1. Introduction

Quality assurance systems regularly assess and monitor the performance of the service against its’ Statement of Purpose, and in accordance with the Fundamental Standards published by the Care Quality Commission (CQC).

This system seeks to provide reassurance to adults who use the service, their families, partner agencies, commissioners and the CQC that the care and support interventions provided by staff are:

  • of good standard;
  • where improvements are identified, action is taken in a timely manner and the impact regularly monitored to ensure the situation has been remedied; and
  • lessons learned have been embedded into front line practice.

Senior managers should be aware of changes in relevant national guidance, regulations and legislation and implement these changes into service practice and delivery as required. They should also understand how quality and safety standards can alter over time, for example when new practices are introduced or because of technological development and build in such changes in the audit process

2. Delivering Best Possible Care and Support

Achieving the best possible quality care and support for adults is essential to the ethos of the service. It aims to provide a professional and effective service which meets all of the requirements of the adults. The objective is to obtain the highest possible level of satisfaction from service users and relatives.

All adults who use the service should:

  • expect the highest quality care and support possible;
  • be given a say in the running of the service through routine evaluations of care and support plans and a larger survey of service user opinion carried out on an annual basis (see Care and Support Planning and Service User Involvement);
  • feel able to make a complaint about any aspect of the service with which they are not satisfied, and to have their complaints received in a professional manner and acted upon promptly (see Complaints);
  • be told about planned CQC inspections and be given unrestricted and private access to inspectors during inspections.

3. Quality Assurance Process

3.1 Information Gathering

The service must have systems in place to gather information including:

  • audits which should be base lined against the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and should, wherever possible, include experiences of adults who use the service, and their family. This must be ongoing, but also in response to identified changing needs of adults who use the service;
  • complaints and comments made by a service user or those acting on their behalf, their views and descriptions of their experiences of their care and treatment at the service;
  • comments, complaints or claims made by others;
  • investigations carried out into the conduct of any member of staff at the service;
  • analysis of incidents that resulted in, or had the potential to result in, harm to an adult (adverse events, incidents, errors or near misses – see also Duty of Candour);
  • advice from and inspection reports by the Care Quality Commission;
  • relevant national reviews and guidance;
  • relevant records held by the service;
  • disciplinary hearings;
  • professional and expert advice as appropriate;
  • Safeguarding Adult Reviews;
  • coroners’ reports;
  • ombudsman cases;
  • major incidents / accidents;
  • business continuity;
  • large scale investigations.

All staff should be free to raise issues, concerns or complaints without fear of unfair treatment (see also Whistleblowing).

Systems and processes should be continually reviewed to ensure they remain fit for purpose, including:

  • being able to identify where quality and / or safety are, or are at risk of, being compromised and to respond appropriately and without delay;
  • ensuring access to all necessary information;
  • ensuring scrutiny and responsibility at all levels.

Information should be up to date, accurate and properly analysed and reviewed by staff with the appropriate skills and competence to understand the significance of data. When areas of concern are identified, results should be escalated to the appropriate manager, appropriate action taken and the impact monitored.

3.2 Feedback

The service should actively seek the views of stakeholders, including adults who use the service, their family, staff, visiting professionals, professional bodies, commissioners, local groups, members of the public and other bodies, about their experience of, and the quality of care and support delivered by the service.

3.3 Action Planning

Risks identified from information gathered is compiled into an action plan, with actions to be taken to ensure lessons learned are embedded into front line practice to minimise risks, timeline and person responsible for leading on action to be taken.

3.4 Reporting

Information should be collated into a report to senior managers which will show how information has been analysed and include a draft action plan to address issues where they are raised. The plan will include timelines and key responsible leads and will be signed off by senior managers.

Where audits recognise concerns, professional advice must be sought as appropriate and in a timely manner to help identify the best course of remedial action in order to make the required improvements.

4. Sharing Information

Information from report and action plans shared with key staff and managers as appropriate.

In addition, the service must share relevant information, about incidents or risks for example, with other relevant individuals or bodies, including Safeguarding Adults Boards, coroners and regulators. Where such bodies identify improvements are required, these must be made without delay and ongoing monitoring processes put in place (see Section 6, Sharing Information with the Safeguarding Adults Board, Information Sharing and Confidentiality).

All staff, at all levels in the service and in all posts, are required to demonstrate commitment to quality and quality improvement in every aspect of their daily work and practice.

The service must ensure that staff are suitably trained, supervised and supported as appropriate to their role (see Supervision and Staff Training). In particular:

  • all new staff must read this Quality Assurance and Learning Lessons chapter as part of their induction process, along with other policies and procedures relevant for their post;
  • each member of staff will have a personal development plan in which their training needs are identified and a plan made as to how such needs will be met;
  • each member of staff will be offered training to national standards covering training needs identified within their development plans.

5. Review

Action plans should be reviewed on an agreed regular basis by senior managers. Progress and impacts should be fed back to relevant staff and managers.

6. Learning Lessons

See also Duty of Candour.

All of the above processes reference learning lessons from previous incidents and accidents, including near misses. It is essential that the service can improve the care and support it delivers to the adults in its care as a result of any such events. This is relevant to individual staff, the service, partner colleagues and agencies to learn lessons about the way in which they work both individually and collectively in providing care and support.