A quality framework for care homes for adults and older people
Key question 4: How good is our setting
This key question has three quality indicators associated with it.
They are:
4.1. People benefit from high quality facilities
4.2 The setting promotes people’s independence
4.3 People can be connected to and involved in the wider community
Quality indicator 4.1
People benefit from high quality facilities
Key areas include the extent to which:
the layout of the setting and quality of fittings supports people’s outcomes
the setting is comfortable and homely
the setting is safe and well maintained.
Very good
The setting has been designed or adapted for high quality care and support for example, taking account of good practice guidance such as the King’s Fund tool for people with dementia, ‘Living in the community’ and ‘Building Better Care Homes’.
People can choose to use private and communal areas and have the right to privacy when they want.
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.
People benefit from a setting which is the right size for them, including experiencing small group living, where this is possible. They have specialist medical devices and equipment which best meets their changing needs and equipment is provided when required.
People are actively involved in giving their views about the setting; how well it works for them and what could be improved. They feel they are listened to and can influence changes and upgrades.
Weak
The design and layout of the building has a negative impact on the quality of life for the people who live there. The setting does not offer sufficient space or different options where people can spend time. There may be insufficient opportunities for people to experience privacy.
Staff do not identify changing needs for equipment or facilities, which means that people may not be able to maintain their independence and get the most out of life. This could include communication technology, reassessing how space is used or items to help people with new experiences or interests.
Very good
People benefit from a warm, comfortable, welcoming environment with plenty of fresh air, natural light and sufficient space to meet their needs and wishes. The environment is relaxed, clean, tidy and well looked-after, with no evidence of intrusive noise or smells.
Weak
Living space is functional rather than creating a warm, homely environment to meet people’s needs and preferences. It may not be clean and there is a lack of attention to standards such as homely touches, decoration and the quality of furniture. Staff areas may encroach on the living space of people who live in the care home.
Very good
There are clear planned arrangements for regular monitoring and maintenance of the premises and the equipment to ensure people are safe. This includes training and assessing staff competency to safely use and maintain any equipment their role requires.
All staff are aware of environmental cleaning schedules and clear about their specific responsibilities. Staff carrying out housekeeping and cleaning in the service are familiar with required environmental and equipment decontamination. This includes the safe management of linens, uniforms and waste.
Weak
Systems for the ongoing maintenance of the environment and equipment are either not organised or not followed, which may place people at risk. Some equipment may not be fully functioning or break down regularly.
People are not protected from the spread of infection because cleaning schedules and regimes are not based on good practice guidance or carried out when needed. This may be because there are not enough domestic staff, or because staff have not had the necessary support to devise an effective schedule.
Staff are not clear about their responsibilities to report any issues with environmental cleanliness or maintenance to the person in charge.
Observation of:
experiences of people in the service
staff practices
the physical environment – utilising tools, for example the kings fund tool, where appropriate.
Discussions with:
people living in the care home
staff, including maintenance and housekeeping staff
visitors, such as relatives, friends and carers of people living in the service
visiting professionals.
Sampling of:
maintenance records
cleaning schedules
training records for use of equipment, where appropriate.
Consideration of:
how the environment meets the needs of the people living there.
Quality indicator 4.2
The setting promotes people’s independence
Key areas include the extent to which:
the setting promotes people’s independence
people can influence the layout of the setting and decide how to use it
people can freely choose to spend time outdoors.
Very good
People benefit from a setting which is designed, or adapted, so that everyone can independently access all parts of the premises they use, including outdoor space. Those with a physical, sensory, mental health, dementia or other cognitive impairments are supported through the provision of appropriate aids and signage where appropriate.
All aspects of the setting promote independence with use of facilities such as kitchens, as well as people having control of their own lighting, heating, ventilation and the security of their bedrooms. In addition, people have their own furniture and are supported to use their own space as they want.
People benefit from options to keep connected using technology such as radio, phone, TV and the internet.
Weak
The setting does not promote independence, and this impacts negatively on people by restricting their movement or increasing their dependence on staff. This may also curtail people’s choices as to where they spend their time.
Equipment is available for people to use, but staff are not appropriately trained in how to use it. Internal facilities and fittings may restrict people’s choices and comfort in their daily life, such as inappropriate equipment. Options for using technology as people wish are limited.
Very good
People are, where possible, involved in a meaningful way in decisions about the layout of the setting and how the space is used. This encourages people to keep as active as possible and supports them in maintaining their mobility and independence.
Weak
People tell us they do not have influence over their living space, and it is unclear what opportunities leaders have created for this.
Very good
People go outside independently because gardens areas are safe, accessible, well kept and welcoming, with options to get involved with gardening or other leisure pursuits. People living on upper floors can access outdoor space as they wish.
Weak
Outdoor space is not used to its potential, and may not be freely accessible to people.
There is a risk-averse approach to the use of any outdoor space, and it may not be freely accessible to people.
Observation of:
experiences of people in the service
staff practices
the physical environment – utilising tools, for example the kings fund tool, where appropriate.
Discussions with:
people living in the care home
staff, including maintenance and housekeeping staff
visitors, such as relatives, friends and carers of people living in the service
visiting professionals.
Sampling of:
maintenance records
risk assessments for the environment
training records for use of equipment, where appropriate.
Consideration of:
ease of movement for people around building, access to outside areas
access to equipment that enables people to be as independent as they want
access to or areas for people to prepare drinks and snacks.
Quality indicator 4.3
People can be connected to and involved in the wider community
Key areas include the extent to which:
the setting supports people being connected to family and friends
the setting has a sense of community and belonging
people benefit from meaningful links with the local community.
Very good
The location and the culture of the care home supports the inclusion of family and friends. This includes being able to plan for family members, friends or partners to sometimes stay over.
There are a variety of ways in which people can stay connected, including having easy access to the internet and a telephone. People are routinely and actively supported to make best use of these, where appropriate.
People using the service, and their family members and friends, know about visiting arrangements because these are clearly communicated to everyone.
The design of the setting contributes to people developing relationships, with space to spend time in small groups as well as join larger functions.
The service is inventive in their approaches, supporting people to benefit from having animals in their lives.
People are supported to keep a pet where possible, but this is balanced with the needs and wishes of other people who use the service.
Weak
The care home lacks, or has limited ways of supporting the inclusion of family and friends. The setting or the culture of the care home doesn’t allow people to plan for friends and family to sometimes stay over.
People’s opportunities to stay connected with their family and friends are limited. While there may be access to telephone and the internet, people are not routinely or actively supported to use these or cannot do so in private.
The culture in the service is insular, with limited attempts to establish methods of engaging with families, professionals and other stakeholders.
There is limited flexible space which means that people lack choice or privacy to develop friendships or invite friends to visit.
There is little or no consideration given to supporting people who wish to keep a pet.
Very good
There is limited flexible space which means that people lack choice or privacy to develop friendships or invite friends to visit.
There is little or no consideration given to supporting people who wish to keep a pet.
Weak
The culture in the care home is likely to be insular, with limited links to the local community. People may spend all their time in the care home, even when they could, with support, be more involved in their local community
Very good
There are strong links with the local community that encourage the growth of informal support networks. People benefit from this in a variety of ways, including meeting new people, cross generational relationships, links that support individual interests, and introducing different ideas and experiences. People have a sense of belonging and worth through contributing to the wider community.
Weak
The location of the setting, or access to transport links, makes it difficult for people to be active members of the local community or to access local amenities.
The location of the setting, or transport links, may enable access to the local community and amenities however, people are not routinely supported where appropriate to access these.
Observation of:
experiences of people in the service
staff practices
space within the service, both communal and private.
Discussions with:
people living in the care home
staff, including maintenance and housekeeping staff
visitors, such as relatives, friends and carers of people living in the service
visiting professionals.
Sampling of:
information on local resources for use by people and risk assessments for the environment
information in personal plans
meeting notes and action records from people, staff and relatives
Consideration of:
links and access to the community
how staff support people to keep in touch with important people to them
how visitors to the service are welcomed.