Carevia Knowledge Centre · Governance and assurance

What audits should a care home manager complete each month?

A practical monthly audit programme should cover medicines, infection prevention and control, incidents, safeguarding, daily notes, feedback, the environment, food hygiene and mealtime support. Nursing homes should also include clinical governance oversight.

The right schedule depends on the people you support, the risks within your service and what previous checks have found. CQC does not prescribe one monthly audit checklist for every care home. Regulation 17 requires effective systems to assess, monitor and improve the quality and safety of care, including people’s experiences.

A starting audit schedule for care homes

The following schedule provides a starting point. These are planning frequencies, which should be adjusted to reflect current guidance, provider requirements, identified risks and the effectiveness of existing controls.

These audits sit alongside the routine visual checks and monitoring completed within the service. Examples include daily fire alarm panel checks, food temperature checks, daily temperature checks of medicine storage areas and medicines fridges, and other routine safety checks. These continue at the frequency required by relevant guidance, risk assessments and the provider’s procedures.

The audits help you test whether those checks are being completed properly, whether records reflect practice and whether concerns are acted on. A completed temperature chart, for example, should lead you to check whether readings were within range and what happened when they were not. A quarterly fire safety audit also sits alongside a competent fire risk assessment and the required routine checks.

Similarly, a quarterly care plan audit is a check of the quality and consistency of care planning. Individual plans and risk assessments still need reviewing when needs or circumstances change, as well as through their planned review arrangements. Consent and capacity decisions also need attention when the relevant decision or circumstances change.

Does the registered manager have to complete every audit?

The registered manager does not have to personally complete every audit. Audits can be delegated to a deputy, team leader or another appropriate colleague. The person completing the audit must be suitably skilled, trained and competent for the particular area they are reviewing.

Before delegating, check that the person understands the relevant standards, knows what good practice looks like and can assess evidence, recognise concerns and escalate them appropriately. Agree what needs to be checked, when the audit is due and how findings will be reported. Give them enough time, information and support to complete it properly.

The registered manager remains accountable for ensuring audits are completed on time and to an appropriate standard. This includes reviewing findings, challenging unsupported conclusions, ensuring concerns are acted on and checking that agreed improvements have worked. The provider also retains responsibility for effective governance.

For more on choosing a competent auditor, setting a clear brief and keeping oversight, read Does the registered manager have to complete every audit?

When should I audit more frequently?

Increase the frequency or depth of checks when you have reason to question whether an area is safe or working well. This could follow an incident, complaint, safeguarding concern, change in people’s needs or an audit that identifies repeated gaps.

If a medicines audit finds unexplained MAR gaps, immediate investigation and appropriate action come first. Focused follow-up checks can then help establish whether the problem has been resolved. Waiting until the next monthly audit could allow the same issue to continue.

You can also vary your sample. Checking the same records, staff or shifts each time may give you a reassuring picture while missing problems elsewhere.

What should each audit actually tell me?

An audit should help you establish what is happening, what needs attention and whether previous action has worked. Finding a completed document is only part of that process.

For example, a mealtime audit might confirm that a person has a current eating and drinking plan. To test whether that plan guides their support, you could use RAOF™: Read, Ask, Observe and Feedforward:

• Read the plan and relevant professional recommendations.
• Ask staff how they support the person and what they would do if something changed.
• Observe whether preparation and support reflect the plan and the person’s preferences.
• Feedforward what you learn into clear actions and the next check.

Give each action an owner, a timescale and a clear description of what improvement should look like. Follow it through by checking what has changed for the people receiving care.