. | |
| Scottish Care Home Census | April 2016 - date to be confirmed. | The submission period is not affected. You'll receive a message from us nearer the time to confirm the date of submission |
If you have any concerns please contact the Contact Centre helpline on 0345 600 9527
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Make Every Moment Count
We have worked with a team of experts to develop the ‘Make Every Moment Count’ resource, an information leaflet which contains easy to read and simple guidance for everyone supporting older people in a care home or at home.
The resource highlights how making the most of every moment can make a real difference to a person’s quality of life in simple but very meaningful ways.
The five key messages are:
- Get to know me
- It's not just what you do... it's how you make me feel
- Know what I can do and support me to do it
- Help me feel comfortable, safe and secure in my surroundings
- Remember little things all add up
By providing key messages on how to better understand an individual’s needs, values and lifestyle, the guide will help people working in care services to deliver an enhanced experience for Scotland’s older people.
Hear more about the resource in our video.
To order copies of this information leaflet, poster or DVD, please call our enquiries team on 0345 600 9527 or email This email address is being protected from spambots. You need JavaScript enabled to view it..
Some signposts to useful information
www.knowledge.scot.nhs.uk/dementia
http://www.nmhdu.org.uk/silo/files/lets-respect-toolkit-for-care-homes-.pdf
http://www.bhfactive.org.uk/home/index.html
http://www.active-ageing-events.org.uk/home/index.html
Actively Engaged
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Falls and Fractures
The 'Managing Falls and Fractures in Care Homes for Older People good practice resource' is a revised and improved edition of the resource pack launched in 2011.
This resource pack will help staff in care homes to assess how well falls prevention and management and the prevention of fractures is being addressed in their service.
It aims to provide the answers to many of the questions care home managers have, and can also act as an educational tool for new or existing care home staff. It provides practical help, guidance and tools and signposts to resources available online.
There are a number of changes and additions in the 2016 edition.
The self assessment is still your starting point when using the resource pack; you will notice it has a few additional ‘good practice statements’ in line with the updated practice. It will help you identify what improvements, if any, you need to make in your care home to prevent falls.
Section 5 - 'Learning from falls' emphasises the importance and value of learning from the information you gather about falls. Section 2 'Guidance for improving the quality of care’ is a new section which has been added to support you to identify, plan, test and implement lasting improvements in your care home. Section 4 ‘Keeping well’ is another new section, focusing on 10 common risk areas and includes guidance, points to consider, tools and links to useful websites.
Care home stories have been added throughout the resource pack to give examples of new ways of working. To emphasise the importance of working with the wider health and social care team Section 6, ‘Working together’ has been added, which suggests ways to develop and improve links.
And finally, some tools in the toolkit have been updated and new tools added including a falls data spreadsheet to gather and analyse information about falls in your care home (this is accessible on the internet along with instructions for its use) and a DVD education pack that goes with the falls awareness DVD that came out with the original pack.
Please make use of the revised resource in a way that fits with the needs of the staff and residents in your care home. We hope you find it useful, comprehensive and easy to use. Most importantly we hope it supports you to improve the care and lives of older people at risk of falling.
The resource can be downloaded here or by clicking on the image above.
Resource Tools
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Tool 1a The Model for Improvement
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Tool 1b The Model for Improvement and PDSA cycle planning and progress proforma
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Tool 2a Improvement log
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Tool 2b Action plan
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Tool 4a Multifactorial Falls Risk Screen (MFRS) and falls care plan
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Tool 4b Care home resident falls and fracture risk/intervention tool
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Tool 6 Falls management checklist
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Tool 10 Protocol for measuring lying/standing blood pressure (BP) (checking for Orthostatic Hypotension)
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Tool 13 Bedrail risk assessment
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Tool 14 Seating matters
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Tool 15 Post fall pathway for managing a resident who has fallen or has been found on the floor
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Tool 16 Telecare matters: A quick guide to technology enabled care and support
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Tool 17a Guidelines for completing a post falls/incident report form
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Tool 17b Post fall/incident report form
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Tool 18b Care home monthly falls diary
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Tool 19 Fall data spreadsheet
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Tool 20a Procedure for the use of measles chart/falls plotting
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Tool 20b Measles chart example
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Tool 21b Falls safety cross
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Tool 22 Training database
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Tool 23 Managing falls and fractures in care homes for older people: DVD education pack (This links with the falls awareness DVD which is available below)
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Tool 24 Service directory
Watch the falls awareness educational video here.
We first published the resource in 2011 and carried out and evaluation in 2012. You can read the full evaluation report here.
For more information please contact Fiona Currie, Improvement Adviser at This email address is being protected from spambots. You need JavaScript enabled to view it..
Strength and Balance DVD to prevent falls and keep well
A DVD has been produced by Active Fife in partnership with Paths for All and is accompanied by their 'Walk Your Way to Better Strength and Balance' leaflet. Anyone outside of Fife who wishes to get copies of the DVD or leaflet can get them directly from Paths For All or through their local health walking group.
The videos contained within the DVD are also available through Paths for All on YouTube.
Useful information
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Variations around the skills mix in care homes
Care homes for older people
The Care Inspectorate is aware of the challenges faced by some care providers on the recruitment and retention of nurses in the care sector. Some care providers have approached us about reconfiguring their staffing model, to develop the role of their senior care workers so that they can deploy their nurses more effectively and in some cases reduce reliance on agency nursing in order to promote more stable staff teams.
The Care Inspectorate recognises and strongly supports the role that nurses play in many care homes, particularly in providing clinical leadership and planning care for residents. We are also keen to support innovation in care that reflects changing needs and demands, where this improves outcomes for service users.
Where care homes for older people are proposing to vary the skills mix in a care home, and this would require a change to staffing schedules, we will consider proposals through our registration variations process. We expect such proposals to improve the quality of care for residents. We will ask care homes to provide us with specific information to support the variation request.
If agreed, we may place specific time-limited conditions on the registration of the service. We will expect any such initiative to be evaluated by the care home provider, before consideration is given to confirming these arrangements as permanent. Where a variation is agreed, the next inspection of the care home is likely to look at all quality themes, even if the home has been performing at a high level for some time.
Prior to submitting your variation, the registration team will be able to advise on what actions you should be taking to support your application. This should include engagement with local commissioners, as well as with residents and relatives and the development of a plan to evaluate the impact and effectiveness of your initiative. Please note, cost saving will not be an acceptable reason for application.
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