1. EPSO Risk Working Group – Malmö 23 September 2019
Using Risk Indicators & Forensics in the Supervision of Care Services in Scotland
EPSO Risk Working Group – Malmö
23 September 2019
Kevin Mitchell
Executive Director of Scrutiny & Assurance

2. Enforcement Review
Between we closed 7 care homes for older people using our enforcement procedures “…serious risk to resident’s life, health and wellbeing …” What are the lessons learned ? Could we have intervened earlier ?

3. Some Initial Findings
Notifications
Managers' qualifications
Managers’ knowledge, skills & values
Significant events when residents were injured or harmed
Reporting and responding to harm
The lead Inspector has a pivotal role to play in assessing significant information about risk, including information from complaints
“…serious risk to resident’s life, health and wellbeing …”
What are the lessons learned ? Could we have intervened earlier ?

4. Enforcement Review
The manager(s) could not answer questions and contradicted themselves
Good practice guidance on staff recruitment was not followed
They were defensive about complaints rather than open to looking at the issues
Residents were blamed for what happened when they were injured or upset
Residents were objectified and called ‘wanderers’ or ‘feeders’
Residents’ concerns were not taken seriously or investigated
Staff said managers did not listen to their concerns and there was clear evidence to support this
When we checked with fire service and environmental health we found that the service had not made progress with outstanding fire safety and food hygiene recommendations
A high turnover of staff/high level of inexperience /unqualified staff
Lack of training, no supervision, appraisals of staff or staff meetings
Offers of free training by HSCP turned down
Lack of knowledge about residents' needs
Not familiar with good practice guidance or standards
History of finding it difficult to recruit and retain staff
Lack of knowledge and understanding core areas e.g. nutrition, tissue viability, managing & incidents, protection, falls management

5. Some Initial Findings The Complex & Evolving Risk Assessment
notifications
The Complex & Evolving Risk Assessment
Information to/from Police
Notifications
Feedback from monitoring visits
Information to/from HSCP
Information to/from fire, LA, EH & HSE

6. Some Initial Findings
Chronologies
History of poor performance
Limited capacity for improvement
Numerous / repeated requirements made
Provider’s lack of motivation / investment
Insufficient provider oversight
High risk services that are performing at adequate or below should have a chronology and regulatory plan allocated to a Lead Inspector

7. Some Initial Findings Assessing Capacity to Improve
notifications
Assessing Capacity to Improve
specific factual details about risk to life, health and wellbeing
Support to mitigate risk while improvements made
Provider’s capacity to improve
Provider’s current improvement plan / self-evaluation

8. Some Initial Findings
Services de-registering and re-registering
History of poor performance when de-registering change of legal entity (car analogy / old car new owner)
Services registered with conditions to improve the environment numerous / repeated requirements made
Inspection and registration inspectors should agree a a plan to follow up on environment conditions at the point of registration

9. More about the role Early Indicators of Concern
Concerns about management and leadership
Concerns about staff, skills, knowledge and practice
Concerns about residents’ behaviours and wellbeing
Concerns about the service resisting the involvement of external people and isolating individuals
Concerns about the way services are planned and delivered
Concerns about the quality of basic care and the environment
(University of Hull, 2012)