Statement of Purpose Audit - Care Homes

Evidence to check

• • Current Statement of Purpose is available
• • Document includes version number, issue date, review date and next review date
• • Named document owner is identified
• • Obsolete versions are archived or removed from circulation

Evidence to check

• • Review schedule is documented
• • Review takes place at least annually or in line with provider policy
• • Out-of-cycle review occurs after changes to registration, service model, staffing, premises, bed numbers or management
• • Review history or version log shows what changed and why

Evidence to check

• • Current version is approved by the registered manager or appropriate senior lead
• • Provider, nominated individual or responsible individual sign-off is recorded where applicable
• • Approval date is visible
• • Governance minutes or document control record confirm approval

Evidence to check

• • Copy is available in welcome packs, reception, resident information folders, website or on request
• • Staff know how to provide a copy
• • Residents and relatives are informed that the document is available
• • Access arrangements are consistent across all shifts

Evidence to check

• • Staff can explain the purpose of the document in simple terms
• • Staff know where the current version is stored
• • Induction or policy awareness includes the Statement of Purpose
• • Knowledge checks include day, night, bank and senior staff where relevant

Evidence to check

• • Website, welcome packs, printed folders and digital copies are checked after updates
• • Obsolete printed copies are removed promptly
• • Document control prevents multiple uncontrolled versions being used
• • Staff know who is responsible for replacing old copies

Evidence to check

• • Provider name matches CQC registration and legal documentation
• • Legal entity type is accurate
• • Registered address is correct
• • Information matches contracts, service user guide and website where applicable

Evidence to check

• • Registered manager name and role are accurate
• • Vacancy or interim management arrangements are stated where relevant
• • Nominated individual details are accurate where applicable
• • Changes in key persons are updated promptly

Evidence to check

• • Regulated activity wording matches CQC registration
• • Care home service type is accurate, such as nursing, residential or dementia care
• • The service does not claim to provide activities outside registration
• • Registration conditions or limitations are reflected where relevant

Evidence to check

• • CQC location ID or registration details are correct where used
• • Details match CQC registration records
• • Any internal reference numbers are accurate
• • Incorrect or outdated registration details are corrected promptly

Evidence to check

• • Aims and objectives align with the registered activity
• • Wording reflects the home's actual care model and resident group
• • The document describes what the service is designed to achieve
• • Claims are realistic, evidence-based and not misleading

Evidence to check

• • Age range and resident groups are clearly stated
• • Needs supported are described, such as dementia, nursing needs, frailty, physical disability or sensory needs where applicable
• • Exclusions or limits are stated where relevant
• • Description matches admissions criteria and actual resident profile

Evidence to check

• • Maximum number of residents or beds is accurate
• • Room types, floors, units, en-suite provision and shared facilities are described accurately
• • Information matches fire records, floor plans, contracts and registration conditions
• • Any temporary closures or unavailable beds are reflected where relevant

Evidence to check

• • Staffing roles and management structure are described accurately
• • Nurse cover is stated correctly where applicable
• • Skill mix and staffing approach are not overstated
• • Description matches workforce establishment, rotas and actual practice

Evidence to check

• • Document describes safer recruitment, induction, training, supervision and appraisal arrangements
• • Role-specific competence is referenced where applicable
• • Staff support and development are included
• • Description matches training matrix, supervision records and recruitment procedures

Evidence to check

• • Description of lifts, gardens, lounges, dining rooms, bathrooms, bedrooms and outdoor areas is accurate
• • Accessibility features are not overstated
• • Environmental limitations are not hidden where they affect admissions or support
• • Description matches the actual layout and facilities

Evidence to check

• • Pre-admission assessment and care planning processes are described
• • Person-centred care, risk assessment and review arrangements are included
• • Resident and family involvement is described
• • Description matches sampled care plans and review records

Evidence to check

• • Document covers safety, medicines, nutrition, hydration, dignity, activities, personal care and end-of-life care where relevant
• • Descriptions are specific enough to be meaningful
• • Claims align with current policies and care delivery evidence
• • No key service area is omitted where it forms part of the care offer

Evidence to check

• • Safeguarding principles and reporting arrangements are described
• • Staff responsibilities and escalation routes are referenced
• • Local authority safeguarding process is acknowledged where appropriate
• • Description aligns with safeguarding policy and staff practice

Evidence to check

• • Document explains how residents, relatives or representatives can raise complaints
• • Internal complaints route and response expectations are clear
• • External escalation routes are included where appropriate
• • Information matches the current complaints policy and displayed information

Evidence to check

• • Independent advocacy and IMCA access are referenced where relevant
• • Resident involvement in reviews, decisions and complaints is described
• • Support for people without family or representatives is included
• • Description aligns with MCA, advocacy and care planning records

Evidence to check

• • Document explains commitment to equality and non-discrimination
• • Reasonable adjustments are referenced
• • Cultural, religious, communication, disability and identity needs are considered
• • Language is inclusive and respectful

Evidence to check

• • Document references audits, feedback, incidents, complaints, action plans and continuous improvement
• • Governance arrangements are described realistically
• • Description matches the home's Quality Assurance Framework
• • Claims are supported by audit programme, QIP and governance minutes

Evidence to check

• • Document references IPC policy, staff training, cleaning, PPE and outbreak response where relevant
• • Arrangements are proportionate to the care home setting
• • Description aligns with IPC audits and outbreak plans
• • Information is current and not based on outdated outbreak arrangements

Evidence to check

• • Telephone, email, postal address and website details are accurate
• • Named contact or manager details are current where included
• • Enquiry and visiting arrangements are described accurately
• • Contact details match website, welcome pack and service user guide

Evidence to check

• • Claims about staffing, activities, facilities, nursing care, specialist support and routines are checked against evidence
• • Residents and relatives experience the service as described
• • Aspirational statements are not presented as current practice unless evidenced
• • Inaccurate or misleading wording is corrected promptly

Evidence to check

• • Information matches the service user guide, website, brochure, contracts, admissions criteria and welcome pack
• • Contradictions are identified and corrected
• • Externally shared information is consistent
• • Marketing language does not overpromise beyond the registered service offer

Evidence to check

• • Care plans show person-centred planning, choice, dignity and involvement as described
• • Daily records and observations reflect stated care approach
• • Resident feedback confirms commitments are experienced in practice
• • Gaps are added to the QIP or action log

Evidence to check

• • Staffing claims are compared with rotas, dependency data and workforce establishment
• • Nurse cover, senior cover and specialist roles are accurately described
• • Vacancies or interim arrangements do not make the document misleading
• • Changes in staffing model trigger review

Evidence to check

• • Premises walkaround confirms accuracy of room, unit, bathroom, lift, garden and communal area descriptions
• • Accessibility claims are realistic
• • Temporary closures, building works or restricted areas are reflected where relevant
• • Descriptions do not imply facilities that are unavailable

Evidence to check

• • Governance claims are supported by audit programme, QIP, incident learning and meeting minutes
• • Quality monitoring processes described are actually operating
• • Improvement claims are supported by evidence
• • Weak or inactive governance arrangements are not overstated

Evidence to check

• • Document uses clear language and avoids unnecessary jargon
• • Sections are easy to navigate
• • Tone is respectful, welcoming and factual
• • Residents or relatives can understand what the home provides

Evidence to check

• • Large print, easy-read, translated, audio or digital versions are available where required
• • Residents with communication or sensory needs are supported to access information
• • Accessible versions are consistent with the approved current version
• • Availability of alternative formats is communicated

Evidence to check

• • Document describes routines, visiting, meals, activities, personal care, involvement and choice
• • Information is realistic and not overly generic
• • Residents and relatives confirm expectations are clear
• • Day-to-day expectations align with actual practice

Evidence to check

• • Resident involvement, consent and choice are described
• • MCA and best-interest decision-making are referenced where appropriate
• • Family, representative and advocacy involvement are explained
• • Information aligns with MCA policy and care planning records

Evidence to check

• • Language is inclusive and non-stigmatising
• • Document avoids assumptions based on age, disability, diagnosis, sexuality, gender identity, religion or ethnicity
• • Residents are described respectfully
• • EDI commitments are practical and consistent with care planning

Evidence to check

• • Version history is complete
• • Tracked changes or review notes show what was amended
• • Governance or management minutes record review where applicable
• • Review evidence is retained for audit

Evidence to check

• • Registered manager, nominated individual or provider changes are updated
• • Bed numbers and room configuration remain accurate
• • Premises changes, unit changes or service model changes trigger review
• • Timescale from change to update is reasonable and documented

Evidence to check

• • Updated version is issued to relevant staff and made available to residents and families
• • Website, welcome packs and reception copies are updated
• • External stakeholders receive updated information where appropriate
• • Obsolete versions are removed

Evidence to check

• • Staff briefings, team meetings or read-and-understand records confirm communication
• • Key changes are summarised clearly
• • Staff can describe changes relevant to their role
• • Bank, night and part-time staff are included

Evidence to check

• • Current document is immediately available
• • Version control details are complete
• • Review and approval dates are visible
• • Sign-off evidence is retained

Evidence to check

• • Welcome pack copy, reception copy, website copy or digital copy is available
• • Residents and families know they can request it
• • Accessible versions are available where needed
• • Current version is used in all access points

Evidence to check

• • Staff can describe the home's aims, resident group and care approach
• • Staff explanations match the Statement of Purpose
• • Staff understand limits of the service offer
• • Responses are consistent across roles and shifts

Evidence to check

• • Claims are checked against rotas, training records, audits, activities, resident feedback, care plans and premises observations
• • Any inconsistency is recorded and actioned
• • The Statement of Purpose reflects current reality, not historic or aspirational practice
• • Triangulation outcome is documented

Evidence to check

• • SoP review is included in policy or governance audit schedule
• • Accuracy is checked before inspections, provider reviews or major service changes
• • Findings are added to the QIP where needed
• • Senior leaders understand the regulatory importance of an accurate SoP

Evidence to check

• • Resident groups supported and exclusions are clear
• • Admissions criteria align with registered activity, staffing, premises and competence
• • Pre-admission assessments check whether the home can safely meet needs
• • The home does not admit residents outside the stated or registered service scope without appropriate review

Evidence to check

• • Claims about dementia care, nursing care, end-of-life care, complex care or behavioural support are evidenced
• • Staff training and competency support specialist claims
• • Environment and care planning align with specialist statements
• • Unsupported specialist claims are removed or amended

Evidence to check

• • Feedback is sought through resident meetings, family forums, surveys or review discussions
• • Residents and relatives can identify whether the document matches lived experience
• • Feedback is considered during review
• • Changes are made where the document does not reflect reality

Evidence to check

• • Audit checks registration details, provider details, leadership, service user groups, bed numbers and regulated activity
• • Audit also checks whether residents actually experience what the document promises
• • Evidence includes document review, staff questioning, resident feedback and practice observation
• • Findings lead to document updates or service improvement actions

Evidence to check

• • Inaccuracies are corrected promptly
• • Practice gaps are added to the QIP rather than only changing wording
• • Actions have owners, deadlines and evidence requirements
• • Follow-up confirms the document and practice remain aligned