Short Observation Framework for Inspection

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Short Observation Framework for Inspection
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Why we developed this methodology?

• The Quality Review of Inspection Report
  identified that inspectors find it difficult to
  include the experiences of people who use
  services especially those who have communication
  difficulties.
• SOFI provides a framework for directly observing
  and reporting on the quality of care experienced
  by people who have communication difficulties.
• Through using SOFI, an observer can attempt to
  tune into the residents experience, look for
  clues in their general level of mood and
  engagement and how those providing care interact
  with them.

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The SOFI value base

• PERSON CENTRED CARE
• Valuing people
• Treating people as individuals
• Looking at the world from the perspective of the
  person
• Recognising that people need socially enriched
  environments

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What is SOFI?

• Direct experience of sitting alongside people for
  a couple of hours during a regular part of the
  day in a communal space within the care home.
• Values people experiencing a sense well-being as
  evidenced by observing their mood and by their
  engagement with the world around them.
• It shows whether staff have the skills and
  opportunities to provide an environment that
  supports people psychologically.

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SOFI principles

• Positive feedback on person centred care for
  services for people living with dementia and
  learning disabilities
• Practical as part of regular inspection
• Inspectors trained in the necessary skills to use
  the tool
• Quality of care improves

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Typical SOFI

• 2 hour continuous observation
• 5 residents
• Communal area
• Making recordings every 5 minutes

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The three elements

• The general state of observable well-being
• The level of engagement that the participants
  show
• The style of staff interaction

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SOFI - State of being

• Positive mood state evidenced by signs of
  well-being
• Passive mood state no observable signs of
  well-being but no signs of ill-being either
• Negative mood state as evidenced by overt signs
  of ill-being
• Withdrawn behaviour the participant is awake
  but appears to be in their own inner world
• Sleep the participant has their eyes closed

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Order of Precedence

• Record only one state of well-being for each
  participant in each time frame
• Give precedence to the most positive and active
  state regardless of length of time the person has
  spent in that state
• Positive over passive over negative over
  withdrawn over sleep

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What is Engagement?

• Engagement in SOFI terms is when a person
  connects or bonds with something or somebody
  outside of themselves.
• To be engaged with ones social environment is a
  sign of confidence and well-being.
• We will be looking for
• Engagement with other people such as staff,
  residents or visitors and with any animals such
  as pet dogs or cats.
• Engagement with an act of doing - a task or
  activity such as eating a meal or joining in a
  sing-song.
• Engagement with objects such as a soft toy, a
  doll, a bag or clothing.

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Staff Interactions and Well Being

• How you relate to us has a big impact on the
  course of the disease. You can restore our
  personhood, and give us a sense of being needed
  and valued. There is a Zulu saying that is very
  true. A person is a person through others.
  Give us reassurance, hugs, support, a meaning in
  life. Value us for what we can still do and be,
  and make sure we retain social networks. It is
  very hard for us to be who we once were, so let
  us be who we are now and realise the effort we
  are making to function.
• (Christine Bryden, 2005 p127)

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Malignant Social Psychology

• Kitwood described the various common ways that he
  had observed personhood being undermined in care
  settings, coining the phrase Malignant Social
  Psychology (MSP) as an umbrella term.
• Malignant Social Psychology becomes interwoven
  into the care culture. This way of responding to
  people in care is learnt in the same way that new
  staff learn to fold sheets.

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What do we observe and record?

• Good or Excellent interactions these
  interactions are those that enhance personhood
• Neutral interactions these interactions neither
  undermine or enhance people. They are part of
  everyday care, often short requests or
  suggestions
• Poor interaction these interactions undermine
  person-hood