SCOPE OF THIS CHAPTER
This chapter outlines policy for the auditing and quality assurance of children's case records stored within the CareFirst Integrated Children's System (ICS). ICS is a business process and data storage system designed to support and record the key tasks of assessment, planning, intervention and review.
Contact and work with children, young people and families referred for social care services will be recorded within CareFirst. The auditing and quality assurance policy and procedures are designed to ensure that case records are accurate, up-to-date and reflect practices likely to result in the best possible outcomes for children, young people and families.
This chapter is relevant to all staff involved in recording the details of children's social care service users and the work undertaken with them. The chapter is of particular relevance to staff involved in the management and review of social care interventions, and to those staff responsible for the management and maintenance of case records, whether in the course of case supervision or while undertaking audits.
Retention and Destruction of Records Procedure
- References – Legal, Central Government and other External Documents
- References – Salford Children’s Services
- Authority to Sign Off or Vary the Policy
- Outline of the Audit Process
- Outline of Audit Practice
- Responsibilities of Auditors
- Remedial Actions
- Post-audit Compliance
The purpose of audit is to promote case recording that supports effective social work practice. Effective social work leads to beneficial outcomes for children; the audit policy is to examine, question and test all aspects of case recording that are relevant to the achievement of beneficial outcomes. The results of case record auditing are shared with managers and practitioners, so as to modify or improve individual case records and to develop optimal social work practice. The aggregation of audit results is also used to estimate the characteristics of the whole social care case record population, to provide an indication of the state and potential for improvement in overall service performance.
2. References to Legal, Central Government and Other External Documents
Adoption Act 1976
Adoption Agency Regulations 2005
Care Planning, Placement and CAse Review (England) Regulations 2011
Children Act 1989
Children Act 2004
Children's Homes Regulations 2011
National Minimum Standards for Adoption 2011
National Minimum Standards for Children's Homes 2011
National Minimum Standards for Fostering Services 2011
National Minimum Standards for Residential Special Schools DoH 2002
The boarding-out of Children (Foster Placement) Regulations 1988
3. References to Salford Children's Services
Child Protection & Safeguarding Policy and Procedures (June 2009)
LAC Policy and Procedures
Salford Children's Services Procedures Manual (draft 2010)
4. Authority to Sign Off or Vary the Policy
Assistant Director, Specialist Services. Proposals for the variation in audit policy can also be brought through the monthly Specialist Services Performance Management Meeting (PMM), chaired by the Assistant Director, Specialist Services.
Case record auditing is a process for ensuring and improving service quality through the systematic examination of case records. During an audit a case record is evaluated against set criteria and an assessment is made about completeness, quality and the need for remedial action. The purpose of case file auditing is to improve outcomes for children, by promoting excellent social work and case management practices. Case file auditing is not an inspection or an interrogation and it should, ideally, be undertaken with the consent, understanding and support of all the social care staff with responsibility for a particular case.
The audit process is subject to continuous review. The form, focus and volume of case record auditing has developed in response to the Safeguarding Improvement Plan first adopted in 2010. There are now two complementary approaches to case record auditing: whole case record audits, in which a randomly selected sample of cases are examined each month, and 'thematic' auditing, in which all case records of a particular type are examined as at a fixed date or over a longer time period to determine changes over time.
6. Outline of the Audit Process
Within the independent Safeguarding and Quality Assurance Unit there exists a Quality Assurance and Audit Team, comprised of a Service Manager, four Quality Assurance Officers and an Administrator. Responsibility for the audit process rests with the Service Manager, with accountability through the Head of Safeguarding to the Strategic Director, Children's Services, and to the Assistant Director, Specialist Services.
Audits are undertaken by Quality Assurance Officers and by members of the 'audit pool'. The audit pool is comprised of Directors, Heads of Service, managers and specialists within children's social care, all of whom will be allocated and will complete one case record audit in each calendar month. The Quality Assurance Officers also review a random sample of audits undertaken by each other and by members of the audit pool, so as to achieve an acceptable level of consistency, particularly in the judgements made about case record quality.
The Service Manager reports each month to the Assistant Director, Specialist Services, through PMM. During the period covered by the Safeguarding Improvement Plan reports are also prepared for each meeting of the Safeguarding Improvement Board. Where the results and findings of the audit process have a bearing on individual or general social work practice, recommendations or requirements for practice improvement are communicated to the social care workforce through Practice Managers, for matters particular to specific cases, or through Service Managers and PMM on matters of policy.
7. Outline of Audit Practice
Whole case record audits are based on a sample of all cases open within CareFirst on a specific date, usually the 10th of each month. The five service areas considered are: Looked after Children (LAC), Child Protection & Planning/Children in Need (CP&P/CIN), Referral and Initial Assessment (RIAT), Children with Disabilities (CWD) and Next Step. Case records for Locality Teams and Fostering and Adoption are stored in other systems and are covered by other audit policies and procedures.
On or around the 10th of each month a list of the case file population (i.e. all cases open In LAC, CP&P/CIN, RIAT, CWD and Next Step) is provided to the Quality Assurance Team Administrator by the Social Care Research Analyst. The case file population is stratified and sampled as set out in the Quality Assurance Team sampling guide. The size of the sample is determined by the estimated number of available auditors in the relevant audit period/month, based on the assumption that each 'pool' auditor will complete one audit and that each Quality Assurance Officer will complete up to 20 audits, in addition to supporting and quality assuring the work of the audit pool.
Each audit follows a pattern prescribed by an audit form and processes embedded within CareFirst. Quality Assurance Officers and audit pool members are trained to access and complete the form as they might any other online assessment document.
See e-learning audit training module and guidance. (Click ICT and systems button on the 'Welcome to e-tutor' page)
At the beginning of each audit period the Quality Assurance Team Administrator notifies Quality Assurance Officers and audit pool members that they have been assigned an audit. An 'activity' is simultaneously created on their CareFirst clipboard, notifying them of the case record that has been selected for audit. The audit should be completed within 20 working days. On completion of the audit the auditor authorises it, which creates a follow-on 'activity' on the Quality Assurance Team clipboard. One of two possibilities follow: either the audit is passed for quality assurance, based on prior selection by random sampling, or it is assigned to the clipboard of the Practice Manager in whose team the case is being supervised. Where remedial actions are required the Practice Manager has 25 working days in which to authorise them as completed.
8. Responsibilities of Auditors
Auditors have a critical place in Salford's programme for achieving service excellence, as the Council relies on the accumulation of auditor judgements to assess standards, to highlight good practice and to identify areas for improvement. Achieving these outcomes depends on auditors being consistent in completing audits within timescale, in exercising good judgment and in framing clear recommendations for remedial action to case records, where necessary.
Auditors have 20 days in which to complete their audits within CareFirst. The Quality Assurance Team's reporting timetable means that delays in audit completion reduce the case record data for analysis and with it the reliability of service standard estimates. Where auditors are assigned an audit that they cannot complete within 20 days, for example because of annual leave commitments, it is the auditor's responsibility to request a deferment or dispensation. The expectation is that all Directors, Heads of Service, managers and specialists will be members of the audit pool and will complete one audit in each audit period; any actual or anticipated difficulty in doing so should be notified to the Service Manager, Quality Assurance.
Auditors are expected to judge case records fully, fairly and critically; completing all the required sections of the audit form within CareFirst and detailing clearly the merits and deficits evident in the case record.
Case record auditing relies on the exercise of judgment. Without measures to promote consistency between auditors, as well as by individual auditors in their completion of successive audits, judgements might vary widely. The Quality Assurance Team periodically undertakes an inter-rater reliability exercise, based on all Quality Assurance Officers completing an audit on the same case record. Variations between officers are discussed, so as to arrive at a common understanding on all significant criteria. The reliability of audit pool members' judgements is measured and tested through the quality assurance process, in which Quality Assurance Team members review each month a random sample of completed audits. Audit pool members are encouraged to work closely with the Quality Assurance Team; audit pool members frequently consult Quality Assurance Officers in the course of completing their audits.
10. Remedial Actions
It is particularly important that auditors should evidence their judgements and that they state clearly whether remedial actions are required. Where there is any suggestion of practices or omissions relevant to child safety, the auditor must immediately notify the Service Manager, Quality Assurance or, in their absence, the Head of Safeguarding, either of whom will discuss the circumstances and will decide with the auditor how and by whom the issue(s) will be raised with the relevant Practice Manager. In the event of the Practice Manager not being available the issue(s) will be raised with the responsible Service Manager or, in their absence, the relevant Head of Service.
Regardless of when any case file omissions or errors identified in the audit process occurred, responsibility for completing achievable remedial actions will rest with the current Practice Manager and allocated social worker.
From the creation of a remedial action 'activity' within CareFirst the Practice Manager has 25 working days to effect remediation. Although the nature of the required remedial action might necessitate work by the allocated social worker, the responsibility for compliance remains with the Practice Manager, who should sign off the action(s) as completed within 25 days.
Some necessary remedial actions are not achievable, where these would require information from managers and social workers who are no longer employed in the authority. In these and similar circumstances the policy is that where remedial actions cannot reasonably be completed for lack of information, Practice Managers should provide an explanation using the CareFirst 'Management Decision' facility within Observations. Such Management Decisions should be authorised by a Service Manager before the audit remedial action activity is completed and the audit form is authorised by the Practice Manager. If the need arises to make use of the 'Management Decision' facility then reference to this should be made within the Practice Manager 'Authorisation Comment' section on the Assessment Completion and Authorisation page of the audit form.
On a related point, the policy is that where the allocated Social Worker is absent for a significant part of the time available in which to make remedial actions, responsibility for undertaking the remedial actions falls to the supervising Practice Manager.
Although the monthly audit sample is drawn from all cases open on or around the 10th of each month, it is possible that a case within the sample will have closed before the audit activity begins. With effect from February 2012 no case should be closed with an uncompleted audit activity, an audit being treated for the purposes of completion before closure as no different to any other form of assessment. Where an audit has begun closure will be contingent on completion of the audit and fulfillment of any and all remedial actions.
Whenever a referral is received and a case is reopened, the Practice Manager must consider whether there are any relevant and or unfulfilled remedial actions from previous case record audits. Where a case record has previously been closed prior to the completion of an audit, or without remedial actions having been completed, where feasible the remedial actions must then be fulfilled. Where this is not possible a 'Management Decision' must be entered, as for non-achievable actions.
Where there is a disagreement between the auditor and the receiving Practice Manager and/or social worker, as to the necessity or feasibility of the required remedial actions, in the first instance the responsibility for attempting resolution rests with the auditor, Practice Manager and/or social worker. Disagreements relevant to safeguarding issues must be referred to the Service Manager, Quality Assurance or, in their absence, to the Head of Safeguarding, as also should be other disagreements that cannot be resolved. In circumstances where agreement cannot be reached the audit will be quality assured by a Quality Assurance Officer, at the request of the Service Manager, Quality Assurance; thereafter the issue(s) will be resolved in discussion between the auditor, the Practice Manager and/or social worker, the Service Manager, Quality Assurance and any other responsible Service Manager.
11. Post-audit Compliance
Among the provisions of the Safeguarding Improvement Plan are agreements for the review of remedial actions identified during case record audits. These agreements are formalised in the Post Implementation Review Internal Audit Report 7648/PIR/V2.00/2011/12, published on 2 December 2011.
In compliance with the PIR, the Quality Assurance Team reviews all remedial actions on a four month delay. Quality Assurance Officers examine all case records in which remedial actions are required and record whether the actions have been fulfilled (i.e. done), 'completed' (i.e. signed-off by a Practice Manager) and 'authorised' (i.e. confirmed by a Practice Manager or Service Manager as fulfilled).
The Quality Assurance Team assembles a spreadsheet listing the state of remediation four months post-audit. The list is broken down into teams and is distributed to the relevant Practice Managers, with a copy to the responsible Service Manager and Head of Service. Responsibility for ensuring the completion of any outstanding activities rests with Practice Managers. The Service Manager, Quality Assurance, reports to PMM on the number and nature of remedial actions identified during post-audit compliance reviews. The Quality Assurance Team will periodically undertake a further 'review of reviews', to determine whether improvements resulting or intended from remedial actions have been sustained.