Audit and Assurance in Older People’s Services: Proving Quality Beyond Paper
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Audits are one of the most misunderstood elements of quality governance in older people’s services. When used poorly, they become box-ticking exercises. When used well, they act as early-warning systems that protect people and services alike.
Commissioners and inspectors are less interested in how many audits you complete and more interested in what you do with the results. Effective audit frameworks align closely with Governance & Leadership and the improvement cycles set out in Continuous Quality Improvement.
What audits must actually test
In older people’s services, audits should test whether care is:
- Delivered as planned
- Recorded accurately and contemporaneously
- Responsive to changing need
- Safe, respectful and person-centred
This means auditing practice, not just paperwork.
Operational example 1: Care plan quality audits linked to observation
Context: A care home had comprehensive care plans, but inspectors previously found gaps between plans and delivery.
Support approach: The provider redesigned audits to include observation alongside record review.
Day-to-day delivery detail: Managers reviewed care plans, then observed support during key routines (personal care, mobility support, meal assistance). Any mismatch triggered immediate feedback and plan updates.
How effectiveness/change was evidenced: Repeat audits showed improved alignment between plans and practice. Staff could explain why care was delivered in specific ways.
Operational example 2: Medication audits that reduce risk
Context: MAR charts were completed, but timing errors and PRN rationale were inconsistent.
Support approach: Medication audits focused on high-risk indicators rather than every field.
Day-to-day delivery detail: Senior staff checked timing windows, allergy prompts and PRN justification. Findings were discussed in team meetings and reinforced through supervision.
How effectiveness/change was evidenced: Error types reduced and staff confidence improved. Audit outcomes directly informed training priorities.
Operational example 3: Auditing missed care in domiciliary services
Context: A home care service relied on complaint data to identify missed care.
Support approach: The provider introduced proactive call monitoring audits.
Day-to-day delivery detail: Managers reviewed visit duration data weekly, followed up short calls, and contacted service users where patterns emerged.
How effectiveness/change was evidenced: Missed-care incidents reduced and complaints decreased. Audit logs demonstrated preventative action.
Building an effective audit programme
Strong audit frameworks typically include:
- Risk-based audit schedules
- Clear scoring and thresholds
- Action plans with named owners
- Re-audit dates and evidence tracking
- Links to supervision and training
Commissioner and regulator expectations
Commissioner expectation: Commissioners expect audits to demonstrate control, learning and improvement — not just compliance activity.
Regulator / Inspector expectation (CQC): CQC expects providers to assess, monitor and improve quality using effective audit and assurance systems.
Outcomes and impact
Well-designed audits strengthen safety, improve consistency and provide confidence to commissioners and inspectors. They help providers spot risk early and demonstrate control — before quality issues escalate into enforcement or reputational damage.
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