ABC Audit - Care Homes (Antecedent, Behaviour, Consequence)

Q1 | Unanswered

Is there a current Behaviour Support / Managing Distress / Restrictive Practice policy that includes ABC recording and review?

Q2 | Unanswered

Is there a clear definition of behaviours of concern (distress behaviours) and when ABC charts must be used?

Q3 | Unanswered

Is there a named lead responsible for behaviour support governance (e.g., RM/clinical lead) and audit follow-up?

Q4 | Unanswered

Are ABC reviews discussed in governance forums (clinical meetings, quality meetings) with recorded outcomes and actions?

Q5 | Unanswered

Are behaviour-related incidents analysed for themes and shared learning across staff teams?

Q6 | Unanswered

Are action plans from behaviour audits assigned to owners with deadlines and reviewed for completion and impact?

Q7 | Unanswered

Are CQC-notifiable incidents and safeguarding referrals linked to behaviour incidents identified and actioned appropriately?

Q8 | Unanswered

For residents presenting with behaviours of concern, is there a documented baseline of usual presentation and functioning?

Q9 | Unanswered

Is there evidence that physical health causes are considered and ruled out (e.g., pain, constipation, UTI, delirium, dehydration)?

Q10 | Unanswered

Is there evidence that mental health and cognitive factors are considered (e.g., delirium, dementia progression, depression, psychosis)?

Q11 | Unanswered

Are medication factors considered (side effects, interactions, recent changes, PRN use, missed doses)?

Q12 | Unanswered

Are sensory and communication needs assessed (hearing/vision impairment, aphasia, learning disability, autism, trauma history)?

Q13 | Unanswered

Is sleep quality assessed where behaviours occur at night or on waking (sleep disturbance, sundowning)?

Q14 | Unanswered

Is there evidence of environmental assessment (noise, lighting, crowding, temperature, signage, layout) linked to behaviours?

Q15 | Unanswered

Is there a trigger for initiating a formal behavioural assessment (e.g., frequency threshold, severity, injury risk)?

Q16 | Unanswered

Where required, is a functional assessment (including ABC analysis) completed by a suitably skilled professional?

Q17 | Unanswered

Are ABC charts completed consistently when behaviours occur, rather than retrospectively or only for severe incidents?

Q18 | Unanswered

Do ABC records include precise date/time, location, and names/roles of staff involved?

Q19 | Unanswered

Are antecedents recorded objectively and specifically (what happened immediately before, not assumptions or labels)?

Q20 | Unanswered

Is the behaviour described in observable terms (what was seen/heard) rather than subjective language (e.g., 'aggressive')?

Q21 | Unanswered

Is intensity recorded using an agreed scale (e.g., mild/moderate/severe) with clear criteria?

Q22 | Unanswered

Is duration recorded (how long the behaviour lasted) and frequency captured over time?

Q23 | Unanswered

Are consequences recorded accurately (how staff responded, what the resident gained/avoided, what changed afterwards)?

Q24 | Unanswered

Is the resident’s perspective or possible unmet need explored within records where feasible (pain, fear, confusion, boredom)?

Q25 | Unanswered

Are injuries, near-misses, or property damage recorded and cross-referenced to incident forms?

Q26 | Unanswered

Are ABC records legible, complete, and stored securely in line with information governance requirements?

Q27 | Unanswered

Are staff supported to record consistently across shifts (including nights/weekends) to reduce reporting bias?

Q28 | Unanswered

Are ABC charts analysed at a defined frequency (e.g., weekly/monthly or after X incidents), with documented summaries?

Q29 | Unanswered

Are patterns identified by time of day, day of week, staffing levels/skill mix, and environmental factors?

Q30 | Unanswered

Are patterns identified by activity type (personal care, medication rounds, mealtimes, bathing, visiting times, transitions)?

Q31 | Unanswered

Are patterns identified by specific people (staff/other residents/visitors) or interaction styles that may escalate distress?

Q32 | Unanswered

Are patterns linked to health status changes (pain episodes, constipation cycles, infections, sleep disruption)?

Q33 | Unanswered

Are patterns linked to meaningful occupation and boredom (lack of stimulation, isolation, lack of choice)?

Q34 | Unanswered

Are patterns linked to communication breakdowns (misunderstanding, rushed instructions, lack of explanation)?

Q35 | Unanswered

Are patterns linked to sensory overload/under-stimulation (noise, bright lights, busy areas, lack of quiet space)?

Q36 | Unanswered

Are patterns linked to trauma triggers (personal space, touch, gender of staff, certain words/tones, confinement)?

Q37 | Unanswered

Are patterns used to update proactive strategies (pre-empt triggers) rather than only reactive responses?

Q38 | Unanswered

Is there an up-to-date Behaviour Support Plan / PBS plan for residents with behaviours of concern?

Q39 | Unanswered

Does the plan clearly describe known triggers, early warning signs, and de-escalation techniques that work for the individual?

Q40 | Unanswered

Does the plan include proactive strategies (routine, choice, meaningful activity, environment adaptations, communication approaches)?

Q41 | Unanswered

Does the plan include reactive strategies (what to do in the moment) aligned to least restrictive practice?

Q42 | Unanswered

Are staff able to describe the agreed approach and demonstrate consistent implementation?

Q43 | Unanswered

Are reasonable adjustments documented (communication aids, sensory tools, visual prompts, preferred routines)?

Q44 | Unanswered

Is the plan reviewed after incidents, and at least within a set timeframe, with evidence of learning applied?

Q45 | Unanswered

Are family/representatives involved in behaviour planning where appropriate, and their input documented?

Q46 | Unanswered

For residents lacking capacity, are best-interests decisions documented for behaviour interventions where needed?

Q47 | Unanswered

Are any restrictive interventions used (physical intervention, seclusion, environmental restriction, chemical restraint) clearly identified?

Q48 | Unanswered

Is every restrictive practice supported by a proportionate risk assessment and the least restrictive option rationale?

Q49 | Unanswered

Where restriction may amount to deprivation of liberty, is the DoLS/LPS status checked and aligned with practice?

Q50 | Unanswered

Are restrictions time-limited, reviewed regularly, and reduced/removed where possible with evidence of attempts?

Q51 | Unanswered

Is PRN medication use monitored as a potential restrictive practice (frequency, triggers, effectiveness, side effects)?

Q52 | Unanswered

Is there clear documentation of debriefs after restrictive incidents for both resident and staff?

Q53 | Unanswered

Are staff trained and competent in any physical intervention techniques used, with up-to-date certification and refreshers?

Q54 | Unanswered

Are behaviour incidents recorded promptly with clear linkages between incident forms and ABC data?

Q55 | Unanswered

Are post-incident reviews completed to identify antecedents and improve prevention strategies?

Q56 | Unanswered

Are safeguarding concerns raised where behaviours may be linked to abuse, neglect, exploitation, or peer-on-peer harm?

Q57 | Unanswered

Are injuries to residents/staff investigated and actions taken to reduce recurrence (environment, staffing, training, care plan updates)?

Q58 | Unanswered

Are notifications made to relevant bodies where required (e.g., CQC notifications), and is this documented?

Q59 | Unanswered

Are staff supported after significant incidents (wellbeing support, supervision, reflective practice)?

Q60 | Unanswered

Is there evidence of timely involvement of relevant professionals (GP, mental health services, psychiatry, psychology, SALT, OT, physio)?

Q61 | Unanswered

Where communication or swallowing is a factor, is SALT involvement considered and recommendations followed?

Q62 | Unanswered

Where sensory or environmental factors are prominent, is OT involvement considered and recommendations followed?

Q63 | Unanswered

Where pain is suspected, are pain assessments completed and reviewed (including for non-verbal residents), with treatment evaluated?

Q64 | Unanswered

Where dementia-related distress is present, is specialist dementia support accessed where available and documented?

Q65 | Unanswered

Where risks are high or complex, is a multi-disciplinary risk management meeting held with actions recorded?

Q66 | Unanswered

Are professional recommendations embedded into the care plan and evidenced in daily practice (not just filed)?

Q67 | Unanswered

Do staff receive training in de-escalation, dementia care, trauma-informed practice, and communication strategies appropriate to the setting?

Q68 | Unanswered

Are staff supervised and supported to implement behaviour plans consistently across shifts?

Q69 | Unanswered

Is staffing deployment adjusted based on known triggers (e.g., two staff for personal care, experienced staff during peak times)?

Q70 | Unanswered

Do handovers include behaviour updates, triggers, effective strategies, and any changes to plans?

Q71 | Unanswered

Is there evidence of a calm, person-centred culture (tone, approach, pacing) rather than punitive responses to distress?

Q72 | Unanswered

Are agency staff briefed on key behaviour plans and triggers before providing care?

Q73 | Unanswered

Are clear outcome measures used (incident frequency/severity, PRN use, injuries, quality of life indicators) to assess effectiveness?

Q74 | Unanswered

Is there evidence that interventions reduced behaviours of concern over time (before/after analysis)?

Q75 | Unanswered

Are unsuccessful strategies identified and changed rather than repeated without review?

Q76 | Unanswered

Is the resident’s wellbeing and participation improved as a result of behaviour support (activities, relationships, comfort, autonomy)?

Q77 | Unanswered

Are families/representatives kept informed about behaviour trends and plans, with feedback documented?

Q78 | Unanswered

Is there evidence that learning from ABC analysis has informed service-wide improvements (environment, routines, training, activities)?

Q79 | Unanswered

Can staff give a recent example where ABC analysis led to identifying a trigger and preventing recurrence?

Q80 | Unanswered

Can a senior member provide evidence of recent ABC trend reports and the resulting action plans and outcomes?