Observation Tool for Outcome 1

Observation prompts and guidance for monitoring compliance Guidance for inspectors

Outcome 4: Care and welfare of people who use services

PoC2B 100961 1.00 Observation prompts and guidance – 1 Outcome 4: Care and welfare of people who use services Introduction

This guidance explains how to use observation to gather information during visits, to help assess whether a provider is meeting Outcome 4: Care and welfare of people who use services (Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010). There are prompts at the end of the guidance to help you.

You should read this alongside our guidance on:

 The essential standards of quality and safety (including the documents listed in appendix B of that guidance).  How to carry out a visit.  Using observation during visits.  Using pathway tracking.  Semi-structured interviews.

1. When should I  You should use observation when you have reviewed and use observation triangulated the evidence you have collected as part of a to assess review of compliance, and you have found that: Outcome 4? o You need to focus on the care and welfare of people who use services. o There are gaps in the information that prevent you making a robust judgement about whether the outcome is being met. o You have concerns about whether the provider is meeting the outcome. o A visit to the location is the most appropriate way to gather additional information.

2. What are the  When carrying out an observation for Outcome 4, your focus limitations of is on the delivery of care. You should observe the way that using staff interact with and care for people who use services. observation to  Observations include what you see, hear and smell. assess Outcome 4? However, observing is only one of a number of ways that you can use to assess whether the provider is meeting Outcome 4. You can use additional methods, alongside observation, to triangulate your evidence to ensure you reach a robust judgement.

PoC2B 100961 1.00 Observation prompts and guidance – 2 Outcome 4: Care and welfare of people who use services 3. Is observation  Yes. The guidance on carrying out visits says that you should for Outcome 4 spend about 50% of your time on most visits observing the appropriate in care process. That may include observations in relation to all settings? Outcome 4 where you have identified that you need to review this outcome.  Observation by itself will not cover every aspect of an outcome. You should use it alongside other inspection tools such as interviews and surveys. Not all aspects of care can be observed and not all observations can be interpreted without additional information.  The observation prompts in this document are generic and can be used in a variety of settings and service types.  It is important that you observe in an unobtrusive way that preserves people’s dignity and human rights. You can find further information about this in the guidance on using observation during visits.

4. Do I have to  No. The prompts are to help you focus on the kind of check every observations that capture the essence of Outcome 4. They prompt at the do not cover the whole of the outcome, as they relate only to end of this aspects that you can observe. Not every prompt will or can guide? be observed at each visit. Your focus will depend on the type of provider or location you are visiting and what it was that made you decide to visit.  When you are planning your visit, you can look at the prompts in this document and select those that are relevant to the area under review and that are most likely to generate the evidence you need. You can copy the selected prompts to your visit plan and record.  The prompts are suggestions for what you may observe or look for. They are not a checklist and other observations may be equally, or more, relevant to the specific concern for which you are gathering evidence.  You are not expected to record comments on every prompt. You may not plan to observe or ask any questions about some of the areas at all, because they don't relate to an aspect of the outcome that you have concerns about. Or, you may plan to observe something but the opportunity doesn’t present itself during your visit.

PoC2B 100961 1.00 Observation prompts and guidance – 3 Outcome 4: Care and welfare of people who use services Observation prompts: Care and welfare of people who use services (CWF)

CWF1 Care or treatment being delivered with due regard to people’s:  Age.  Gender.  Religious faith or belief.  Sexual orientation.  Racial origin.  Cultural and linguistic background.  Any disability they may have.

CWF2 Opportunities for people using services, or others acting on their behalf, to be involved in the planning and development of care and treatment:  When/where/how to have care/treatment/support.  Care plans/PCPs.  Medium/longer-term activities such as holidays in a care home setting.

CWF3 Coordination of care and treatment with other providers (or with other services within the same provider) for people with complex, wide- ranging or changing needs.  Handover/communication at transfer.  Visits by other professionals.  Inter-professional working.

CWF4 Explanations and information provided in the appropriate accessible formats and in plain language and being understood by people using services or those acting on their behalf:  Explanation of specialist or medical terms.  Use of unnecessary/unexplained jargon.  Opportunities for people who use services and/or their representatives to ask questions.

CWF5 Arrangements for contact with families and friends, bearing in mind the type of care or treatment being provided:  When can visitors visit?  Facilities to meet privately.  Family and friends welcomed and treated with respect.

PoC2B 100961 1.00 Observation prompts and guidance – 4 Outcome 4: Care and welfare of people who use services  Comfortable visiting facilities.

CWF6 Care and treatment being safe, for the people using services, staff and others:  Health and safety.  Moving and handling.  Infection control.  Safe promotion of independence.  Age-appropriate facilities.

CWF7 People’s (observable) needs being met effectively and timely:  Acting on changes in health status.  Responses to requests, including by family, friends or other advocates.  Non-verbal requests/signs of need.

CWF8 Risk management in practice (individual and/or general risks):  Talking to people using services, and/or those who act on their behalf, about risks and how they can be managed.  Positive risk taking where appropriate, for example as part of improving independence.

CWF9 For those whose care pathway you have tracked: Care and treatment is personalised:  As requested and agreed in the care plan.  Equality and diversity taken into account.

CWF10 For those whose care pathway you have tracked: The outcomes of risk assessments are being followed:  Needs based on diversity and clinical condition taken into account.  Balancing the right to take informed risks with safety.

PoC2B 100961 1.00 Observation prompts and guidance – 5 Outcome 4: Care and welfare of people who use services