Day Care Settings

ARC Conference

Thursday 12 March 2015

Friday 13 March 2015

OBJECTIVES

• Inspection Methodology

• Review of Inspection Year 2014 / 2015 (Maire Marley)

• Inspection Themes 2015 / 2016

(Suzanne Cunningham / Louise McCabe)

Principles Guiding RQIA

• Proportionate

• Consistent

• Transparent

• Accountable

• Targeted Better Regulation Commission

Inspection Policy

Inspection Methodology

Intelligence and

Information

Compliance Levels

Risk Assessment

Report Format

RQIA’s Key Strategic Priorities 2015-18

• Is care safe?

• Is care effective?

• Is care compassionate?

RQIA Stakeholder Outcomes

Is Care Safe?

Avoiding and preventing harm to patients and clients from the care,

treatment and support that is intended to help them.

Is Care Compassionate?

Patients and clients are treated with dignity and respect and should be

fully involved in decisions affecting their treatment,

care and support.

Is Care Effective?

The right care, at the right time in the right

place with the best outcome.

Stakeholder Outcomes

Key Changes to Inspection Methodology

No Self Assessment Improvement Tool

Unannounced Short Notice

Risk Based Approach Determine Frequency

Inspectors Observations/Consultations

Report Format Focused on Outcomes

Review Of Inspections 2014/2015

• Theme 1: The use of restrictive practice within the context of protecting service user’s human rights (Reg.14(4))

• Theme 2: Management and control of operations

• Standard 7: Records and reporting arrangements

Theme 1: Findings

• Policies and Procedures

• Staff awareness of restrictive practice

• Staff knowledge of de-escalating techniques

• Innovative practice in regard to empowering service users

• Care plans current and responsive to need

Concerns Identified

• Evidence of restrictive practice

• Staff unclear about restraint, restriction and seclusion.

• Lack of clarity about Deprivation of Liberty (DOLs)

• Regulation 14 was cited in 76 centres

Theme 2: Findings

• Evidence of registration with NISCC

• Appraisals and supervision in place

• Appropriate policies in place

Concerns Identified

• Responsible person’s monthly monitoring reports and visits in need of improvement

• Service users views not always reflected in monthly report

• Lack of competency and capability assessments

• Requirement 20 was cited on 42 occasions

Standard 7: Findings

• Policies and procedures reflective of DHSSPS guidance and regional protocols

• Staff demonstrated good awareness of confidentiality

• Records stored securely

• Need to improve service users awareness of the right to see information

Over-all Improvement in Day Care Services

• Innovative services driven by service

users

• Positive feed-back from service users and their representatives

• Greater use of user friendly information

• Technology / Makaton

• RQIA is committed to continuous improvement

• To improve how we regulate

• To improve outcomes for services users

Overview

• To develop improvement tools for providers

• To inform all stakeholders and the public on regulated establishments and agencies

• To include learning from reports on our activities

Overview (cont.)

Day Care Settings Focus

Standard 8 – Service Users’ Involvement

Service users views and comments shape the quality of services and facilities provided by the service.

Theme – Continence Promotion

This theme will be inspected in those day services which care for service users with an assessed continence need. Where this theme is not inspected, inspectors may inspect an additional area based on their knowledge of the day service.

STANDARD 8 – Service Users’ Involvement

• Regulation 13 (1), (2) and (3) of The Day Care Setting Regulations (Northern Ireland) 2007

• Standard 8.1, 8.2, 8.4, 8.5, 8.6 and 8.7 of the Day Care Settings Minimum Standards (January 2012)

Is Care Safe? (Quality of Life)

• Staff actively seek service users and their representatives’ views and incorporate these into practice, to ensure that choices, issues of concern, complaints or risks are recorded and acted on

• The needs assessment, risk assessments and care plans are kept under continual review, amended as changes occur and kept up to date to accurately reflect at all times the needs and preferences of the service user. The needs assessment and care plan is appropriately signed.

Is Care Effective? (Quality of Management)

• There is a range of methods and processes where service users’ and their representatives’ views are sought, recorded and include details of the action taken.

• Service users are enabled to be involved in and given opportunities to influence the running of the day care setting.

• Service users’ (or their representative) participate in decisions about the care and support services received and are enabled to exercise choice and control over their lifestyle while not infringing on the rights of others’.

Is Care Compassionate? (Quality of Care)

• Service users are listened and responded to by staff who are knowledgeable about individual service users’ communication needs.

• Staff consistently demonstrate the integration of the philosophy of care and values into their practice.

• Service users are kept informed about issues affecting them and are treated with respect.

• Staff are knowledgeable and can reflect a person centred approach, underpinned by informed values which are required to deliver care and support services.

Sources of Evidence – Standard 8

Statement of Purpose

Service User Guide

Service user agreement

Minutes of service users’ meetings

Annual quality assurance service user questionnaires and summary report

Information in service user’s care files

• Service user’s annual review preparation report and minutes of review

Sources of Evidence – Standard 8 (Cont.)

Designated registered person’s monthly

monitoring reports

Complaints record

Suggestion box

Service user involvement in the introduction or review of the centre’s routines, practices and policies and procedures

Centre’s current annual quality review report

THEME – Continence Promotion

• Regulation 13 (1) (a)(b) 13(8), 14(1),18 (2)(b) and (20) (1)(c) of The Day Care Setting Regulations (Northern Ireland) 2007

• Standard 2, 4, 5 and 6 of the Day Care Settings Minimum Standards (January 2012)

Is Care Safe? (Quality of Life)

• There is a continence promotion policy and procedure in place.

• The needs assessment, risk assessments and care plans are kept under continual review, amended as changes occur and kept up to date to accurately reflect at all times the needs and preferences of the service user.

Is Care Effective? (Quality of Management)

• There are appropriate supplies of continence products and staff are aware of how to meet assessed needs and staff have unrestricted access to these.

• There are adequate supplies of and ease of access to Personal Protective Equipment (PPE) for staff.

• Staff receive appropriate education and training in continence promotion.

Is Care Compassionate? (Quality of Care)

• Staff are knowledgeable and can reflect a person centred approach, underpinned by informed values which are required to deliver care and support in meeting individual continence promotion.

• Service users, their representatives and professionals are satisfied that informed values underpin how continence needs are identified, met and reviewed.

Sources of Evidence – Continence Promotion

Consultation with service users, staff and others

Continence promotion policy and procedures(s) reflect current good practice

Needs assessments and care plans include (where appropriate) continence promotion which details service user’s preferences, is current, informed by professional assessment, kept under review.

Needs assessments and care plans are dated, signed by all relevant parties

Sources of Evidence – Continence Promotion (Cont.)

Identify methods used to support staff to develop their knowledge and skills to ensure they are compassionate and competent in providing continence care and support

Observation of staff interaction with service users

Induction and staff training records

Staff meeting records

Formal supervision records

Returned questionnaires

Review of the environment

Resources

Living Fuller Lives (2007) The Bamford Review of Mental Health and Learning Disability (NI)

The Human Rights Act (1998)

SCIE – Dignity in care (2013)

NICE Guidelines on the Management of Urinary Incontinence in Women (September 2013)

NICE Guidelines on the Management of Faecal Incontinence (June 2007)

DOH (2006) Infection Control Guidance

Guidance on Strengthening Personal and Public Involvement in Health and Social Care. It can be accessed at: http://www.dhsspsni.gov.uk/userinvolvement.pdf