General principles Scores should be based on the conditions seen at the time of the assessment. It is the sites/ organisations’ responsibility to provide a clean environment at all times, and therefore no allowance should be made for such things as the weather, building works or the next scheduled cleaning, except for those items that are subject to scheduled but infrequent cleaning/maintenance. The assessment should not be made against how well a site/organisation is doing with what it has, but how well it is doing against the defined criteria and guidance. No allowance should be made for shortcomings that are the product of infrastructural obstacles – age/design etc. Something being ‘as good as it can be in the circumstances’ is not sufficient reason to award a high score. If there are investment or management implications for the organisation as a result, this is a matter for the trust/ organisation to address. The PLACE assessment form applies to all types of hospitals, hospices and independent treatment centres. Where there are recognised differences/special considerations that should be taken into account, these are reflected in the detailed guidance. Other than this, no allowances should be made for the particular challenges that may face specific units. Such difficulties are not an excuse for less-than- acceptable standards, even if this means that the highest scores cannot be achieved. Over- or under-scoring benefits no-one as it presents a false picture of the standards being provided. If organisations are to be able to continuously improve, they need to understand their current position. The results of the assessments are shared with the Care Quality Commission, who use the information in their monitoring of provider compliance with the essential standards of quality and safety, and to inform inspection of relevant standards. Other organisations (for example NHS England, or the National Institute for Health and Clinical Excellence (NICE)) may also use the data in support of their own objectives. The PLACE process requires organisations to respond formally to their assessments and develop a plan for improvement.
The assessment The assessment falls into five broad categories: cleanliness; condition, appearance and maintenance food and hydration; privacy, dignity and wellbeing; and dementia There are a number of questions which are for the organisation to answer, since these are factual. These questions should be answered before the assessment and copies provided to patient assessors. Scope of the assessment For large sites/organisations, a minimum of 25 per cent of wards (or ten, whichever is the greater) and a similar number of non-ward areas should be included in the assessment. For smaller sites/organisations with ten wards or fewer, all should be included. In all cases the area assessed should: be sufficient to allow the PLACE team to make informed judgements about those parts of the site/organisation it does not visit; where possible, focus on areas of the site/ organisation not included in recent PLACE assessments so that over a period of time all areas will be assessed; the team may also want to consider visiting areas of failure from the previous assessment to check for improvement); include all buildings/wings of different ages and conditions. Final decisions on which wards or areas of the site/organisation to be assessed should not be made until the day of the assessment, and should be a joint decision by all members of the team, although the staff will have an important role to play in ensuring that the wards or areas chosen are reflective of the range of services and, where appropriate, the buildings and wings that make up the site/organisation.
Scoring To achieve a pass, all aspects of all items must meet the definition/guidance as set out in the assessment form. There is no margin whereby an item can fail to meet the required standard There are a range of scoring approaches depending on the area and aspect being assessed. They are: Cleanliness PASS/QUALIFIED PASS/FAIL Y/N and still achieve a pass. It is not possible to set out the point at which a qualified pass becomes a fail. Those undertaking the assessment need to exercise judgement. Teams will therefore need, through discussion, to agree which score to apply where it is obvious that a pass is not appropriate. For example, a Buildings and facilities Privacy, dignity and wellbeing PASS/FAIL Y/N AN ANSWER TO BE SELECTED FROM A PREDETERMINED LIST OF OPTIONS small amount of fluff on a floor should not be deemed as a fail, but fluff under every bed and/ or in every corner would be a fail. Similarly, a small amount of spilled liquid would not be a fail, but any bodily substances – blood, faeces, urine etc – on any surface would constitute a fail regardless of the quantity or frequency. Where separate teams assess different areas of the site/organisation, the scores should be agreed by each team. It is recommended that: each team score as they go – final scores for each ward or area should be agreed at the conclusion of the assessment of that ward/ area before moving to the next. (NB: this does not apply to internal areas, where a single score reflecting all similar areas seen is still required – see below); no member of the team should assess any area alone, so that any faults or shortfalls are agreed by at least two people. NB – patient assessors should never be allowed to undertake assessments, or parts of an assessment, unaccompanied. Other areas – for example corridors, lifts, public toilets – can be aggregated for the purpose of agreeing a final score. The score awarded should reflect the standards found across all those seen – this will inevitably require teams to exercise a degree of judgement. Dementia Y/N Food Y/N AN ANSWER TO BE SELECTED FROM A PREDETERMINED LIST OF OPTIONS GOOD, ACCEPTABLE OR POOR (THE FOOD QUALITY ASSESSMENT ONLY) More guidance on scoring is included in the assessment forms. The scoring guidance should be applied consistently across all areas.