Agency Usage Audit - Care Homes

Evidence to check

• • Current agency or temporary staffing policy is available and reviewed
• • Policy defines approval routes, emergency use, preferred agencies and restrictions
• • Policy explains compliance checks for carers, nurses and specialist workers
• • Managers and rota staff understand when agency use must be escalated

Evidence to check

• • Named registered manager, provider lead, HR lead or rota lead is documented
• • Responsibilities include agency approval, compliance packs, induction, performance monitoring and spend review
• • Deputy arrangements are in place
• • Lead can explain current agency risks, preferred agencies and reduction plans

Evidence to check

• • Governance minutes include agency hours, spend, reasons for use, quality issues and continuity
• • Actions have owners and timescales
• • Agency reliance is reviewed alongside vacancies, sickness, turnover and resident risk
• • Progress on reducing avoidable agency use is monitored

Evidence to check

• • Thresholds are defined, such as percentage of hours, spend level, short-notice gaps or repeated unfamiliar staff
• • Exceeding thresholds triggers management or provider review
• • Escalation actions are recorded
• • Thresholds are linked to resident safety, continuity and quality outcomes

Evidence to check

• • Contingency plan includes bank staff, overtime, redeployment, rota changes and provider support
• • Agency is used when safer internal options are unavailable or insufficient
• • Decision-making considers fatigue, continuity and competence
• • Use of agency in emergencies is recorded with rationale

Evidence to check

• • Agency use is reviewed against falls, medication errors, complaints, safeguarding, call bell response and documentation issues
• • Trends by unit, shift, agency or role are analysed
• • Actions are taken where agency usage is linked to increased risk
• • Findings are shared through governance and staffing reviews

Evidence to check

• • Preferred agency list is documented
• • Criteria include compliance, reliability, worker quality, continuity, cost and responsiveness
• • Poor-performing agencies are reviewed or removed
• • Preferred staff are requested where continuity benefits residents

Evidence to check

• • Contracts, framework agreements or service terms are available
• • Agreed rates, cancellation rules, compliance requirements and invoicing arrangements are clear
• • Escalation process for concerns, no-shows and poor performance is documented
• • Contract terms are reviewed periodically

Evidence to check

• • Rate cards or written agreements are available
• • Invoices match agreed rates
• • Enhancements are transparent and authorised
• • Unexpected rate changes are challenged and documented

Evidence to check

• • Invoices are checked against rota, timesheets and sign-in/out records
• • Breaks, cancellations and early finishes are accounted for
• • Overbilling or discrepancies are challenged
• • Invoice approval is completed by an authorised person

Evidence to check

• • Weekly or monthly agency spend reports are available
• • Spend is reviewed by role, unit, agency and reason for use
• • Reports are compared with vacancy and sickness data
• • High spend triggers a reduction or recruitment action plan

Evidence to check

• • Preferred supplier rates are reviewed periodically
• • Caps, block bookings, bank development or framework rates are considered
• • Short-notice premium use is monitored
• • Cost control does not compromise competence, safety or continuity

Evidence to check

• • Cancellations, no-shows and late arrivals are logged
• • Agencies are challenged where service failure affects safety or continuity
• • Repeated reliability issues influence preferred supplier decisions
• • Resident impact and mitigation are recorded

Evidence to check

• • Agency compliance packs include required checks
• • DBS level and barred list checks are appropriate to role
• • Right to work and identity checks are confirmed
• • Training and health information meet local policy and role requirements

Evidence to check

• • NMC PIN checks are completed before shifts
• • Registration status, restrictions and expiry are verified
• • Rechecks occur at defined intervals or before repeat use
• • Agency nurse cannot work if registration cannot be verified

Evidence to check

• • Agency insurance evidence is current
• • Professional indemnity arrangements are confirmed for nurses or specialist staff where applicable
• • Contracts clarify liability and responsibilities
• • Gaps in insurance evidence are escalated before use

Evidence to check

• • Policy states workers cannot work until required documents are received and verified
• • Non-compliant profiles are blocked or flagged
• • Restrictions are communicated to rota and management staff
• • Exceptions are risk assessed and authorised only where lawful and safe

Evidence to check

• • Booking records show who approved the shift
• • Rota staff follow approved booking routes
• • Informal or direct booking outside policy is prohibited
• • Emergency bookings are retrospectively reviewed

Evidence to check

• • Booking request states role, unit, shift, required competence and key risks
• • Requirements include medication-trained carer, nurse-in-charge experience, dementia competence or complex care where needed
• • Agency confirms worker suitability before shift
• • Unsuitable workers are rejected or restricted

Evidence to check

• • Agency staff are not left as lone nurse or shift lead unless competence is verified
• • Nurse-in-charge allocation is authorised by management
• • Agency carers are allocated tasks matching competence
• • High-risk resident care is supported by permanent or familiar staff where possible

Evidence to check

• • Agency staff are buddied or supervised where unfamiliar
• • Complex tasks are allocated to competent permanent or known staff where possible
• • Agency staff receive clear task allocation
• • Shift leader reviews whether agency deployment is safe during the shift

Evidence to check

• • Agency deployment is reviewed by role, unit and task type
• • Workers repeatedly used in high-risk roles have competence evidence
• • Concerns trigger restrictions or additional induction
• • Known reliable workers are prioritised for continuity

Evidence to check

• • Agency use does not routinely replace manager, clinical lead or quality lead oversight
• • When management becomes backfilled into care due to agency gaps, this is recorded and escalated
• • Impact on audits, supervision, care planning and governance is considered
• • Provider support is sought where oversight is compromised

Evidence to check

• • Agency induction checklist is available and used
• • First shift induction is signed, dated and retained
• • Repeat workers receive refreshers when policies, systems or resident risks change
• • Induction completion is checked during audits

Evidence to check

• • Induction includes fire, gas leak, missing person, choking, first aid and medical emergency procedures
• • Agency staff know alarm points, exits and escalation routes
• • Night agency staff receive the same emergency information
• • Knowledge gaps are corrected before the worker begins unsupervised tasks

Evidence to check

• • Induction covers PPE, hand hygiene, isolation, cohorting, outbreak rules and waste handling
• • Agency staff are informed of current outbreak status or infection risks
• • IPC expectations are observed during the shift
• • IPC breaches are corrected and reported

Evidence to check

• • Agency staff are told whether they may administer or support medicines
• • MAR/TAR expectations, PRN protocols and error reporting routes are explained
• • Medication tasks are restricted where competence is not verified
• • Medication incidents involving agency staff are reviewed

Evidence to check

• • Agency staff are shown equipment locations and key transfer plans
• • Hoist, sling and stand aid rules are explained
• • No-lift guidance and escalation of unsafe transfers are covered
• • Agency staff are not asked to transfer residents without knowing the plan

Evidence to check

• • Agency staff are shown call bells, exits, sluice, clinical rooms, medication areas, storage and staff base
• • Restricted or hazardous areas are explained
• • Staff know where to find help during the shift
• • Orientation is adapted for night shifts where access may differ

Evidence to check

• • Agency induction references key policies
• • Agency staff know how to report safeguarding and whistleblowing concerns
• • Confidentiality and professional boundaries are explained
• • Agency staff know how to complete or report incidents

Evidence to check

• • Agency staff receive information on falls, choking, IDDSI, pressure care, behaviours of distress, allergies and oxygen use
• • Risk information is shared proportionately and confidentially
• • Agency staff confirm understanding before supporting residents
• • High-risk residents are supported by familiar or permanent staff where possible

Evidence to check

• • Agency staff are briefed on preferred names, communication approaches and sensory needs
• • MCA, DoLS and restriction-related information is shared where relevant to care delivery
• • Agency staff understand how to approach residents who may become distressed
• • Communication failures involving agency staff are reviewed

Evidence to check

• • Induction records include worker name, agency, date, time and signature
• • Records identify person completing induction
• • Induction records are stored securely and retrievable
• • Missing induction records are investigated

Evidence to check

• • Competency evidence is reviewed for medicines, catheters, insulin, PEG, wound care and other specialist tasks where relevant
• • Evidence is current and role-specific
• • Tasks are restricted where evidence is missing or unclear
• • Competency concerns are escalated to the agency

Evidence to check

• • Spot checks are completed for medication rounds, documentation, moving and handling or complex care where relevant
• • Feedback is recorded and acted on
• • Unsafe practice leads to immediate coaching or restriction
• • Good practice is recorded to support preferred worker selection

Evidence to check

• • Restrictions are recorded, such as no medicines, no catheter care, no being in charge or no complex care tasks
• • Shift leaders know each agency worker's restrictions
• • Restricted tasks are allocated to competent staff
• • Breaches of restrictions are investigated

Evidence to check

• • Nurse-in-charge competence is verified before allocation
• • Experience, NMC status and previous feedback are considered
• • Agency nurse receives local leadership expectations and escalation routes
• • Permanent senior support is available where needed

Evidence to check

• • Agency staff know who the senior person is
• • Agency staff know how to contact GP, 111, 999, manager or on-call
• • Escalation expectations are included in induction and handover
• • Incidents show agency staff escalated appropriately where needed

Evidence to check

• • Training evidence or agency profile includes dementia or de-escalation competence where required
• • Resident-specific behaviour support plans are shared
• • Agency staff are not allocated high-risk behavioural support without briefing
• • Distress-related incidents involving agency staff are reviewed

Evidence to check

• • Agency staff can understand instructions, care plans and emergency procedures
• • Digital care system access and training are provided where required
• • Documentation is checked for quality and completeness
• • Communication concerns are escalated to the agency

Evidence to check

• • Agency staff receive guidance on paper or electronic care notes, incident forms, body maps and charts
• • System access is appropriate and secure
• • Documentation is reviewed during or after the shift
• • Poor recording is corrected and reported

Evidence to check

• • Shift leaders know how to respond to unsafe agency practice
• • Immediate action is taken to protect residents
• • Concerns are documented and escalated to management and agency
• • Worker is restricted or removed where risk remains

Evidence to check

• • Incident forms identify whether agency staff were involved
• • Reviews consider induction, competence, supervision, communication and staffing deployment
• • Learning is shared with the agency and internal teams
• • Repeat issues trigger agency or worker restrictions

Evidence to check

• • Complaints and concerns involving agency staff are logged
• • Agency is notified where appropriate
• • Outcome and response from agency are recorded
• • Resident and family feedback informs future booking decisions

Evidence to check

• • Feedback records include punctuality, competence, attitude, teamwork, documentation and resident feedback
• • Ratings are used to identify preferred workers
• • Poor ratings are followed up
• • Performance information is shared with agencies fairly and factually

Evidence to check

• • Do-not-return process is documented
• • Poor performance decisions are evidence-based
• • Agency is notified with clear reasons
• • Rota staff can identify workers who must not be booked

Evidence to check

• • Near misses involving agency staff are recorded and reviewed
• • Positive feedback is captured and used to request reliable workers
• • Learning informs induction and supervision arrangements
• • Preferred worker list reflects quality and continuity, not only availability

Evidence to check

• • Agency continuity is reviewed by unit, shift and resident group
• • Known staff are requested for residents with dementia, anxiety, complex needs or communication difficulties
• • High use of unfamiliar workers is treated as a risk
• • Resident and family feedback on continuity is considered

Evidence to check

• • Sign-in and sign-out records are complete
• • Times are verified by shift leader or manager
• • Rota, timesheet and invoice hours match
• • Discrepancies are challenged before payment

Evidence to check

• • Allocation sheets identify agency workers and assigned duties
• • Named buddy or supervisor is recorded where required
• • High-risk tasks are allocated only where competence is verified
• • Allocation records are retained for audit

Evidence to check

• • Agency staff attend shift handover before care delivery
• • Safety huddles include agency staff where relevant
• • Attendance or briefing is recorded
• • Agency staff receive updates about risks, changes and priorities

Evidence to check

• • Named supervisor or buddy is allocated for unfamiliar agency staff
• • Support level reflects worker familiarity, role and resident risk
• • Shift leader checks in during the shift
• • Concerns are addressed before harm occurs

Evidence to check

• • Agency workers know how to raise safeguarding concerns
• • Concerns are recorded and escalated to safeguarding lead
• • Local authority or CQC notification is considered where required
• • Agency worker is protected from retaliation when raising concerns

Evidence to check

• • Spend reports break down agency use by role, unit, date and reason
• • Reasons include sickness, vacancies, enhanced observations, surge demand or emergency cover
• • Spend data is compared with rota and vacancy data
• • High-cost areas are prioritised for action

Evidence to check

• • Short-notice bookings, high enhancements, cancellations and premium agency use are analysed
• • Cost drivers have action plans
• • Root causes such as vacancies, poor rota planning or sickness are addressed
• • Cost control is balanced with safe staffing

Evidence to check

• • Agency costs are compared with bank, overtime, recruitment, retention and permanent staffing options
• • Business cases or workforce plans use cost data
• • Decisions consider continuity and quality, not only cost
• • Savings plans do not create unsafe staffing risks

Evidence to check

• • Agency reduction plan includes recruitment pipeline, retention actions, bank development and roster improvements
• • Actions have owners and deadlines
• • Progress is monitored through governance
• • Plan focuses on safe, sustainable reduction rather than unsafe cuts

Evidence to check

• • Reports show vacancy levels alongside agency spend
• • True cost of vacancies is considered
• • Data informs strategic recruitment and retention decisions
• • Provider leadership reviews long-term staffing sustainability

Evidence to check

• • Block bookings are documented with rationale
• • Quality, continuity, compliance and cost are reviewed
• • Block-booked workers are monitored like other agency staff
• • Arrangements are changed if they are poor value or poor quality

Evidence to check

• • Compliance pack includes DBS, right to work, identity, training, references and role competence evidence
• • NMC checks are included for nurses where applicable
• • Documents are current and verified
• • Missing information results in restriction or non-use

Evidence to check

• • Sampled induction checklists are complete and signed
• • Checklists include emergency procedures, key policies, resident risks and recording systems
• • Induction timing shows it happened before care delivery
• • Missing induction evidence is investigated and corrected

Evidence to check

• • Spend report covers the requested period
• • Trend analysis identifies role, unit, agency and reason for use
• • Actions to reduce reliance are documented
• • Impact of actions is reviewed

Evidence to check

• • Performance feedback records are available
• • Do-not-return decisions are documented and communicated
• • Preferred worker list is updated based on performance
• • Agency performance is reviewed through governance

Evidence to check

• • Audit includes resident feedback, staff feedback, incident review, rota review and compliance sampling
• • Audit checks continuity, dignity, response times, documentation quality and handover effectiveness
• • Findings are linked to staffing, training, recruitment and agency reduction plans
• • Actions lead to safer, more consistent and more person-centred care

Evidence to check

• • Agency risks and actions appear in workforce planning or QIP where relevant
• • Agency reduction is linked with recruitment, retention, wellbeing and training plans
• • Provider leadership monitors sustainability
• • Improvements are measured through lower reliance, better continuity, fewer incidents and improved resident or staff feedback