Regulating in Care Homes Oral Care as Part of the Overall Health Improvement Agenda Margaret Hughes Inspector.

Regulating in Care Homes

Oral Care as Part of the Overall Health Improvement Agenda

Margaret HughesInspector

Who we are • Scotland’s independent scrutiny and

improvement body for care, social work and child protection services

• was set up under the ‘Public Services Reform (Scotland) Act 2010’

• carries out the functions by the former Care Commission, HMIE child protection team and Social Work Inspection Agency (SWIA).

What we doWe regulate and inspect to improve the quality of care, social work and child protection services in Scotland.

This includes: • around 15,000 care services• social work and child protection services within Scotland’s 32 local authorities.

Legislation• Public Services Reform (Scotland) Act 2010

• Scottish Statutory Instrument 210/2011 Welfare of users 4 (1) (a) A provider must make proper provision for the health, welfare and safety of service users;

Strategic objectives (CORPORATE PLAN 2014–18)

To provide assurance and build confidence through robust regulation and inspection of the quality of care

To contribute to building a rights

based, world class care system in

Scotland

To support peoples understanding of high

quality, safe and compassionate care

by promoting the standards and quality of service they should expect and make sure their voices are heard

To build capacity within careservices to make sure thereis high quality developmentand improvement ofrights based careacross Scotland

To support and inform localand national policydevelopment by providinghigh quality, evidence basedadvice and informationon care

To perform effectively andefficiently as anindependent scrutiny andimprovement body andwork in partnershipwith others

Standard 5 – Management and staffing

You are confident that all the staff use methodsthat reflect up-to-date knowledge and best-practiceguidance, and that the management are continuouslystriving to improve practice.

Standard 13 – Eating well

Staff will regularly reviewanything that may affect your ability to eat or drink, such as your dental health.They will arrange for you to get advice.

Standard 14 - Keeping well - healthcare

You are confident that the staff know your healthcare needs and arrange to meet them in a way that suits you best.

Inspection Process

Quality Themes1. Quality of Care and Support2. Quality of Environment3. Quality of Staffing4. Quality of Leadership & Management

Health

nutrition

hydration

medication

pain

Skin Integrity

1.3 Health & Wellbeing

Sleep

Oral health

What do we want to see??• Assessment• Detailed plan of care

– Person centred– Based on best practice– Linked to other plans of care

• Records of care being delivered• Records of professional input• Records of family input• Reviews

Outcomes for Service Users

• Comfortable and pain free mouth• Ability to eat and drink• Ability to talk and be understood• Positive self esteem• Feeling like yourself

What we find ………..• Most services have heard about Caring for Smiles• Most services have assessments for oral care needs• Most people have recording documentation for oral

care• Some staff have attended oral health training• Some service have oral care champions• Some service users have positive outcomes• Some ………….. Don’t

Case Example• Intelligence from unhappy relative about poor oral care• On arrival Met service user with ill fitting dentures• Personal plan documentation – no oral health assessment• Personal plan – basic, refers to “cleaning teeth” in personal

care plan• Recordings showed occasional teeth cleaning• Discussion relative – Service user had missing denture• Discussion with staff – relative arranging dental appointment• Service user had history of weight loss• Was on a soft diet – but given pureed food• No SALT/ Dietetic or Dental contacts noted for extended period

• Admission to care home – falls history - weight loss

• Oral health assessment as part of holistic assessment on admission• Family were unclear of oral status• Care team unsure – denture, teeth removed• Dental referral• Service user un cooperative with oral examination• Persistent in attempts for full dental assessment• Required a partial dental plate• Ability to eat and drink improved• Weight gained• Overall wellbeing (physical and mental) improved

However ……….

Grading

• 6 - Excellent• 5 – Very Good• 4 - Good• 3 - Adequate• 2 - Weak• 1 - Inadequate

The Big Questions….???

How do we improve oral care for people using care service?

Who’s responsible for this?

Everyone

Everyone

Our Responsibility as a Regulator

Service UsersProvider

- Staff- Best practice- Quality assurance

Information on the Care Inspectorate can be found at

www.careinspectorate.com