# Health and social care, Level 4: assuring practice

*The shift from doing the work to being answerable for how others do it.*

## Production summary

- Modules to record: 2
- Total script: 861 words, about 6 minutes of finished audio
- Voices: Amara (host) and Nadia (practice educator)
- Level: Level 4, deputy managers and team managers

## Accreditation wording that must appear in the description

- **The CPD Certification Service** (planned): Application scheduled.
- **Skills for Care knowledge sets and the Care Certificate standards** (aligned): Mapped by us to published Skills for Care material. This is our own mapping and implies no endorsement or assurance by Skills for Care.

> Do not upgrade any of these words in a description or a thumbnail. Aligned is not accredited, and planned is not approved.


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## Supervision, audit and addressing underperformance

**Runtime** about 3 minutes. **Words** 409. **Starts at** 00:00 in the full course recording.

### Learning outcomes to state on camera

- Structure supervision so concerns surface early
- Build an audit that tests care rather than records
- Address a performance concern proportionately and early
- Identify the early signs of a closed or drifting culture

### Script


`[CUE 1]` *Supervision agenda that opens with concerns rather than tasks.*

**AMARA**  [00:00]
I do supervision every eight weeks, I complete the form, it is filed. Tick.

**NADIA**  [00:05]
Is anything different afterwards? If nothing changes as a result, you have spent an hour producing evidence that a meeting happened.

**AMARA**  [00:14]
What should it produce?

**NADIA**  [00:15]
Information you did not have. Start with who they are worried about and what they have raised that nobody has acted on. Then stop talking. The honest answer usually arrives after an uncomfortable pause, and most managers fill that pause.


`[CUE 2]` *Triangulation diagram: the chart, the jug, the person, the stock.*

**AMARA**  [00:31]
And if I need to raise a performance issue?

**NADIA**  [00:35]
Keep it out of supervision where you reasonably can. The moment supervision becomes where people get told off, they stop bringing you anything, and you have traded your best early warning system for a filed form.

**AMARA**  [00:49]
Audits next. Ours come back green almost every month.

**NADIA**  [00:53]
That worries me rather than reassures me. Green every month usually means you are auditing whether paperwork exists.


`[CUE 3]` *Permanently green audit flagged as a finding in itself.*

**AMARA**  [01:00]
The paperwork is the evidence.

**NADIA**  [01:02]
The paperwork is evidence that somebody wrote something. Take the fluid chart that says drinks were offered hourly, then go and look at the jug. The jug does not know it is being audited.

**AMARA**  [01:16]
That feels like distrusting my staff.

**NADIA**  [01:18]
It is not about individuals. Every service under pressure records things that did not quite happen as written, usually with no bad intent. Triangulating is how you find out where the pressure is before somebody is harmed by it.


`[CUE 4]` *Four routes for underperformance: capability, training, health, conduct.*

**AMARA**  [01:34]
You said perfect records are a warning sign. That seems backwards.

**NADIA**  [01:38]
Real care is messy. Charts have gaps because somebody was called away. When every record is complete, uniform and always on time, ask who is completing them and when. Immaculate paperwork is a documented feature of services that were later found to be seriously failing.

**AMARA**  [01:56]
A manager has watched someone's practice slip for six months and said nothing. Now it is formal.

**NADIA**  [02:03]
Then the delay is part of the problem. Six months of silence arriving at once is unfair to the individual and procedurally weak for the organisation.


`[CUE 5]` *Drift indicators: silence, agency use, repeated names, hardened language.*

**AMARA**  [02:13]
What is the recovery from there?

**NADIA**  [02:16]
Start now, specifically, informally, and record that you did. Then establish which of four things it is: capability, a training gap, health, or conduct. They have entirely different routes.

**AMARA**  [02:27]
And choosing wrongly between them?

**NADIA**  [02:29]
Is how organisations end up at a tribunal explaining why they treated a health problem as misconduct. And anything that is a safeguarding concern leaves this process altogether and goes down the safeguarding route, immediately.

### Sources for the on screen credit

- Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, legislation.gov.uk
- Closed cultures: guidance for inspectors, Care Quality Commission
- Effective supervision in adult social care, Skills for Care
- Acas code of practice on disciplinary and grievance procedures, Acas

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## Safe staffing, fact finding investigations and evidencing quality

**Runtime** about 3 minutes. **Words** 452. **Starts at** 02:43 in the full course recording.

### Learning outcomes to state on camera

- Build a rota that reflects dependency rather than habit
- Carry out a fair fact finding investigation
- Assemble evidence that answers a regulator's question
- Handle a complaint through to a defensible response

### Script


`[CUE 1]` *Rota copied forward for five years against rising dependency.*

**AMARA**  [02:43]
Our rota has been the same for years and it works.

**NADIA**  [02:48]
It worked for the people who were living there when it was set. Are they the same people? Dependency rises quietly. The rota does not notice, because nobody rebuilt it, they just kept copying it forward.

**AMARA**  [03:02]
So how do I justify a number?

**NADIA**  [03:05]
By writing down how you reached it. Dependency, layout, skill mix. Regulation 18 asks for sufficient numbers of suitably qualified, competent, skilled and experienced staff, and people read the first word and skip the rest.


`[CUE 2]` *Regulation 18 with suitably qualified and competent emphasised beside the number.*

**AMARA**  [03:19]
Meaning five is not always five.

**NADIA**  [03:21]
Five where four are agency who have never met anybody is a different service from five who know every resident, and the rota shows both as five. That difference is where night time incidents come from.

**AMARA**  [03:36]
Investigations. I witnessed the incident myself, so I know what happened. Can I not just investigate it?

**NADIA**  [03:42]
No, and that is one of the clearest procedural defects there is. You are a witness. A witness cannot fairly weigh their own evidence, and anything you conclude will be set aside on appeal.


`[CUE 3]` *Investigation roles separated: witness, fact finder, decision maker.*

**AMARA**  [03:56]
What else gets services into trouble?

**NADIA**  [03:58]
The same person finding the facts and making the decision. It feels efficient in a small service and it loses more cases than anything else. Separate them, even if the second person is your own manager.

**AMARA**  [04:13]
And I interview the person complained about when?

**NADIA**  [04:16]
Before you have formed a view, not after. If you interview them last, having already decided, they will know, and so will anybody reading it afterwards.


`[CUE 4]` *Three evidence layers: intent, reality, response.*

**AMARA**  [04:26]
Evidence. We have folders for everything.

**NADIA**  [04:29]
Folders prove a policy exists. Nobody is asking whether you have a falls policy. They are asking whether people fall, when, and what you did about it.

**AMARA**  [04:40]
So what should I be holding?

**NADIA**  [04:42]
Three layers for each area. What you intend, which is the policy. What actually happened, which is data and observation. And what you did when it did not, with dates and outcomes.


`[CUE 5]` *Complaint response answering each point in the complainant's own terms.*

**AMARA**  [04:55]
The third one feels like handing over a list of our failures.

**NADIA**  [05:00]
It is the only one that persuades anybody. A service that found its own problem and fixed it is demonstrably working. A service with no problems on record is not believed by any inspector who has ever worked in one.

**AMARA**  [05:16]
Last thing. Complaint responses. Ours are polite and they still come back.

**NADIA**  [05:20]
Then they are probably answering a different question from the one asked. Take each point separately, in her words, and say plainly where she is right. People will accept a great deal if they can see they were heard. What they will not accept is a letter that defends an organisation to somebody who was talking about their mother.

### Sources for the on screen credit

- Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, regulation 18, legislation.gov.uk
- Acas guide to conducting workplace investigations, Acas
- Safe staffing guidance for care homes, National Institute for Health and Care Excellence
- Complaints handling and remedies guidance, Local Government and Social Care Ombudsman

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