A quality framework for care homes for adults and older people
You should carefully consider the aims and objectives of the service when looking at the quality illustrations and evaluating it using the quality indicators and key questions.
Key question 1: How well do we support people’s wellbeing?
This key question has five quality indicators associated with it.
They are:
1.1 People experience compassion, dignity and respect
1.2 People get the most out of life
1.3 People’s health and wellbeing benefits from their care and support
1.4 People experience meaningful contact that meets their outcomes, needs and wishes
1.5 People’s health and wellbeing benefits from safe infection prevention and control practice and procedure
Quality indicator 1.1
People experience compassion, dignity and respect
Key areas include the extent to which people experience:
compassion
dignity and respect for their rights as an individual
help to uphold their rights as a citizen free from discrimination.
Very good
People experience care and support with compassion because there are warm, encouraging, positive relationships between staff and people living in the care home. This supports people to achieve their individual outcomes.
People feel respected and listened to because their wishes and preferences are used to shape how they are supported, including if they wish to decline an aspect of their support.
People experience support that promotes independence, dignity, privacy and choice. They feel connected, as they are enabled to maintain and develop relationships within and outside the care home.
Weak
Staff interact with people in ways which are impersonal or abrupt. Staff may appear rushed and have no time for meaningful interaction with people.
People’s views and preferences are not actively sought when planning and delivering care and support. People’s views and preferences are not reflected in daily practice. Care and support are delivered around routines and tasks with little regard for individual needs and wishes.
The rights of people in making choices and maintaining their independence, for example, freedom of movement, are not promoted and a risk averse approach is prevalent.
Very good
People’s rights are respected. They are treated fairly, and staff actively challenge any form of discrimination.
Where people’s independence, choice and control are restricted, they are well informed about these, and legal arrangements and appropriate supports are in place. Restrictions are kept to a minimum and carried out sensitively.
People’s wellbeing and sense of worth is enhanced by staff who are knowledgeable about and value diversity. Where people’s behaviour may be seen as challenging to others, staff provide sensitive support to reduce the impact
Weak
There are a limited range of opportunities for people to be involved in decisions about the care home. Where views are gathered, people still feel they are not listened to and there is little evidence to demonstrate how their views have been taken into account.
Where there are restrictions placed on people’s freedom of movement, choice or independence, these are not designed to benefit the individual or are not linked to risk. Restrictions are not clearly documented and are not implemented with the involvement and consent of relevant people.
Very good
People are well informed about their citizenship rights, including voting. They are actively supported to exercise these rights and staff demonstrate the principles of the health and social care standards in their day-to-day practice.
People are involved in decisions about the care home in ways which are meaningful to them.
People feel empowered because their voice is heard and action taken, including opportunities to use independent advocacy.
Weak
Staff are unclear about the purpose of obtaining consent, or do not actively seek consent, from people or their representatives.
Staff do not know about the Health and Social Care Standards, or they are not clear about how the principles should inform their practice.
People may experience stigma or feel as though they are judged or not valued because of their circumstances.
Observation of:
experiences of people in the service
staff practices
communication and interactions
formal SOFI 2 observation.
Discussions with:
people living in the care home
visitors, such as relatives, friends and carers of people living in the service
visiting professionals.
Sampling of:
policies/procedures and practice for restriction of freedom
review/meeting minutes, action plans and evidence change in practice
Duty of Candour records.
Consideration of:
what information the service provides about any limitations or restrictions on choice as a result of using the service – in admission or welcome documents
how communication support tools are used in gathering people’s views and decision-making
how policies, procedures and practice ensure that people are not subject to discrimination based on protected characteristics, including disability, gender, age, sexuality
Guidance for care providers in Scotland using CCTV
Guidance on human rights charter for technology and digital in social care
Health and Social Care Standards
Mental health strategy for Scotland
Mental Welfare Commission resources
National trauma training programme
Older people in care homes-Sex, sexuality and intimate relationships
Proud to care: LGBT and dementia
Rights, respect and recovery: alcohol and drug treatment strategy
Psychology and psychological interventions in dementia
Transforming psychological trauma: a knowledge and skills framework for the Scottish workforce
Quality indicator 1.2
People get the most out of life
Key areas include the extent to which people:
make decisions and choices about how they spend their time
are supported to achieve their wishes and aspirations
feel safe and are protected but have the opportunity to take informed risks
are getting the right service to meet their needs and outcomes.
Very good
People are recognised as experts in their own experiences, needs and wishes. This means they are fully involved in decisions about their care and support which affect them.
People choose where and how they spend their time and benefit from maintaining and developing their interests and what matters to them. People are supported to be emotionally resilient and have a strong sense of their own identity and wellbeing.
The impact of people’s health condition or diagnosis is taken into account when supporting people to identify outcomes which build their aspirations.
Weak
People experience care and support at a basic level, focussed on tasks and routines which does not treat them as individuals entitled to personalised care. The quality of people’s experience is negatively affected because staff do not know the person or use their personal plan to enhance both the care provided and social interactions.
There is a lack of recognition of people’s interests, culture or past life, including sexuality, gender identity, spirituality or important relationships, with little acknowledgement of the importance of this for each person.
Opportunities for meaningful activity and engagement are sparse and may only include group or indoor activities at set times of the day or week. Choices are limited and people’s aspirations are restricted by assumptions of what is safe or possible.
Very good
People are enabled to get the most out of life with options to maintain, develop and explore their interests, strengths and skills, which may include education and learning, employment and leisure.
People with specific communication needs or cognitive impairment are supported to participate in ways which suit them best.
People regularly have fun and social bonds are strengthened because the support they receive enables people to build and maintain meaningful relationships with others both within and outside of the care home. There are opportunities to connect with family, friends and contribute to local communities, in creative and imaginative ways, including digital participation.
People are able to get involved in a wide range of activities and interests. They have regular opportunities that promote their creativity, including through the arts.
People benefit from regular interactions and engagement from staff, and experience support that promotes independence, dignity, privacy and choice. This includes encouragement and resources to take part in meaningful occupations that validate a person’s identity. It also involves providing opportunities for people to feel included and attached to others, thus promoting their sense of wellbeing.
Weak
People who communicate in different ways are disadvantaged because staff have difficulty understanding and supporting them or lack the resources to respond appropriately.
People are not enabled to have a sense of purpose or direction because the support provided lacks appropriate structure or stimulation.
Staff show an inconsistent attitude to supporting people to become involved in their community. People’s confidence suffers because they have limited chances to be socially active or are not given the support they need to participate. New experiences are rare, and people do not get the encouragement and support they need to be active
Very good
People feel safe and staff demonstrate a clear understanding of their responsibilities to protect people from harm, neglect, abuse, bullying and exploitation. Measures are in place to prevent this happening, and staff are confident that if they identify concerns, the open and supportive culture within the care home ensures that they are responded to appropriately.
People’s right to make choices and take informed personal risk is fully embedded within the culture of the care home. People are confident that staff have the skills and understanding to support people to exercise these rights where appropriate, enabling ambitious and aspirational choices.
People’s right to control their finances and personal property is respected and actively promoted, maximising choice, control and independence. Where people are unable to manage their finances, decisions made enhance quality of life and support arrangements are clear, safe and accountable.
People are able to choose how they spend their money or receive the right support to manage it.
Weak
People may not be or may not feel safe and staff are unclear of their role in identifying and reporting concerns about the safety and wellbeing of people. Appropriate assessments, supports and referrals may not be made. Harm may be ignored or not identified, for example as a result of assumptions that altercations between people are inevitable.
Staff may participate in or accept poor practice without considering the impact on people’s emotional wellbeing and dignity.
The culture makes it hard to report poor practice which may lead to people being at risk of unsafe care and support.
People are not protected from financial abuse or exploitation as staff are not aware of potential signs or good practice guidance. Processes to keep people’s money and valuables safe are not robust.
Very good
Where relevant, people, their families, friends and professionals are involved in a holistic assessment of their needs in a meaningful way, informing the care and support they experience. Where there are identified changes to people’s support needs, appropriate measures are taken to address these.
People can choose care and support that is based on their needs and wishes. Their views are central to on-going assessment which identify the changes required to support best outcomes.
People experience high quality care and support as result of strong multi-agency partnerships. Planning, commissioning, and contracting arrangements ensure people get support that is right for them.
Weak
People, families, and professionals have limited involvement in the assessment and review process. People’s holistic needs are not considered, and the service does not adapt to people’s changing circumstances.
Decisions about care and support arrangements are made for people, without appropriate legal powers, or without taking into account the principles of relevant legislation.
People’s support choices are limited or undermined by pressure on resources.
The commissioned service which people are experiencing does not meet their needs, rights or choices.
Observation of:
experiences of people in the service
staff practices
communication and interactions
formal SOFI 2 observation.
Discussions with:
people living in the care home
visitors, such as relatives, friends and carers of people living in the service
visiting professionals
staff.
Sampling of:
meeting minutes and action plans for people, relatives and staff
activity planners for both individual and group/communal activities
the adult protection procedure, training, knowledge and referrals made.
Consideration of:
how people spend their time and any policies or records which relate to this
how people are supported to be involved in the community and engage in activities/hobbies that they enjoy
how care and support plans are informing care and evidence change.
Adult protection and social care
Care home guidance for people with learning disabilities who have dementia
Care about physical activity
Care workers compendium of digital resources
Dementia learning and promoting excellence
Dementia resources for the deaf community
Disability Rights UK – doing sports differently
General standards for neurological care and support 2019
Guidance for delivering meaningful activity
Information on supporting people with complex needs and sight loss
Information resources on person-centred practice
Jenny’s diary – supporting conversations about dementia with people who have a learning disability
Let's get active, connected and included resource
Mental Health Foundation – Recovery information
Scottish recovery network – peer support resources
See Hear – strategic framework for meeting the needs of people with a sensory impairment
Supporting people with an intellectual/learning disability and advanced dementia moving into a care home
Quality indicator 1.3
People’s health and wellbeing* benefits from their care and support
Key areas include the extent to which people experience:
care and support based on relevant evidence, guidance, good practice and standards
the right healthcare from the right person at the right time
food and drink that meets their needs and wishes.
* References to health and wellbeing in the quality illustrations include people’s physical, emotional and mental health and wellbeing.
Very good
People benefit from a comprehensive holistic health assessment, screening and care and support, based on good practice and evidence-based guidance.
People have as much control as possible over their medication and benefit from a robust medication management system which adheres to good practice guidance. People’s medication is regularly reviewed to ensure it meets their identified health needs.
People have a range of opportunities and health education that can promote health and wellbeing. People have control of their own health and wellbeing by using technology and other specialist equipment.
People’s wellbeing, mobility and confidence are enhanced as the service promotes a person-centred approach to managing and preventing falls and fractures.
Weak
People’s care and support may be compromised because health assessments are basic and do not reflect evidence based practice, or do not involve the appropriate people.
Intimate personal care is not carried out with dignity and respect or at the right time.
Staff working in the service may lack understanding about supporting people’s physical, mental and emotional wellbeing, so opportunities to improve people’s health are missed. People’s wellbeing may be compromised because rigorous processes are not in place to support effective communication about changes to people’s wellbeing.
The support which people receive and how they spend their time has limited links to current good practice, health promotion, recovery and/or harm reduction. There is limited access to equipment and technology and its use is often focused on assisting staff rather than on allowing people to have more control over their life.
Very good
People are encouraged to move regularly and remain as active as they can be, including using outdoor space where possible. Appropriate support for this is sought from allied health professionals.
Palliative and end of life care is managed in line with the person and their family’s needs and wishes. The principles of care at this time in life are anticipated. Plans are agreed and in place to provide high quality comfort, care and support.
Where relevant, people benefit from high quality nursing care, led and delivered by registered nurses.
People benefit from regular healthcare assessments, access to community healthcare and treatment from competent trained practitioners, including prevention and early detection interventions.
People are well informed about their care and treatment because information about treatment options, rehabilitation programmes or care is available in a format which is right for them. This helps ensure that people experience care and treatments which are safe, effective and in line with their wishes and choices.
People are fully involved in making decisions about their care and support, including those with long-term and life limiting conditions, through their personal plans and the process of anticipatory care planning.
There are a range of opportunities which promote physical and mental health education, including sexual wellbeing, harm reduction and sleep health.
There are a range of opportunities which promote physical and mental health education, including sexual wellbeing, harm reduction and sleep health.
Where people do not consent to elements of their care, staff are pro-active, confident and skilled in assessing risks and sharing information to protect people from harm.
People’s skin integrity is maintained because the service have a proactive and person-centred approach which is based on good practice recommendations and the assessment of risk. An appropriate prevention and management plan is in place which reflects this
Weak
Decisions in relation to end of life care or ‘Do not attempt cardiopulmonary resuscitation’ (DNACPR) are not made as part of a person-centred assessment. The views of the person and their family or any proxy decision-maker, such as a welfare attorney or guardian, are not sought. As a result, there is limited opportunity to consider the risks and benefits of any treatment or intervention for an individual.
Access to appropriate healthcare in their local community is limited and the provider or manager has not taken action to address this. Even where there is access to healthcare professionals, people’s healthcare needs are not reliably followed through. This may result in people experiencing reactive or disjointed care and support, which could impact on health outcomes.
People’s health and wellbeing may be compromised because processes are not in place to support effective communication about changes or deterioration in their condition.
People may not always receive the right medication or treatment at the right time, with the potential to affect their physical and emotional wellbeing. The use of ‘as required’ medication may not be clearly laid out or in line with good practice guidance.
Decisions about care and treatment for people who have a deterioration in their condition are not made on an individual basis or based on the person’s best interests. They are not made in consultation with the individual or their families/representatives or take account of any expressed wishes contained in their anticipatory care plan or ethical practice guidance.
Where people’s medication needs to be given covertly or the person does not have capacity to consent, the relevant legal powers, consents and processes are not in place.
People only access health, including mental health, or sexual health education in response to specific issues, rather than as part of the service’s ethos of health promotion.
Staff are not able to recognise, or information is not appropriately escalated, where people are unwilling or unable to consent to elements of their care and support plan being undertaken which has the potential to cause them harm.
People’s skin integrity is at risk and where people have developed a pressure ulcer or wound, the right staff do not assess, document and monitor progress or seek external professional support and advice when necessary
Very good
People’s wellbeing benefits from an approach that enables a healthy attitude to food and drink. Staff share information appropriately when they observe changes in people’s eating and drinking.
There is a system in place to ensure regular access to drinks, meals and snacks, especially for people who need support to eat and drink. Records are maintained where required.
People are central to the planning, budgeting, shopping, and preparation of food as part of their daily life, and these are used as an opportunity to build skills and independence.
People benefit from access to a tasty, varied and well-balanced diet. They can choose from a variety of, meals, snacks and drinks which reflect their cultural and dietary needs and preferences, including fresh fruit and vegetables.
People enjoy their meals in an unhurried, relaxed atmosphere when and where they want to. People benefit from a wide range of aids and have the required support.
Weak
People have insufficient opportunities to be involved in purchasing, growing, preparing and serving their own food.
Options for meals, snacks and drinks are limited and do not always reflect people’s preferences, cultural or dietary needs.
People may not get enough to eat or drink, and the necessary help is not always available where they need support with this. People often do not enjoy their meals and do not always receive the right support to help them eat the best diet for them. There are limited methods used to help people make choices at mealtimes resulting in others often making the choices for them.
Staff may control access to food and drink without professional rationale. As a result people may not be able to eat or drink when they want or need to outside of regular mealtimes.
Staff lack knowledge and skills to appropriately assist people who require support to eat and drink. Support is not provided in a way that maximises independence, dignity or respect.
Observation of:
experiences of people in the service
staff practices
communication and interactions
formal SOFI 2 observation
care and support at mealtimes
medication processes.
Discussions with:
people living in the care home
visitors, such as relatives, friends and carers of people living in the service other professionals who provide support to the home or individual. Contact and seek views of GP and visiting nurses, mental health officer, dieticians, and any other professionals as appropriate
staff.
Sampling of:
assessment tools used for people to identify / monitor health needs
personal plans and risk assessments relating to health and wellbeing
medication administration records including protocols for administration of ‘as required’ medication.
Consideration of:
mental health supports – do staff know which aspects of their support is covered by compulsory measures under the Mental Health (Care and Treatment) (Scotland) Act 2003 (MHCTA) and what their responsibilities are, including under the principles of the Act? Where residents are subject to current MHCTA powers, is there a copy of the order and the Responsible Medical Officer’s care plan? `
where people lack capacity to make their own decisions, is care and support provided in line with the principles of the Adults with Incapacity (Scotland) Act 2000?
when psychoactive medication is prescribed for people with dementia, is good practice implemented in line with the Scottish Government Communication ‘Dementia - psychoactive medication prescribing and review’?(September 2020).
key areas for adults experiencing life-limiting conditions should include comfort measure and active care including skin care, nutrition (including special diets, weight loss, fluid intake), oral health, medication and pain management or where people are fed using PEG.
how care and support plans are used to promote people’s health and wellbeing, including specific plans to support people with for example, epilepsy, harm reduction or behaviour support plans.
Blood monitoring of type 2 diabetes
Care experience improvement model (CEIM)
Eating and drinking well in care: good practice guidance for older people
Falls prevention for people with learning disabilities
Guidance about medication, personal plans, review, monitoring and record keeping in residential care services
Guidance for care of people prescribed clozapine in care homes
Guidance for social care services for supporting people living with HIV in Scotland
Guide for those caring for a vegan or vegetarian
Guide for vegetarians and vegans who require texture-modified diet
Healthcare framework for adults living in care homes
Hospital passport: for people with a learning disability coming into hospital
Intermediate care including reablement
Mental Welfare Commission good practice guides: covert medication
My health passport: resource for autistic people who might need hospital treatment
Notifications about controlled drugs: guidance for providers, 2015
Palliative and end of life care resources
Physical deterioration and escalation tool for care settings
Pressure ulcers measurement toolkit
Promoting continence for people living with dementia and long-term conditions
Safe administration of medication: modules 1-3 (Scottish Social Services Council)
Safe swallowing practice note (care homes)
Scottish commission for learning disability healthy eating healthy living pack
Sexual health framework 2015-2020
Standards for prevention and management of pressure ulcers
Supporting better oral care in care homes
Trauma informed practice – National trauma training plan and resources
Quality indicator 1.4
People experience meaningful contact that meets their outcomes, needs and wishes
Key areas include the extent to which people:
are supported to have a range of meaningful contacts within and outwith the service with others who are important to them
are supported to develop and maintain personal relationships.
Very good
People benefit from creative and innovative ways to stay connected to family, friends and local communities, including through the use of technology.
People’s rights and quality of life are enhanced because staff actively promote visiting. Staff are knowledgeable about current guidance and apply it consistently. This ensures that named person(s) are identified along with the role they have in providing care, support and meaningful contact.
People have easy access to the internet and a telephone and are routinely and actively supported to make best use of these. This includes space to have private conversations.
Respect for people’s right to a private and family life is promoted. Staff are proactive, responsive and flexible in how they ensure people stay connected, feel engaged and part of a community.
People’s emotional and physical wellbeing is supported, and their rights protected in the services approach to visiting. This includes enabling contact where someone plays an active part in their loved one’s care.
Weak
Staff do not attempt to look for other ways of helping people stay connected where they do not have family that can visit.
Staff do not have time to support / teach people to use technology to engage with family or friends.
There is an overly cautious or risk-averse approach to visiting and wider community engagement. Policies do not take account of local flexibility and professional judgement or safely balance risks of harm.
The service does not recognise the importance of meaningful contact, even in times of crisis. Friends, family member or others may not feel welcome when visiting the care home.
People do not have a plan to identify how they, as individuals will be supported to stay connected to those important to them. There is little recognition of the impact of changes to people’s carers or routines. This includes a lack of understanding of the importance of the role that relatives, friends, named person(s) or others may play in the delivery of care.
Very good
Family members and representatives are actively encouraged to participate in the delivery of direct care when this is the person’s choice. Staff understand and value the contribution family and representatives can make to improving people’s wellbeing.
People benefit from approaches to visiting that are person-centred, creative and maximise meaningful contact. Visits are sympathetically supported, anticipatory and responsive.
Staff are proactive in recognising where meaningful contact may be beneficial to people, even where they do not routinely receive visitors. The service works with local partners to identify ways to support individuals who may benefit from increased contact with others outside of the care home.
People are encouraged and supported to get out and about with their family and friends and overnight stays are facilitated. Any restrictions placed on time away from the service is supported by evidence and clearly documented. People are supported to manage their relationships and how they communicate in a way that suits their wellbeing. Staff recognise when people are missing those who are important to them and give them support to stay connected. Communication tools, aids or translation services are routinely used where necessary.
Staff support people to remember and celebrate important occasions and life events of those important to them. Life story work helps staff understand what and who is important to people, and this helps them to support people in maintaining personal connections.
Weak
People are unable to stay connected as providers have not taken steps to minimise the impact of poor access to technology or areas where there is limited Wi-Fi or phone signal.
People do not feel included or lack opportunities for meaningful engagement as there is no guidance for staff on how to support people transitioning to the service unexpectedly or who are required to self -isolate.
Staff do not support people to celebrate or mark important occasions or life events for example the sending of messages, cards or gifts.
Visiting arrangements are determined by the service and are not flexible enough to respond to individual needs and outcomes. The number or timing of visits is limited by the service and does not meet the needs of the person or their family.
People are not supported to identify any nominated named person(s) or this information is not recorded.
Restrictions are placed on residents who may wish to go out with their loved ones that is not based on evidence or informed by local health protection teams.
Observation of:
experiences of people in the service
communication and interactions.
Discussions with:
people living in the care home
visitors, such as relatives, friends and carers of people living in the service
staff.
Sampling of:
information in personal plans relating to meaningful contact / keeping in touch
policies and procedures for visiting.
Consideration of:
processes in place to support people maintain contact with those important to them, for example private spaces to meet with visitors
processes in place to support the management and development of friendships and other relationships.
Bringing generations together
Care Inspectorate information on supporting meaningful connection
Consenting adults: Capacity, rights and sexual relationships
Health and Social Care Standards for visiting and staying connected: Guidance for providers
Open with care - supporting meaningful contact in care homes: guidance
Supporting people to keep in touch when care homes are not accepting visitors
Quality indicator 1.5
People’s health and wellbeing benefits from safe infection prevention and control practices and procedures
Key areas include the extent to which people:
leadership and staffing arrangements ensure all necessary systems and resources are in place to prevent the spread of infection
during outbreaks of infectious diseases, people’s health and wellbeing needs continue to be met and their rights are protected.
Very good
People are safe and protected because leaders are proactive in ensuring that systems and resources are in place to support infection prevention and control and are responsive to potential outbreaks of infection.
People are confident that staff have the necessary training, skills and competence to prevent the spread of infection and support them during an outbreak of an infectious disease.
Staff carrying out housekeeping and cleaning, or supporting people to do their own, adopt and implement the Care Home Infection Prevention and Control Manual (CH IPCM) to ensure relevant cleaning products and disinfection processes. They adopt systematic measures to prevent infection and minimise cross infection in different areas of the environment.
Leaders carry out regular observations and audits. This is to ensure good governance and robust monitoring across all care areas. This includes regular observations and audits of staff and staff practice, the safe management of linen, uniforms and waste.
Compliance monitoring includes infection prevention and control incident reporting focuses on improvement to ensure safe practices and review.
Leaders in the service understand the potential challenges presented by outbreaks of infectious diseases and plan appropriately for these. They work in partnership with GPs, pharmacists and other health professionals to ensure they have timely access to medications, including palliative and anticipatory medications, if needed, to help alleviate symptoms and administer comfort measures.
Staff recognise the potential impact transmission-based precautions may have on communication and relationships. For example, when face masks or visors are used. They adjust how they communicate and take sensitive steps to minimise any negative impact.
Staffing arrangements are determined by a process of continuous assessment that includes consideration of the number of people being supported in their rooms, requiring one-to-one support, or additional support to maintain good hygiene and infection control practices.
All staff are able to recognise and respond to suspected or confirmed cases of infectious diseases, including following local reporting procedures and contacting local health protection teams.
Weak
Leaders in the service do not have systems in place to coordinate and communicate a clear plan for how the service should respond to an outbreak of infectious disease for staff, people experiencing care, their families and carers.
There are no protocols in place about the use of agency, sessional or bank staff, which are designed to help prevent transmission of infectious diseases.
The service does not have a staffing contingency plan in the event that staff are absent as a result of widespread illness, self-isolation or exclusion, for example following a positive Covid-19 test.
Staff working in the service are not familiar with, or do not follow, the principles of infection prevention and control contained in the Care Home Infection Prevention and Control Manual (CH IPCM), or other up to date guidance about infection prevention and control from Antimicrobial Resistance and Healthcare Associated Infection (ARHAI), Public Health Scotland and the Scottish Government.
People are not protected from the spread of infection because cleaning schedules, systems and resources are not in place to adopt the principles of infection prevention and control contained in the CH IPCM. This may be because there are not enough domestic staff resources, or because staff do not have the appropriate support from leaders.
Staff show limited understanding of when and how they should use personal protective equipment (PPE) and do not recognise other infection prevention and control precautions, including handwashing and social distancing. This is because training has been insufficient to enable staff to feel confident about the correct infection prevention and control measures.
Leaders do not ensure there is a nominated lead with responsibility for infection prevention and control and appropriate actions are not taken in response to an incident or outbreak or follow up on actions identified.
Staff do not have ready access to the appropriate equipment and resources including PPE, due to poor planning or storage of supplies
Very good
Family members and friends know about changes in visiting arrangements due to an outbreak of an infectious disease because these are clearly communicated to everyone. This includes people living with dementia and their representatives.
The home has clear policies and procedures in place that ensures people have access to those important to them even when there is an outbreak. This includes essential and named visitors for people who are experiencing increased stress and distress and those receiving palliative or end of life care.
There is a system in place to ensure regular access to food and drinks, especially for people who need to isolate in their bedrooms and need support to eat and drink. Records are maintained where required.
There are clear signs directing people to handwashing facilities, and reminders of the recommended technique, that reflect the needs of people using the service, for example accessible pictorial or written cues.
Staff are proactive in recognising and responding to challenges people may have in following guidance on physical distancing and infection prevention and control, including those with reduced capacity, dementia, sensory loss and physical and learning disabilities.
Weak
People’s human rights are compromised because there is a risk-averse approach to restrictions in place to prevent the spread of infection. The restrictions, including those that apply to visiting arrangements, are not person-centred, reasonable, justifiable, or in line with current good practice.
Families and others who are important to people are not kept up to date about the impact of any outbreaks of infectious diseases in the service.
People’s psychological needs are not being met as they lack a sense of purpose or direction because there is not enough additional structure or stimulation when they cannot pursue their normal routines and daily activities.
People may not always receive the right medication or treatment at the right time, with the potential to negatively affect their health. Repurposing of medication is used inappropriately in place of good medication management systems.
Staff lack understanding about the potential for atypical presentation of common transmissible infections, for example Covid-19, particularly in people who are older or frail, and they do not escalate concerns, seeking clinical advice as necessary.
Sufficient attention is not paid to the difficulties people may have in recognising when and how they should follow infection prevention and control and social distancing guidance. This may lead to people not receiving the support they require and putting themselves and others at risk.
People are not supported to understand and make decisions about testing and attempts to seek informed consent from individuals or their representatives are not made.
Scrutiny and improvement support actions
Observation of:
experiences of people in the service
staff practices
communication and interactions
the environment, single-use and shared equipment
availability of PPE at key points, including alcohol-based hand rub
availability of appropriate cleaning materials.
Discussions with:
people living in the care home
staff, including domestic/ancillary staff
visitors, such as relatives, friends and carers of people living in the service
visiting professionals
care home assurance groups.
Sampling of:
cleaning matrix and schedules.
policies and procedures are in line with The Manual
risk assessments if the CH IPCM recommendations are not adopted for any reason
training records.
Consideration of:
how is cross-contamination minimised within the service and is it in line with good practice from the CH IPCM? For example, from people moving about different areas of the home.
how standard infection control precautions (SCIPs) are maintained in balance with the provision of a ‘homely setting’. • availability of CH IPCM: all staff are aware of, have access to and know where to locate the CH IPCM
Covid-19 – living with dementia in care homes
Healthcare associated infection (HAI) standards
National infection prevention and control manual
Norovirus – guidance for care homes
Norovirus - guidance for care homes poster
Preventing infection in social care settings (app)