Late / Shortened Visits Audit

Have late or shortened visits impacted the safe administration of time-critical medicines (e.g., insulin, Parkinson's medication)?

What we look for: Identify clients on time-critical medicines. Compare their prescribed medication times with actual arrival/departure times on the ECM system. A fail is medication given outside the safe window due to poor timekeeping without clinical consultation.

Evidence: MAR charts, ECM logs cross-referenced with medication times, Incident reports

Do staff rotas include sufficient and realistic travel time between visits to prevent systemic late arrivals and shortened calls?

What we look for: Sample rotas for 3-5 care workers. Check that travel time is calculated realistically based on distance, traffic, and mode of transport, rather than zeroed out. A fail is back-to-back scheduling across different postcodes causing inevitable delays.

Evidence: Weekly rotas, Staff schedules, Route mapping software logs, Travel time allowances

Are significantly late or missed visits resulting in potential or actual harm escalated as safeguarding concerns and clinical incidents?

What we look for: Check the incident and safeguarding logs. If a visit was severely delayed or missed (e.g., resulting in a missed meal or medication for a vulnerable person), it must be formally reported and investigated. A fail is treating missed visits merely as logistical errors without assessing harm.

Evidence: Safeguarding log, Incident reporting system, Local Authority alerts, Missed visit policies

When a visit is shortened, is there clear documentation confirming that all assessed needs and essential tasks were still safely completed?

What we look for: Sample care notes for visits flagged as shortened. The notes must evidence that the client's needs were fully met despite the reduced time, rather than tasks being skipped. A fail is rushed care where essential personal care or nutrition is missed.

Evidence: Daily care notes, Task completion logs, Care worker daily records

Is there evidence that people using the service (or their families) are promptly contacted and informed when a care worker is running late?

What we look for: Cross-reference known late visits with the office communication log. Good looks like the office calling the client proactively to advise of the delay and expected arrival time. A fail is clients waiting anxiously with no communication.

Evidence: On-call communication logs, ECM alert notes, Client contact records, Duty logs

Are all shortened (by >5 mins) or late (by >15 mins) visits clearly identified and flagged through Electronic Call Monitoring (ECM) or timesheet analysis?

What we look for: Review a sample of ECM data or timesheets for a 1-week period. Good looks like clear system flags for any visit that starts late or is cut short. A fail would be a lack of tracking, meaning management is unaware of clipped calls.

Evidence: ECM exception reports, Timesheets, Rota system alerts, Call duration logs

Are complaints and informal concerns regarding poor timekeeping or clipped visits logged, investigated, and responded to appropriately?

What we look for: Review the complaints log for themes around late or short calls. Management must investigate these thoroughly, check ECM data, and provide an honest response and apology if at fault. A fail is dismissing client concerns about timekeeping.

Evidence: Complaints register, Investigation outcomes, Duty of Candour letters, Service user feedback forms

Does the Registered Manager routinely analyze late/shortened visit data to identify trends, adjust rotas, and ensure accurate billing?

What we look for: Examine the monthly governance reports. The manager should track the percentage of late/short calls, identify underlying causes (e.g., specific rounds, traffic, overbooking), and take corrective action. A fail is collecting ECM data but never using it to drive improvements.

Evidence: Monthly management reports, Quality assurance audits, Invoicing adjustments, KPI dashboards