Care Assurance Visits

Guidance for Care Assurance Visits

Background

The purpose of the Care Assurance visit is to observe the clinical environment with fresh eyes and to provide the clinical team with objective feedback. The information gained will provide a better understanding of how patients and service users first experience their care environment and also how welcome visitors are made to feel on entering the clinical environment. (15 steps NHS England 2017 - accessible here)

Care Assurance Visit using the Combined Care Assurance Audit Tool (CCAAT)

Guidance Video

Objectives of the visit:

1. To provide leadership, professional development and support to colleagues delivering clinical care
2. To assure the delivery of safe, effective and person-centred care.
3. To give objective feedback to the clinical team regarding the clinical areas visited
4. To provide expert, visible nursing/allied health professional (where available)  leadership
5. To identify examples of good practice for sharing & themes for quality improvement
6. To provide a data set of quality of care at ward, hospital and sector level 

Who should carry out a Care Assurance visit?

Two experienced Healthcare Professionals (HCPs), Band 6 or above, neither of whom are affiliated to the clinical area. Both HCPs must have knowledge and understanding of medical and nursing documentation, risk assessments and the care assurance process.

How often should a Care Assurance visit be carried out?

All acute inpatient wards must have a Care Assurance visit using the Combined Care Assurance Audit Tool (CCAAT) a minimum of once every 12 months. Further information can be found here.

How can I prepare for a Care Assurance Visit?

To prepare to undertake a Care Assurance visit it is recommended that you read the 15 steps guidance (NHS England), watch the guidance video above and familiarise yourself with the CCAAT v12.2

How long do the visits take?

The Care Assurance visit normally takes 3-4 hours and must include the opportunity to observe a meal service. 

Initial Approach in Clinical Environment 

• Spend time in reception/waiting area
• Spend time walking through the clinical area
• If possible, spend time in an empty bed space/trolley space with the curtains closed-what can you hear?
• How does this environment make you feel?
• How long before you are approached by a member of staff to ask if you need help?

Arrival in Clinical Area 

All staff undertaking a Care Assurance visit must be in uniform and should identify themselves on arrival to the nurse in charge, explaining the purpose of the visit. 

Speaking to Staff, Patients & Carers

Take time during your visits to speak to staff, patients and carers/visitors to gain feedback about the clinical area from their perspective. However please check with nurse in charge if there are any patients that should not be approached due to their clinical condition.

CCAAT sections

Clinical area details, including date, SCN/SCM/TL, Nurse in Charge name & staffing skills mix

• Welcoming ward
• Quality Assurance
• What & Who matters to me?
• Maintaining patient dignity and privacy
• Decision making, consent & capacity
• Initial Assessment on admission to Hospital
• Ongoing Care 
• Pressure Ulcer Prevention
• Nutritional Care
• Comprehensive Geriatric Assessment
• Pharmaceutical care
• End of Bed documentation
• Delirium
• Dementia
• Falls assessment, prevention & management
• Rehabilitation
• Discharge planning
• Care transition / Patient Pathway and Flow
• End of Life care
• Mealtime observation

End of the Visit

The CCAAT must be completed by the two HCPs, who discuss, agree and record their observations/comments into the electronic document. The HCPs should provide verbal feedback on the visit and the initial compliance score must be shared with the senior charge nurse/nurse in charge. The overall compliance score and the completed CCAAT must be emailed to the clinical areas SCN / SCM / TL and the lead nurse respectively no later than 5pm on the day of the visit. 

Improvement Plan

An integral part of the Care Assurance process is the completion of an improvement plan targeted at any area of the CCAAT which returns a red or amber score. The improvement plan template is located within the second sheet of the CCAAT. The SCN / SCM / TL of the clinical area visited is responsible for completing an improvement plan within 28 days of the visit.