Q. What does the CQC mean when it says that we have to have a sufficient number of staff on duty in our care home?

Published: Wednesday, 14 December 2016

A. Regulation 18 (1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 says: ‘Sufficient numbers of suitably qualified, competent, skilled and experienced persons must be deployed’.

This is explained in detail in the Provider handbook for residential adult social care services (Appendix B). Prompt S3 for the safe key line of enquiry (KLOE) states that the CQC will require the care home to provide evidence showing that staffing levels are regularly assessed and monitored to make sure they are flexible and sufficient to meet people’s individual needs and to keep them safe. The provider will also be required to show evidence of how it takes into consideration the layout of the building when determining staffing levels.

The CQC will also want to know what arrangements there are for making sure that staffing levels have the right mix of skills, competencies, qualifications, experience and knowledge to meet people’s individual needs.

From the above we can see that staffing levels have two components. These are:

  • sufficient staff on duty
  • staff with the right qualities to meet people’s needs.

One way that care providers can evidence that they are compliant with Regulation 18 and prompt S3 is by using a dependency-based staffing levels calculator. Sometimes this tool is included in care planning software, but otherwise a simple spreadsheet can be used. Each service user is assessed as part of the normal care planning process and assigned a dependency level. This may be a general dependency level or it may depend on the support the person needs at key moments of the day, such as getting up or mealtimes. The dependency scores are collated to determine the overall dependency for the service. If this is calculated in minutes per hour, then it is a simple calculation to divide this by 60 to arrive at the overall staffing level required in that hour. 

Next, the provider has to consider the skill and qualification mix of staff. It must take into account the needs of service users and the type of care provided, along with the tasks required of the staff on duty. For example, if a nursing home cares for people who require 740 collective minutes of nursing care in an eight-hour shift period, then two nurses are required (740/480 > 1). The same applies to other designations of staff. 

One caveat is that staffing levels must be sufficient in all circumstances, for example in the event of an emergency evacuation. Care providers will have developed personal escape and evacuation plans (PEEPS) for individual service users, and will have a fire risk assessment with an evacuation plan. This evacuation plan and the PEEPS must be cross-referenced with staffing levels, especially at night. If a unit in a care home has eight service users who all need two staff to evacuate them to a safe area, and each takes on average one minute to evacuate them, then the unit requires eight staff on duty to evacuate them all in two minutes! 

The tools described above must be reviewed regularly and in response to any change in service users, change in need, incident, staffing changes etc. This will demonstrate that the care provider is deploying sufficient numbers of suitably qualified staff to meet the needs of service users.


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