Survey of Care Form | Caring Alliance

Survey Details

Care Setting / Service Name

Provider / Registered Manager

Surveyor Name

Date of Survey

Type of Service

Number of People Using Service

Rate each area from 1 (inadequate) to 4 (outstanding). Record observations and any actions required.

Observation Criteria	Rating 1 to 4	Evidence / Notes	Action Required
Safeguarding systems are in place and understood by staff
People are protected from abuse, neglect, and discrimination
Medicines are managed safely and effectively
Infection prevention and control measures are followed
Staff recruitment checks are completed before employment starts

Observation Criteria	Rating 1 to 4	Evidence / Notes	Action Required
People's needs are assessed before care begins
Staff have the right skills, knowledge, and experience
People are supported to eat and drink enough to maintain good health
People's health and wellbeing is monitored and responded to
Staff work well with other professionals to deliver effective care

Observation Criteria	Rating 1 to 4	Evidence / Notes	Action Required
People are treated with dignity and respect
People are supported to express their views and be involved in decisions
People's privacy is respected in all aspects of care
Staff demonstrate kindness and compassion in their interactions
People's cultural, religious, and personal preferences are respected

Observation Criteria	Rating 1 to 4	Evidence / Notes	Action Required
Care plans are person-centred and reviewed regularly
People know how to raise concerns or complaints
Activities and social opportunities are available and accessible
Care responds to people's changing needs
End of life wishes are identified and respected where applicable

Observation Criteria	Rating 1 to 4	Evidence / Notes	Action Required
The service has a clear vision and values that staff understand
Quality assurance systems identify areas for improvement
Staff feel supported and receive regular supervision
There is a culture of openness, honesty, and learning
Accurate and up-to-date records are maintained

Key strengths identified

Key areas for improvement

Overall judgement and rationale

Role	Name	Signature	Date
Surveyor
Registered Manager