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CQC Evidence Categories 3: Observation

We understand that many providers are rightly concerned about the meaning of the various elements of the CQC’s single assessment framework. To date there has been a lack of clarity about what the various elements of the framework mean and how they might apply to care settings.


Now the clarity around the meanings of various elements is now slowly emerging as the CQC put on webinars and now with the release of updates on service type specific evidence category guidance, as well as the new “I statements” which help frame what is expected by the way of experience for service users.


In this blog we will take a look at the evidence category, observation and consider what this means for providers of social care as well as how Bettal can help.


Remember observation is only one of six evidence categories, each of which require the attention of the provider / registered manager:

• People's experience of health and care services

• Feedback from staff and leaders

• Feedback from partners

• Observation

• Processes

• Outcomes


Observation


As the name suggests, observation entails CQC inspectors and specialist professional advisors coming into the premises of providers to observe the delivery of care – what many of us know as undertaking an inspection. Other agencies, such as Healthwatch, may also undertake observations of care which may be used as evidence by the CQC. In this sense observation as an evidence category only ever occurs on-site.


How is the judgement made?


It is worth now understanding what the CQC, or others, will be observing for and therefore what this means providers need to be aware of. CQC are very clear about what is being observed:


Safe


Safeguarding:

• staff practice (including how they deliver care, staff culture and behaviours)


Involving people to manage risks:

• equipment

• staff practice (including how they deliver care, staff culture and behaviours)

• the care environment


Safe Environments:

• equipment

• staff practice (including how they deliver care, staff culture and behaviours)

• the care environment

Safe and effective staffing

• staff practice (including how they deliver care, staff culture and behaviours)


Infection prevention and control:

• equipment

• staff practice (including how they deliver care, staff culture and behaviours)

• the care environment


Medicines Optimisation:

• equipment

• staff practice (including how they deliver care, staff culture and behaviours)

• the care environment

(these are the only ones which apply to domiciliary care).


Caring


Kindness, compassion and dignity:

• equipment

• staff practice (including how they deliver care, staff culture and behaviours)

• the care environment


Treating people as individuals:

• equipment

• staff practice (including how they deliver care, staff culture and behaviours)

• the care environment


Independence, choice and control:

• equipment

• staff practice (including how they deliver care, staff culture and behaviours)

• the care environment


Responding to people’s immediate needs:

• equipment

• staff practice (including how they deliver care, staff culture and behaviours)

• the care environment


Responsive


Person-centred care:

• staff practice (including how they deliver care, staff culture and behaviours)

• the care environment


What this suggests is that at physical inspection, the CQC will be looking for specific indicators of quality through observation. The observations are clearly focussed on:


• equipment – presumably the availability of the right equipment, properly services, clean and used correctly by staff who ensure they consent and talk the Service User through its use.

• staff practice – how staff are seen to behave in the delivery of care, how they interact with each other and care they take over their environment.

• the care environment – the physical environment, e.g. cleanliness and maintenance and how it reflects the needs and preference of the Service Users, i.e. is it fit for purpose?


Unfortunately there is no indication of exactly what is being observed nor for how long. Neither is there any indication that there is any objectivity about the observations as there is no schedule of observation or questionnaire to be completed by the observer.


Preparing the service

There are a few things managers can do to make sure that they are prepared for the observation element of the inspection process, this includes:

• Being visible and observing for oneself – you will know what is right and what is not right with staff-Service User interactions.

• A managers daily walk around checking the environment and action planning, and acting, on this that are not as they should be.

• Keeping up to date with maintenance and the décor of the environment of care.

• Ensuring staff understand their role and are up to date with training and competencies as well as supervisions and staff meetings.

• Using the Bettal Quality Statements Pre-Inspection Audit tool.

• Having a mock inspection / inviting the manager of a nearby service in to undertake some observations.


Summary


While being the evidence category with the least descriptors, observation is perhaps the one which managers and staff most worry about as it is the one associated with physical inspections. From the requirements of observation as an evidence category, it is clear that managers and providers need to consider three key elements of the care setting: the equipment, staff behaviour and the environment itself.


Managers and providers need to stay on top of this element as once an inspection is underway, there is nothing they can do to redeem the situation!


Bettal, can help with preparing for inspection and regulatory compliance, for example by providers using our Quality Statements Pre-Inspection Audit tool. If you would like to know more, browse our website, or get in touch:


Telephone: 01697741411


Peter Ellis MA MSc BSc(Hons) RN

Consultant

Bettal Quality Consultancy

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