Audit, Assurance and Continuous Improvement in Dementia Services
Audit and assurance in dementia services is not about producing paperwork for inspections. At its best, it provides a live, structured understanding of how care is actually experienced day to day, where risks are emerging, and whether quality systems are genuinely protecting people living with dementia.
This article sits within Dementia – Quality, Safety & Governance and aligns closely with Dementia – Service Models & Care Pathways, because audit approaches must be tailored to the specific service context in which dementia support is delivered.
Why generic audit frameworks fail in dementia services
Many providers rely on generic audit tools that focus heavily on documentation compliance. In dementia services, this often misses critical aspects of lived experience, such as emotional safety, communication quality and consistency of relational care.
Effective dementia audit frameworks focus on:
- What people experience, not just what is recorded.
- Patterns over time, not isolated incidents.
- Consistency of practice across staff teams.
- Early indicators of distress, restriction or neglect.
Regulator / CQC expectation: meaningful quality assurance
Regulator / Inspector expectation (CQC): inspectors expect providers to demonstrate that audit activity drives improvement. This includes evidence that:
- Audits reflect dementia-specific risks.
- Findings are analysed, not just recorded.
- Action plans are implemented and reviewed.
- Leaders understand and act on audit intelligence.
CQC scrutiny often focuses on whether providers can explain what audits have changed in practice.
Commissioner expectation: assurance that risk is controlled
Commissioner expectation: commissioners expect audit and assurance systems to provide confidence that dementia-related risks are identified early and managed effectively. This includes visibility of:
- Falls trends and contributing factors.
- Safeguarding and MCA compliance.
- Restrictive practice monitoring.
- Staff competence and supervision quality.
Operational Example 1: Falls audit driving practice change
Context: A domiciliary care provider supporting people with dementia experienced an increase in non-injury falls, despite completed risk assessments.
Support approach: The provider introduced a dementia-specific falls audit focusing on timing, environment and staff response.
Day-to-day delivery detail:
- Falls logs reviewed weekly by senior staff.
- Patterns linked to time of day and medication routines.
- Care plans updated with anticipatory support strategies.
- Staff supervision used to reinforce observation skills.
How effectiveness is evidenced: Reduction in repeat falls and improved confidence among staff in proactive risk management.
Operational Example 2: Auditing communication quality
Context: A supported living service identified inconsistent communication approaches across shifts, leading to increased distress.
Support approach: A qualitative audit tool was introduced focusing on tone, pacing and response to distress.
Day-to-day delivery detail:
- Observational audits conducted during routine support.
- Feedback shared in reflective supervision.
- Positive practice examples recorded and shared.
- Training refreshed using real audit findings.
How effectiveness is evidenced: Reduced behavioural incidents and improved inspection feedback on relational care.
Operational Example 3: Assurance of restrictive practice reduction
Context: A care home struggled to evidence reduction of restrictive practices identified in inspections.
Support approach: A restriction audit register was embedded within governance processes.
Day-to-day delivery detail:
- Restrictions logged with rationale and review dates.
- Monthly senior review meetings.
- Family involvement in best interests decisions.
- Action plans linked to staff training.
How effectiveness is evidenced: Clear reduction trajectories and improved CQC outcomes.
Turning audit into continuous improvement
High-performing dementia services close the audit loop by:
- Tracking improvement actions to completion.
- Re-auditing to test effectiveness.
- Sharing learning across teams.
- Embedding findings into supervision and training.
Audit becomes meaningful when it shapes how care is delivered, not just how it is recorded.