Recommendations on The Future of Residential Care for Older People in Scotland

A strategic examination of the purpose and desired structure of residential care services fit for the aspirations and needs of future generation.

Annex B: Example Risk Register



Exposure to Risk

Stability of care home management

It is widely regarded that in the absence of an effective and established care home manager being in place, there can be a deleterious impact on staff culture and quality of care.

Manager in post for over 3 months

Manager in post for less than 3 months

Manager not in post

Use of agency staff

The absence of a settled staff group, operating within an established culture, can be an indicator of concern. That is not to say there is no role for agency staff, or that agency staff are inferior in any way. This is a commentary on how settled and established teams are.

<1% of weekly care hours delivered by agency staff

1-5% of weekly care hours delivered by agency staff

> 5% of weekly care hours delivered by agency staff


Industry and lenders have a sense of what levels of occupancy will be required in order to make a care home financially viable. While this will vary by geography and provider, occupancy levels below 85% are generally a cause for concern.




Profitability of care home

Partly a derivative of occupancy levels, EBITDAR (profit before rent) is also a signal of the financial health of a particular care home.

EBITDAR per bed of £8k

EBITDAR per bed of £6k-£8k

EBITDAR per bed of <£6k

Care Inspectorate Grades

Care Inspectorate grades offer an evaluation of the quality of the care home and are important in analysing risk.

Consistently achieve grades of 3+

Temporarily dropped below grades of 3+

Consistently achieve grades of <3

Additional Risk Factors



Op-co/prop-co split

Where the property owner is different to the operating company, it doubles the number of parties who can choose, or who may be forced, to exit the market. It can also introduce complex contractual arrangements.


Where the property is in a location that is inconsistent with the commissioning plan of the Health and Social Care Partnership.

Service-user feedback

Where there is soft intelligence about dissatisfaction in a care home, this should also be factored into the risk assessment process.


Email: George Whitton

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