Night Visit Audit - Care Homes

Evidence to check

• • Night visit record includes date, time, duration and name of visitor
• • Staff on duty are listed by role and unit/floor
• • Areas visited are recorded, including bedrooms, communal areas, kitchen, laundry and medication areas
• • Any immediate concerns identified during the visit are recorded clearly

Evidence to check

• • Named senior, nurse in charge or shift lead is recorded
• • Senior person can explain escalation, delegation, medication, clinical concerns and emergency responsibilities
• • Staff know who is leading the shift
• • Senior person has access to on-call support and emergency contacts

Evidence to check

• • Night rota and allocation sheet reviewed
• • Staffing levels reflect resident dependency, moving and handling needs, dementia needs, end-of-life care and clinical risks
• • Skill mix is appropriate for the residents on each floor or unit
• • Any staffing gaps, sickness or agency use are risk assessed and escalated

Evidence to check

• • Break schedule is available and understood by staff
• • Coverage remains safe during breaks
• • Senior person monitors break arrangements
• • Residents with high-risk needs are not left without appropriate staff support

Evidence to check

• • Staff can explain emergency procedures during questioning
• • Emergency contact numbers and on-call details are accessible
• • Fire evacuation roles and resident PEEPs are understood
• • Staff know when to call 999, NHS 111, GP out-of-hours, senior management or safeguarding

Evidence to check

• • Observation of bedrooms, corridors, bathrooms, sluices and communal areas
• • Odours linked to continence, waste, laundry or poor cleaning are addressed promptly
• • Cleaning or continence actions are recorded where needed
• • Persistent odours are escalated to management

Evidence to check

• • Observation of noise levels from staff conversations, call bells, doors, equipment, televisions, radios and cleaning
• • Staff speak respectfully and quietly in corridors and communal areas
• • Residents are not disturbed unnecessarily
• • Noise-related concerns are recorded and acted on

Evidence to check

• • Observation of resident comfort, positioning, bedding, room temperature and safety
• • Residents are dressed or covered appropriately to protect dignity
• • Residents in communal spaces have a clear reason and appropriate support
• • Any resident found distressed, uncomfortable or unsafe is supported immediately

Evidence to check

• • Observation of staff interaction with awake residents
• • Care plans explain night-time routines, preferences and distress triggers
• • Residents are not ignored, left isolated or told off for being awake
• • Staff provide reassurance, drinks, toileting, comfort or meaningful engagement where needed

Evidence to check

• • Lighting is sufficient to prevent falls and support safe care
• • Bedroom lighting respects sleep and resident preference
• • Bathrooms and corridors are safely lit
• • Excessive glare, shadows or dark areas are addressed

Evidence to check

• • Observation of temperature in bedrooms, lounges, corridors and bathrooms
• • Residents at risk from cold or overheating are identified
• • Heating, cooling, blankets or ventilation are adjusted where needed
• • Temperature concerns are recorded and escalated

Evidence to check

• • Night environmental checks are completed
• • Windows and external doors are secure where required
• • Fire doors are closed correctly and escape routes are clear
• • Call bells and safety equipment are checked and faults escalated

Evidence to check

• • Sampled residents have call bells within reach where they use them
• • Call bell response times are reviewed where system data is available
• • Staff respond respectfully and do not silence bells without attending
• • Residents unable to use call bells have alternative monitoring arrangements

Evidence to check

• • Staff appearance is professional and suitable for care delivery
• • PPE is available and used appropriately for personal care, continence care, cleaning or infection risks
• • Hand hygiene is observed before and after care tasks
• • PPE use is not excessive, missing or inappropriate

Evidence to check

• • Observation of staff attentiveness and tone
• • Staff respond promptly to residents’ needs
• • Staff do not appear asleep, disengaged or distracted by personal phones
• • Residents are spoken to with patience, dignity and kindness

Evidence to check

• • Drinks are available, fresh and suitable for resident needs
• • Residents who need assistance are offered drinks
• • Fluid restrictions, thickened fluids or swallowing guidance are followed
• • Night-time fluid intake is recorded where required

Evidence to check

• • Continence care plans state night-time support needs
• • Checks are completed respectfully and not used as unnecessary disturbance
• • Residents are clean, dry and comfortable
• • Skin integrity risks linked to continence are identified and escalated

Evidence to check

• • Turning charts match the resident’s care plan
• • Records include time, position and staff initials or electronic equivalent
• • Residents are repositioned safely and with dignity
• • Gaps, copied entries or missed turns are investigated

Evidence to check

• • Fluid charts are current, legible and completed in real time
• • Intake and output are recorded where required
• • Low intake or concerning output is escalated
• • Fluid monitoring links to the resident’s care plan and clinical risk

Evidence to check

• • MAR charts are up to date with no unexplained gaps
• • Night medicines, PRN, controlled drugs and time-critical medicines are clearly recorded
• • Medication records are stored securely
• • Allergies and special instructions are visible and checked

Evidence to check

• • Medication due at night is checked against MAR records
• • Reasons for omissions, refusals or delays are recorded
• • PRN use includes reason, dose and effectiveness review
• • Medication concerns are escalated to senior staff, GP, pharmacy or emergency services where needed

Evidence to check

• • Care plans identify residents requiring wound, dressing or equipment checks
• • Air mattresses are functioning and set correctly
• • Dressings are intact and concerns are escalated
• • Clinical devices such as catheters, oxygen or feeding equipment are checked where relevant

Evidence to check

• • Cleaning schedule or task list is available
• • Cleaning is carried out quietly and safely
• • Wet floor signs and safe chemical use are observed
• • Cleaning does not compromise resident rest, dignity or safety

Evidence to check

• • Kitchen and food areas are clean and secure
• • Fridges and freezers are within safe temperature range where checked overnight
• • Food is covered, labelled and stored correctly
• • Residents who access food overnight are supported safely where this is part of their plan

Evidence to check

• • Laundry areas are clean, organised and free from trip or fire hazards
• • Machines are used according to safety procedures
• • Soiled and clean laundry are separated correctly
• • Lint filters, chemicals and hot surfaces are managed safely

Evidence to check

• • Night notes and handover records identify any concerns
• • Escalation to nurse, senior, GP out-of-hours, emergency services or safeguarding is recorded where needed
• • Actions taken are timely and proportionate
• • Residents are monitored after concerns are identified

Evidence to check

• • Observation of staff reassurance and communication
• • Care plans identify night-time comfort strategies
• • Staff offer appropriate support such as drinks, toileting, conversation, comfort items or quiet activity
• • Distressed residents are not ignored, restrained unnecessarily or treated as disruptive

Evidence to check

• • Handover notes are current and include key night events
• • Clinical concerns, falls, refusals, PRN use, fluid concerns and safeguarding issues are included
• • Agency or relief staff receive resident-specific information
• • Handover supports continuity into the day shift

Evidence to check

• • Agency staff receive local induction and allocation guidance
• • Permanent staff support agency staff with resident-specific needs
• • Agency staff know emergency procedures and escalation routes
• • Agency staff are not allocated tasks beyond their competence

Evidence to check

• • Incident forms are completed where required
• • Immediate actions, observations and escalation are recorded
• • Care plans and risk assessments are updated after incidents
• • Relatives, professionals, safeguarding or CQC notifications are considered where appropriate

Evidence to check

• • DoLS status, conditions and expiry dates are recorded where applicable
• • Restrictions are included in care plans and risk assessments
• • Consent, capacity and best-interest decisions are recorded where needed
• • Restrictions are reviewed to ensure they remain least restrictive

Evidence to check

• • CCTV policy, signage and access controls are in place
• • CCTV is used only in approved areas and for a clear purpose
• • Staff understand privacy expectations
• • Any faults, concerns or inappropriate access are reported

Evidence to check

• • Staff understand current IPC status of the home
• • Isolation or zoning guidance is followed where applicable
• • PPE, hand hygiene, waste and laundry procedures are observed
• • IPC concerns are escalated and recorded

Evidence to check

• • Charts are completed at the correct frequency
• • Entries are accurate and not copied or pre-filled
• • Charts link to care plan requirements
• • Concerns shown in charts are escalated and acted on

Evidence to check

• • Admission, discharge or transfer records are complete where relevant
• • Medication, risk, dignity and communication needs are managed
• • End-of-life care is calm, personalised and respectful
• • Families and professionals are updated where appropriate

Evidence to check

• • Senior person conducts checks during the shift
• • Junior, new or agency staff receive support
• • Concerns are addressed during the shift rather than left for day staff
• • Leadership is visible and engaged across the home

Evidence to check

• • Previous night audit findings are available
• • Shift leader can explain current action points
• • Recurring risks such as call bell delays, documentation gaps or staffing issues are known
• • Actions are followed up during the visit

Evidence to check

• • Staff are asked about workload, morale, support and concerns
• • Signs of fatigue, stress or low morale are noted
• • Concerns about staffing, breaks or support are escalated
• • Positive practice is recognised

Evidence to check

• • Complaints, compliments and feedback log reviewed for night care themes
• • Resident and family feedback about night care is considered
• • Themes such as noise, call bell delays, dignity, continence or staff attitude are reviewed
• • Actions from night feedback are tracked

Evidence to check

• • Previous action plan reviewed
• • Completion evidence is checked during the night visit
• • Staff can describe changed practice where relevant
• • Actions are reopened where improvements have not been sustained

Evidence to check

• • Visitor discusses findings with the senior person before leaving
• • Immediate risks are addressed during the shift
• • Senior person has opportunity to clarify issues or provide evidence
• • Agreed actions are documented

Evidence to check

• • Visit report lists all new concerns
• • Actions are specific and allocated to responsible people
• • Urgent risks are escalated immediately
• • Timescales reflect the level of risk

Evidence to check

• • Visit report is signed or electronically authenticated
• • Report is submitted to the registered manager, provider or governance lead
• • Findings are reviewed in quality or governance meetings
• • Actions are tracked until completed

Evidence to check

• • Visitor observes staff interactions, call bell response, continence support, repositioning, medication security and environment
• • Observation findings are compared with care records
• • Residents who are awake are spoken with where appropriate
• • Concerns seen during observation are acted on immediately

Evidence to check

• • Audit compares night practice with expected daytime standards
• • Resident comfort, dignity, response times and care quality are reviewed
• • Staffing, leadership and escalation arrangements are tested
• • Findings are used to improve consistency across 24-hour care