Staffing Levels and Dependency Audit - Care Homes

Evidence to check

• • Current staffing or workforce planning policy is available and reviewed
• • Policy explains use of dependency or acuity tools, skill mix, rota planning and escalation
• • Policy covers day, night, weekends, bank holidays, outbreaks and emergencies
• • Staff and managers understand how staffing concerns should be raised

Evidence to check

• • Named registered manager, deputy manager, HR lead or workforce lead is documented
• • Responsibilities include rota oversight, dependency review, recruitment, agency use and escalation
• • Deputy arrangements are in place
• • Lead can explain current staffing risks, vacancies and mitigation plans

Evidence to check

• • Governance minutes include staffing, dependency, vacancies, agency use and quality indicators
• • Staffing is reviewed alongside falls, pressure ulcers, medication errors, complaints and resident feedback
• • Actions have owners and deadlines
• • Follow-up confirms whether staffing actions improved safety or outcomes

Evidence to check

• • Staffing escalation procedure is documented
• • Staff know who to contact when staffing is unsafe
• • Escalation routes cover day, night and out-of-hours periods
• • Records show shortfalls are escalated and mitigated, not normalised

Evidence to check

• • Staffing levels are justified using dependency, acuity and risk information
• • Decisions consider resident needs, safety, quality of life and care outcomes
• • Budget pressures do not override known safety risks
• • Managers can evidence rationale for staffing levels and skill mix

Evidence to check

• • Staffing reviews reference regulatory expectations and resident outcomes
• • Rota planning considers skills, competence and experience, not only headcount
• • Night, weekend and agency cover are included in safe staffing assurance
• • Inspection readiness evidence shows staffing is monitored and acted on

Evidence to check

• • Funded establishment is documented for nurses, senior carers, carers, activities, housekeeping, kitchen, maintenance and management roles
• • Establishment is reviewed when occupancy, dependency or service model changes
• • Vacancies are tracked against funded establishment
• • Actual staffing is compared with planned establishment

Evidence to check

• • Rotas show skill mix by shift and unit
• • Medication-trained staff and senior staff are identified
• • Dementia, end-of-life, moving and handling, clinical and complex care competence is considered
• • Skill gaps are escalated and mitigated

Evidence to check

• • Minimum staffing levels are documented by shift and unit
• • Different needs of nursing, residential, dementia or high-dependency units are considered
• • Minimum levels are reviewed against dependency and incidents
• • Falling below minimum levels triggers escalation and recorded mitigation

Evidence to check

• • Rotas confirm registered nurse cover where required
• • Nurse registration and competence are verified
• • Cover arrangements for sickness, breaks and emergencies are clear
• • Nurse shortages are escalated promptly and risk assessed

Evidence to check

• • Nurse in charge or senior carer is identified for each shift
• • Shift leader responsibilities are understood
• • Allocations are documented and reviewed during the shift
• • Shift leaders know escalation routes for staffing, clinical and safeguarding concerns

Evidence to check

• • Rota includes housekeeping, kitchen, laundry, activities and maintenance cover where needed
• • Care staff are not routinely covering domestic or kitchen duties at the expense of resident care
• • Ancillary staffing gaps are monitored for impact on care delivery
• • Shortfalls are escalated and mitigated

Evidence to check

• • Risk assessments cover nights, small units, single nurse working and isolated areas
• • Check-in, emergency call and support arrangements are in place
• • Staff know how to summon help quickly
• • Lone-working incidents or concerns are reviewed

Evidence to check

• • Dependency or acuity tool is documented and consistently used
• • Methodology considers resident need, complexity, risk and support time
• • Tool is understood by managers and senior staff
• • Outputs are reviewed critically rather than accepted without professional judgement

Evidence to check

• • Dependency reviews are completed at planned intervals
• • Reviews occur after falls, infections, hospital discharge, end-of-life changes, deterioration or new behaviours of distress
• • Changes are reflected in staffing discussions and rotas
• • Delayed reviews are identified and followed up

Evidence to check

• • Assessments include mobility, continence, nutrition, personal care and medication support
• • Cognitive needs, dementia, distress, wandering, anxiety and communication needs are included
• • Emotional wellbeing and supervision needs are considered
• • Dependency scoring does not understate residents who are physically independent but cognitively high risk

Evidence to check

• • Enhanced observation or one-to-one support is documented with reason and risk
• • Start date, review date and expected outcomes are recorded
• • Staffing calculations include the additional hours required
• • Enhanced support is reviewed for effectiveness and least-restrictive practice

Evidence to check

• • Night dependency considers repositioning, toileting, continence, pain, dementia-related waking and monitoring
• • Night incidents, call bells and care records are reviewed
• • Night staffing reflects actual resident needs
• • Night staff feedback is included in dependency reviews

Evidence to check

• • Acuity includes wound care, catheter care, insulin, PEG, oxygen, end-of-life care, diabetes and complex medicines
• • Staff competence and time required are considered
• • Nurse or senior availability matches complexity
• • Complex care changes trigger staffing review

Evidence to check

• • Dependency calculations include two-person transfers, hoist use, bariatric support and repositioning schedules
• • Peak transfer times are considered
• • Enough trained staff are available for safe transfers
• • Manual handling risks are escalated where staffing is insufficient

Evidence to check

• • Staffing plans include meaningful activity and engagement, not only personal care tasks
• • Activities staff or engagement roles are considered
• • Residents are not left with only basic care due to staffing assumptions
• • Quality-of-life outcomes are reviewed alongside staffing levels

Evidence to check

• • Recent dependency reports are compared with rotas
• • Changes in dependency lead to changes in staffing, skill mix or allocation
• • Managers can explain how acuity affects staffing decisions
• • No gap exists between assessed need and actual planned staffing without documented mitigation

Evidence to check

• • Rotas are issued with reasonable notice
• • Manager or senior oversight is evident before rotas are finalised
• • Rotas cover peak care times, mealtimes, medication rounds and night checks
• • Late rota changes are monitored and minimised

Evidence to check

• • Rotas identify nurses, senior staff, medication-trained staff and experienced staff
• • Skill mix is appropriate for each unit and shift
• • Specialist competence is considered where residents have complex needs
• • Gaps in skill mix are escalated and covered

Evidence to check

• • Daily allocations are documented
• • Allocations are updated when staffing or resident needs change
• • Changes are communicated to staff
• • Staffing pressures are not hidden by leaving the rota unchanged

Evidence to check

• • Safety huddle or shift briefing records are available
• • Briefings cover staffing, acuity changes, risks, admissions, incidents and priorities
• • Staff can describe current shift risks
• • Escalation occurs when staffing is below safe levels

Evidence to check

• • Staffing plans recognise peak workload times
• • Additional support or adjusted allocation is used where needed
• • Residents do not routinely experience rushed care during pinch points
• • Delays or missed care during peak times are reviewed

Evidence to check

• • Redeployment decisions are recorded or communicated clearly
• • Residents with dementia, anxiety or complex needs are considered
• • Staff are not moved repeatedly in a way that weakens continuity
• • Redeployment does not leave another area unsafe

Evidence to check

• • Break arrangements are included in shift planning
• • Areas remain safely covered during breaks
• • Staff are able to take breaks in practice
• • Missed breaks or unsafe break cover are monitored and acted on

Evidence to check

• • Overtime, double shifts and short turnarounds are monitored
• • Managers review fatigue risk before approving additional shifts
• • Errors, sickness or incidents are reviewed alongside overtime patterns
• • Excessive overtime triggers recruitment or contingency review

Evidence to check

• • Bank staff are used where familiar and competent
• • Agency use prioritises staff who know the home and residents
• • Frequent unfamiliar agency cover is monitored for risk
• • Pairing or supervision is used where unfamiliar staff are deployed

Evidence to check

• • Manager rota status is clear
• • Supernumerary expectations are documented
• • Manager time is available for oversight, governance, staff support and quality assurance
• • Routine use of the manager to cover care shifts is monitored and escalated

Evidence to check

• • Records show when management staff are counted in numbers
• • Impact on oversight, audits, supervision, complaints and safeguarding work is considered
• • Provider support or additional cover is requested where needed
• • Repeated backfilling by managers triggers workforce review

Evidence to check

• • Supernumerary hours for key roles are planned
• • Role expectations and outputs are defined
• • Protected time is not routinely lost to cover shifts
• • Loss of protected time is recorded and escalated

Evidence to check

• • Audit logs, supervision records, competency checks and care plan review schedules evidence use of time
• • Incident investigations and clinical reviews are completed
• • Outputs are reported through governance
• • Protected time leads to visible improvement

Evidence to check

• • Backfilling is recorded with reason and approval
• • Frequency of lost supernumerary time is monitored
• • Provider or senior leadership review repeated backfilling
• • Alternative staffing solutions are explored

Evidence to check

• • Records show what oversight work was delayed or reprioritised
• • Provider support, temporary cover or external nurse support is considered
• • High-risk tasks such as safeguarding, medication audits or care plan reviews are protected
• • Impact is reviewed after the staffing crisis

Evidence to check

• • Vacancy tracker shows WTE gaps by role
• • Recruitment plan includes actions, owners and timescales
• • Hard-to-fill roles are escalated
• • Vacancy impact on staffing and quality is reviewed

Evidence to check

• • Workforce data includes turnover, sickness, agency hours and reasons for absence or leaving
• • Trends are reviewed by role, shift or unit where possible
• • Mitigation actions are documented
• • Impact of mitigation is reviewed

Evidence to check

• • Retention plan includes supervision, career pathways, wellbeing support, recognition and training access
• • Staff feedback informs retention actions
• • Good practice and compliments are shared with staff
• • Retention outcomes are monitored

Evidence to check

• • Exit interviews are offered and recorded where staff agree
• • Themes include workload, culture, management, pay, rota and wellbeing
• • Actions are taken where avoidable themes are identified
• • Leaver data is reviewed through governance

Evidence to check

• • Induction, shadowing and competency records are completed
• • New staff are not allocated high-risk tasks before sign-off
• • Probation reviews include confidence, competence and support needs
• • Managers know the restrictions or development needs of new staff

Evidence to check

• • Workforce plan considers winter, outbreaks, annual leave, school holidays and recruitment market risks
• • Contingency staffing arrangements are documented
• • Additional cleaning, isolation or clinical workload is considered during outbreaks
• • Plan is reviewed after seasonal pressures

Evidence to check

• • Agency policy or procedure is available
• • Agency profiles include DBS, right to work, training and role competence evidence
• • Approval process for agency bookings is clear
• • Agency staff are not used without required checks

Evidence to check

• • Agency induction checklist is completed
• • Induction includes fire, safeguarding, infection control, call bells, documentation and escalation
• • Resident-specific risks are shared before care is delivered
• • Agency induction quality is checked through feedback or spot checks

Evidence to check

• • Agency staff are not placed in charge unless competence and approval are verified
• • Agency nurses are checked before lone nurse or complex clinical shifts
• • Bank staff competence is known and recorded
• • Unfamiliar staff are supported by permanent staff where needed

Evidence to check

• • Medication-trained staff are clearly identified
• • Competence records are current
• • Rota and allocation ensure medicines rounds are safely covered
• • Medication tasks are not delegated to unauthorised staff

Evidence to check

• • Competency matrix or records show gaps
• • Spot checks, supervision and retraining are used
• • Staff are restricted from tasks until competent where needed
• • Competency gaps are considered in rota planning

Evidence to check

• • Continuity data or rota review considers familiar staff presence
• • Agency use is reviewed for consistency
• • Residents with dementia, anxiety or complex communication needs are prioritised for continuity
• • Feedback from residents and families is considered

Evidence to check

• • Falls, pressure ulcers, medication errors, safeguarding concerns and incidents are reviewed alongside staffing data
• • Trends by shift, unit, staffing level or skill mix are analysed
• • Staffing-related contributory factors are recorded honestly
• • Actions address root causes rather than blaming individuals only

Evidence to check

• • Call bell response data is reviewed by shift and unit
• • Delays are considered alongside staffing levels and deployment
• • Resident feedback about waiting times is reviewed
• • Actions are taken where staffing affects response times

Evidence to check

• • Records identify missed turns, late medication, missed hydration rounds, delayed personal care or missed activities
• • Reasons and impact are recorded
• • Staffing shortfalls are identified where relevant
• • Care plans, rotas or staffing levels are adjusted where needed

Evidence to check

• • Complaints about slow response, rushed care, inconsistent carers or lack of time are categorised
• • Feedback from residents and families is reviewed
• • Actions are linked to rota, dependency, training or communication improvements
• • Outcomes are shared where appropriate

Evidence to check

• • Activity participation, meaningful engagement, time outdoors, mealtime experience and social contact are reviewed
• • Staffing is not judged only by completion of basic care tasks
• • Residents' emotional wellbeing and loneliness are considered
• • Quality-of-life gaps influence staffing or deployment decisions

Evidence to check

• • Sickness, turnover, agency reliance, errors, morale and supervision themes are reviewed
• • Staff report whether workload is manageable
• • Burnout risks trigger support and workforce action
• • Staff wellbeing data is linked to resident safety and continuity

Evidence to check

• • Outbreak plan includes cohorting, isolation support, PPE, enhanced cleaning and staffing impact
• • Staffing plans consider additional IPC workload
• • Agency or redeployment arrangements are identified
• • Plans are reviewed after outbreaks or drills

Evidence to check

• • Enhanced cleaning, isolation support and PPE requirements are considered in staffing
• • Care staff are not routinely diverted from care without replacement cover
• • IPC incidents are reviewed alongside staffing pressures
• • Residents in isolation still receive safe care and meaningful contact

Evidence to check

• • Admissions and discharges are planned with staffing impact considered
• • Escorts, paperwork, medication reconciliation and settling-in support are covered
• • On-floor staffing remains safe during hospital transfers
• • Short-notice admissions are risk assessed before acceptance

Evidence to check

• • Escalation routes include provider oversight, regional support, emergency agency, commissioners or local authority where needed
• • Staff know when shortages must be escalated externally
• • Severe shortages are recorded with mitigation and resident impact
• • Lessons from staffing crises are reviewed

Evidence to check

• • Recent 4-8 weeks of rotas are available
• • Rotas show planned and actual staffing
• • Sickness, agency, bank and overtime are clearly recorded
• • Discrepancies between planned and actual staffing are reviewed

Evidence to check

• • Recent dependency reports are available
• • Reports link to rota changes, staffing requests or skill mix decisions
• • Managers can explain any gap between dependency output and actual staffing
• • Actions from dependency reviews are followed up

Evidence to check

• • Audit logs, supervision records, care plan review schedules and incident investigation records are available
• • Supernumerary time is linked to clear outputs
• • Lost supernumerary time is recorded and escalated
• • Quality oversight is not repeatedly delayed due to staffing gaps

Evidence to check

• • Shortfall records include date, shift, staff expected, staff available and resident impact
• • Mitigation actions are recorded
• • Escalation to manager, provider, agency or commissioners is evidenced where needed
• • Shortfalls are analysed for trends and prevention

Evidence to check

• • Audit includes rota review, staff interviews, resident feedback, observations and care record review
• • Audit considers whether residents receive timely, unrushed and person-centred care
• • Findings are compared with incidents, complaints, call bells, missed care and staff wellbeing data
• • Actions lead to measurable improvement in staffing safety and resident experience

Evidence to check

• • Staffing-related actions appear in the QIP where risks are identified
• • Actions include owners, timescales, resources and measurable outcomes
• • Progress is reviewed by senior leaders
• • Sustained improvement is evidenced through reduced incidents, improved feedback, better continuity or improved staff wellbeing