Guidance for cqc staff: Inspecting the quality of care for residents with diabetes mellitus living in care homes

Diabetes screening on admission that is recorded and audited.

This can reduce the number of GP call-outs and hospital admissions linked to undiagnosed diabetes and associated complications.

2. 
   Availability of a fully-stocked and maintained hypoglycaemia kit.
   

This can reduce ambulance call-outs and hospital admissions due to hypoglycaemia.

3. 
   A risk-calculation and assessment tool for diabetes foot disease.
   

Use of such a tool by suitably trained staff can reduce unnecessary amputations.

4. 
   Access to good quality diabetes education and training for care home staff.
   

Good training can lead to fewer GP call-outs and hospital admissions for hypoglycaemia, infections, and other common medical problems associated with diabetes.

Good leadership and management in relation to the care of diabetes includes regular audit and assessment of these elements in practice.

Appendix 1 below sets out a flow chart for assessing diabetes care in care homes.

8. What things should be included in care plans for people living with diabetes?				Information about the signs and symptoms of hypoglycaemia and hyperglycaemia (very high levels of blood sugar). How and when the person’s urine should be tested for glucose, who should do this, and where the results should be recorded. When, how and by whom blood glucose levels are tested and recorded. What should be done in the event of hypoglycaemia, including where the hypoglycaemia kit is kept (it can be worth checking expiry dates as these kits can be stored for a long time). Guidance about when glucose/oral fluids should be given, and when not. The action that needs to be taken when glucose levels are above or below a certain level (for example, reducing insulin / giving glucose drinks). How the person’s skin should be cared for (for example on their feet, skin infections and abscesses, when to involve a podiatrist). Information about the person’s diet, and when to involve a dietician Continence care (where needed; people living with diabetes can be prone to urinary tract infections). Eye care for the person, including arrangements for their annual screening. How and when to involve a Specialist Diabetes Nurse/ Clinic
9. What information is available for providers who want to improve the quality of their care for residents with diabetes?		Appendix 2 below includes links to websites with information about diabetes and key references for this guidance. They include information from national and international sources, results from the First England-Wide Diabetes National Care Home Audit, and references for major research articles and reviews in this area.