Guide to Safe Staffing and Regulations in Care

What is Safe Staffing?

Having safe levels of staff means having enough team members, who possess the right values and skills, available to deliver high-quality care and support to service users. You must have contingency plans in place to maintain safe staffing levels, ensure that you recruit the right people (with the right values, skills and experience), do compulsory recruitment checks and certify staff are safe and competent to do their role.

Getting this right means that people receive safe and effective care and support that’s suited to their needs, it isn’t just about the good inspection ratings. Not doing this correctly could put the people you support and your staff at risk, as it can lead to staff shortages, put your service under extreme pressure and could lead to staff choosing what they can and can’t deliver during the day. This can lead to a safeguarding incident, reputational damage and/or neglect.

Signs of Inadequate Staffing

Fortunately, there are signs that you can look out for when it comes to inadequate staffing. If all or some of the following apply to your care service, then it could mean that you’re not meeting the safe staffing requirements:

• Constant changes to rotas
• High sickness rates – mainly related to stress
• High staff turnover
• Lack of communication from staff – with service users, their families and professionals
• Limited and/or rushed staff inductions
• Limited support for staff such as supervision
• New staff don’t stay for long
• No staff consistency
• Relying too much on temporary workers
• Staff have ‘no time to care’ and can just about perform their tasks and duties
• Staff learning and development is restricted to mandatory training
• Struggle to recruit enough staff
• Unorganised rota system and processes that are hard to review and use

The CQC Standards Around Safe Staffing

CQC regulations have been designed to explain the minimum standards that adult social care services need to adhere to when it comes to safe staffing. The elements of safe staffing are included in the following CQC (Registration) Regulations 2009:

• Regulation 9: Person-centred care
• Regulation 12: Safe care and treatment
• Regulation 13: Safeguarding service users from abuse and improper treatment
• Regulation 15: Premises and equipment
• Regulation 18: Staffing
• Regulation 19: Fit and proper persons employed

If you would like to learn more about the above regulations, you can find all of the information you need on the CQC website.

How Many Staff Do You Need?

There isn’t a single solution when it comes to deciding how many staff you need to deliver safe, effective and responsive care. Your perfect number of staff and care staff ratio to residents will depend on your care service and the people you support, and your needs may change over time. Below are several factors you should keep in mind to help you make the right decision on when and who to hire. 

Calculate How Many Staff You Need

To help you decide on how many staff you need, you should use an effective system, like a dependency tool, and process. This must consider the needs of the people you support, as well as other factors like time for additional activities, training, travel time and reporting. Some of the things you should consider when making this decision include:

• Be realistic about how staff turnover, sickness, annual and special leave, and learning and development can impact your staffing levels.
• Consider environmental issues that could have an impact on staff levels e.g. the layout of the care service or the location of people who require home care.
• Consider factors outside of the workplace that could affect your staff’s ability to deliver safe care and support e.g. long shifts will lead to fatigue.
• Consider the impact of using inexperienced care workers, recruitment agency workers, bank workers and volunteers.
• Ensure staff are given the right amount of time to do everything that their role involves outside of directly delivering care e.g. handovers, talking to relatives, filling in documents, etc.
• Ensure that staff who are determining staffing levels fully understand how to do so e.g. they’re familiar with CQC regulations and are trained in any systems that you use.
• Think about times when more staff might be needed and be prepared to switch up the rota to meet these needs e.g. when someone’s needs increase.
• Use realistic formulas when determining staffing levels that will meet the needs and wishes of your service users.

Dependency Tools

Dependency tools can be used to collate information about the needs of the people who require your care and support, how many staff can support these needs, and how to log other requirements, such as time for record-keeping, communicating and administration. In return, this can help you make informed decisions about the number of staff your care service needs to meet safe staffing levels. The tool can also be shown as evidence to your CQC inspector.

Plan Your Staff Rota

Once you are comfortable with the number of staff you need, you should use the data you’ve acquired to plan your staffing. If your staffing levels don’t match the data from the dependency tool, you could put your service users at risk.

A good rota that contains information on your staff, such as working times, responsibilities and location, can help you plan your team and time efficiently. They can help you plan your staff schedule, improve communication with staff and your service users, and use it as evidence during CQC inspections. When using rotas, you should consider:

• Communicating staffing with your workforce, so they have sufficient notice e.g. through a rota.
• Ensuring staff responsible for determining safe staffing levels are available as an escalation point and know what they need to do if there is an emergency.
• Having a system in place that alerts concerns with staffing levels, so you can promptly respond.
• Having contingencies for short-term staff shortages and making sure responsible staff understand them.
• Investigating any incidents relating to safe staff, and start using what you learn to improve your practice.
• Using data from a process such as a dependency tool, to plan your staffing.

Put Contingency Plans in Place

Many things can have an impact on short-term staffing levels and the safety of your service. To maintain your standards of care and reputation, you should have contingency plans in place that can be used to respond to these issues when they arise. Once your contingency plans have been established, they should be explained to responsible staff, so they know what they are. Your contingency plans should:

• Build working relationships with other local services that could cover shifts.
• Have an explanation to staff and your service users about any changes to staffing that are a result of staff shortages, and how this can impact them.
• Have a team of bank staff who can be used to fill gaps in the rota.
• Include a succession plan to help you manage resignations or long-term absences.
• Record and monitor the impact of staff shortages on your business.
• Run a volunteering programme to enable more people to enjoy new experiences and activities, and enhance the support you’re able to provide.
• Train other staff on how to cover specific responsibilities in case of staff shortages or absences.
• Use agency staff during emergencies.

Review Your Staffing Level

As part of your quality assurance processes, you should regularly review and revise your staffing levels to ensure they continue to meet the needs of your care service. However, you may need to do an ad-hoc review if a member of your team needs to change their hours or if a service user’s needs change. If you don’t review your staffing levels when you should, it can impact the quality of care and support you provide alongside risk safety. Here of the things you should consider when determining staffing levels:

• Compare different systems, what they have to offer and their price range to fund the best value for money.
• Consider the original set-up and long-term running costs e.g. staff training, and make sure you can commit to the budget to support upgrades and maintain the software.
• Ensure you know what you need before you commit to it and choose a system that will meet this as close as possible.
• Involve employees from across the business in demonstrations and reviews of the system, to ensure it’s easy to use and fit for purpose.
• Record and monitor the impact of staff shortages in your care service and include them in your quality assurance process.
• Speak to your supplier about the evolution of their software and future plans, to ensure they’re flexible, sustainable and can adapt if your care service changes.
• Train staff (which includes managers, care workers and office staff) on how to use the system and any apps associated with it.

CQC Safe Staffing Inspections

During CQC inspections, you will need to demonstrate how you calculate safe staffing levels and how this enables you to deliver safe care and support. The CQC may inspect your service using the following methods, so you should think about how you can collect the evidence you need and prepare everyone in your care service.

Interviews

During their interviews, CQC may ask people who require your care and support, as well as their friends and family, about certain things. This may include questions surrounding their experience of the number of staff on duty at different times, whether there are enough staff with the right skills to keep everyone safe, how quickly the service recognises and meets their needs, the time it takes to respond to pain and distress, and how leader and manager support their staff.

Managers and directors may be questioned on their awareness of relevant regulations, legislations and standards, whether they think there are enough staff, how employees are trained to keep people safe and how everyone’s needs are met promptly. CQC may also speak to your staff and ask them about their workload capacity, the usefulness of their rotas, their competence to keep people safe and what training they’ve completed alongside the support they get to ensure they can support others.

Observations

When carrying out observations, CQC may look out for safe practice in your service in day-to-day care. They might want to know how fast you respond to people’s care and support needs, as well as the quality of this interaction. During the day of inspection, they could observe the number of staff on shift and staff deployment, to ensure that the number and skills of staff can meet the needs that are currently required by your care service.

Records and Policies

It’s common for CQC to want to take a look at evidence that supports your actions, especially when it comes to safe staffing. They may want to look at various records and policies, such as care plans, staff rotas and schedules, staff recruitment and employment records, and staff training, induction and development planning.

CQC Staff Recruitment Guidelines

Once you’ve determined how many staff your service needs, you will need to carry out recruitment activities to attract and choose the right people to fill the positions. Without the right recruitment practices in place, you may end up failing to carry out the right checks, which could lead to you hiring the wrong people for the job. As a result, this could increase the risk of providing unsafe care and support to your service users. And it could also put your business and current employees at risk.

When selecting the right people, taking a values-based approach is recommended as this can lead to finding carers who are more likely to stay. This will save you money and time in return and will protect your continuity of care and support. However, you mustn’t forget to carry out essential recruitment checks, such as DBS, reference and right-to-work checks. Planning your recruitment, attracting and selecting the right people and reviewing your recruitment activities are the key steps to success, while a DBS in health and social care is a legal requirement that protects both your service users and your team.

Some of the things you should avoid when recruiting new staff include dropping your standards to fill vacancies and employing people who don’t have the right values or skills to work in care. Not checking references or waiting for DBS checks to complete before allowing staff to work. And not valuing new or current employees, as everyone’s role is essential in your care service. You should never blame the lack of staff on recruitment difficulties, as CQC expect good services to carry out effective recruitment.

Safe and Competent Staff

Good and outstanding care services won’t expect staff to carry out their duties until they are safe and competent to do so. This can be achieved through effective induction, learning and development and ongoing support. Many care services face challenges when it comes to budgeting for this, but to meet CQC standards for safe care, you will need to invest in the development of your staff and regularly assess that they’re competent in their role. We have a great article about mandatory training for care workers that you may find useful.

Improve Recruitment and Retention in Care

Now that you fully understand safe staffing and regulations in health and social care, you should take the necessary steps to improve recruitment and retention in your care service. The first is downloading our FREE guide that features expert contributors to help care providers recruit and retain more of their best staff.  The next step is to invest in suitable software to help improve and simplify your processes.

Over the years, we at Access have developed a fantastic range of software to digitise your business and make your life easier. Our recruitment and screening software can help you attract the best candidates for your care organisation while offering complete fast, automated background screening and candidate compliance checks. Our automated screening solution for care management is part of The Access Care Suite, which is our portfolio of integrated solutions which empower professionals in healthcare, support and social care.

Whether you provide residential, domiciliary or care in another setting, managing all your staff to ensure adequate, safe levels of staff with the necessary skills is a constant juggling act. It can be made much easier, more reliable and robust through the use of care scheduling and rostering software. Our market leading rostering solution has configurations for all care settings and is relied upon by thousands of UK care services every day.

If you would like to try out our leading online care management software, get in touch with us today to learn more or book your free demo.