Clinical Quality Assessment in
Nursing Care homes
Anne Moore
Director of Nursing and Clinical Quality,
Safeguarding
Director of Infection Control
Rationale & Context
 Serious Case Review findings
 Increase in number of Adult safeguarding referrals –
quality of nursing care
 Care Quality Commission Essential Standards –
opportunity to strengthen
 Improved patient experience -Quality outcomes
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CQA Programme – Project Brief
The scope and objectives are detailed below:
Objective 1
This project will report the findings of the baseline audit within the
first tranche as prioritised
Objective 2
This project will report on soft intelligence collated as a result of the
audit assessment.
Objective 3
This project will report on a proposed set of core standards to
measure and monitor clinical quality nursing care in care homes to
inform and ensure contract compliance
Objective 4
This project will report on the learning outcomes
Objective 5
This project will report on prospects for continuous improvement of
clinical quality standards in care homes
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The Assessment Framework
Key Standards
Nutrition and hydration
Falls
Pressure Ulcers
Infection prevention and control
Continence care
Diabetes
End of life
Dementia care
Stroke
Key activity
 Appointment of 1 x Nurse CQA post
 Completion of self assessments & agreed Improvement
Plan
- 60 nursing care homes across Tees
- 2 visits per each home ( 1 base line, 1 validation)
- Communication strategy – all Stakeholders
- Reference Group - monthly
- Interim report – October 2010
- Final Report – December 2010
Initial Findings & Feedback
 14 base line audits completed across Tees
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( Hartlepool 1, Stockton 7, Mbro 3, Redcar &
Cleveland 3)
 7 ( Southern Cross )
 7 ( includes Bupa, Executive Care, no of private owners
 14 Improvement Plans agreed
Initial Findings & Feedback
 Key areas for improvement ( Policy, procedures, workforce
development , leadership & management & retention & recruitment
of qualified competent staff, clinical supervision, formal induction,
audit & care planning.
 Evidence of Clinical Standards – variance despite a number of
corporate providers with frameworks for supporting improvements
in clinical ‘quality’
 Self assessment – received positively by all of the nursing care
homes – opportunity expressed by care home staff to share best
practice with colleagues working within the sector although limited
mechanisms to do this outside of LA/NHS support.
 Information within the self assessment enabled signposting to tool
kits , guidance and access to a range of resources to drive quality
improvements ( including local expertise) – awareness limited with
some care homes regarding current & up to date information
Initial Findings & Feedback
 CQC expectations /regulations – lack of clarity in relation to clinical
requirements e.g reporting of pressure sores
 Confidence in corporate organisations questioned in relation to
implementing improvement plan – ( Resource led/driven – e.g
availability of staff to undertake identified training within working
hours
 Lack of consistency in corporate response to drive and deliver
improvements in clinical practice & quality outcomes
Key Challenges
 Sustaining and embedding improvements
( quality of care)
 Self Assessments – baseline and validation
 Joint working between LA and NHS to monitor ‘quality
outcomes’ across a spectrum of need
 Contracts – essential standards must be contained
 Sharing Intelligence and best practice
Questions?