Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Location

Belvedere Care Homes

New Residents / Re-admissions

  • WCR1-1<br>Have all risk assessments been completed, and 72-hour documentation audit has addressed any gaps in support plan for any new residents or re-admissions?

  • WCR1-2<br>Have new residents or re-admissions had all medications prescribed and is it now in stock?

  • WCR1-3<br>Have all required referrals been made and any registrations with the GP been completed?

  • WCR1-4<br>Are we meeting the needs of new residents and re-admissions? (e.g. is all required equipment in place, have staff completed any specialist training / skills update)

  • WCR1-5<br>Have we received each new admissions discharge letter and has the support plan been updated with any changed needs?

Tissue Viability

  • WCR2-1<br>Have any newly identified wounds been incident reported and identified in current skin plan with additional short term plan for evaluation and actions needed?

  • WCR2-2<br>Have you reviewed all wound events and can confirm all appropriate action (e.g. 7-day review, weekly photograph ''WOUND WEDNESDAY') has been completed?

  • WCR2-3<br>Have all appropriate TVN / DN / GP referrals been made, followed up and are evidenced via support plan and health professionals log?

  • WCR2-4<br>Are positional change charts in place and completed accurately to reflect the management plan?

  • WCR2-5<br>Have all wounds with signs of infection been swabbed and referred to the GP?

  • WCR2-6<br>Does the home have a sufficient supply of all dressings for all wounds?


  • WCR3-1<br>Have all accidents / incidents this week been reported and entered onto incident log?

  • WCR3-2<br>Have these been reviewed by management for any trends, such as unexplained bruising, which require further investigation been investigated?

  • WCR3-3<br>Have all safeguarding referrals been made in a timely manner (within 24 hours)?

  • WCR3-4<br>Have all CQC notifications been made in a timely manner (within 24 hours)?

  • WCR3-5<br>Have families, where appropriate, been informed of all incidents?

  • WCR3-6<br>Have all relevant support plans been updated to reflect newly identified risks such as changes in mobility / swallowing / behaviour?

  • WCR3-7<br>Are current restrictions in place still the least restrictive option (i.e. sensor alarms)?

  • WCR3-8<br>If we have doubts about a resident's capacity around a newly implemented intervention has a mental capacity assessment (MCA) been completed? If applicable is a best interest decision in place?

  • WCR3-9<br>Have all falls in the last week been reported, falls risk assessments updated, falls diary completed and where appropriate referral to Falls Clinic made and followed up?

  • WCR3-10<br>Has post-fall monitoring and top-to-toe assessments been completed and placed in grab files for all falls?

  • WCR3-11<br>Have any other concerns been positively addressed? (e.g. staffing levels, skill mix of staff)

  • WCR3-12 Have daily log entries been reviewed for high clinical risk residents identified and any incidents identified that may need escalation?

Nutrition and Hydration, Swallowing / Choking / Aspiration

  • WCR4-1<br>Have any incidents of choking, swallowing difficulties, coughing on eating and drinking etc been followed up? (Review notes and support plans / SLT referrals)

  • WCR4-2<br>Have the weekly and / or monthly weights tracker been reviewed this week for losses or gains and appropriate support plans are in place to manage?

  • WCR4-3<br>Has the chef been informed, and is involved with residents requiring additional nutritional support and / or texture modified diets?

  • WCR4-4<br>Has log my care been checked for fluid totals for people at risk, with interventions and outcomes documented?

  • WCR4-5<br>Have referrals been made, and follow up to the Dietician / GP / SLT when a concern has been identified?

  • WCR4-6<br>Have all changes to prescribed texture of food or fluids been clearly documented and shared with the chef and all staff?

  • WCR4-7<br>Have Thickened Fluids been fully and accurately completed evidencing safe administration and hydration needs being met?

Positive Behaviour Support

  • WCR5-1<br>Have any new, or changes in, behaviour been seen this week, and if so have triggers been identified and person-centred strategies developed to support the resident and staff?

  • WCR5-2<br>If a resident has displayed new or changed behaviour this week and they are prescribed medication for their stress and distress has the PRN / as required medication protocol been update to relfect the changes? (e.g. behaviour is clearly described, there is no judgemental language used such as aggressive / abusive, assessment of triggers, linked to emotional well-being plan)

  • WCR5-3<br>Have underlying causes such as pain / infection / delirium / loss / change in environment been assessed and managed?

  • WCR5-4<br>Has all peer on peer incidents been reported internally and externally as appropriate?

  • WCR5-5<br>Have referrals been made and followed up to GP / CPN / Social workers etc?

  • WCR5-6<br>Have family / advocates / POA been notified and involved as appropriate?

  • WCR5-7<br>Have medication reviews been requested for any residents who have displayed changes in behaviour?

  • WCR5-8<br>Have all PRN / as required medications used to support residents who are displaying signs of stress or distress been reviewed within the last 3 months and evidenced in support plan?

  • WCR5-9<br>Are the resident / peer group and staff safe? (e.g. risk of injury to staff or residents, self-harm)

Medical Conditions that Impact on Care

  • WCR6-1<br>If a resident has experienced unstable blood glucose levels this week, is this being well-managed? (e.g. advice been sought from GP / Diabetic Nurse, review invidual diabetes management plan to check it is updated)

  • WCR6-2<br>For any residents who have deteriorated or you are concerned for their welfare, has relevant medical intervention been sought and appropriate measures put in place to meet their needs? (e.g. support plan thoroughly captures new support needs and these are communicated clearly to the team, all relevant referrals made and followed-up)

  • WCR6-3<br>Have all new infections this week been incident reported on LOG MY CARE with Infection weekly tracker updated?

  • WCR6-4<br>For all new infections this week, have short term generic assessments been implemented into health and medication support plans and are they being monitored?

  • WCR6-7<br>For any residents who have been newly assessed as End of Life in the last week, have relevant actions been taken? (e.g. support plan around end of life wishes which respects the wishes of the resident and / or family, end of life medication (if appropriate), GP review, DN referral, documentation updated, DNACPR in place, statement of intent)


  • WCR7-1<br>Have any issues with prescribing or delivery of medication been resolved? (particular focus on issues which have potential to impact resident care)

  • WCR7-2<br>Have all medication errors been incident reported, investigated and action taken to ensure resident safety?

  • WCR7-3<br>If there have been any concerns that a resident(s) have been negatively affected by side effect / risk factors with medication (e.g. bleeding / over-sedation / mobility concerns), has appropriate action been taken? (e.g. GP / Pharmacy input sought, support plans reviewed)

  • WCR7-4<br>Identify any residents who have been refusing medication. Has appropriate action been taken to support them? (e.g. GP review, support plan review, capacity assessments, refer to covert medication procedure)

  • WCR7-5<br>For any resident who has commenced on a covert medication pathway in the last week, is all relevant documentation completed? (e.g. GP and pharmacy involvement, MCA / best interest decision, clear instructions from prescriber on how to adminster each covert medication safely)

Shared Learning

  • WRC8-1 LESSONS LEARNT: Following review of incidents or any investigations completed, are there any lessons learnt. If so, have these been cascaded to the team and how?

  • WRC8-2<br>Is there evidence that any alerts (e.g. MHRA) or shared learning has been cascaded to the team?

  • WRC8-3 Has the call bell been checked randomly. Please identify location and how long. Are there any issues to report?

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.