Regulating in Care Homes Oral Care as Part of the Overall Health Improvement Agenda Margaret Hughes Inspector

Who we are Scotland’s independent scrutiny and improvement body for care, social work and child protection services was set up under the ‘Public Services Reform (Scotland) Act 2010’ carries out the functions by the former Care Commission, HMIE child protection team and Social Work Inspection Agency (SWIA).

What we do We regulate and inspect to improve the quality of care, social work and child protection services in Scotland. This includes: around 15,000 care services social work and child protection services within Scotland’s 32 local authorities.

Legislation Public Services Reform (Scotland) Act 2010 Scottish Statutory Instrument 210/2011 Welfare of users 4 (1) (a) A provider must make proper provision for the health, welfare and safety of service users;

Strategic objectives (CORPORATE PLAN 2014–18) To provide assurance and build confidence through robust regulation and inspection of the quality of care To contribute to building a rights based, world class care system in Scotland To support peoples understanding of high quality, safe and compassionate care by promoting the standards and quality of service they should expect and make sure their voices are heard To build capacity within care services to make sure there is high quality development and improvement of rights based care across Scotland To support and inform local and national policy development by providing high quality, evidence based advice and information on care To perform effectively and efficiently as an independent scrutiny and improvement body and work in partnership with others

Standard 5 – Management and staffing You are confident that all the staff use methods that reflect up-to-date knowledge and best-practice guidance, and that the management are continuously striving to improve practice.

Standard 13 – Eating well Staff will regularly review anything that may affect your ability to eat or drink, such as your dental health. They will arrange for you to get advice.

Standard 14 - Keeping well - healthcare You are confident that the staff know your healthcare needs and arrange to meet them in a way that suits you best.

Inspection Process

Quality Themes 1.Quality of Care and Support 2.Quality of Environment 3.Quality of Staffing 4.Quality of Leadership & Management

Health nutrition hydration medication pain Skin Integrity 1.3 Health & Wellbeing Sleep Oral health

What do we want to see?? Assessment Detailed plan of care –Person centred –Based on best practice –Linked to other plans of care Records of care being delivered Records of professional input Records of family input Reviews

Outcomes for Service Users Comfortable and pain free mouth Ability to eat and drink Ability to talk and be understood Positive self esteem Feeling like yourself

What we find ……….. Most services have heard about Caring for Smiles Most services have assessments for oral care needs Most people have recording documentation for oral care Some staff have attended oral health training Some service have oral care champions Some service users have positive outcomes Some ………….. Don’t

Case Example Intelligence from unhappy relative about poor oral care On arrival Met service user with ill fitting dentures Personal plan documentation – no oral health assessment Personal plan – basic, refers to “cleaning teeth” in personal care plan Recordings showed occasional teeth cleaning Discussion relative – Service user had missing denture Discussion with staff – relative arranging dental appointment Service user had history of weight loss Was on a soft diet – but given pureed food No SALT/ Dietetic or Dental contacts noted for extended period

Admission to care home – falls history - weight loss Oral health assessment as part of holistic assessment on admission Family were unclear of oral status Care team unsure – denture, teeth removed Dental referral Service user un cooperative with oral examination Persistent in attempts for full dental assessment Required a partial dental plate Ability to eat and drink improved Weight gained Overall wellbeing (physical and mental) improved However ……….

Grading 6 - Excellent 5 – Very Good 4 - Good 3 - Adequate 2 - Weak 1 - Inadequate

The Big Questions….??? How do we improve oral care for people using care service? Who’s responsible for this?

Everyone Everyone

Our Responsibility as a Regulator Service Users Provider - Staff - Best practice - Quality assurance

Information on the Care Inspectorate can be found at