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Registration Number: {{org_field_registration_no}}

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Staffing Levels and Rotas Policy

1. Purpose

The purpose of this policy is to ensure that {{org_field_name}} maintains appropriate staffing arrangements and an effective rota system to provide safe, high-quality, person-centred care and support in accordance with the Health and Care (Staffing) (Scotland) Act 2019, the Health and Social Care Standards, the Public Services Reform (Scotland) Act 2010, the Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, the Care Inspectorate’s Quality Framework for Support Services (Care at Home, including Supported Living), and the Scottish Social Services Council Codes of Practice.

{{org_field_name}} recognises that appropriate staffing means having suitably qualified, competent and skilled staff, in appropriate numbers, available at the right time and in the right place, to meet the health, wellbeing, safety, assessed needs, wishes and outcomes of the people who use the service. Staffing arrangements must also take account of staff wellbeing where this affects the provision of safe and high-quality care.

This policy outlines the procedures for planning, monitoring, and adjusting staffing levels and rotas. It aims to ensure that people receiving care experience consistent and reliable service delivery while staff work in a structured and supportive environment.

2. Scope

This policy applies to all individuals involved in planning, managing, supervising or delivering care and support on behalf of {{org_field_name}}, including care workers, senior carers, supervisors, managers, administrative staff, bank staff, agency staff, temporary workers, self-employed workers, apprentices and volunteers.

Students undertaking supernumerary placements or protected learning time must not be counted as part of the staffing establishment required to deliver care and support. They may require staff support and supervision and this must be considered when planning rotas and workloads.

This policy also applies to all staff responsible for rota planning, workforce deployment, on-call arrangements, contingency planning, monitoring staffing capacity, responding to staffing concerns and reviewing staffing arrangements.

3. Legal and Regulatory Framework

This policy is informed by and must be implemented in accordance with the following legislation, standards and guidance:

• Health and Care (Staffing) (Scotland) Act 2019 – places a statutory duty on care service providers to ensure that, at all times, suitably qualified and competent individuals are working in such numbers as are appropriate for the health, wellbeing and safety of people using the service, the provision of safe and high-quality care, and staff wellbeing where this affects either of those matters. The Act came into force on 1 April 2024.
• Public Services Reform (Scotland) Act 2010 – provides the legislative framework for the regulation and registration of care services in Scotland.
• Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 – requires providers to make proper provision for the health, welfare and safety of service users, provide services in a way that respects privacy and dignity, and maintain personal plans. Personal plans must be reviewed when requested, when there is a significant change in the person’s health, welfare or safety needs, and at least every six months.
• Health and Social Care Standards: My support, my life – sets out the rights-based and person-led outcomes people should experience, including care and support that is right for them, planned and safe, and provided by people who know their needs, choices and wishes.
• Care Inspectorate Quality Framework for Support Services: Care at Home, including Supported Living – sets out quality indicators relevant to care at home services, including how well people’s wellbeing is supported, how well staff are recruited, developed and deployed, whether staffing arrangements are right, and whether personal plans inform care and support.
• SSSC Codes of Practice for Social Service Workers and Employers, 2024 – sets out the standards expected of social service workers and employers. The revised Codes came into effect on 1 May 2024. Employers must support workers to meet their Code, provide learning and development, have systems for workers to report resourcing or operational difficulties, and address concerns that may affect care or support.
• Working Time Regulations 1998 – sets requirements on working hours, rest breaks, rest periods and annual leave.
• Equality Act 2010 – requires fair, non-discriminatory rota planning, reasonable adjustments where applicable, and equal treatment in employment and service delivery.
• Employment Rights Act 1996 – applies to employment rights, contractual arrangements and employment protections.
• Health and Safety at Work etc. Act 1974 – requires the organisation to protect, so far as reasonably practicable, the health, safety and welfare of staff and others affected by the service.
• Public Interest Disclosure Act 1998 – protects workers who raise qualifying concerns, including concerns about unsafe staffing, poor care, neglect, abuse, risk or unlawful practice.

4. Principles of Safe Staffing Levels

Staffing levels must be appropriate to meet the needs of the people we support, ensuring that care is delivered in a safe, effective, compassionate, and high-quality manner. {{org_field_name}} determines staffing levels based on the following principles:

• Person-centred care needs: Staffing levels are determined by the assessed care needs of individuals, ensuring each person receives the right level of support at the right time.
• Continuity of care: Rotas are designed to minimise disruption and maintain consistency in care delivery.
• Appropriate staffing, not fixed ratios: Staffing arrangements are based on the nature and size of the service, the aims and objectives of the service, the number of people receiving care, their assessed needs, risks, wishes and outcomes, staff competence and skill mix, travel time, geography, continuity of care, and the level of supervision and management support required. {{org_field_name}} does not rely on fixed staffing ratios unless these are required by a contract, assessed need, professional requirement, risk assessment or registration condition.
• Workforce well-being: Rotas are developed to provide staff with appropriate work-life balance, ensuring adequate rest periods in line with Working Time Regulations.
• Flexibility and responsiveness: The rota system allows for adjustments to respond to unforeseen changes, such as staff absences or fluctuations in care demand.
• Right people, right skills, right place, right time: Rotas must ensure that staff have the appropriate knowledge, skills, competence, values, experience and training to meet the needs of the people they support.
• Personal plans inform staffing: Staffing levels and deployment decisions must be informed by people’s personal plans, risk assessments, communication needs, moving and handling needs, medication support needs, health needs, behavioural support needs, outcomes, preferences and agreed visit times.
• Risk enablement: Safe staffing does not mean removing all risk. Staffing decisions must support positive risk-taking and independence where this is consistent with the person’s wishes, assessed needs, legal rights and safety.
• Openness and escalation: Staff must be able to raise concerns about staffing levels, workload, travel time, missed visits, late visits, rushed visits, competence, fatigue or any other matter that may affect care quality or safety. Concerns must be recorded, reviewed and acted upon.

4.1 Safe Staffing Duty

{{org_field_name}} has a duty to ensure appropriate staffing at all times. This means ensuring that suitably qualified and competent staff are working in such numbers as are appropriate for:

• the health, wellbeing and safety of people using the service;
• the provision of safe and high-quality care and support; and
• staff wellbeing, where this affects the health, wellbeing and safety of people using the service or the provision of safe and high-quality care.

In determining appropriate staffing, {{org_field_name}} will consider, as a minimum:

• the nature of the care at home service;
• the size of the service;
• the aims and objectives of the service;
• the number of people using the service;
• the assessed needs, wishes, outcomes and risks of people using the service;
• the skills, competence, experience and training of staff;
• staff availability, sickness, vacancies, turnover and use of agency or bank staff;
• travel time, geography, visit duration and scheduling pressures;
• the need for continuity and consistency of care;
• the support, supervision and management arrangements available to staff;
• any contractual, commissioning or registration requirements; and
• any incidents, complaints, missed visits, late visits, safeguarding concerns, medication errors or other evidence that staffing arrangements may not be safe or effective.

Staffing arrangements will be kept under review and adjusted where people’s needs change, where risk increases, where staff raise concerns, or where monitoring shows that the rota is not enabling safe, effective and person-centred care.

5. Rota Planning and Management

5.1 Responsibilities in Rota Planning

The Registered Manager is responsible for ensuring that rota planning and staffing deployment comply with this policy and current Scottish legal and regulatory requirements. Their responsibilities include:

• ensuring that there are suitably qualified, competent and skilled staff in appropriate numbers to meet people’s assessed needs, outcomes and preferences;
• ensuring that care visits are planned using personal plans, risk assessments, agreed visit times, required visit duration, staff competence, travel time and continuity of care;
• ensuring that rotas are realistic and do not routinely rely on staff working excessive hours, missing breaks, travelling in unpaid or unrealistic time, or rushing visits;
• ensuring that staff are matched to people using the service based on skills, training, competence, experience, communication needs, moving and handling needs, medication support needs, behavioural support needs, cultural needs and continuity preferences;
• ensuring that all staff deployed have completed required induction, mandatory training, role-specific training and any person-specific competency checks before working unsupervised;
• ensuring that bank, agency and temporary staff are used safely and receive sufficient information, induction and supervision to deliver care in line with personal plans;
• ensuring that staff have sufficient notice of working hours wherever practicable;
• ensuring that working hours, rest breaks, rest periods and overtime arrangements comply with the Working Time Regulations 1998 and staff contracts;
• monitoring missed visits, late visits, shortened visits, complaints, incidents, medication errors, safeguarding concerns, staff sickness, vacancies and turnover to identify staffing risks;
• maintaining records of staffing assessments, rota changes, staffing concerns, escalation decisions and actions taken;
• escalating unresolved staffing risks to the provider, senior management, commissioners, the Care Inspectorate or other relevant bodies where required; and
• ensuring that staff are supported to raise concerns without fear of detriment.

5.2 Rota Development Process

Rotas are developed using a person-centred, outcomes-focused and safe staffing approach. The rota planning process will include the following steps:

1. Assess care and support needs: Review each person’s personal plan, risk assessments, agreed outcomes, visit requirements, communication needs, medication needs, moving and handling needs, health needs, wellbeing needs, personal preferences and any changes in circumstances.
2. Confirm required visit duration and timing: Ensure each visit is planned for the agreed duration and at a time that meets the person’s assessed needs, preferences and contractual or commissioned arrangements. Visit times must not be reduced to manage staffing pressures unless this has been risk assessed, authorised, recorded and communicated appropriately.
3. Include realistic travel time: Rotas must include realistic travel time between visits, taking account of geography, public transport, parking, weather, traffic, rurality and any staff mobility or safety issues. Travel time must not reduce the time allocated to the person’s care visit.
4. Match staff to people: Staff will be allocated based on competence, training, experience, continuity of care, relationship with the person, language and communication needs, cultural considerations, medication competence, moving and handling competence, and any person-specific support requirements.
5. Balance workload and staff wellbeing: Rotas must be planned to avoid excessive workloads, unsafe lone working, fatigue, repeated missed breaks, unreasonable travel demands or patterns that could compromise staff wellbeing and care quality.
6. Plan supervision and support: Where staff are new, inexperienced, returning from absence, working with a person for the first time, or supporting complex needs, the rota must include appropriate supervision, shadowing, competency checks or management support.
7. Finalise and communicate rotas: Rotas will normally be issued at least two weeks in advance where practicable. Changes will be communicated promptly to staff and to people receiving care where the change affects the timing of the visit, the identity of the worker, continuity of care or the agreed support arrangement.
8. Monitor and adjust: Rotas will be reviewed continuously to ensure they remain safe, realistic and responsive to changing needs, staffing availability, incidents, complaints, staff feedback and service demand.

5.3 Shift Patterns

Shift patterns are structured to ensure sufficient coverage throughout the day and night while balancing staff availability. {{org_field_name}} uses a variety of shift patterns, including:

• Morning shifts – Covering early care needs such as personal care and medication administration.
• Afternoon/evening shifts – Covering meal support, companionship, and additional care.
• Overnight shifts – Where required for individuals needing 24-hour care or waking night support.
• On-call support – Providing assistance in case of emergencies or last-minute absences.

Shift patterns and visit schedules must be planned so that staff know who to contact for advice, support or escalation at all times while they are working. Where staff work alone, lone working arrangements must be risk assessed and must include procedures for checking in, reporting concerns, responding to emergencies, and escalating situations where the staff member feels unsafe or unable to complete the visit safely.

On-call arrangements must be clearly communicated to staff and must be sufficient to respond to urgent staffing concerns, missed visits, late visits, emergencies, safeguarding concerns, medication issues, staff illness, adverse weather, transport disruption or sudden changes in a person’s health or wellbeing.

5.4 Changes to Rotas and Communication with People

{{org_field_name}} will make every reasonable effort to provide consistent and reliable care and support from staff who know the person’s needs, choices and wishes. Where changes to planned visits are unavoidable, the service will:

• assess the impact of the change on the person’s health, wellbeing, safety, dignity, routine, medication, nutrition, continence, mobility, communication and personal outcomes;
• notify the person and, where appropriate, their representative, family, carer or commissioner as soon as practicable;
• explain the reason for any significant change to visit time, duration or worker;
• record the change, the reason for it, the risk assessment and any action taken;
• prioritise continuity of care for people with complex needs, communication needs, distress, dementia, palliative care needs, medication support, moving and handling needs or known risks; and
• review repeated changes to identify whether staffing arrangements need to be improved.

Any missed visit, significantly late visit or shortened visit must be treated as a potential care and support concern, recorded, reviewed and escalated in line with the incident, safeguarding, complaints, notification and contractual reporting procedures.

6. Managing Staffing Shortages

Staffing shortages may occur due to sickness, emergency leave, vacancies, adverse weather, transport disruption, increased care needs, outbreaks, sudden service demand or other unforeseen circumstances. {{org_field_name}} will manage staffing shortages through a structured, risk-assessed and recorded process to ensure that people continue to receive safe, high-quality and person-centred care. Staffing pressures must never be normalised or allowed to result in repeated missed, late, rushed or unsafe visits without escalation and corrective action.

6.1 Preventative Measures

• Robust recruitment strategies to ensure a sufficient workforce is available.
• Use of bank and agency staff as a contingency plan.
• Encouraging internal shift swaps, where appropriate.
• Offering additional shifts to part-time staff, ensuring compliance with working time regulations.
• Cross-training staff to increase workforce flexibility and adaptability.

• maintaining a workforce plan that considers current and future service demand, vacancies, staff turnover, sickness absence, training requirements and skill mix;
• monitoring dependency levels and changes in people’s assessed needs;
• maintaining an up-to-date list of staff competencies, availability and geographical areas covered;
• ensuring business continuity arrangements include staffing disruption scenarios;
• reviewing commissioning or contractual arrangements where care packages cannot be delivered safely within available staffing capacity;
• ensuring staff know how to raise concerns about workload, unsafe staffing, travel time or rota pressures.

6.2 Immediate Actions for Staffing Shortages

When an unexpected staffing shortage occurs, the Registered Manager, rota coordinator or on-call manager must:

• identify which visits, people and staff are affected;
• assess the level of risk to each person, including medication, personal care, nutrition, hydration, continence, mobility, pressure care, distress, communication, safeguarding, palliative care and time-critical needs;
• identify whether the visit can be covered by suitably trained internal staff, bank staff or agency staff;
• ensure any replacement worker has the required information and competence to deliver the visit safely;
• consider whether management, senior staff or other suitably competent staff can provide direct care support in exceptional circumstances;
• communicate promptly with affected people and, where appropriate, families, representatives, carers, commissioners and other professionals;
• record the staffing shortage, risk assessment, decisions made, people contacted and action taken;
• escalate unresolved risks to senior management and, where required, commissioners, the Care Inspectorate, safeguarding services or emergency services;
• review the event afterwards to identify learning and prevent recurrence.

Decisions to delay, shorten, rearrange or cancel a visit must only be made following risk assessment and management authorisation. The decision and rationale must be recorded.

6.3 Prioritisation of Visits During Staffing Shortages

Where staffing shortages mean that not all visits can be delivered at the planned time, visits must be prioritised according to assessed risk and the potential impact on the person. The following visits will normally be treated as highest priority:

• medication support that is time-critical or where omission may cause harm;
• support with food, fluids or nutrition where the person cannot meet this need independently;
• personal care where delay would compromise dignity, skin integrity, continence, comfort or health;
• moving and handling support where the person cannot move safely without assistance;
• visits for people receiving palliative or end-of-life care;
• visits for people who are unable to summon help independently;
• visits where there is a known safeguarding, mental health, distress, self-neglect or environmental risk;
• visits required to prevent hospital admission, deterioration or significant harm.

Lower-risk visits may only be delayed or rearranged where this has been risk assessed and the person, and where appropriate their representative or commissioner, has been informed. Repeated delays, shortened visits or cancellations must trigger a management review of staffing capacity and service commitments.

6.4 Use of Agency and Bank Staff

Agency and bank staff may be used to maintain safe staffing levels where regular staff are unavailable. They must only be deployed where the service is satisfied that they are suitable, competent and appropriately trained for the work they are asked to perform.

Before working unsupervised, agency and bank staff must receive sufficient information to deliver safe care, including:

• the person’s personal plan and relevant risk assessments;
• medication support requirements, where applicable;
• moving and handling requirements, where applicable;
• communication needs and preferences;
• infection prevention and control requirements;
• emergency contacts and escalation procedures;
• reporting and recording requirements;
• professional boundaries, confidentiality and safeguarding expectations.

The use of agency or bank staff must be monitored as part of staffing quality assurance. High or repeated reliance on agency staff must trigger a review of workforce planning, recruitment, retention and continuity of care.

7. Monitoring, Review and Quality Assurance of Staffing Arrangements

{{org_field_name}} will monitor staffing arrangements to ensure that rotas remain safe, effective, person-centred and compliant with legal and regulatory requirements. Monitoring will include:

• weekly review of rota capacity, unallocated visits, staff availability, travel time, sickness absence, vacancies and use of bank or agency staff;
• review of missed visits, late visits, shortened visits, medication errors, incidents, complaints, safeguarding concerns and staff concerns to identify whether staffing was a contributory factor;
• regular review of personal plans and risk assessments to ensure staffing levels and skill mix continue to meet people’s needs and outcomes;
• monitoring continuity of care, including the number of different staff supporting each person and the impact on people’s wellbeing;
• reviewing staff workload, travel demands, overtime, breaks, fatigue and wellbeing;
• checking that staff deployed have completed required training, competency assessment, supervision and registration requirements;
• seeking feedback from people using the service, families, carers, staff, commissioners and relevant professionals about whether staffing arrangements meet people’s needs;
• identifying trends, risks and improvement actions through quality assurance and service improvement planning.

Staffing information will be reviewed at management meetings and workforce planning meetings. Where monitoring identifies actual or potential unsafe staffing, the Registered Manager must ensure that action is taken, recorded and reviewed. This may include revising rotas, increasing staffing, reducing new admissions or care packages, changing deployment arrangements, providing additional training, escalating to commissioners or reviewing whether the service can safely continue to deliver a package of care.

7.1 Staff Concerns, Escalation and Whistleblowing

Staff must raise concerns promptly if they believe staffing levels, skill mix, workload, travel time, rota arrangements, fatigue, lack of training, lack of supervision or any operational issue may affect the safety, dignity, wellbeing or quality of care provided to people using the service.

Concerns may be raised with the line manager, Registered Manager, on-call manager, senior management or through the whistleblowing procedure. Staff will not be treated unfairly for raising a genuine concern.

Managers must respond to staffing concerns promptly, record the concern, assess the risk, take action where required and provide feedback to the staff member where appropriate. Where a concern cannot be resolved internally and presents a risk to people using the service, the matter must be escalated to the provider, commissioner, Care Inspectorate or other relevant authority as appropriate.

{{org_field_name}} will promote an open culture where staff are supported to report resourcing or operational difficulties that may affect care and support.

8. Staff Wellbeing and Support

{{org_field_name}} recognises that staff wellbeing is directly connected to safe, high-quality care. Staffing arrangements must therefore take account of workload, travel time, rest breaks, fatigue, emotional demands, lone working, supervision, training, support and the complexity of people’s needs.

{{org_field_name}} will support staff by:

• providing regular supervision, appraisal and opportunities to discuss workload, wellbeing and practice concerns;
• ensuring staff receive appropriate induction, mandatory training, role-specific training and person-specific competency checks;
• planning rotas to provide adequate rest periods and breaks in accordance with the Working Time Regulations 1998;
• monitoring excessive overtime, repeated short-notice changes, long working days, missed breaks and travel demands;
• supporting staff to raise concerns about unsafe workload, fatigue, stress, distressing incidents, abuse, harassment or lone working risks;
• taking reasonable steps to prevent bullying, harassment, discrimination, violence and abuse;
• providing access to wellbeing support, debriefing or confidential counselling where available and appropriate;
• considering flexible working requests fairly and in line with operational requirements and employment law;
• ensuring additional hours or overtime are agreed, recorded and paid in accordance with contracts and employment law.

Where staff wellbeing concerns may affect the safety or quality of care, managers must assess the risk, take action and review the effectiveness of the action taken.

9. Emergency Response and Business Continuity Planning

In the event of significant disruption, including extreme weather, illness outbreak, transport disruption, IT or telephony failure, major staff absence, public health emergency, utility failure or other unforeseen circumstances, {{org_field_name}} will activate its emergency rota and business continuity arrangements.

The emergency response will include:

• identifying people at highest risk and prioritising essential care visits;
• reviewing personal plans and risk assessments to determine critical support needs;
• redeploying suitably competent staff, including senior staff and managers where appropriate;
• using bank or agency staff where this can be done safely;
• communicating with people using the service and, where appropriate, relatives, representatives, carers, commissioners and professionals;
• liaising with local authorities, HSCPs, emergency services or health professionals where required;
• recording decisions, risks, actions and communications;
• reviewing the rota daily or more frequently depending on the level of disruption;
• submitting notifications to the Care Inspectorate or other bodies where required.

Emergency arrangements must continue to respect people’s dignity, rights, choices and safety. Where any agreed care cannot be delivered, the decision must be risk assessed, authorised, recorded and escalated.

9.1 Missed, Late or Shortened Visits

A missed, significantly late or shortened visit may place a person at risk and must be managed as a care and support concern. Staff must report any missed, late or shortened visit immediately to the office, on-call manager or Registered Manager.

The manager or delegated responsible person must:

• assess the immediate risk to the person;
• arrange replacement support where required;
• contact the person and, where appropriate, their representative, family, carer or commissioner;
• record the incident, reason, impact and action taken;
• consider whether a Care Inspectorate notification, adult support and protection referral, complaint response or commissioner report is required;
• review whether staffing levels, travel time, rota planning, communication or staff competence contributed to the event;
• take corrective action to prevent recurrence.

Repeated missed, late or shortened visits must be reviewed as a staffing governance concern and reported to senior management.

9.2 Where the Service Cannot Safely Deliver a Package of Care

{{org_field_name}} will only accept or continue care packages where it can provide safe, high-quality care with appropriate staffing, skill mix, travel time, supervision and management oversight.

Where the service identifies that it cannot safely deliver a current or proposed package of care, the Registered Manager must:

• assess and record the reasons and risks;
• consider whether additional staff, training, supervision, equipment, revised visit times or revised care arrangements would make the package safe;
• discuss concerns with the person, and where appropriate their representative, family or carer;
• escalate concerns to the commissioner, local authority, HSCP or relevant professional;
• agree interim risk management arrangements where possible;
• record all decisions, communications and actions;
• consider whether the Care Inspectorate or other authority must be notified.

The service must not knowingly continue arrangements that place people or staff at avoidable risk without escalation, review and action.

10. Related Policies

This policy should be read alongside:

• Recruitment and Retention Policy
• Supervision and Appraisal Policy
• Health and Safety Policy
• Workforce Well-being and Support Policy
• Contingency Planning and Business Continuity Policy

• Adult Support and Protection Policy
• Safeguarding Policy
• Medication Policy
• Missed and Late Visits Policy
• Lone Working Policy
• Whistleblowing Policy
• Complaints Policy
• Incident Reporting and Notification Policy
• Training and Development Policy
• SSSC Registration Policy
• Data Protection and Confidentiality Policy
• Equality, Diversity and Human Rights Policy
• Business Continuity and Emergency Planning Policy
• Agency and Bank Staff Policy
• Risk Assessment and Risk Enablement Policy
• Personal Planning Policy

11. Policy Review

This policy will be reviewed at least annually or sooner if there are changes in legislation, statutory guidance, Care Inspectorate guidance, SSSC requirements, commissioning requirements, organisational structure, staffing arrangements, service delivery model or identified risk.

The policy will also be reviewed following significant staffing-related incidents, repeated missed or late visits, serious complaints, safeguarding concerns, enforcement action, inspection findings, workforce changes or evidence that current rota arrangements are not supporting safe, high-quality care.

Any amendments will be communicated to staff and relevant stakeholders. Staff will receive guidance or training on any changes that affect their role.

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Responsible Person: {{org_field_registered_manager_first_name}}{{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next Review Date: {{next_review_date}}
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