Spot Check form

• Site conducted

  Select

• Conducted on:

  Date

• Prepared by:

• Langdon Member name:

• Consider each risk factor, and list the interval period suggested by that factor in the right hand column. Below you will select the minimum period as the actual interval between spot checks

• Potential issues with the environment within which the Langdon Member lives, including isolation:

• Any other factors relevant to the individual Langdon Member’s service, including temporary factors:

Record Checks

Time and attendance records:

• Did the staff turn up on time?

  Yes

  No

  N/A

Care Plans/task lists:

• Is a current care plan in place?

  Yes

  No

  N/A

• Is the care plan person centred and reflects the members needs and wishes?

  Yes

  No

  N/A

• Are the records stored securely?

  Yes

  No

  N/A

Medication records:

• Is there a Medication Record in place?

  Yes

  No

  N/A

• If medication is being administered by the member of staff, does the person follow the medication policy and ensure that the Langdon Member receives the right medication at the right time?

  Yes

  No

  N/A

• Is the MAR sheet clear and concise?

  Date

• MAR sheets completed satisfactorily?

  Yes

  No

  N/A

• Stock of medications matched records?

  Yes

  No

  N/A

Observations

• Does the member of staff include the member in all aspects of the daily tasks?

  Yes

  No

  N/A

• Does the member of staff use the Langdon Member's preferred name?

  Yes

  No

  N/A

• Does the member of staff consistently work in a person centred way?

  Yes

  No

  N/A

• Does the member of staff consider capacity issues and always act in the Langdon Member's best interests?

  Yes

  No

  N/A

Member of Staff:

• Is the member of staff clean, presentable and polite?

  Yes

  No

  N/A

• Is the member of staff wearing an ID badge?

  Yes

  No

  N/A

Langdon Member Interview:

• Are you aware of the existence of the Care Plan/task list?

  Yes

  No

  N/A

• Are you aware of the content of the Care Plan/task list?

  Yes

  No

  N/A

• Have there been any no-shows? Investigate and quantify if “Yes”

  Yes

  No

  N/A

• Are there any concerns with staff time keeping?

  Yes

  No

  N/A

• Is the duration of the visits as specified in the Care Plans/task lists being delivered? Investigate and quantify if “No”

  Yes

  No

  N/A

Note: if Langdon Member questions visit attendance time or duration, attempt to identify some individual samples where independent evidence is available, and particularly note any discrepancies between evidenced time and duration and the signed records

• Are you generally satisfied with the service as it is currently delivered?

  Yes

  No

  N/A

• Are you generally happy with the staff allocated to you? If not, ask for reasons

  Yes

  No

  N/A

• Do the staff preserve your privacy and dignity, and treat you with respect?

  Yes

  No

  N/A

• Do the staff refer to you by your preferred name, as recorded in your Care Plan/task list?

• Do the staff handle any of your money? If “Yes”, are you happy with the arrangement? If you have concerns about the arrangements, what are they?

  Yes

  No

  N/A

• Have you given the staff any presents, or have they solicited any, or bought anything from you?

  Yes

  No

  N/A

• Do you have any problems which you would like to discuss with me apart from the ones we have discussed already?

  Yes

  No

  N/A

• Any other matters: