Service Specification for Specialist Residential - Care

SERVICE SPECIFICATION
FOR THE PURCHASE OF
Specialist Dementia Residential Care
Provision of residential care on permanent or short stay basis
(respite or transitional) for people with a diagnosis of severe or
moderate dementia
Dated: 1st Day Of July 2009
framework/demrescarespec/j1jul09/updated 1
ADULT HEALTH & COMMUNITY SERVICES
DIRECTORATE
Adult Commissioning Unit

1.. HIGH LEVEL SERVICE OUTCOMES AND OBJECTIVES
1.1. Specialist Dementia Residential Care
The overall purpose of the specialist service is scheme is to provide safe and
secure accommodation for Older People with a diagnosis of moderate or
severe dementia in an environment that is homely and where people have
control over their own life, personal space, privacy and security.
1.2. Service Provision that:
1. Promotes independence and delivers the ongoing care and supports the
needs of its residents.
2Contributes to supporting people to stay healthier and recover quicker from
illness or accident, reduce the likelihood of admission to hospital or long
term nursing care and facilitate timely hospital discharge.
3. Enables through effective early care planning for a person to die with
dignity, pain free and in a way that meets their identified spiritual, religious
and cultural needs.
2 CARE SPECIFICATION
2.1 Philosophy and Core Principles
5 Principles that apply for mainstream care will also apply to dementia care
and these are:
• Person centred care: Care is to be provided in a manner that meets
the identified needs of each individual resident. This is best achieved
through an individual care plan, which recognises individual ethnic,
religious, cultural and social needs and the characteristics of residents.
• Choice and independence: Care should be provided in a manner that
promotes and encourages residents’ independence and the
enhancement of their individual rights. This includes choice about
activities of daily living and access to activities that present reasonable
risk.
• Dignity and respect: Care is to be provided in a manner that offers
privacy, respect and dignity to each individual resident both in life and
in death.
• Consultation: No decisions about the care provided to a resident
should be made without their full participation and agreement, and
where appropriate, the full participation and agreement of their
family/carer/supporters. Where there is no family member/
supporter/carer, consideration should be given to an appropriate
person from outside the home advocating on their behalf.

• Participation: Residents should be encouraged to participate in
activities of daily living and social activities within the home and the
wider community in accordance with their interests and abilities.
2.2 Characteristics of good quality dementia care
In order to meet these principles of care, dementia care homes need to have
in place a suitable set of conditions. These conditions will be supported by a
local specific dementia strategy, which will form the basis of the homes
management and care of people in their care. The strategy will be led by a
senior member of staff and will, as key to its delivery, ensure that:
• Staff have an appropriate level of understanding and training about
dementia, effects of dementia and strategies and techniques to
communicate with and provide care for people with dementia, this
includes end of life care planning through advanced
directives/advanced care planning.
• Staff are supported in their care task by good leadership, staff
management, staff training and development and person centred care
planning.
• The home reflects the type of environment that is appropriate for
people who have dementia, has purposeful activities that relate to
individual preferences rather than general entertainment, and establish
strong links with and involvement in local communities.
• Partnership working with voluntary and specialist agencies has been
established to assist the home to cater for changing emotional,
cognitive and physical health needs of its residents.
• There is close working with family and/or informal carers to both
understand the unique personality and life experience of the resident
and what their care needs are and also to allow the family to continue
to participate, if they wish, in the care of their loved one.
• There is a nominated dementia Champion/leader who will take
responsibility for improving quality and ensuring that people have
access to a range of social activities that may involve their families.
• There is a regular review at least every six months of the persons
physical and mental health to ensure the care provided is appropriate.
• There is a policy in place agreed with the commissioner on the use of
anti-psychotic drugs, their review and the removal of those drugs when
appropriate. Staffing and design should promote the avoidance of the
use of anti psychotic drugs.

2.3.2. Outcomes and Key Performance Indicators (KPIs)
2.3.2.1. The Service outcomes are based on promoting independence,
the delivery of ongoing care and support, avoidance of
admission to hospital or nursing accommodation, and good
quality well co-ordinated end of life care:
Service Level Outcomes
A service that can:
1. Promote independence and deliver the ongoing care and support
needs of its residents.
2. Contribute to supporting people to stay healthier and recover quicker
from illness or accident, reduce the likelihood of admission to hospital
or long term nursing care and facilitate timely hospital discharge.
Measurement Framework for Outcome One
Deliver the ongoing care and support needs of its residents through a
localised dementia strategy for the home
Individual Outcome Measures Methodology
a. Improved lives of
people residing in
the home with a
diagnosis of
dementia
Development of
dementia specific
strategy for the
management and care
of people in the home
to include key
characteristics as
listed at 2.2
Provider strategy and
pathway measurement
Provider records,
Customers files
Consultation with users
and carer
Measurement Framework for Outcome Two
Promote independence and deliver the ongoing care and support needs
of its residents through a defined dementia care pathway
a. Ongoing
improvement,
maintenance or
minimised
deterioration in
ability to undertake
daily living functions
% of Customers
whose ability to
undertake a daily
living function has
improved since
receiving the Service.
Provider strategy and
pathway measurement
Activities of Daily Living
(ADL) assessment /
assisted assessment via
discussion

% of Customers
whose ability to
undertake a daily
living function has
been maintained since
Provider records,
Customers files
b. Ongoing
improvement,
maintenance or
minimised
deterioration in
ability to self care
% of Customers
whose ability to self
care has continued to
improve since
% of Customers
whose ability to
undertake self care
has been maintained
since receiving the
Service.
ADL assessment /
discussion
Provider records,
Customers files
c. Ongoing
improvement,
maintenance or
minimised
deterioration in
mobility function
% of Customers
whose mobility has
continued to improve
since receiving the
Service.
% of Customers
whose mobility has
ADL assessment /
discussion
Provider records,
Customers files
d. Ongoing
improvement,
maintenance or
minimised
deterioration in
confidence and
independence
% of Customers
whose wellbeing,
confidence and
independence has
continued to improve
since receiving the
Service.
ADL assessment /
discussion
Provider records,
Customers files

% of Customers
whose wellbeing,
confidence and
independence has
e. Ongoing
improvement,
maintenance or
minimised
deterioration in
health – both
physical and mental
health
% of Customers
whose health – both
physical and mental
health has continued
to improve since
% of Customers
whose health – both
physical and mental
health has been
maintained since
ADL assessment /
discussion
Provider records,
Customers files
f. Continued
involvement and
support from family
and Carers
% of family / Carers
who undertake or
contribute to the care
of their family member
who feel that they
have been offered or
given suitable support
to care.
Self-assessment by
Family/Carer / assisted
assessment via
discussion
Questionnaire/discussion
g. Reduced anxiety % of Customers who Self-assessment /

about ill health by
individual and their
families
feel less anxious
about their ill health.
% of family / Carers
who feel that the
Service has
contributed to feeling
less anxious about the
ill health of their family
member.
discussion
Measurement Framework for Outcome Three
Ensure people have good end of life care.
a. Management of
Pain and distress
No. of Customers with
advanced care plan or
advance directive
No. of supportive
services available
Person is registered
and reviewed by GP
as Palliative care
patient
Quantitative data
collection
Discussion with
family/supporter
Discussion with GP
Sight of palliative care
reviews and register
where appropriate.
b. Meeting a persons
cultural, spiritual and
religious needs
No. of Customers
linked to their
preferred cultural or
religious services
Discussion with
family/supporter
Discussion with GP

Service Specifications
This Service Specification sets out the commissioning requirements for
Warwickshire County Council (WCC) when procuring residential care for
people suffering from dementia and is set out as follows:
1. High Level Service Outcomes and Objectives
2. Care Specification
3. Service Description
4. Service Management
5. Service Delivery
6. Positive Interventions in Care Provision
7. Pre-admission and Discharge
8. Staff and Recruitment
9. Equipment, Facilities and Environment
10. Contract Monitoring
It is expected that all the criteria for the registration for the
home will and are being met.

3. SERVICE DESCRIPTION
3.1The service will provide 24-hour specialist dementia care for people with a
diagnosis of moderate or severe dementia. This includes Permanent and
Short Stay Residential Care.
3.2The service will be provided in an environment that is homely and where
people have control over their own life, personal space, privacy and
security. The environment is expected to comply with dementia specific
environmental standards.
3.3Customers will be helped to exercise choice and control over daily aspects
of living such as food and clothing.
3.4Care Staff will regularly monitor and review the emotional, cognitive and
physical health of the customer to ensure that appropriate care and
services are provided.
3.5Customers should be able to have visitors at any reasonable time and if
informal carers wish to be involved in personal care, this should be
supported.
3.6All efforts should be made to understand and actively communicate with
the service user, using good practice as appropriate. High importance will
be given to communication and social interaction.
3.7The Customer will be helped to engage in everyday activities of daily living
such as helping with gardening, laundry and domestic chores.
3.8Access to social activities outside the Home will be facilitated by the
service provider.
3.9The provider should have effective mechanisms for liaising with other
agencies to ensure that assessment of need and allocation of service
provision results in the best achievable outcomes for the Customer.
The list of agencies can include:
• Older People Community Mental Health Team
• Social Care
• Advocacy (Mental Health Act and Mental Capacity Act)
• Primary Health Care Teams
• Specialist Health Services
• Admiral Nurses
• Voluntary organisations such as Guidepost etc
• Mental Health Liaison Workers
• Spiritual, cultural and religious services

4. SERVICE MANAGEMENT
4.1 The service will be provided within a framework of:
• Effective Leadership
• Quality Assurance Systems
• Staffing and role allocation
• Key Information and reporting
4.2 Effective leadership
4.2.1 The Manager of the Home will be a registered CQC manager within 6
months of their appointment with the company and will have both a
management qualification and at least 2 years experience of managing
dementia specific services.
4.2.2 Effective leadership should be demonstrated through:
• Clear understanding of the principles and practice of a person-centred
approach
• Formal qualifications including accredited dementia specific
qualifications
• Adequate training to support procedure
• Robust operational procedures
• Effective development of policies that support service delivery
4.3 Quality Assurance Systems
Quality Assurance system should confirm that:
• Policies are developed and disseminated to staff
• Policies and procedures are adhered to by staff
• Complaints are recorded and followed up
• Continuous improvement in service development and delivery take
place
4.4 Staffing and Role allocation
4.4.1 Registered Manager is responsible for ensuring that all contractual
requirements are met, including:
• Safeguarding key information and reporting (section 4.5)
• Care planning and quality of provision (sections 5 and 6)
• Procedures around pre-admission and discharge are adhered to
(section 7)
• Staff recruitment and training (section 8)
• Equipment, facilities and environment (section 9)

4.4.2 Staffing levels should adequately meet the level of need at any given
time including Waking Night staff.
4.4.3 Each Customer should be assigned a key worker within the service
who is responsible for both liaising and linking with family, completing a
life storybook and ensuring that the care plan is met.
4.5 Key Information and reporting
4.5.1 Significant Event
• Hospital Admission
• Temporary move or permanent discharge from contracted Home
• Serious illness/injury
• Death
• Lost or missing
These will be will be reported to the council’s contract monitoring team
immediately by telephone (and followed up by written confirmation
within 24hours). They will also be reported to the carer where one has
been identified.
4.5.2 Safeguarding issues which include financial or physical abuse or
Deprivation of Liberty (DOLS) will in addition be reported to the
safeguarding team. Where mental capacity is a concern, a mental
capacity advocate will be contacted.
4.5.3 For both significant events and safeguarding issues, contact with
relatives must be recorded including attempted contact. Details
recorded will be
• Time
• Date
• Name of relative spoken to
• Name of worker who made contact with relative
4.5.4 In the event of a major incident where the ongoing delivery of care to
the Customers may be interrupted, the provider will notify the Council’s
contract monitoring team within 24 hours. Major incidents include:
• Fire
• Flood
• Disruption to power, heating and lighting
• Infection outbreak
• Major staffing disruptions
• Any loss of money or property
• Any circumstance where the Customer is in need of medical
attention but refuses to seek medical help.

4.5.5 The provider will notify the Council’s contract monitoring team within
one month should the registered manager leave with details of interim
arrangements. (See 4.2.1 for reporting appointment of new manager),
any interim position must have accredited suitable dementia
experience.
4.5.6 The Provider will ensure that all information including policies and
procedures relating to the service is available to people who use
services and Carers in a format that is acceptable and accessible to
them. This may include policies relating to money-management,
confidentiality, abuse if not included in other guidance.
4.5.7 The Care Home will make staff policies and procedures available for
inspection by the County Council on request. This should include the
following but can include others:
4.5.7.1 Medications policy which must comply with the standards set out
by Care Quality Commission. Where appropriate every opportunity
to access dementia specific medication should be sought. Excess
medication should not be used to subdue or restrain individuals
without the express permission of the Consultant and family. If anti
psychotic medication is used it must only be with a consultants
agreement, be reviewed within 6 weeks of prescribing and only be
a drug recognised by NICE as suitable for Dementia patients.
• The home should have a medication policy and all staff who
administers medication should be adequately trained in both
medication dispensing and dementia care clients, to do so
• Appropriate medication should be administered for physical
conditions and pain relief
• Medication should not be used as a behaviour management
method and where appropriate advice should be sought from
informal carers and/or specialist agencies such as the
Community Mental Health Team.
4.5.7.2 Complaints policy which stipulates that when a complaint is made
against the provider, it will be recorded and investigated. If and
when the complaint is escalated the provider must record every
interaction with the complainant and or their advocate/family
including telephone calls made and any verbal or written
interactions. This information to be made available to the contract
monitoring team on request.
4.5.7.3 Handling of money The provider must ensure that only minimal
amounts of money is handled e.g. under £50 on behalf of the
Customer. No staff member of associate must have Power of
Attorney (POA)

4.5.8 Customers and Carers must be given written information on
the facilities and services in place in a format that is understandable
and acceptable.
4.5.9 The provider will not offer advice on financial matters. A referral
should be made to the Advocacy Service if no relative is appointee.
5. SERVICE DELIVERY
5.1 All care shall be person-centred and based around appropriate
assessments and a tailored care plan. Care planning should reflect not
only previous needs but those that might arise with increasing age and
progression of the dementia.
5.2 Informal Carers or advocates will be involved in the assessment and
planning process and should have access to all information available to
enable them to make an informed choice about the placement.
5.3 All prospective customers at the point of referral will have a specialist
Mental Health assessment. Where possible, this will be at the person’s
own home and will cover:
• Medication needs
• Mental Capacity Act assessment where appropriate
• Key professionals
• Frequency of reviews
• Cost of package
• Potential care needs
• Family involvement
• End of life Advanced directive where appropriate
5.4The Carer and Customer will be offered the opportunity to prepare the
room allocated to the Customer in a way that will help the Customer to
settle in and feel more at home using familiar and personal items
belonging to the Customer.
5.5The provider may not transfer customers from a private room to a shared
room without first consulting the social work team, Customer, their family
and advocate or broker and getting agreement in written form.

5.6The Customer will have a detailed assessment of their needs within 1
(one) week of taking up service. This will be agreed with Customer and
carer or appointed advocate and will include:
• Goals of the service user based on what they can do not what
they can’t.
• Named key worker and personal contact (family carer or
advocate)
• The Care Plan to include:
Self care capabilities
Nutritional screening
Meaningful opportunities for engagement and activity
Need for aids and adaptations and Assistive Technology
• Timetable for review and who involved
• Where the resident will live
• Management of risk
• End of Life care planning
• Family involvement in care
5.7Implementation of care and services provided should be in accordance
with needs outlined in the care plan. Where the Customer lacks capacity,
a mental capacity advocate should be involved.
5.8Customers should be able to have visitors at any reasonable time and if
informal cares wish to be involved in personal care, this should be
supported and the care plan widened.
5.9Care staff will constantly monitor well and ill-being including pain, distress
and other symptoms to ensure that Customers receive the care they need
5.10 Reviews of care plans should take place at agreed intervals and
services adapted to take account of changing needs and risks. Carers
should be involved where appropriate. These reviews will include
medication reviews to ensure medication is appropriate. At no point will
heavy medication be used without the permission of the family, or if no
family, the relevant advocate.
5.11 All services provided should be in line with accepted best practice and
the provider will keep up to date with development in this area through
active research and attendance of training and events as appropriate.

6. POSITIVE INTERVENTIONS IN CARE PROVISION
6.1 Challenging Behaviour
6.1.1 The Manager and Care Staff must be aware of the contributory
psychological and emotional factors that may initiate or perpetuate
challenging behaviour and as such will:
• provide the Customer and their family/carer/supporter with
appropriate support, advice and encouragement in order to
moderate or rectify any inappropriate or challenging behaviour
• encourage and assist the Customer to communicate and express
their choices and personal preferences and to take advantage of
the opportunities which are available to them
• encourage and support the Customer to remain or be more active
in their own care and therefore less dependant on carers
• seek help with behaviour that is likely to cause risk to others or put
the placement at risk. Referrals should be made to CWPT older
age psychology services for support and intervention
6.1.2 A risk assessment should be completed, and a written Support Plan
will be formulated to manage inappropriate or challenging behaviour,
liaising with other professionals as appropriate. The effectiveness of
this should be measured not only around the reduction of challenging
behaviour but also should include how people are engaged and how
and who they spend their time with.
6.2 Nutrition
6.2.1 The home will encourage a positive mealtime experience for its
Customers. Meals and drinks will be provided in accordance with
preferences identified in the care plan.
6.2.2 Every effort will be made to ensure that a nutritious and balanced diet
is provided through at least 2 (two) sit down hot meals a day.
6.2.3 Appropriate action will be taken to address any risks that may be
present or highlighted in the nutritional screening e.g. ready availability
of finger food and access to drinks throughout the day if appropriate to
the nutritional needs of the Customer, and active monitoring of weight
and hydration.
6.2.4 Positive encouragement to eat and taking action to address any factors
that result in failure to meet nutritional needs such as physical inability
to eat, depression, food presentation or because food is inadequate or
unappetising, isolation/need for company.

7. PRE-ADMISSION AND DISCHARGE
7.1 Referral
7.1.1 Customers will either access the service directly through an agreed
referral process or through a worker charged by Warwickshire County
Council or other partner agency who organise support on a Customer’s
behalf (this may be a broker, Personal Advisor or similar).
7.1.2 Admission to the permanent dementia placement unit will depend on
Customers meeting the criteria for admission to residential care for
older people with dementia. Minimum standards relating to timescales
from referral to actual service delivery will be agreed with the authority
7.1.3 Short stay referrals will be made when the individual requires a short
stay in residential care as a result of an emergency, or to provide
respite to a family Carer or to enable assessment (and this could not
be undertaken in their own home without serious risk to themselves or
others).
7.1.4 For admission to the short stay dementia unit, Customers will have a
diagnosis of dementia and needs that cannot be met in an ordinary
residential care home with trained staff. The individual must not
require the availability of qualified nursing staff on a 24-hour basis.
7.2 Trial period and Discharge
7.2.1The purpose of the Trial Period shall be to ensure that the placement is
satisfactory to all parties in meeting the needs of the Customer.
Following completion of the Trial Period a decision will be made in
conjunction with the Customer either to extend the Trial Period or to
effect a permanent placement. During the Trial Period the Individual
Placement Agreement (IPA) can be terminated on the giving of 1 (one)
week’s notice by any party. The Council may in agreement with the
Provider extend the Trial Period on behalf of the Customer after
consultation with the Customer and their relative/advocate. For short
term, short stay or respite care the Trial Period shall not be applicable.
7.2.2Any referral of a Customer, which is not accepted by the Provider shall
be explained by the Provider to the Council.
7.2.3Any discharge will be part of a planned process (unless it is an
emergency discharge to hospital) and measures will be put in place to
ensure that the needs of the Customer are recognised and planned into
the process.

8. STAFF AND RECRUITMENT
8.1 Management and recruitment
8.1.1 The Provider will demonstrate an efficient and appropriate use of staff
and will seek to ensure that their employment practice and conditions
of service are such that they maximise the retention of experienced
staff and minimise unreasonable turnover of staff
8.1.2 Staffing levels must be such as to provide Customers with individual
attention and enable the delivery of the Customers care plans. At no
time should the staffing levels be allowed to fall below a level that is
necessary to ensure the safety and wellbeing of the Customer.
8.1.3 Staffing levels should be prescribed by the manager and reviewed
weekly and at times when there is a change in the needs of one or
more Customer or other circumstance within the service.
8.1.4 Staff will be required to consistently demonstrate;
• Willingness to listen and skills in all kinds of communication
• Understanding of how to problem solve, be creative, keep
people occupied and be person-centered in the ways in which
they work with individuals who have dementia.
• Highly developed abilities to read non-verbal signals, and to
tune into emotional components of the words and actions of
Customers
• Ability to make sympathetic interpretations
• Special techniques for communicating with those who have little
speech
• Willingness to apply their communication and interpretation
skills to Customers and their relatives
• Skill in avoiding and managing conflict
• Interest in, and ability to complete and research and use, life
histories to support identity
• Knowledge of typical disabilities and experiences of people with
dementia.

8.1.5 Staff will require recognition that dementia care is emotionally
demanding for staff and for managers and support needs should be
recognised and addressed:
• Recognition and appreciation for all positive aspects they bring
to their work
• Ongoing reassurance that holistic care is worthwhile
• Opportunities to reflect and review their ongoing performance
• Opportunities to discuss difficulties encountered during the
course of their work
• Management that is as interested in how they give personal
care as it is in speed and efficiency
• Opportunities to reflect upon their own needs for identity, sense
of control, hope and social confidence
• Leadership that demonstrates person-centred understanding
and skills.
• Peer support for new staff from more experienced dementia
trained staff to support skill development and confidence
building.
8.1.6 The Home will ensure that its’ recruitment policy takes into account all
current legislation, including Equal Opportunity legislation. The policy
will establish the competencies and qualifications of all staff and will
cover (but is not limited to);
• Advertising
• Job Descriptions
• Person Specification
• Application forms
• Interview
• Written References
• Criminal Records Bureau Checks
• Medical Clearance
8.2 Staff training
8.2.1 The Home will have a registered manager qualified to a minimum of
NVQ4 standard or equivalent. The manager will in addition have a
minimum of two years relevant experience of working with people with
moderate to advanced dementia. The Home will have an appropriate
number of care staff, qualified to at least NVQ2 level or equivalent.
Accredited Dementia qualifications will be essential for the manager
and Key Workers. The provider will need to ensure that the dementia
skills and knowledge of all care staff are sufficient to meet the needs of
Customers.

8.2.2 The Provider will keep appropriate records relating to recruitment,
supervision and training
8.2.3 The Home will provide all staff with an induction and training
programme to comply with current regulations covering a probationary
period to ensure all recruited staff have (but are not limited to);
• A good understanding of the needs of people with dementia
• Suitable experience and qualifications
• The appropriate attitude to deliver the required service
8.2.4 The Provider will provide all staff with
• An accredited dementia training programme
• Ongoing dementia specific training relevant to the skills needed
to deliver the service. This will involve all staff, irrespective or
status that may at some point come in contact with Customers,
e.g. cleaners, kitchen staff etc.
• Written information on their employment status
• A job description and the general Social Care Council (GSCC)
Codes of Practice
• Standards, Policies and Procedures including Health and Safety
• Performance appraisal arrangements which might involve
people who use the services
8.2.5 The Care Home will ensure that management supervision is provided
to all staff on at least a quarterly basis. The aim of supervision is to
promote the highest standards of care and the provider will ensure that
written arrangements exist and records kept relating to the
management and support for all staff and subsequent good practices
achieved.
8.2.6 The use of volunteers should be positively encouraged and they
should be trained in both working with individuals with dementia,
communication and support with eating where appropriate and
encouraging interaction and social participation of Customers.
9. EQUIPMENT, FACILITIES AND ENVIRONMENT
9.1The provider will ensure that a robust approach to cleaning is in operation
at the home, which facilitates a safe and clean environment. Providers
should deliver the service in-line with the DH publication of infection in
Residential and Nursing Homes 2006

9.2The Home will provide all equipment necessary to support a Customer,
including hoists and other specialist equipment within the contracted price
for the service.
9.3The Provider must ensure that any transitional and permanent beds are in
two discreet units, which are in areas separate from other service
provision.
9.4 The Home shall have designated areas for eating, social activities and
private areas and every effort should be made to identify and delineate
these areas, using signage, and appropriate use of furniture so that
Customers and staff can easily find their way around.
9.5 Entrances to social areas should be well lit and welcoming. The
development of materials and objects as cues for following or ‘sensing’ a
route is recommended.
9.6 As and where possible, the Home should adapt the interior design to meet
the needs of people who have dementia. For example:
• Creation of a therapeutic ambience
• Avoidance of contrasting patterns in flooring and walls
• Level flooring, avoiding contrasting interface between 2 rooms
• Minimal use of reflective surfaces, recognising the potential effects that
reflective surfaces and mirrors may have on some service users
• High contrast in toilet seat and doors to aid recognition and orientation
• Appropriate use of ‘cues’ and stimulus to help orientate people such as
pictures, lighting and shelf displays
10. CONTRACT MONITORING
10.1 Care homes to make available at request a copy information relating to
CQC assessment.
10.2 An annual questionnaire relating to the capacity of each provider
should also be completed by the provider and returned to the contract
monitoring team as requested to enable county wide mapping of
provider capacity
Current best practice/Legislation/Initiatives
In addition to the legislation, strategies and current initiatives identified in
this specification and contract also apply:
• NHS & Community Care Act 1990
• Mental Health Act 1983, Mental Capacity Act 2005
• Deprivation of Liberty Safeguards 2008
• Transforming the Quality of Dementia Care DoH 2008

• Care Standards Act 2000
• Safeguarding Adults CSCI Regulations
• National Dementia Strategy
• Equality and Diversity legislation and policies
Monitoring for Dementia Care for Residential Homes (Draft)
Section 1: About the Care Home
We need you to give us the details of your home, its capacity and registration
to CQC.
Name of Home:
Name of Home Manager:
Name of Contract Monitoring Officer:
Date of visit:
1. THE HOME
1a. Are you the Registered Manager with CQC?
If no what is the Name of the Registered Manager:
1b.Has the Fit Person Interview taken place?
?
1c. Name of Deputy Manager:
1d. CQC Registration Category:
 With nursing  Learning disability
 Dementia (EMI)  Old age only
 Mental Health  Physical disability

1e. Date of last CQC Inspection Report:
1f. Confirmation of Rating

1g. What areas of improvement have been identified since the last CQC
inspection report and what has been done to address these?
1h. Number of beds:
Double En suite Single En suite Twin En suite
     

Section 2: Framework to monitor quality and outcomes
Key area Indicator Possible sources of
evidence
Comments
Staff awareness?
Evidence of
outcomes
Management
framework
Good leadership
and defined
dementia pathway
Named person
to lead on
dementia
strategy in
place
Strategy and pathway
Policy and procedures
Dementia
Champion to
monitor and
improve
practice
Training attended
Training cascaded
Improvement Measures
put in place
Training
schedule in
place and
adhered to
Provider records
Communication Information
available
about: service
policies in
place
other key
services
Provider records
Policies
Customer records
Observation and
questioning
Questionnaire to carers
Awareness of
key reporting
requirements
Provider records
Policies
Customer records
Observation and
questioning

Involvement of
family/carer in
assessment and
care
Family/carer
have
continued
involvement
and can
support
customer:
Customer records
Observation
Policies
Questionnaire to carer
Carers have
been informed
of any
significant
changes
Customer records
Carers feel the
service has
contributed to
them feeling
less anxious
about the
health and
wellbeing of
their family
member
Self-
assessment/assisted
assessment via
discussion
Safeguarding Safeguarding
issues are
recognised by
staff and policy
in place
Provider records
Training records
questioning
Training
Capacity
assessments
in assessment
and review
Customer records
Awareness of
role of IMCA
and how and
when to
contact
Provider records
Training records
Policies
Awareness of
DOLS
Provider records
Training records
Policies
Complaints
policy in place
and
understood by
staff,
customers and
carers:
Provider records
Policy/.
Complaints log
training
leaflet
questionnaire to carer

Independence
outcomes
Care planning
that focuses
on retaining
independence
based on the
abilities of
customer
ADL assessments
Discussions with
carers/supporters
Recording of
improvement,
maintenance
or deterioration
in ability to self
care,
undertake
daily living
functions,
mobility etc
ADL assessments
Discussions with carer
Staff aware of
abilities and
interests of
individual
customers
Questioning
Observation
Interaction with
service user
time spent with
each individual
daily
Customer records
Person centred record
Range of
activities
Customer
/Carer
consultation
Links with
range of
activity
providers who
visit home or
are visited by
customer
Provider records
Questioning
Observation
Customers
appear secure
and
undertaking
tasks,
activities,
personal
interaction
Questioning
Observation

Health outcomes Physical and
mental health
is recorded
and reviewed
on regular
basis to
include health
screening and
dental checks
Customer records
Anti psychotic
drug
prescriptions
are noted and
reviewed 6
weekly
Customer records
Medicine records
Good quality of
nursing care to
ensure health
of patient and
prevent
deterioration
for example,
wound care ,
catertirasion,
pressure
sores, food
intake.
Customer records
Carer discussions
No of infections
Level 4 or 5 sacral
wounds
Customer is
supported to stay
healthier and
recover quicker.
Reduce likelihood
of admission to
hospital or long
term nursing care
Links with
General
Practitioner,
CMHT or allied
health
professional
who can
respond to
emerging
customer
needs
Provider records
Customer records
Questioning
Facilitate timely
discharge
Links with
hospital liaison
as necessary
to respond to
emerging
needs to
include pre
admission and
discharge
planning
Provider records
Discussion
View of plans

End of Life care Good
management
of pain and
distress
Provider records:
Numbers of Advanced
care plan or advance
directives
Number of support
services available
Customer records:
Person is registered by
General Practitioner as
Palliative Care patient-
Palliative care reviews
where appropriate
Meeting
cultural,
spiritual and
religious needs
Provider records;
Number of cultural or
faith based support
services available
Customer records:
No of customers linked
to their preferred cultural
or religious service
Environment
Layout and
ambience of
home
Designated
areas for
eating, social
activities with
appropriate
cues and
stimulus to
help people
sense a route
and recognise
where they are
Things to look for
include:
Appropriate use of
furniture
Well lit doorways
Doors contrasting colour
with walls
Use of signs
Pictures and shelf
displays convey purpose
of room
ambience Rooms should be:
Warm and welcoming
Neutral colour of walls
and flooring

Not too noisy or crowded
Choice of private or
group area
Appropriate décor
and signage
Avoidance of contrasting
patterns in flooring and
walls
Level flooring, avoiding
contrasting interface
between 2 rooms
Minimal use of reflective
surfaces and mirrors
High contrast in toilet
seat and doors to aid
recognition and
orientation
Appropriate signage on
front doors of customers
to enable easy
identification of their own
room

Service Specification for Specialist Residential - Care

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