CQC places a huge emphasis on the importance of person-centred care, particularly in relation to services caring for people with dementia. This is reflected in the Key Lines of Enquiry (KLOEs) that CQC inspectors are required to answer during an inspection. It is important that providers are able to demonstrate and evidence positive dementia support during inspections to ensure a positive CQC rating. I highlight below some of the key KLOEs linked to effective dementia care.
Staff training and care plans
One of the KLOEs CQC are required to answer is ‘How does the service make sure that staff have the skills, knowledge and experience to deliver effective care and support?’. Appropriate training strengthens good dementia care through staff understanding and the development of positive staff values, attitudes and empathy. Providers should ensure that relevant staff receive training to ensure they are equipped with the correct skills to provide a high standard of personalised care. This can range from how to devise detailed care plans and making reasonable adjustments to reflect service users’ needs to training on communicating effectively with individual service users with differing levels of capacity and how to manage behaviours which challenge.
Another KLOE CQC will consider is ‘How do people receive personalised care that is responsive to their needs?’. Care plans will usually be the inspectors first port of call in trying to answer this question. Care plans should primarily reflect the current needs of service users. When considering initial care planning it is good practice to consult the service user themselves along with family and friends where relevant. An initial focus should be placed on what is important to them considering their concerns and priorities in terms of current and future outcomes. Care plans for people with dementia should be empowering and proactive, written in dementia friendly language and reflect personal preferences and life histories as well as their healthcare needs. Detailed, up-to-date and well-developed care plans can go a long way in assisting CQC inspectors to answer this question positively.
Consent
Valid consent should always be sought for service users, and providers should ensure that this is appropriately considered particularly in relation to people with dementia who can display fluctuating capacity. The Mental Capacity Act 2005 must be followed if a service user is deemed to lack capacity to make a particular decision. Providers need to ensure they have detailed records of all decisions made including any capacity assessments or best interests decisions made on behalf of a service user, including details of relevant individuals involved in the decision making process. CQC inspectors will be looking at such records to answer the question ‘Is consent to care and treatment always sought in line with legislation and guidance?’.
Premises and decor
The environment can have a huge impact on a person living with dementia. This has been recognised by CQC through the KLOE ‘How are people’s individual needs met by the adaptation, design and decoration of premises?’. There are many ways providers can adapt the environment to make it more dementia friendly. While specific adaptations will depend on the presenting needs of the individual service users, examples of adaptations include the use of colour coordinated decoration, signage and personalised memory boxes by service users’ bedrooms. Each of these adaptations can aid service users in finding their way around the home and reduce potential confusion.
Transfers between services
Admission to hospital can be stressful and worrying, particularly for someone with dementia. Care homes should have processes in place to ensure this distress is kept to a minimum. One of the best ways of doing this is to ensure the appropriate sharing of information between services. There is no set way of doing this and different hospitals may provide different directions as to the type and style of information required. However, care homes can be proactive in ensuring their service users have appropriate information available for hospital passports which include details such as ‘how I communicate’, ‘what to do if I’m anxious’, ‘how do you know that I am in pain’ and ‘things I like and dislike’. Sharing information about how a person’s behaviour is impacted as a result of their dementia is an important part of minimising anxiety when moving between services. Some providers also adopt the use of ‘This is me’ documents, as recommended by the Alzheimer’s Society to ensure key information is communicated. Care homes should ensure that relevant documentation is kept up to date, shared with relevant staff and easily accessible. CQC will be looking at the effectiveness of such practices when answering the KLOE ‘How well do staff, teams and services within and across organisations work together to deliver effective care, support and treatment?’.
Although many examples of good practice in dementia care provision are seen daily throughout the care sector, it is often the case that only the negative is portrayed to the public. Providers should ensure they are clear about what is expected of them and ensure they can demonstrate this through staff practices and records. Providers should not become complacent with the provision of personalised dementia care and it is vital that this is continually encouraged throughout the sector.
