The never-ending audit trail

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Compliance in your care home or home care agency is of vital importance – with new data from the Care Quality Commission (CQC) revealing 1,122 nursing homes had failed inspections in England (that’s one in four).

Bill Watson from Insequa explores the essentials of audits.

Since the climate changed in November 2017 following changes to CQC regulations, you need to ensure you are doing everything you can so that the inspector’s visit is a happy one.

At Insequa, we regularly help care providers prepare for CQC inspections. We also assist providers with remedial action plans following disappointing inspections. Our CQC Inspection Support enables us to get a measure of how and where providers are falling down in their compliance efforts and gain valuable insights to apply to our own compliance advice.

Frequently, feedback from CQC inspections indicates it is a lack of rigour in the auditing process that lets providers down. Furthermore, we’re picking up on a lack of understanding of how audits actually work. We meet registered managers who view audits as an end in themselves, to be dealt with and promptly forgotten when completed. This behaviour is missing the point that audits work in a cycle, as a continuous process of data collection, evaluation and ongoing improvement.

Here’s a graphic that explains the audit cycle in greater detail with a breakdown of the sections and how they relate to the continuous flow of action and improvement demanded by CQC.

Diagram of the audit cycle

Set standards

For care, the standards are largely externally-driven, by regulatory bodies such as CQC. Standards should be read thoroughly and understood fully, so that they can be implemented correctly. It is incumbent on registered managers to understand regulatory standards. You can’t set standards and expect others to meet them, unless you understand and meet them yourself on a continuous basis.

Measure current practice

Put simply, this refers to the audit itself. This is a process of comparing practice with standards and involves data collection and record taking. Your organisation may have an impressive culture of constant and continuous checks, and safeguards to ensure the excellence of your care, but unless this is noted and stored as evidence, the CQC inspector has to take your word for it – and guess what? They won’t. Monitor, measure and document everything so that when you are called to account, you can lay your hands on exactly the evidence required to exemplify your fantastic care delivery.

We see many providers who stop at this stage of the process. Done the audit, tick, on to the next pressing matter. As we can see from the diagram, however, this isn’t even half way round the cycle. Keep going.

Compare results and standards

Once you’ve collected the information in the process of conducting the audit, you now need to compare it with the required standards. This allows you to identify any areas where your practice does not comply with the standards and identify what you need to do to rectify things.

Reflect, plan and change

The next stage is to compare and contrast with previous data to identify any common or repeating issues, patterns and trends. The value of the audit process largely comes from this stage – so dig deep to identify meaningful results you can act upon. What does the data say to you? Reflect upon why you are getting these results. Are there regular gaps and inconsistencies in certain areas? Do certain unwelcome incidents keep occurring? You and your team need to ask why and how this is happening. You may need to implement changes in policy or staffing, for example, to really address the root cause of the issue.

All this reflection, planning and any change you implement needs to be written up as an action plan. This will help you keep track of the changes you make and provide the evidence the CQC inspector will be looking for.

Re-audit

Welcome to compliance Groundhog Day. Yes, now all you have to do is repeat the process, taking care to contrast and compare with previous cycles. Make this regular, detailed approach a habit and the words ‘CQC inspection’ will no longer strike fear into your heart.