Quality Monitoring Visit Audit - Care Homes

Evidence to check

• • Visit report includes current visit date and previous visit date.
• • Previous actions are referenced for comparison.
• • Areas reviewed during the visit are clearly listed.
• • Report shows whether quality has improved, declined or remained stable since the last visit.

Evidence to check

• • Visitor name, role, qualification or experience is recorded.
• • Visitor has appropriate knowledge of care home regulation, safeguarding and quality assurance.
• • Report shows professional challenge, not only description.
• • Conflicts of interest or lack of independence are considered where relevant.

Evidence to check

• • Previous action plan reviewed line by line.
• • Completed actions have evidence, not only manager assurance.
• • Overdue actions have revised deadlines and escalation.
• • Repeated non-completion is reported through governance.

Evidence to check

• • Resident and family feedback gathered during the visit.
• • Feedback includes safety, staff conduct, responsiveness, dignity and communication.
• • People with dementia or communication needs are included using suitable methods.
• • Concerns raised during feedback are added to the action plan.

Evidence to check

• • Safeguarding log reviewed.
• • Open safeguarding cases have clear actions, owners and updates.
• • Risk assessments and care plans are updated following safeguarding concerns.
• • Safeguarding themes are reviewed for learning and prevention.

Evidence to check

• • Health and safety risk assessments are current.
• • Walkaround identifies hazards such as clutter, flooring, lighting, equipment or storage risks.
• • Actions from health and safety checks are tracked to completion.
• • Staff understand how to report hazards and escalate urgent risks.

Evidence to check

• • Observation of lounges, corridors, dining areas, bathrooms and bedrooms.
• • No avoidable odours, clutter, trip hazards or unsafe storage.
• • Equipment is clean, labelled where required and stored safely.
• • Resident bedrooms are respected as private spaces.

Evidence to check

• • Incident log reviewed for the previous three months.
• • Investigations include root cause and immediate action.
• • Repeated incidents are analysed for patterns.
• • Learning is reflected in care plans, training, supervision or environmental changes.

Evidence to check

• • Current fire risk assessment and action plan.
• • Fire drill records include different shifts where possible.
• • Staff can explain fire procedures, evacuation roles and resident support needs.
• • PEEPs are current and match residents' actual needs.

Evidence to check

• • Observation of hand hygiene, PPE use, cleaning practice and waste disposal.
• • IPC audits and action plans are current.
• • Enhanced cleaning or outbreak procedures are understood where relevant.
• • Staff practice matches policy and training.

Evidence to check

• • Soap, water, disposable towels or hand gel available where needed.
• • Hand hygiene posters or guidance displayed appropriately.
• • Facilities are clean and accessible.
• • Staff are observed using hand hygiene at the correct times.

Evidence to check

• • Business continuity plan is current and specific to the home.
• • Plan covers staffing, utilities, fire, flood, outbreak, cyber failure and evacuation.
• • Staff know where to find the plan and who to escalate to.
• • Plan has been tested or discussed through scenario exercises.

Evidence to check

• • Bed rail risk assessments are current where bed rails are used.
• • Call bells are within reach and working for sampled residents.
• • Bed rail bumpers or alternatives are used only where risk assessed.
• • Staff understand consent, capacity and least-restrictive considerations.

Evidence to check

• • Care review records include resident and/or relative input.
• • Resident views about safety, comfort and environment are recorded.
• • Relatives are involved where consent or best-interest arrangements allow.
• • Concerns raised during reviews are followed up.

Evidence to check

• • Medication audit includes MAR accuracy, gaps, stock balances, PRN, controlled drugs and allergies.
• • Medication errors and near misses are reviewed for learning.
• • Actions from medication audits are tracked.
• • Staff administering medicines are trained and competent.

Evidence to check

• • Records for electrical, gas, water, fire, lifting equipment, hoists, beds and wheelchairs are current.
• • Maintenance log shows repairs reported and completed.
• • Overdue checks or defects are risk assessed.
• • High-risk issues are escalated to senior management.

Evidence to check

• • Care plans sampled across different units or floors.
• • Risk assessments are current and linked to practical care actions.
• • Daily notes show staff follow care plan guidance.
• • Care plans are updated after changes in need or professional advice.

Evidence to check

• • Staff files include application, references, DBS, right to work, identity and employment history checks.
• • Employment gaps and disclosures are risk assessed.
• • Disciplinary or conduct concerns are managed and recorded appropriately.
• • Agency staff checks are verified where used.

Evidence to check

• • Rotas reviewed against resident needs and dependency.
• • Agency usage, vacancies and sickness are monitored.
• • Skill mix is suitable for clinical, dementia, end-of-life or complex care needs.
• • Staffing concerns are escalated and acted on.

Evidence to check

• • Accident and incident log reviewed.
• • Falls, medication errors, pressure damage, distress, aggression and near misses are analysed.
• • Safeguarding threshold is considered where relevant.
• • Actions reduce recurrence and improve resident safety.

Evidence to check

• • Training matrix is up to date.
• • Mandatory and role-specific training gaps are identified.
• • Competency checks confirm staff can apply training in practice.
• • Training gaps are linked to action plans and supervision.

Evidence to check

• • Window restrictor checks are current.
• • Bed rail checks and risk assessments are current.
• • Faults are reported and repaired promptly.
• • Safety controls are proportionate and do not create unnecessary restriction.

Evidence to check

• • Feedback records from residents and relatives.
• • Feedback includes staff kindness, dignity, response times and communication.
• • Themes are reviewed by managers.
• • Actions are taken where feedback identifies poor practice.

Evidence to check

• • Mealtime observation completed during the visit.
• • Residents receive appropriate support, texture-modified meals and drinks where needed.
• • Staff interaction is respectful and unrushed.
• • Concerns about nutrition, choking risk or dignity are escalated.

Evidence to check

• • Induction records for new, bank and agency staff.
• • Local induction covers fire, safeguarding, resident needs, call bells, IPC and reporting concerns.
• • New staff are supervised before working independently.
• • Feedback or observation checks whether induction prepared staff for the role.

Evidence to check

• • Records of GP, SALT, dietitian, tissue viability, mental health, pharmacy or therapy input.
• • Professional advice is added to care plans promptly.
• • Referrals are tracked until outcome is known.
• • Delayed professional responses are escalated where risk remains.

Evidence to check

• • Sampled daily notes are timely and meaningful.
• • Charts such as repositioning, food, fluid, bowel or behaviour records are completed accurately.
• • Records avoid judgemental or task-only language.
• • Documentation supports continuity between staff and shifts.

Evidence to check

• • Capacity assessments are decision-specific.
• • Best-interest records include relevant people and least-restrictive options.
• • Consent is sought for everyday care where the resident has capacity.
• • DoLS status, conditions and expiry dates are monitored where applicable.

Evidence to check

• • Supervision and appraisal schedule is current.
• • Records include practice reflection, training needs, conduct, wellbeing and resident feedback where relevant.
• • Actions from supervision are followed up.
• • Performance concerns are managed fairly and promptly.

Evidence to check

• • Observation of staff-resident interaction during the visit.
• • Staff use respectful language and know residents personally.
• • Residents are not ignored, rushed or spoken over.
• • Families and visitors are treated respectfully.

Evidence to check

• • End-of-life or advance care plans sampled where relevant.
• • Plans include comfort, symptom control, spiritual/cultural wishes and family involvement.
• • DNACPR or treatment escalation decisions are recorded where applicable.
• • Staff understand how to provide dignified end-of-life care.

Evidence to check

• • Observation shows doors, curtains, clothing and personal space are respected.
• • Care plans promote independence and choice.
• • Advocacy is offered where residents need support to express views.
• • Residents are not treated in an institutional or task-focused way.

Evidence to check

• • Staff can explain how they respect culture, identity, faith, sexuality, disability and personal choice.
• • Care plans record relevant equality and identity needs.
• • Discriminatory language or behaviour is challenged.
• • Residents' rights are considered in restrictions, routines and care decisions.

Evidence to check

• • Complaints policy and log are current.
• • Complaints include investigation, outcome, apology or action where appropriate.
• • Themes are reviewed through governance.
• • Actions from complaints are completed and checked for impact.

Evidence to check

• • Staff can explain confidentiality expectations.
• • Records and screens are not visible to unauthorised people.
• • Information is shared with relatives only with consent or lawful basis.
• • Confidential conversations take place in appropriate settings.

Evidence to check

• • Pre-admission assessments are complete and realistic.
• • Admission decisions consider staffing, skills, equipment and risks.
• • Care plans reflect assessed needs and resident preferences.
• • Early reviews confirm whether care is meeting needs.

Evidence to check

• • Care reviews include resident and family input where appropriate.
• • Communication preferences are recorded.
• • Actions from resident or family feedback are followed up.
• • Residents' own views remain central.

Evidence to check

• • Activity plans reflect resident preferences and life history.
• • One-to-one activities are available for residents who do not join groups.
• • Residents with dementia, sensory needs or limited mobility are included.
• • Activity outcomes and enjoyment are reviewed.

Evidence to check

• • Bedrooms include personal items, photos or preferred decor where residents wish.
• • Staff knock and seek permission before entering.
• • Personal belongings are respected and safely managed.
• • Rooms are clean, safe and not used for inappropriate storage.

Evidence to check

• • Complaint log includes date, issue, investigation, outcome and actions.
• • Actions have owners and timescales.
• • Follow-up with complainant is recorded.
• • Repeated themes are escalated through governance.

Evidence to check

• • Resident and family feedback about management is gathered.
• • Managers respond to concerns promptly and respectfully.
• • Families know who to contact.
• • Feedback themes are reviewed and acted on.

Evidence to check

• • Manager walkarounds, resident contact and staff engagement are evident.
• • Managers know current risks, incidents and quality priorities.
• • Staff feel able to raise concerns with management.
• • Leadership presence is visible across shifts where possible.

Evidence to check

• • Quality assurance schedule covers key areas of risk and experience.
• • Audits link to action plans and governance.
• • Repeated issues trigger deeper review.
• • Quality monitoring includes resident outcomes and lived experience.

Evidence to check

• • Survey results are available and analysed.
• • Findings identify themes, strengths and areas for improvement.
• • Action plans are created from survey findings.
• • Residents and families are updated on changes made.

Evidence to check

• • Meeting minutes are available and current.
• • Actions are recorded with owners and timescales.
• • Feedback from meetings informs service improvement.
• • People are updated on progress from previous meetings.

Evidence to check

• • Audit schedule is current.
• • Completed audits include evidence, judgement and actions.
• • Action plans include owners, deadlines and follow-up.
• • Audit findings lead to improved practice and outcomes.

Evidence to check

• • Staff, residents and families can give examples of improvements made.
• • Incidents, complaints, audits and feedback are used for learning.
• • Leaders are open about risks and progress.
• • Quality improvement is visible in practice, not only in governance records.

Evidence to check

• • Visit report includes observations from lounges, dining areas, corridors and resident areas.
• • Staff-resident interactions are reviewed for dignity, kindness and responsiveness.
• • Observation findings are compared with care records and manager assurance.
• • Concerns seen during the visit are acted on immediately where needed.

Evidence to check

• • Visit report identifies high, medium and low priority actions.
• • Urgent issues are escalated on the day of visit.
• • Immediate actions are recorded where residents may be at risk.
• • Senior leaders are informed of serious or repeated concerns.

Evidence to check

• • Previous completed actions are rechecked during the visit.
• • Evidence confirms changes are embedded in practice.
• • Staff can describe new expectations or changed practice.
• • Actions are reopened where improvements have not been sustained.