Managing Audits

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What is an audit and why do I need to do it?

An audit in social care is the process used to compare the care you provide against an agreed view of what good quality care looks like. The purpose of an audit is to identify the difference between the care you provide and an agreed view of good quality care. You can then use this information to look at how you can improve the care you provide.

An audit is a series of questions based on best practice and an agreed view of what good quality care looks like.  For example, if one of your audit questions is "Do staff treat residents with dignity?" you need to know what good quality dignified care looks like.

Audits should identify where you are providing good quality care and where there are areas you need to improve. This information must then be used to inform an action plan that will allow you to monitor the implementation of remedial actions.

If the Care Quality Commission (CQC) identify something you are not aware of it will indicate that your audit process is not effective and you are weak in key line of enquiry 'Well led'.

The worst case scenario is that you identify an issue and then do nothing about it and subsequently an individual suffers harm. If you identify a shortfall then you must do something about it. If you have identified a shortfall and can evidence to the CQC through a robust action plan and monitoring that you are addressing the issue appropriately then you are in a much better place. You need to ask yourself relevant questions regarding the quality of the care you provide.

What questions should I be asking in an audit?

The key guidance as to what good care looks like are the CQC Key Lines of Enquiry (KLOE's)External link.

This is always your first point of call. The CQC publish a lot of information on what good quality care looks like and how they will form a judgment on the care you provide. Unfortunately the KLOES are not always totally clear and some clarification is required.

In addition to the KLOE's a range of specialist organisations provide information on good quality care. For example, in the case of dignity, the Social Care Institute for Excellence dignity page External link would be a very good starting point for anyone looking to undertake a dignity audit.

Similarly if you are undertaking a medication audit the National institute for Clinical Excellence External link publish guidance, which is followed by CQC.

Private and voluntary organisations, for example the Alzheimer's society, provide some good guides on providing high quality dementia care.

An audit framework

Once you are clear on what good quality care looks like and the questions you need to ask then you can begin your audits.

You can answer your audit questions in one of two ways;

  1. By what you observe, and recording what you have observed,
  2. By what has been recorded, including what has been seen by others.

As a registered manager you are legally accountable so assume nothing and don't believe anything until you have seen it yourself or you have it written in a signed and dated document. These are the only forms of evidence admissible in court, coroners or otherwise. Hopefully you will never have to test this but it is better to be prepared. 

For an audit to be useful you must have a clear set of questions based on good practice. You must record your judgment against these.  You should also provide a clear outline of the evidence you have used to reach that judgement.

Once you have a document containing this information and it is signed and dated you have completed your audit. However, this is not the end of the process.

The audit only defines the issues. It is the action plan that provides the evidence that you have done something about it.

The action plan

Following the audit you need to create an action plan, or transfer the results of the audit to an action plan. It is useful to  be able to cross reference  items on the aciton plan to the audits where thye were identified. For example, "Item 16 on the action plan is from the care plan audit carried out on 4th July". The action plan should then clarify what the issue is  and what you are planning to do about it.

You do not need to include everything on the action plan. If the toilet roll or soap is missing in one bathroom just get someone to deal with it. If they are missing from all bathrooms and this happens recurrently that should go onto the action plan. Try to chunk things up to reduce the number of lines on the action plan.  For example, if there is an issue with decorating don't list all the areas that need decorating. The action plan should  include a decorating plan for the whole building and not list each door that needs painting.

When putting actions onto the action plan they need to be clear, unambiguous and owned by an accountable person with a completion date. For example a clear action would be;

"Head of maintenance team to produce a decorating schedule for the senior management meeting on 5th November to address all identified issues within 6 months, to be monitored monthly by the manager in supervision and walk round".  

When the Care Quality Commission question the issues around decoration you can produce the plan and your monthly updates as evidence.