Regulating in Care Homes Oral Care as Part of the Overall Health Improvement Agenda Margaret Hughes Inspector
Jan 08, 2018
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