Measuring quality How do we measure quality?This section considers how to measure residents’ experiences of home life and offers a range of materials to ensure they receive a high-quality service. It is necessary to collect evidence in a variety of ways, especially when people are unable to verbalise their views. This can be done by: Observing what is happening in the care home. Listening to residents, relatives, friends, staff and managers talk about their experiences with regard to the social life of the home and activity provision. Reading supporting documentation. Observing the behaviour and interactions between residents, staff, visitors and managers. Observing people engaging in activities. Do they look content, happy, frustrated, animated, withdrawn or agitated? Carrying out an audit. The activity audit Collect evidence by using the different methods already suggested. Record the evidence in the evidence box. Use the evidence to rate the performance for each quality indicator. The audit will highlight what the service is doing well and areas for possible action. Agree a list of actions to be taken. Use the Action Plan Forms. Agree and record who will take responsibility for completing each action and a timetable for implementing them. Agree a review date to repeat the audit to measure and record improvements. Example: Enabling everyday activities audit Quality Indicator and evidence to support rating Yes Partial Not Residents are included in activity planning on a regular and ongoing basis ✔ Evidence to support rating: Activity Co-ordinators hold a monthly meeting with residents to discuss ideas for events and groups. Enabling Everyday Activity Audit - ProcessDownload the process audit form. Enabling Everyday Activity Audit - Process (PDF, 159.9KB) Enabling Everyday Activity Audit - Staff responsibilitiesDownload the staff responsibilities audit form. Enabling Everyday Activity Audit - Staff responsibilities (PDF, 153.7KB) Enabling Everyday Activity Audit - Embedding activityDownload the embedding activity audit form. Enabling Everyday Activity Audit - Embedding activity (PDF, 189.45KB) Audit summaryDownload the audit summary form. Audit summary (PDF, 67.38KB) Outcomes and action planningOutcomes should be designed to evaluate practice and performance. An action plan can be developed and implemented and then used to monitor changes and review ongoing performance to develop best practice. Outcomes can be used: To provide evidence of best practice for enabling activity within the care home. To improve the quality of choices and activities available within care homes. To raise awareness among staff about their own and their colleagues’ performance. To increase understanding and improve working practices between residents, staff and management. An example of a person-centred outcome The first person (i.e. ‘I’) is used because an outcome should be written with the resident and reflect their point of view. Need To get regular weekly exercise Desired outcome I go out for a walk twice a week with staff and attend the exercise class on a Wednesday How and who is responsible? I discuss with my keyworker how far I would like to walk and where. We discuss any risks/worries when going out and agree a plan to build up my stamina. (Keyworker) On Mondays, staff within my care team look at the home’s diary for the week and agree with me the best days for going for a walk. The staff member records these two days in the diary. (Keyworker to check weekly) On the agreed days the manager will allocate a member of staff to walk with me and confirm a time. (Keyworker) If the walk does not happen the keyworker records reasons why. (Manager) On Wednesdays, staff remind me about the exercise group. (All care home staff) When? This plan will be reviewed with me each month (by 30th or 31st of each month) An example of an exercise that can assist with identifying a starting point for an action plan Asking residents, relatives and the staff team: What makes a good home life? Then asking the group(s): What do we do well / what are our strengths? What could we develop further? Can we use our strengths and resources to agree possible actions? Strengths and needs table Strengths Needs Possible actions An example of an action plan QUALITY INDICATOR Residents are free to engage in personal and social activities of their choice in a relaxed and friendly environment within the care home. EVIDENCE Each resident has a list of likes and dislikes, and personal preferences, included in their care plan. All permanent staff can describe a randomly selected resident’s personal preferences, likes and dislikes when asked in supervision. Resident survey and minutes from resident’s meeting – 90 per cent of residents report they choose their daily routine. Minutes, agendas, posters advertising meetings – residents are invited to monthly meetings to discuss the daily life of the home and to plan events. Residents and relatives’ survey and minutes from resident’s meetings – 95 per cent of residents and relatives can list a few activities that they have enjoyed in the past month. 1-day observations – manager maps activity, interaction between residents, staff and relatives in the communal areas and records evidence of warm, positive interactions, relaxed behaviours, examples of activity. ACTIONS Manager to investigate why only 70% of residents report they choose their daily routine. Audit group to explore how residents with special communication needs are surveyed. Manage to review policies on supporting personalisation/residents’ choice. TO BE ACTIONED BY DATE REVIEW DATE Integrating activities into care planning Role Responsibilities Manager or Head of Care Establish channels of communication and processes to support communication regarding activities. Lead on monitoring and evaluating roles and responsibilities of staff and their leaning needs. Capture the views of residents and relatives and progress with action plans. Ensure that the environment is set up to support activity, such as lighting, signage, safe access to the outdoors, multisensory stimulation. Named nurse Liaise with the activity co-ordinator, ensuring they have a copy of a profile of the resident and establish a daily and weekly routine that works for the resident. Use their knowledge of individual residents’ preferences and strengths and skills to write and regularly review care plans, outcome measures and risk enablement plans with the resident and, at the resident’s request, their family or people who are close to them. Keyworker Be guided by the named nurse and activity co-ordinator to support the resident to carry out daily activities and attend social events. Know the resident, their strengths and skills, help required, preferences, likes and dislikes, people who are important to them and potential visitors. Activity co-ordinators Know each resident and liaise with each resident’s care team to build up a personal profile and establish a care plan that reflects and supports the resident to do activities that are important to them. Agree a process for reporting back to care staff after an activity event. Care staff Know each individual resident – their life history, likes and dislikes how they like to spend their day, what they can do and when and how they might need help, who their family are and who may visit them. Assist residents by working with them to carry out personal care, ask how they might want to spend their day and offer assistance to achieve this. Help residents to organise their rooms, so that they can reach and find things that are important to them. Housekeeping, catering and maintenance staff Know the residents and take time to talk and have a catch up. Be aware that individual residents may want to get involved in working with or helping staff with the running of the home. The named nurse and activity co-ordinator may work with the facilities staff to establish a plan on how best to achieve this. Specialist services Sometimes further advice and support is required when a resident’s needs are multiple and complex. Specialist advice may be required from an occupational therapist and other specialist services, such as physiotherapy, speech and language therapy and podiatry.