Residential KLOEs – Prompts and sources of evidence. · Residential KLOEs – Prompts and sources...

20140609 ASC Wave 1 Residential KLOE/Prompts/Evidence V1

Residential KLOEs – Prompts and sources of evidence.

Introduction.

The prompts and sources of evidence, linked to the KLOEs, have been developed to help you answer the 5 questions, is the service, safe, effective, caring, responsive and well led? The prompts and the sources of evidence are not an exhaustive list but are there to support what you may wish to cover during the inspection process for an individual service.

Developing a picture of the service and its history, during planning, is key in helping you focus on what you need to look at in more detail and will also help you with making rating judgements from the characteristics in relation to, for example, consistency and ongoing improvement.

Thorough planning should provide you with evidence you can use before the visit. Some prompts may not always apply to a service or during planning there may be no indication that you need to cover a specific prompt to help you answer a KLOE. In this case don’t plan to use the prompt.

You can develop your own prompts to help you answer the questions and develop your own thinking, individual to the service. In order to have sufficient evidence to reach a robust judgement, you will need to consider the amount and depth of evidence you will need to answer the KLOE and the overall question. This may mean that you do not need to cover each prompt for each KLOE.


Safe.

Safe

S1 How are people protected from bullying, harassment, avoidable harm, abuse that may breach their human rights?

Prompts Sources of evidence

• People feel safe because they are protected from abuse and avoidable harm, including breaches of dignity and respect which can result in psychological harm

• People are protected from discrimination, which might amount to discriminatory abuse or cause psychological harm including discrimination on the grounds of age, disability, gender, gender identity, race, religion, belief or sexual orientation. People are safe because staff know what to do when safeguarding concerns are raised and they follow policies and procedures.

• People are supported to understand what keeping safe means and are encouraged to raise any concerns they may have about this

• When people display behaviour which challenges others, staff deal with it safely and respect people’s safety and dignity and protect their rights.

• Staff understand the requirements of the Mental Capacity Act 2005, its main Codes of Practice and Deprivation of Liberty Safeguards, and puts them into practice to protect people.

We should always start by looking at the history of the service to give us a picture of how well they manage people’s safety. Speaking with inspectors who have had the service before and reviewing information we have on CRM can help with this. During the planning stage, you can gather evidence on safety through reviewing the information pack and PIR for the service. Records, where available of feedback, statutory notifications for safeguarding/deprivation of liberty and incidents of restraint and complaints can also help to provide a picture of safety for people at the service.

We should contact people for evidence before the visit, such as the IMCA advisor, specialist nursing staff or the local safeguarding team as this help with the picture of the service and may save time at the location.

When visiting the service the focus is on people telling us how they feel: whether they feel safe: whether they feel they are discriminated against and exploring with them whether they know what keeping safe means and whether they are encouraged to


• People are only restrained as a last resort. Appropriate decisions are made about when and how restraint is used. Risk assessments for restraint and restrictive practice are regularly reviewed.

raise concerns. In addition, we should spend time with people to observe practice, non-verbal feedback and to see, if possible, whether people are safe. This could cover a range of issues, from, for example, placing restrictions on people who have dementia, to staff dealing positively with people whose behaviour challenges. We should be looking for characteristics of good practice. If it is good then you could look for additional evidence to see if it is outstanding.

We should talk to staff to determine their understanding of keeping people safe, through avoiding discrimination, training on equality and diversity, appropriate methods of restraint and the use of their own policies and procedures or professional guidance. Talking to staff can also help to provide evidence in relation to safeguarding, discrimination and the use of restraint, if any, in the home. The use of restraint does not only relate to people with a learning disability.

To support the evidence we may also wish to look at people’s risk assessments/individual care records, mental capacity and DOL’s assessments, best interest decisions and incident reports. If you need to corroborate your evidence further, you could review a range of policies and procedures, including whistleblowing.


S2 How are risks to individuals and the service managed so that people are protected and their freedom is supported and respected?

Prompts Sources of Evidence

• People feel that their risks are managed appropriately and that they are involved in making decisions about any risks they may take.

• When people are at risk, staff follow risk management policies and procedures to inform them and protect them, whilst also minimising restrictions on people’s freedom, choice and control.

• People are safe because staff use both formal and informal methods to share information on risks associated with their care, treatment and support.

• People can be confident that there are plans to respond to any emergencies and that these are understood by all staff.

• Risks at the service location, and where appropriate to the structure of the service, regional and national level are anticipated identified and managed.

We should always start by looking at the history of the service to give us a picture of how well they manage risk. Speaking with inspectors who have had the service before and reviewing information we have on CRM can help with this. During the planning stage we can gather evidence through reviewing the information pack and service PIR on risk management. Records, where available on CRM, of feedback, statutory notifications and incidents may also provide a picture of risk management at the service. Talking to professionals such as district nurses, specialist learning disability teams, community psychiatric nurses and falls prevention teams may also provide evidence.

When visiting the service, the focus is on people telling us that any risks associated with their care and support are managed positively and appropriately and whether they can exercise choice and control or whether they feel their freedom is unnecessarily restricted. This may also include talking to their relatives and/or friends or advocates. Through spending time with people you may be able to gather evidence through observation on how well risks are managed.

We should talk to staff to determine their understanding of risk management and emergencies, including how they support people to stay safe whilst minimising restrictions on their


freedom.

To support your evidence you may also wish to look at people’s risk assessments/individual care files, accident and incident reports, staff handover records, quality assurance audits and where appropriate any regional or national risk management reports and action plans. If you need to corroborate your evidence further you could review a range of policies and procedures.

S3 How does the service ensure that there are sufficient numbers of suitable staff to keep people safe and meet their needs?


• People are safe because staffing levels are assessed and monitored to ensure they are sufficient to meet people’s identified needs at all times.

• People are safe because the service considers and ensures suitable skill mix, competencies, knowledge, qualifications and experience when arranging staffing so that people’s individual needs are met at all times.

• The service follows safe recruitment practices.

• The service follows clear staff disciplinary procedures when it identifies unsafe practice

The history of the service in relation to staffing levels and recruitment can give you a good picture of how well these aspects of the service are managed. Speaking to previous inspectors can also help. During the planning stage, you can gather evidence through reviewing the information pack and service PIR on staffing in relation to safety. Records, where available on CRM, of feedback, incidents, compliments, and complaints may also provide a picture of staffing at the service.

We can contact people for evidence on staffing safety before the visit, such as visiting nursing staff or the local safeguarding team, which also helps to provide a good picture and may save time


during the visit.

When visiting the service, the focus is on people telling us about how the staffing affects their day to day lives, their safety and care management in both a positive or negative way. We are looking for evidence of good practice. This may also include talking to their relatives and/or friends, advocates and any visiting professionals.

In addition, we should observe practice to see if people have their needs met, are safe and to observe whether call bells are answered promptly.

We should talk to a range of staff to hear their views on the staffing at the service, including shift coverage weekends/nights etc., response to staffing at busy times, use of agencies, deployment and the dependency of the people they care and support.

To support the evidence, if you have concerns that there may be breech of regulations, you may also wish to look at people’s risk assessments/individual care files, staffing level assessment systems, staff handover records, staff rotas over time, agency records, minutes of meetings, internal quality assurance feedback, quality assurance records on patterns/timings of accidents and incidents and, where available any call bell timing records.

If you need to review recruitment and staff disciplinary procedures at the service, you can speak to staff, review staff files and should you need to corroborate evidence, policies and procedures.


S4 How are people’s medicines managed so that they receive them safely?



• People received their medicines as prescribed (including Controlled Drugs) because they are stored, administered and disposed of safely in line with current and relevant regulations and guidance.

• People can administer their own medicines safely.

• People’s behaviour is not controlled by excessive use of medicines.

• The service follows current and relevant professional guidance about the management and review of medicines.

• There are clear procedures for giving medicines in accordance with the Mental Capacity Act 2005.

At the planning stage, you can gather evidence on the safe management of medicines through reviewing the information pack and PIR for the service. Records, where available, on CRM, of feedback, statutory notifications of incidents and complaints can also provide a picture of medicines management at the service. We can contact supplying/visiting pharmacist(s) for evidence before the visit or our own pharmacy inspectors, if they have visited the service in the last year.

When visiting the service the focus is on people telling us if they feel and are happy that their medicines are managed correctly. In addition, where possible, we should observe and look for good practice, to see if people receive their medicines safely and in a timely manner. We should also look at the safe storage and administration of medication for the people we are case tracking and if there are concerns of a breech in regulation, you may wish to explore this further.

We should talk to staff to determine their understanding of the safe storage and management of medicines and discuss their training/competencies and the use of their own policies and procedures.

To support the evidence you may also wish to look at people’s risk assessments/care plans, medication reviews, best interest decisions and staff competency records. Quality audits and checks both internal and external, and action plans can also be of value. If you need to corroborate your evidence further, you could review a range of policies and procedures, including administration of specialist medicines, covert medicines and homely remedies.


S5 How are the premises and equipment managed so people are safe?


• People and their belongings are safe because the service assesses and manages the risks associated with the environment.

• People are safe because the service safely installs, uses, maintains, tests and services equipment (including medical devices).

• Equipment is suitable for its purpose. • People are safe because the service complies with:

o relevant legal requirements for the premises o manufacturers’ instructions for equipment.

At the planning stage, you can gather evidence on premises and equipment safety through reviewing the section on safety in the PIR for the service. Records, where available, on CRM, of statutory notifications for accidents, incidents and complaints can also provide evidence.

When visiting the service, where possible, the focus is on people telling us their views about the premises, security and equipment in relation to safety. Relatives and friends may also provide evidence.

We should look round the home in relation to hazard prevention and security, taking into account any specialist needs of the people living in the home. Also observe the way staff work with people, for example, when moving them with the aid of a hoist. We are looking for good practice. We should talk to staff to determine their understanding of safety measures in place, their training in the use of equipment and risk assessment systems.

To support the evidence, you may wish to review environmental risk assessments, fire safety records and maintenance certificates for the premises and equipment. Where concerns are evident, it may be of value to speak to an external expert such as the local fire or health and safety officer.


S6 How well are people protected by the prevention and control of infection?


• People are protected from acquired infections because the home is kept clean and hygienic.

• Staff demonstrate that they understand their roles and responsibilities in relation to infection control and hygiene

• The service maintains and follows policies, procedures in line with current relevant national guidance.

At the planning stage, you can gather evidence on the prevention and control of infection at the service through reviewing the information pack and PIR for the service. Records, where available, on CRM, of feedback, statutory notifications of incidents and compliments and complaints can also provide evidence. Local infection control nurses may also provide evidence of good practice/management during outbreaks.

When visiting the service the focus is on people telling us if they feel that the home is clean and hygienic. Relatives and friends may also have views on this aspect of the home and we should engage with them as well on this subject.

We should look around the home with regard to cleanliness, odour control and hygiene, taking into account systems that are in place to protect people and support staff. We should also observe practice and look at the equipment people have available to them. We should talk to staff to determine their understanding of their role in relation to the prevention and control of infection and the use of their own policies and procedures.

To support the evidence, if you have concerns of a breech in the regulations, you may also wish to look at people’s risk assessments/care plans and any quality assurance audits/action plans in place. To corroborate your evidence you may wish to review the policies and procedures at the service.


E1 How do people know they receive effective care from staff who have the knowledge and skills they need to carry out their roles and responsibilities?


• People are supported by care staff who have the necessary skills and knowledge to meet their assessed needs, preferences and choices.

• Staff have effective support, induction, supervision, appraisal and training.

• Management have up to date plans to promote good practice and develop the knowledge and skills of their staff.

• Volunteers are trained and supported in the role they undertake.

We should always start by looking at the history of the service to give us a picture of how well they develop and train their staff team to meet people’s needs. Speaking with inspectors who have had the service before and reviewing information we have on CRM can help with this. During planning stage, you can gather evidence on effective care provision from the PIR for the service. Further evidence can be found, if available through feedback, such as ‘tell us your experience forms’ and compliments and complaints. Before the visit we can speak to visiting healthcare professionals, commissioning bodies/training consortiums and organisations such as Healthwatch to give us evidence, which may provide good evidence and save time during the visit.

When visiting the home the focus should be on talking to people and/or their relatives about their experiences and views on whether staff are sufficiently skilled and experienced to care and support them to have a good quality of life.

Observation of practice may provide evidence of good practice where staff have the skills to meet people’s individual needs or it may highlight areas for improvement/staff development.

We should talk to staff and where appropriate volunteers, about the induction, support and training they receive and whether they


feel this enabled them to care and support people effectively when they started work or carry out other roles and responsibilities.

To support your evidence, you may wish to review staff training and development plans, induction and training records/certificates and staff files.

E2 How are people supported to have sufficient to eat and drink and maintain a balanced diet?


• People have enough to eat and drink throughout the day, and night if required, and meals are appropriately spaced or flexible to meet their needs.

• People have a balanced diet that promotes healthy eating.

• People are involved in decisions about their nutrition and hydration needs.

• People, especially those with complex needs, are effectively assessed to identify the risks associated with nutrition and hydration.

• People’s identified needs are monitored and managed.

• People have access to dietary and nutritional specialists as their assessed needs indicate.

At the planning stage, you can gather evidence on effective nutrition and hydration from the PIR for the service. Further evidence can be found, if available through feedback, such as ‘tell us your experience forms’ and compliments and complaints. During the planning stage we can speak to community dieticians and nursing staff, GPs, commissioning bodies and organisations such as Healthwatch for evidence and a picture of people’s nutrition and hydration.

When visiting the home the focus should be on talking to people and/or their relatives to gain their views and experiences of the food and mealtimes at the home. This should include whether staff support them effectively: whether their needs and preferences are met and the quality of the food and drink provided.


• People find mealtimes ‘pleasurable’, unrushed and have food that is served at the correct temperature.

We should spend time with people and observation of practice during mealtimes will provide evidence to support what people say. Also, if appropriate speak to the chef and look at the arrangements for specialist diets or people’s involvement in the preparation or their own food and drink. Look for characteristics of good and if it is good, check to see if it is outstanding.

We should talk to staff to determine their understanding of the care and support people in the home need around nutrition and hydration, specialist diets and people at risk.

To support your evidence, you may wish to review people’s individual care records, food and fluid intake charts, menus, feedback surveys on food and mealtimes, minutes of meetings, risk assessments and weight management records.

E3 How are people supported to maintain good health, have access to healthcare services and receive ongoing healthcare support?


• People feel comfortable to discuss their health needs with staff.

• People are provided with understandable information and explanations about the medicines they take, the health care and treatment options available to them and their likely outcomes.

• People are involved in regularly monitoring their health, and any

At the planning stage, you can gather evidence on healthcare from the PIR for the service. Further evidence can be found, if available through feedback, such as ‘tell us your experience forms’ and compliments and complaints. We can speak to community/specialist-nursing, including tissue viability nurses, and healthcare staff, GPs, commissioning bodies and


changes that may require additional support or intervention are discussed with them.

• When people’s needs change, referrals are made quickly to relevant health services.

• People’s day to day health needs are met.

organisations such as Healthwatch for evidence of good practice and this may save time during the visit.

When visiting the home the focus should be on talking to people and/or their relatives to gain their views and experiences of healthcare in the home. This should include timely referral when necessary.

Where possible we should observe practice, this may include staff arranging a referral to a healthcare professional or staff discussing a person’s health needs at handover.

We should talk to staff to determine their understanding of the care and support people in the home need in relation to their health. Discuss their observations/understanding on how changes in behaviour may indicate changes in people’s health and wellbeing.

To support your evidence, you may wish to review people’s individual care records, including, where appropriate, tissue viability/wound management plans, health action plans and look at any information available to people on matters affecting their health.

E4 How are people’s individual needs met and enhanced by the adaptation, design and decoration of the home?


• People are involved in decisions about the environment they live At the planning stage, you can gather evidence on the premises


in.

• People’s diverse care, cultural and support needs are met by the premises and equipment supplied.

• People have access to appropriate space:

− to see and look after their visitors

− for activities

− to spend time together or

− to be alone.

• People’s needs are met and their independence is promoted through the use of signage, decoration and other environmental adaptations.

from the PIR for the service. Further evidence may be available through feedback, such as ‘tell us your experience forms’ and compliments and complaints. Previous inspectors and inspection work may also give a picture of the premises and use of equipment.

When visiting the service the focus should be on talking to people and/or their relatives to gain their views on how the premises meets their needs, affects their day to day lives and whether they are involved in making decisions about any proposed changes.

We should look round the building and take into account how the design, layout, access and adaptations may affect the quality of people’s lives in both a positive and/or negative way, taking into account the needs and dependency of the people living there. In particular, people with dementia, physical disabilities, sensory impairment and so on.

We should talk to staff so we are aware of any proposed changes to the premises that may improve people’s day to day lives.

To support your evidence, you may wish to review minutes of meetings and if there are areas of concern link with accident and incident records and people’s individual care files.


Caring.

C1 How are positive caring relationships developed with people using the service?


• People say they are treated with kindness and compassion in their day-to-day care.

• People’s needs in respect of age, disability, gender, race, religion or belief, sexual orientation and gender reassignment are understood by the staff that support them and met in a caring way.

• People say that they are listened to and feel that they matter.

• Staff know the people they are caring for and supporting, including their preferences and personal histories.

• People feel that staff show concern for their wellbeing in a caring and meaningful way and respond to their needs at the time they need it.

At the planning stage, you can gather evidence on caring relationships from the PIR for the service. Further evidence may be available through feedback, such as ‘tell us your experience forms’ and compliments and complaints. Talking with relatives and visiting professionals before the inspection may also help provide a picture of how caring staff are at the service.

When visiting the home the focus should be on talking to people and/or their relatives to establish how they feel about the caring approach of staff at the home. This should include whether diversity, time, staffing levels or consistency of staff etc. affects this. Look for characteristics of good practice.

We should spend time observing practice to see and hear the interactions between staff and people living in the home.

We should talk to staff to establish how well they know the people they are caring for and whether this is in a caring and person centred way rather than a task led approach.

To support the evidence, you may wish to look at people’s individual care files for the approach to person centred care and how staff deal with the things that matter to people, however small.


C2 How does the service support people to express their views and be actively involved in making decisions about their care, treatment and support?


• People are involved as partners in their own care as much as they are able; staff support and involve them in planning and making decisions about their care, treatment and support

• People are given the information and explanations they need at the time they need it and staff are able to communicate effectively

• People, and those that matter to them, are encouraged to make their views known about their care, treatment and support and these are respected

• People are given the time they need to make decisions.

• Staff actively seek, listen to and act on people’s views and decisions.

• People are aware of, and are supported to have access to advocacy services that are able to speak up on their behalf.

At the planning stage, you can gather evidence on how the service supports people to make decisions from the caring section of the PIR for the service. Further evidence may be available through feedback, such as ‘tell us your experience forms’ and compliments and complaints. Where possible speak to advocacy staff, who support people at the service and relatives who may also provide a valuable insight.

When visiting the home the focus should be on talking to people and/or their relatives to gain their views and experience on how they have been involved and supported in planning and making decisions about their care and treatment, whether they are given explanations they understand and the time they need.

We should spend time with people and observe the interactions between staff and people and listen to the decision making process to see if people are actively involved and given choice and autonomy. This can be simple day-to-day decisions, like when a person may wish to go to the toilet, how, where appropriate, they are involved in day to day chores or whether someone wants to attend a hospital appointment. We should look for characteristics of good.

We should talk to staff to determine their understanding of giving


people choice, autonomy and control, wherever possible, about their care, treatment and support.

To support your evidence, if you have concerns, you may wish to review people’s individual care files, including records of advocacy visits and quality assurance feedback results.

C3 How is people’s privacy and dignity respected and promoted?


• People are assured that information about them is treated confidentially and respected by staff.

• People have the privacy they need.

• People are treated with dignity and respect at all times.

• People can be as independent as they want to be.

• Staff understand and promote respectful and compassionate behaviour.

• People’s relatives and friends are able to visit without undue restriction.

• There are policies and procedures in place to ensure staff understand how to respect people’s privacy, dignity and human rights in the care setting.

At the planning stage, you can gather evidence on privacy and dignity from the PIR for the service. Further evidence may be found through feedback, such as ‘tell us your experience forms’ and compliments and complaints. Talking to relatives and commissioning bodies may also provide evidence and give you a picture about people’s privacy and dignity at the service.

When visiting the service the focus should be on talking to people and/or their relatives to gain their views and experiences on maintaining their privacy and dignity in the home. We should also discuss how they are supported to maintain their independence and observe how care is delivered. Look for characteristics of good practice.

We should look round the building and take into account how the


design and layout provides people with privacy.

We should talk to staff to determine their understanding and how they support people with their privacy and dignity. In addition we should discuss and explore examples of how they promote people’s independence.

To support the evidence, if you have concerns, you may wish to review people’s individual care files, minutes of meetings and training records/training content. Should you need to corroborate your evidence further you can review a range of associated policies and procedures and check data management.

C4 How are people supported at the end of their life to have a private, comfortable, dignified and pain free death?


• People’s expressed preferences and choices for their end of life care are clearly recorded and acted on.

• As people’s needs change, staff know how to manage their care appropriately in line with their choices and wishes.

• People have access to the specialist palliative care services they need and they, and people that matter to them, are involved in planning, decision making and management of their care.

• People have the equipment they need to meet their end of life needs.

We should start by looking at the history of the service to give us a picture of how well they provide end of life care to meet people’s individual needs. Speaking with inspectors who have had the service before and reviewing information we have on CRM can help with this. At the planning stage, you can gather evidence on end of life care from the PIR for the service and the information pack. Records, on CRM, of feedback such as ‘tell us your experience forms’ and compliments and complaints may help to give a picture of end of life care at the service. Prior to the visit, talking to visiting professional such as GP’s, end of life


• People know how to make advance decisions to refuse treatment or appoint someone with lasting powers of attorney, and are supported if they wish to do so.

• People have a comfortable and dignified death.

• People, their families, friends and staff have the emotional support they need.

nurse specialists, district nurses, and relatives can provide evidence of good practice.

When visiting the home the focus should be on talking to people and/or their relatives to gain their views and experience of end of life care in the home. This should include good practice, decision-making, choice and control, access to specialist support and equipment and symptom management.

We should talk to staff to determine their approach to end of life care, their understanding of people’s individual needs at this time and any training they have attended and how they put this into practice.

To support the evidence, you may wish to review people’s individual care files, including advanced care plans, the management of ‘Do not attempt resuscitation’ orders and training records/training content and look at any accreditation schemes that the service takes part in and how these are put into practice at the service.

Should you need to corroborate your evidence, if you have concerns, you can review a range of associated policies and procedures. People’s individual care records

• Discussion with specialist palliative care staff

• Advanced care plans


Responsive.

R1 How do people receive personalised care that is responsive to their needs?


• People receive care, treatment and support when they need it.

• People are encouraged and supported to express what is important to them.

• People can express their views about their health and quality of life outcomes and these are taken into account in the assessment of their needs and the planning of the service.

• People are supported to be involved, as much as they are able to, in the assessment of their needs and have choice about who provides their personal care.

• People receive the care and support they need in accordance with their valid consent and individual preferences, interests, and aspirations, including relating to their age, disability, gender, race, religion or belief, sexual orientation and gender reassignment.

• People have their individual needs regularly assessed and consistently met.

• People have access to, where required, education and activities that are important and relevant to them and are protected from social isolation through systems that they service has in place

• People are enabled to maintain relationships with their friends and relatives.

We should start by looking at the history of the service to give us a picture of how well they provide a person centred service that meet people’s individual needs. Speaking with inspectors who have had the service before and reviewing information we have on CRM can help with this. At the planning stage, you can gather evidence on responsive, personalised care from the PIR for the service. Further evidence may be found through feedback, such as ‘tell us your experience forms’ and compliments and complaints. Talking to visiting professionals, such as specialist learning disability teams or social care staff and relatives may also provide evidence on the person centred approach to care and support at the service.

When visiting the home the focus should be on talking to people and/or their relatives to gain their views and experiences on the provision of person centred care in the home. This should include how much they are asked for their views, given choice and control, give consent, get the right care, treatment and support when they need it, have their diversity and/or disabilities taken into account and have access to information, activities and where appropriate education. We should look for characteristics of good and if it is good we should question whether it is outstanding.

We should spend time with people and observe practice to see,


• People who are disabled have reasonable adjustments made, in accordance with the requirements of relevant legislation, to ensure they receive the support and equipment they need to support their independence.

where possible, how people are provided with person centred care, whether the daily routine is person or task led, whether consent is sought, whether their diversity is understood and managed to suit people’s needs and whether they get the care, treatment and support they need when they need it.

We should talk to staff, including activity officers, to determine their understanding of person centred care and how put this into practice. We should also discuss their understanding of consent and explore examples with them. We should discuss, daily routines, activities, where appropriate education, and social isolation. We should discuss the arrangements in place to meet people’s spiritual, religious or ethical requirements so people can stay in contact with their communities or culture.

To support the evidence, you may wish to review some people’s individual care files/activity records in detail as this can give evidence across a range of KLOE. Where appropriate include, best interest decisions and specialist care and support assessments, for example, for people with dementia or a learning disability. Look at any accreditation schemes that the service takes part in and how these are actively put into practice in the home.

Should you wish to corroborate your evidence further, if you have concerns, you can review management business plans and training records/content.


R2 How does the service routinely listen and learn from people’s experiences, concerns and complaints to improve the quality of care?


• People’s concerns and complaints are encouraged, explored and responded to in good time.

• People know how to share their experiences or raise a concern or complaint and feel comfortable doing so.

• People, their relatives and friends are encouraged to provide feedback.

• Management reviews act on information received about the quality of care and can show the difference this has made to how care, treatment and support is delivered and the outcomes achieved.

• Concerns and complaints are used as an opportunity for learning or improvement.

At the planning stage, you can gather evidence on the management of concerns and complaints from the PIR for the service and the information pack. Further evidence may be found through feedback, such as ‘tell us your experience forms’ and compliments and complaints recorded on CRM. Talking relatives may also provide evidence on how well the service the manages concerns and complaints.

When visiting the home the focus should be on talking to people and/or their relatives to gain their views and experiences on how, where appropriate, their concerns and complaints have been managed in the home. You should explore whether people feel that they were managed properly and whether they feel that anything has changed in light of the matter raised. You should check with people whether they know how to raise a concern or complaint and whether they feel comfortable to do this.

We should talk to staff to determine their approach to the management of concerns and complaints and explore with them how, where appropriate, improvements have been made or changes to practice implemented. Look for good practice.

To support the evidence, you may wish to review concerns/complaints management systems, records of investigations and associated action plans, minutes of meetings


and associated quality assurance data. Should you wish to corroborate your evidence you could review the complaints procedure and its accessibility.

R3 How are people assured they will receive consistent co-ordinated, person-centred care when they use, or move between, different services?

Prompts Evidence

• People’s needs, wishes and choices are recognised, respected and shared when they move between services.

• People receive consistent, coordinated care and support when they move between services and their needs and desired outcomes continue to be met.

People moving between or starting additional services have this properly planned so they are supported through the process in a way that meets their individual preferences and needs.

At the planning stage, you can gather evidence on the transition between services from the PIR for the service. Further evidence may be found through feedback, such as ‘tell us your experience forms’ and complaints recorded on CRM. Talking to relatives, visiting professionals and commissioning bodies may also provide evidence on this aspect of care.

When visiting the home the focus should be on talking to people and/or their relatives to gain their views and experiences on how well their care and support is managed when they access other services, such as attending hospital. This should include choice and control and the consistency of their care and where appropriate, speak to people who have moved from children’s into adult services.

We should talk to staff to understand how they plan and manage the transition between services, for example hospital admissions, appointments and permanent moves from the service. It may


Well Led.

also be of value to sit in on a staff handover.

To support your evidence, you may wish to review people’s individual care files, transfer information/grab sheets, especially for people with a sensory impairment, learning disability or dementia.

W1 How does the service promote a positive culture that is person-centred, open, inclusive and empowering?


• People are actively involved in developing the service.

• There is an emphasis on support, fairness, transparency and an open culture.

• Where there are few visitors to the service, arrangements are made to ensure there are strong links with the local community

• Staff are supported to question practice. Whistle-blowers, and those who raise concerns, are protected.

• Management are aware of the day to day culture in the service and they keep this under review.

• There are a clear set of vision and values that includes involvement, compassion, dignity, independence, respect, equality and safety. These are kept under review and are

We should start by looking at the history of the service to give us a picture of the culture. Speaking with inspectors who have had the service before and reviewing information we have on CRM can help with this. At the planning stage, you can gather evidence on the culture of the service from their PIR and information gained from looking at other KLOE’S can all help provide evidence. Further evidence may be available through ‘tell us your experience’ forms or complaints recorded on CRM. Talking to relatives, commissioning bodies and other professionals who visit the service may also provide evidence on the culture.

When visiting the home the focus should be on talking to people and/or their relatives to gain their views and experiences on the


understood and promoted by all staff.

culture in the home. Discuss the atmosphere, involvement, openness, transparency and links with the local community. Observe how people are referred to by staff and whether it is appropriate.

We should talk to staff to determine their understanding of the vision and values and of the service and how these are discussed and put into practice. You should also discuss the culture of the service and whistleblowing or raising concerns. Include the approach taken to this in the home and explore openness, transparency, and any examples given.

To support your evidence, you may wish to review the current vision and values of the service, minutes of meetings, social activity calendars and where appropriate records of visits by or on behalf of the provider. Should you wish to corroborate your evidence you could review associated policies and procedures.

W2 How does the service demonstrate good management and leadership?


• Good leadership can be seen at all levels.

• Where required, there is a registered manager in post and all other conditions of registration are met.

• There is consistency between what management and staff say are the key challenges, achievements, concerns and risks.

We should start by looking at the history of the service to give us a picture of management and leadership. Speaking with inspectors who have had the service before and reviewing information we have on CRM can help with this. At the planning stage, you can gather evidence on management and leadership at the service from their PIR. Further evidence may be found


• Resources and support are available to the manager and the team to develop and drive improvement.

• Staff are motivated, caring, supported and open.

• Investigations into whistleblowing or staff concerns, safeguarding and accidents/incidents are thorough, questioning and objective. People, those close to them, and staff are included in the investigation as much as they can be and the service learns from them so they are less likely to happen again.

• The service has a system to manage and report accidents and incidents.

• Where required action plans are developed and monitored to ensure they are delivered.

• Systems are in place to continually review the incidence, type, timing etc. as appropriate, of safeguarding concerns, accidents and incidents, including pressure ulcers. This may be at location, and where appropriate, regional and national level to identify themes and take action where necessary.

through feedback, such as information from the previous inspector, where appropriate and ‘tell us your experience’ forms or complaints, and registration information recorded on CRM. Talking to relatives, commissioning bodies and other professionals who visit the service may also provide evidence on the management and leadership. We are looking for characteristics of good.

When visiting the home you can talk to people and/or their relatives to gain their views and experiences on the management of the home, and whether they think sufficient resources are available to help drive improvement.

We should talk to both care/nursing and ancillary staff and managers to gain their views on the management and leadership at the service. This should include key challenges, achievements, concerns and risks and the resources available to drive improvement. Where appropriate you can discuss any investigations following whistleblowing or staff who have raised concerns. Also discuss how the service learns from accidents and incidents etc. and how they monitor these on an ongoing basis and use the data to inform practice.

To support the evidence, you may wish to review minutes of meetings, where appropriate board meeting minutes and business plans, accident and incident records including ongoing monitoring, results of staff surveys, records of visits to the service by or on behalf of the provider and records of safeguarding/whistleblowing and accident/incident investigations. You may wish to look at any accreditation schemes that the service takes part in and how these are put into practice in the


home.

Should you wish to corroborate your evidence you could review associated policies and procedures and look at the registration certificate.

W3 How does the service deliver high quality care and identify and implement best practice?


• Quality is integral to the service’s approach and they are aware of potential risks to the quality of the service.

• Robust quality assurance and, where appropriate, governance systems are in place and used to drive continuous improvement.

• The service has appropriate data management systems in place.

• The service recognises innovation.

• The service has links with organisations that act as developers and sources of best practice. This includes sector specific guidance around best practice in leadership.

• Management use information from compliments to extend best practice across the service.

At the planning stage, you can gather evidence on quality assurance, risk management and best practice the service from their PIR. Further evidence may be found through feedback, such as information from the previous inspector, where appropriate, and ‘tell us your experience’ forms or complaints recorded on CRM. Talking to relatives, commissioning bodies and other professionals who visit the service may also provide evidence on quality assurance, risk and best practice.

When visiting the home you could talk to people and/or their relatives to see what involvement they have had in quality assurance feedback and how this did or did not affect practice in the home.

We should talk to staff to determine their understanding of how to provide a quality service, and how quality assurance helps drive improvement. You should also discuss how innovation is recognised in the service and any links they have with other


providers or organisations to learn about and implement best practice.

To support the evidence, you may wish to review the quality assurance systems/audits in place and any associated action plans, minutes of meetings and compliments. You may also wish to look at any accreditation schemes that the service takes part in and how these are put actively into practice in the home.

Should you wish to corroborate your evidence you could review associated policies and procedures and staff reward schemes.

W4 How does the service work in partnership with other agencies?


• The service works in partnership with key organisations, including the local authority and safeguarding teams, to support care provision and service development.

At the planning stage, you can gather evidence on working in partnership from the PIR for the service. Further evidence can be found by talking to commissioning bodies, Healthwatch, training consortiums/organisations and other health and social professionals who visit or may link in with the service.

We should talk to staff to explore examples of how they work in partnership with other organisations.

To support your evidence you may also wish to look at any accreditation schemes that the service takes part in and how


these are actively put into practice in the home.

W5 How does the service enable open and transparent communication?


• The service enables and encourage open communication with people, those that matter to them and staff.

• There are accessible, tailored and inclusive methods of communicating with people, staff and other key stakeholders.

• There is honesty and transparency, from all levels of staff and management, when mistakes occur.

• Management give feedback to staff in a constructive and motivating way, outlining the action they need to take.

At the planning stage, you can gather evidence on aspects of communication in the service from their PIR. Further evidence may be found through feedback, such as information from the previous inspector, where appropriate, and ‘tell us your experience’ forms or complaints recorded on CRM. Talking to relatives, commissioning bodies and other professionals who visit the service may also provide evidence on communication, to give you a picture of how it is managed at the service.

When visiting the home you could talk to people and/or their relatives to gain their views and experience of communication in the service. This should include specialist methods of communication for people, for example, with a learning disability, a sensory impairment or dementia.

We should spend time with people to observe communication in the home and try to observe the different methods staff may use with the people they support and care for. We are looking for characteristics of good.

We should talk to staff to understand how communication works in the service, whether it is open and transparent and whether


feedback is constructive and motivating.

To support your evidence, you may wish to review people’s individual care files, minutes of meetings, notices around the home, and staff supervision and appraisal records.

W6 How does the service ensure that responsibility and accountability is understood at all levels?


• Staff know and understand what is expected of them.

• Clear and transparent processes are in place for staff to account for their decisions, actions, behaviours and performance.

• Where there is a registered manager, they understand their responsibilities and are supported by, where appropriate, the rest of the management to deliver what is required.

• Where appropriate to the type of service, the board and management know about, and take responsibility for, things that happen in the service.

• CQC registration requirements, including the submission of notifications and any other legal obligations are met.

At the planning stage, you can gather evidence on responsibility and accountability at the service from their PIR. Further evidence may be found through feedback, such as information from the previous inspector, where appropriate, and ‘tell us your experience’ forms, general enquiries or complaints recorded on CRM. On CRM you should also review whether statutory notifications are being submitted in the appropriate way for the type of service you are inspecting and this should be supported by reviewing the information pack. Talking to relatives, commissioning bodies and other professionals who visit the service may also provide evidence.

When visiting the home you could talk to people and/or their relatives to gain their views on how well staff understand and carry out their responsibilities.

We should talk to staff to determine their understanding of their roles and responsibilities and this should include accountability and the processes in place to manage this. With senior staff you


should discuss responsibility and accountability within the service and the systems used to manage decision making, behaviours and performance.

To support your evidence, you may wish to review the statutory notification system, staff supervision, disciplinary and appraisal records and minutes of meetings. To corroborate your evidence, if you have concerns, you may wish to look at associated policies and procedures, the vision and values of the service, if appropriate, the staff handbook and job descriptions.

Residential KLOEs – Prompts and sources of evidence. · Residential KLOEs – Prompts and sources...

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