Skills for Care as part of their ‘Good and Outstanding Range’ have produced guidance for managers on safe staffing. The guide explains what the CQC looks for in terms of safe stafﬁng and how a service can meet the regulation requirement. It includes guidance around deciding and maintaining safe stafﬁng levels, safe recruitment practices and how to ensure staff are safe and competent.
It draws on evidence from over 60 CQC inspection reports and case studies from residential and community-based services who are rated ‘good’ and ‘outstanding,’ to help providers to understand what ‘good’ looks like and learn from best practice.
What is safe staffing
According to the guide safe stafﬁng is about having enough staff, who have the right values and skills, to deliver high quality care and support. It involves:
- having safe stafﬁng levels, including putting contingency plans in place;
- recruiting the right people, with the right values, skills and experience to deliver safe care and support;
- doing the right recruitment checks;
- ensuring staff are competent and safe to do their role.
Safe staffing is not just about numbers it about having experienced and competent staff who have a clear understanding of the requirements of service users care plans, who stay with the service long enough to establish meaningful relationships with those who they care for.
Identifying characteristics of services who have inadequate stafﬁng
There are some common characteristics of services who have inadequate stafﬁng. If some, or all, of these apply to your service this could indicate that a service is not meeting the requirements for safe stafﬁng.
- High turnover of staff;
- Struggle to recruit enough staff;
- New staff leave within a short time of joining;
- High sickness rates that are particularly stress related;
- Unorganised rota system and processes that are difﬁcult to use and review;
- Rota’s are constantly changing;
- Staff only have time to perform duties and tasks with no time to ‘care’;
- Staff don’t have time to communicate with
people they support, families and professionals;
- Little consistency in staff;
- Over-reliance on temporary workers;
- Staff inductions are limited and/or rushed;
- Staff learning, and development is restricted to mandatory training;
- Limited support for staff such as supervisions.
Impact on service users
- staff have no time to respond to calls for help;
- there is not enough time to do an effective handover;
- staff support people to get ready and have meals at a time that best suits them rather than the individual;
- not enough staff to support people at meal times;
- medication documentation is rushed.
CQC checks on safe staffing
CQC will require managers to demonstrate how they arrived at the numbers of staff to ensure service users are safe. Dependency tools can help the manager to decide how many staff will be needed. They can be used to collate information about the needs (or dependency) of people who need care and support, how many hours/staff support will be needed, and enable the manager to log other requirements such as time for administration, record keeping and communicating. This can help to make informed decisions about how many staff will be needed in your service to meet safe stafﬁng levels. In addition, it provides evidence of how you arrived at your decision about the numbers of staff.
When using a dependency tool, the manager must ensure staff are competent to use it and use it consistently. If they don’t, this can have a negative impact on the outcome of a services inspection.
One residential home graded inadequate by CQC, found that having checked the records following the use of the dependency tool, that records of the assessment hadn’t been completed for some weeks. The provider was unable to demonstrate on what basis they’d decided the current stafﬁng numbers per shift against the needs of people.
This latest guide by Skills for Care on safe staffing gives providers useful advice on how to ensure CQC requirements can be met. It helps providers to recognise the characteristics of services who have safe staffing issues. Dependency tools can be useful in providing evidence of how managers decided on staffing levels, but they should only be used by competent and experienced staff capable of keeping records up to date. Managers are strongly advised to obtain the guide on safe staffing by visiting the Skills for Care Website.
Albert Cook BA, MA & Fellow Charted Quality Institute
Bettal Quality Consultancy