Agnes Chirozvi is a new inspector with the Quality Assurance Directorate of Healthcare Improvement Scotland. Working with the Care Inspectorate on their inspection of care homes, Agnes shares her story of how she became an inspector and what it’s like to go into care homes during the pandemic, whilst ensuring safety for residents and staff, as well as the inspection teams themselves.

When the COVID-19 pandemic broke out I was working as a scrub nurse for a private company working in trauma and orthopaedics operating theatres in a major NHS hospital in Scotland. Although I loved working in trauma and orthopaedics, fixing the broken bones and making people whole again, there was something missing.

Earlier in my career I was in a nursing management role for nearly seven years. I realised that I missed the partnership working and quality assurance aspects of the job, including my focus on infection prevention and control (IPC). This is what inspired me to join Healthcare Improvement Scotland as an inspector in mid-November 2020. I was excited to know that I would help to make a huge difference in people’s lives through driving safety to improve the quality of their lives. I knew Healthcare Improvement Scotland was exactly where I was meant to be.

Building relationships virtually in a new role

On my first day with Healthcare Improvement Scotland it felt a bit strange to be sitting in my home in front of a computer by myself, and not going to an office full of people which I had done before. It felt like a huge contrast to my nursing career and I had all sorts of mixed emotions. But in my second week I was able to get out into the field, shadowing two Care Inspectorate inspectors and one Healthcare Improvement Scotland inspector as part of my supervised induction into my new role. I was excited to meet these experts in the flesh and felt privileged to be able to tap into their vast knowledge.

At the end of January this year, I was ready to take part in my first care home inspection, alongside colleagues from the Care Inspectorate. Since then, I have represented Healthcare Improvement Scotland on eight inspections. My first four months as an inspector have been an exciting time in my life as the learning never ends.  

The challenges of carrying out inspections during the pandemic

The Care Inspectorate is the lead agency for the inspection of care homes across Scotland – at the start of the pandemic, the Scottish Government asked Healthcare Improvement Scotland to provide additional support to the IPC dimension of their work, with our joining them for about 30% of their inspections. Since May of last year, Healthcare Improvement Scotland inspectors have supported over 300 inspections of care homes across the country.

Many of the care homes we have visited have been dealing with outbreaks of COVID-19, so taking extra precautions to keep risks at a minimum was and is an absolute priority. One of the main challenges of carrying out inspections during the pandemic are the complexities of trying to achieve safety for myself, my colleagues, care home staff and the residents.

We take appropriate Personal Protective Equipment (PPE) with us on visits and wear it for each activity we carry out and afterwards, immediately remove our PPE and clean our hands. Inspectors have to carry out a self-administered COVID-19 Lateral Flow Device Test twice a week and before each inspection. If a test is positive, the inspector is taken off an inspection and replaced by someone who is negative. On arrival at a care home, we have our temperature checked as this could be an indication of the onset of symptoms of the virus. We also change into scrubs that can be washed at high temperatures and reverse this process at the end of the inspection. Throughout the inspection, we socially distance from colleagues, care home staff and residents. We also wash our hands in between activities and apply alcohol rub to ensure our hands are clean before and after applying gloves. This can be taxing, but we are all conscious of how it is important it is for individual safety and good public health – and it is no more than we are expecting from the staff working within the care homes we are visiting.

Infection prevention and control

A key difference between a hospital and a care home is that the latter are people’s homes – a place where they should be and should feel safe, comfortable and at home.

As a Healthcare Improvement Scotland inspector, my primary role is to determine whether the infection control practices in place support a safe environment for residents and for staff. We use a standard inspection tool to guide this process, based on the most up to date national guidance available. Our assessments include cleanliness of the physical environment; furnishings and equipment; observation of staff practices; and checking of audits, systems and processes. Speaking with care home staff also provides an invaluable insight into each care home’s understanding of IPC and its use of current national guidance. As inspectors our job is to help keep people safe – and so where we can offer advice and guidance to staff on how to improve IPC we always seek to do so.

It is extremely fulfilling to be part of such an important process and to be a member of a very committed team. By working in partnership with our colleagues from the Care Inspectorate, Healthcare Improvement Scotland staff have made an important contribution to our national COVID-19 response – and we will continue to play our part in helping to keep people safe as the social care sector looks to re-mobilise, recover and re-design.

Agnes Chirozvi is an inspector with Healthcare Improvement Scotland.