Health Information and Quality Authority
Residential Services for Older People
Provider Self-Assessment Tool on Dementia
Care
Published: July 2016
Introduction
This self-assessment tool aims to help providers prepare for inspection, to measure their performance
against regulations and standards, and to identify ways they can improve their service. The
questionnaire includes a series of detailed questions assessing how the provider meets residents’ needs
for health and social care, environmental suitability and suitable staffing, with particular reference to
the needs of residents with dementia.
About the self-assessment tool on Dementia Care
The self assessment tool contains six sections. It should be filled in with reference to HIQA’s Judgment
Framework for Dementia Care at Designated Centres for Older People available on our website,
www.hiqa.ie. The Judgment Framework is used to support the provider and person in charge in
reaching decisions on whether the service is compliant with the regulations and or standards.
Each section assesses how compliant the centre is with each ‘outcome’ listed in the Authority’s
judgment framework, with particular attention given to the specific needs of residents with dementia.
 Section 1 requires Information about the Centre
 Section 2 assesses Health and Social Care Needs
 Section 3 assesses Safeguarding and Safety
 Section 4 assesses Residents’ Rights, Dignity and Consultation
 Section 5 assesses Complaints Management
 Section 6 assesses Suitable Staffing
 Section 7 assesses Safety and Suitability of the Premises
Please note that section 2-7 contains two parts; one about the physical environment in the general
nursing home and another about the physical environment of the Dementia Specific Unit (DSU).
If the centre does not have a Dementia Specific Unit you should only complete the first part.
There is an action plan within each section. This should identify how the provider and person in charge
intends to rectify any problems where full compliance was not achieved. The action plan should specify
the following:
 Improvement to be achieved.
 Actions that need to be taken
 Resources (if any) that are needed.

How the improvement is to be measured

Timescales by which improvements will be achieved.
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How to return the self-assessment
The provider should return the completed self-assessment tool to [email protected].
The policies and procedures listed below should be returned along with the completed questionnaire:
 Admissions
 Management of behaviour that is challenging
 The use of restraint
 Communications
Inspectors will review the policies and this self-assessment and action plan in advance of the
inspection.
Section1: About the centre
1. Centre name:
2. Centre ID:
3. Registered
provider:
4. Number of
Residents:
5. Person in
charge:
6. Number of residents
formally diagnosed with
dementia
6A. Number of residents aged 65 years
and over formally diagnosed with
dementia
6B. Number of residents aged under 65
years formally diagnosed with
dementia
7. Number of residents
suspected of having
dementia by nursing
staff
7A. Number of residents aged 65 years
and over suspected of having
dementia by nursing staff
7B. Number of residents aged under 65
years suspected of having dementia
by nursing staff
8. Do you have a dementia specific unit (DSU) for people with dementia?
Yes
No
8A. If “Yes”, please state the number of residents the DSU can
accommodate?
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RESIDENTS
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Section 2: Overall self-assessment of compliance under Health and Social Care Needs
The outcome against which you should access your service is as follows:
The wellbeing and welfare of each resident with dementia is maintained by a high standard of
evidence-based nursing care and appropriate medical and allied health and social care.
The arrangements to meet each resident’s assessed needs are set out in an individual care plan, that
reflect his/her needs, interests and capacities, are drawn up with the involvement of the resident, their
relative as appropriate and reflect his/her changing needs and circumstances.
References for Health and Social Care Needs
Regulation
Regulation
Regulation
Regulation
Regulation
Residents
Regulation
5: Individual Assessment and Care plan
6: Health Care
13: End of Life Care
18: Food and Nutrition
25: Temporary Absence or Discharge of
29: Medicines and Pharmaceutical Services
Standard
Standard
Standard
Standard
Standard
Standard
2.1
2.2
2.4
2.5
3.4
4.1
Please tick the box that best represents the level of compliance of your service. (See
judgment framework for Dementia Care)
Compliance demonstrated
Substantial compliance
Moderate non-compliance
Major non-compliance
Please tick the box that represents the level of compliance of the Dementia Specific Unit
(DSU) if applicable
DSU Compliance demonstrated
DSU Substantial compliance
DSU Moderate non-compliance
DSU Major non-compliance
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Please outline specific measurable realistic, time-bound actions to ensure compliance with
the Regulations and Standards listed above, in relation to Health and Social Care Needs
Action Plan:
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Section 3: Overall self-assessment of compliance under Safeguarding and Safety
The outcome against which you should access your service is as follows:
Measures to protect residents being harmed or suffering abuse are in place and appropriate action is
taken in response to allegations, disclosures or suspected abuse. Residents are provided with support
that promotes a positive approach to behaviour that challenges. A restraint-free environment is
promoted.
References for Safeguarding and Safety
Regulation 7: Managing Behaviour that is
Challenging
Standard 4.3
Regulation 8: Protection
Standard 3.5
Standard 3.1
Please tick the box that best represents the level of compliance of your service. (See
judgment framework for Dementia Care)
Compliance demonstrated
Substantial compliance
Moderate non-compliance
Major non-compliance
Please also tick the box that represents the level of compliance of the Dementia Specific
Unit (DSU) if applicable
DSU Compliance demonstrated
DSU Substantial compliance
DSU Moderate non-compliance
DSU Major non-compliance
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Please outline specific measurable realistic, time-bound actions to ensure compliance with
the Regulations and Standards listed above, in relation to Safeguarding and Safety as
outlined above.
Action Plan:
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Section 4: Overall self-assessment of compliance under Residents’ Rights, Dignity and
Consultation
The outcome against which you should access your service is as follows:
Residents are consulted with and participate in the organisation of the centre. Each resident’s privacy
and dignity is respected, including receiving visitors in private. He/she is facilitated to communicate and
enabled to exercise choice and control over his/her life and to maximise his/her independence. Each
resident with dementia has opportunities to participate in meaningful activities, appropriate to his or
her interests and preferences.
Regulation 9: Residents’ Rights
Standard 1.1
Regulation 10: Communication Difficulties
Standard 1.2
Regulation 11: Visits
Standard 1.3
Regulation 20: Information for Residents
Standard 1.4
Standard 1.6
Standard 4.2
Standard 1.5
Please tick the box that best represents the level of compliance of your service.
Compliance demonstrated
Substantial compliance
Moderate non-compliance
Major non-compliance
Please also tick the box that represents the level of compliance of the Dementia Specific
Unit (DSU) if applicable
DSU Compliance demonstrated
DSU Substantial compliance
DSU Moderate non-compliance
DSU Major non-compliance
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Please outline what specific, measurable, realistic time-bound actions you intend to take to
ensure compliance with regulations and standards relating to Residents’ Rights, Dignity
and Consultation as outlined above.
Action Plan:
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Section 5: Complaints Procedure and Management
The outcome against which you should access your service is as follows:
The complaints of each resident with dementia, those of his or her family, advocate or representative, or
those of visitors, are listened to and acted upon, and there is an effective appeals procedure.
Regulation 34: Complaints Procedure
Standard 1.7
Please tick the box that best represents the level of compliance of your service. (See judgment
framework for Dementia Care)
Compliance demonstrated
Substantial compliance
Moderate non-compliance
Major non-compliance
Please also tick the box that represents the level of compliance of the Dementia Specific Unit
(DSU) if applicable
DSU Compliance demonstrated
DSU Substantial compliance
DSU Moderate non-compliance
DSU Major non-compliance
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Please outline specific measurable realistic, time-bound actions to ensure compliance with the
Regulations and Standards listed below in relation to Complaints Procedure and Management
Action Plan:
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Section 6: Overall self-assessment of compliance under Suitable Staffing
The outcome against which you should access your service is as follows:
There are appropriate staff numbers and skill mix to meet the assessed needs of residents, in a personcentred way. Staff have up-to-date training and access to supervision, education and training to meet the
needs of residents with dementia.
Regulation 15: Staffing
Standard 7.2
Regulation 16: Training and Staff Development
Regulation 30: Volunteers
Standard 7.3
Standard 7.4
Please tick the box that best represents the level of compliance of your service. (See judgment
framework for Dementia Care)
Compliance demonstrated
Substantial compliance
Moderate non-compliance
Major non-compliance
Please also tick the box that represents the level of compliance of the Dementia Specific Unit
(DSU) if applicable
DSU Compliance demonstrated
DSU Substantial compliance
DSU Moderate non-compliance
DSU Major non-compliance
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Please outline specific measurable realistic, time-bound actions to ensure compliance with the
Regulations and Standards listed below in relation to Suitable Staffing.
Action Plan:
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Section 7: Overall self-assessment of compliance under Safe and Suitable Premises
The outcome against which you should access your service is as follows:
The location, design and layout of the centre are suitable for its stated purpose and meets residents’
individual and collective needs in a comfortable and homely way. The premises, having regard to the needs
of residents with dementia, conform to the matters set out in Schedule 6 of the Health Act 2007 (Care and
Welfare of Residents in Designated Centres for Older People) Regulations 2013.
References:
Regulation 17: Premises
Standard 2.6
Standard 2.7
Please tick the box that best represents the level of compliance of your service. (See judgment
framework for Dementia Care)
Compliance demonstrated
Substantial compliance
Moderate non-compliance
Major non-compliance
Please also tick the box that represents the level of compliance of the Dementia Specific Unit
(DSU) if applicable
DSU- Compliance demonstrated
DSU -Substantial compliance
DSU - Moderate non-compliance
DSU - Major non-compliance
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Please outline specific measurable realistic, time-bound actions to ensure compliance with the
Regulations and Standards listed below in relation to a Safe and Suitable Premises
Action Plan:
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Please email the completed self-assessment to [email protected].
Please ensure that the policies and procedures listed below are returned along with the
completed questionnaire:




Admissions
Management of behaviour that is challenging
The use of restraint
Communications
Inspectors will review the information returned through this questionnaire and the
accompanying policies and procedures in advance of the inspection visit.
If you have any queries, please contact us by email: [email protected]
or by phone on:01 8147400 or 021 2409300
Thank you for completing the self-assessment.
Health Information and Quality Authority
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