The QUIS outcome level is based on observations made by the auditor during their visit.
The overall audit outcome is determined by four indicators:
- QUIS Results – The total score assigned for each five-minute observation period on the days(s) of the audit.
- The Observational Audit Tool Scores – The total scores from the Observational Audit Tool undertaken as part of the overall audit.
- Feedback from people who we speak to as part of the audit experience.
- The outcome of the clinical review undertaken as part of the audit (where applicable).
QUIS Outcome
Each five-minute observation period is categorised into one of five types of care:
- Meaningful engagement
- Positive care
- Neutral care
- Negative/controlling protective care*
- Negative/controlling restrictive care*
* If even one person experiences negative/controlling care during the observation period, that five-minute segment receives a negative/controlling score.
For a description of these care types, refer to the Codes Guidance Description. For guidance on how levels are assigned, see the QUIS Level Descriptions.
Observational Audit Tool(s)
The Observational Audit Tool(s), tailored to the specific type of project or audit based on the people you support, includes essential elements required to achieve your audit outcome. The auditor evaluates whether each element is:
- Present (Yes)
- Partly Present (Partly)
- Not Present (No)
The total number of “Yes,” “No,” and “Partly” responses determine the outcome level:
| Outcome Level | Score (Yes Responses) |
| Outstanding | Greater than 90% |
| Excellent | 80% – 90% |
| Good | 70% – 79% |
| Average | 50% – 69% |
| Improvements Required | 20% – 49% |
| Critical Issues | Less than 20% |
Overall Audit Outcome
| Outcome | Description | Individual Outcomes |
|---|---|---|
| Outstanding (MCM Accreditation Achieved) | An outstanding experience is provided for both the people supported by the service and the team members. There is a strong sense of mutual connection, giving, and well-being. The environment feels like a true home, filled with warmth and inclusivity, without any division between those being supported/living and working there. A QUIS Level 1 outcome is achieved based on the following elements: Meaningful Engagement is the primary experience of the day, accounting for greater than 60% of total positive scores (ME + PC). There is no evidence of negative/controlling restrictive care. Feedback from the team, people being supported/living here, and their family and friends aligns with the observation findings. Evidence of improvement in practices is demonstrated. Development opportunities are recognised, and the service is aware of areas for growth. The team responds dynamically to individuals’ changing needs, embracing a “go with the flow” approach to create meaningful moments consistently throughout the day. Conversations focus on shared memories and experiences rather than tasks. The environment reflects the stories and interests of both people being supported/living and working here, ensuring it remains adaptable as needs evolve. Whilst inevitably an audit can only be a snapshot of a day in the life of a service, an outstanding outcome needs to have evidence that this experience is consistent and sustained. | QUIS: Level 1 Observational Audit Tool: Outstanding |
| Excellent (MCM Accreditation Achieved) | A highly engaged service that prioritises meaningful moments, where emotion-focused care is consistently seen, felt, and heard in interactions with people. Individuality and self-expression are encouraged, allowing people to freely be themselves. Some areas for improvement have been identified that would further enhance meaningful engagement and personal freedom. A QUIS Level 2 outcome is achieved based on the following elements: Meaningful Engagement makes up at least 50% of total positive scores (ME + PC). Feedback from the team, people being supported/living here, and their family and friends aligns with the observation findings. Development opportunities are recognized, and the service is aware of areas for growth. The environment reflects the stories and identities of people being supported/living and working here, ensuring adaptability as needs evolve. | QUIS: Level 1-2 Observational Audit Tool: Outstanding or Excellent |
| Good (MCM Accreditation Achieved) | A service that has shown significant improvement in meaningful engagement and positive care. While positive care may be more prevalent than meaningful engagement, interactions and connections are frequently seen, felt, and heard. Individuality and self-expression are encouraged, allowing people to freely be themselves. Some areas for improvement have been identified that would further enhance meaningful moments and personal freedom. The environment promotes interaction and engagement, featuring destination points that reflect the life stories of people being supported/living and working here. | QUIS: Level 2*-3 Observational Audit Tool: Good or higher *Where the observational audit is rated Good and a Level 2 QUIS is achieved this rating would apply. |
| Average | Elements of person-centred care are present and reflected in interactions with people being supported/living here. However, inconsistencies in team approaches are evident, and task-oriented, negative/controlling care is consistent in the lived experience. Key areas for improvement have been identified, requiring a structured action plan to enhance overall well-being for people being supported/living here. The environment has some home-like qualities, but there is room for improvement in fostering meaningful engagement and creating destination points that reflect the identities and stories of people being supported/living and working here. | QUIS: Level 4-5 Observational Audit Tool: Average or Improvements Required |
| Improvements Required | The approach to care appears disjointed, with sporadic meaningful engagement that is inconsistently applied, leading to expressions of ill-being. Neutral care experiences are common, and negative/controlling care persists. A focused effort on key checklist areas is needed to drive a positive shift in well-being for people being supported/living and working here. Additionally, environmental factors are impacting well-being and require a continuous improvement strategy to create a more supportive and enriching experience for those accessing the service. | QUIS: Level 6-7 Observational Audit Tool: Average or Improvements Required |
| Critical Issues | Critical issues have been identified, including potential risks to care quality and compliance. The predominant experience is task-oriented which results in negative/controlling care types (protective and restrictive) with high levels of apathy and passivity. Engagement beyond meeting physical needs is minimal. Due to these risks, implementing an improvement plan must be a top priority for the management team. | QUIS: Level 8-9 Observational Audit Tool: Improvements Required |
| Serious Risk | A serious risk to people’s health and well-being has been observed. Some interactions may warrant reporting to regulatory authorities, and there may be evidence of neglect. Before leaving the site, senior management was informed of the identified risks. A follow-up discussion between Meaningful Care Matters representatives and the service will determine immediate actions and ensure compliance with regulatory requirements and any reporting requirements which are deemed necessary. | QUIS: Level 10 Observational Audit Tool: Critical Issues |
QUIS Level Descriptions
| Level 1 | Exceptional person-centred care experience where meaning, mattering and connections are achieved. People being supported/living and working in the service are flourishing and ‘Free to be me’. | Meaningful Engagement + Positive Care Scores (Meaningful Engagement > Positive Care*) 75% or more *Where ME is not greater than PC this would be considered as a Level 1/2 | Neutral Scores 21% or less | Negative/Controlling Scores (Protective Only) Under 5% |
| Level 2 | High levels of person-centred care approaches, which create meaningful moments and support connection and loving care, with further potential for development. People are generally ‘Free to be me’. | Meaningful Engagement + Positive Care Scores (Meaningful Engagement > Positive Care) 65-75% | Neutral Scores 20-25% or less | Negative/Controlling Scores (Protective and Restrictive) 7% or less |
| Level 3 | Highly Personalised care experience with elements of meaningful engagement, occupation and connections achieved. Positive care remains more prevalent than meaningful engagement moments. People are kindly cared for and experience person-centred approaches which are genuine. Development areas are identified for increased moments of meaningful engagement and connections. | Meaningful Engagement + Positive Care Scores 55-65% | Neutral Scores 36% or less | Negative/Controlling Scores (Protective and Restrictive) 10% or less |
| Level 4 | Good care observed with key areas of development required to support people to have meaningful engagement opportunities and a greater sense of freedom of choice and expression of self. | Meaningful Engagement + Positive Care Scores 45-55% | Neutral Scores 45% or less | Negative/Controlling Scores (Protective and Restrictive) 10-15% |
| Level 5 | Elements of meaningful connections and positive personal care are observed; however, this is inconsistent/variable. Neutral experiences evidenced by boredom and sustained periods of inactivity are generally the norm. | Meaningful Engagement + Positive Care Scores 35-45% | Neutral Scores 50% or less | Negative/Controlling Scores (Protective and Restrictive) 15-20% |
| Level 6 | High levels of neutral care and sustained inactivity is considered the ‘norm’. Whilst there are moments of meaningful or positive care these are sporadic at best and are generally unable to be sustained. Where negative/controlling experiences are identified/ill-being experience, this is predominately due to controlling care. | Meaningful Engagement + Positive Care Scores 30-35% | Neutral Scores 50% or less | Negative/Controlling Scores (Protective and Restrictive) 20-30% |
| Level 7 | Minimal levels of engagement are experienced, and the experience of neutral care and negative/controlling care are causing peoples’ experience to be significantly diminished. Whilst clinical care may be achieved there is a lack of emotional connection and people are generally ‘existing’ with minimal episodes of meaningful moments being created. | Meaningful Engagement + Positive Care Scores Below 30% | Neutral Scores 40% or less | Negative/Controlling Scores (Protective and Restrictive) 30-40% |
| Level 8 | Serious concerns with a lack of emotional engagement causing a detachment and increased adverse impacts on people who access the service or live in the home. This is evidenced in levels of neutral care, which are predominately devoid of positive interactions, and there are high levels of negative/controlling care with elements of restrictive care practices, which are bordering on emotional neglect. | Meaningful Engagement + Positive Care Scores Below 25% | Neutral Scores 35% or less | Negative/Controlling Scores (Protective and Restrictive) 40-50% |
| Level 9 | The predominant experience for people is of neutral and negative/controlling care. Potential regulatory compliance risks are identified due to the high levels of ill-being experienced by the people in this service Serious actions are required to ameliorate the current lived experience. | Meaningful Engagement + Positive Care Scores Below 20% | Neutral Scores 30% or less | Negative/Controlling Scores (Protective and Restrictive) 50-60% |
| Level 10 | Serious Risk to the wellbeing of people is identified, with restrictive practices and emotional neglect. Potential reporting to regulatory bodies needs consideration given the high levels of restrictive practice being considered the ‘norm’ within the care culture and the significant adverse effects on emotional wellness being perceived. Specific case examples need to be documented and immediate notification to service management and MCM Managing Directors to ascertain response to findings. | Meaningful Engagement + Positive Care Scores 10% or less | Neutral Scores 30% or less | Negative/Controlling Scores (Protective and Restrictive) 60% or more |
Checklist / Audit Tool Outcome
| Outcome | Description | Percentage of ‘Yes’ Responses |
|---|---|---|
| Outstanding | An outstanding experience is provided for both the people supported by the service and the team members. Achievement in all sections of the checklist can be evidenced, reflecting best practice in the field. There is an outstanding understanding of the need to be across all the elements considered necessary for a truly person centred experience. The service is always looking for continuous improvement and can articulate what contributes to its success. | Greater than 90% |
| Excellent | The high score on this checklist reflects that many elements of the checklist are in place contributing to a high quality service, providing person-centred care. This is a service that also looks for continuous improvement and will therefore need to review outstanding ‘Partly’ or ‘No’ elements in the checklist to develop an action plan. | 80-90% |
| Good | Many elements of the checklist have been achieved but with some development still required in key areas to provide consistency and improvement within the service. Reference should be made to the QUIS level outcome and the reasons given for the result. Reflection on how the elements present or missing from the checklist contributed to the outcome is recommended. | 70-79% |
| Average | Some elements on the checklist are in place, but there is a significant opportunity for improvement to support the key positives and development needs identified in the QUIS observation. The checklist shows where strengths and areas for development lie. Some patterns may emerge that will require an action plan to support the development of a person centred service. Reference should also be made to the QUIS level outcome and the reasons given for the result. Reflection on how the elements present or missing from the checklist contributed to the outcome is recommended. | 50-69% |
| Improvements Required | The service has relatively few elements in place required to transform from a task focussed model of care to person-centred approach. A detailed review of the audit tool is recommended to identify key elements to transform from a ‘Partly’ or a ‘No’ to a ‘Yes’. At present, there is a confused approach to support and care in place and concerns regarding quality of care and quality of life experience. Without improvements, any person centred approaches in place will not be sustainable in the long term. | 20-49% |
| Critical Issues | The low score reflects serious concerns including risks to wellbeing, emotional needs, care, quality and compliance. The result indicates a very task-oriented service with high levels of controlling care. The lack of key elements supporting people is considered a critical risk which may may compromise regulatory compliance. Along with the QUIS outcome the result highlights that implementing an improvement plan must be a top priority for the management team. | Less than 20% |
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