Call Record
Enquiry No:
Date:
Share with Caller
About the caller
About the service user: (if different)
Name:
Name:
Contact No:
DOB:
Relationship to caller:
Can we share your identity with the inspector?
Choose from list
Would you be happy to be contacted by the inspector?
Choose from list
If yes how should they get in touch:
If necessary, are you willing for your identity to be known?
Yes
☐
No
☐
Your identity will be kept confidential, unless you give us
permission to share it with other statutory agencies, such
as the police or local safeguarding authorities.
Call Details:
For guidance and information calls, clarify what the query is and refer to FAQs
For all other calls continue
About the service:
Location Name:
Location ID:
Provider Name:
Provider ID:
Ward:
About the concern:
Have you raised these concerns with us before? If yes,
Enter enquiry No / reference no / date contact was made
If yes, how can we further assist you?
Have you raised your concerns with the service manager?
If yes – what actions have been taken:
Are the police or social services aware?
Choose from list
Would you like to speak with the inspector?
Choose from list
MH Calls ask “Would you have any objection to a member
of staff contacting you, should it be felt necessary”
Is someone at risk of harm or has been placed at risk of
Choose from list
harm?
Call Details
For
Safeguarding/Complaint (Refer to complaint part of the call log) obtain: what happened / when did it happen
/ did SU or victim say anything / where did it happen (service location/ward name/elsewhere) / has hospital treatment
been required / has GP been contacted.
For
Mental Health Info & Advice please log what information was requested and what advice was given.
Other Relevant Information
What advice was given to the caller?
(Contact PALS, the Local Government
ombudsman, make a formal complaint to
manager etc. Please detail all advice given to
the individual)
Triage: (tick all relevant)
☐ Safeguarding Alert
☐ Whistleblower
☐ MH Act Complaint
☐ Safeguarding Concern
☐ Complaint about Provider
☐ Guidance/Information
Type of abuse Choose from list
☐ Physical
☐ Sexual
☐ Financial/material
☐ Psychological/Emotional
☐ Neglect
☐ Discriminatory
Victim Information Choose from list
How many service users are affected?
Victim 1 (name, DOB, gender)
Victim 2 (name, DOB, gender)
Other victims
Abuser Information Choose from list
How many abusers are involved?
Abuser 1 (name, DOB, gender)
Abuser 2 (name, DOB, gender)
Other abusers
About a Complaint about provider Choose from list
Have you raised these concerns to the local
If
No refer to t
he LGO process, stating the ombudsmen would
authority/provider?
expect this. Ask if caller wishes to be transferred to the LGO to
explain further (refer to t
he CAP Script explaining the role of the
CQC and complete FAQ’s)
If
Yes explain the role of Local Government Ombudsman and
warm transfer the call to LGO ( complete FAQ’s)
About a Whistleblower: Whistleblower guidance Choose from list
Whistleblower Triage
Your relationship to the service
(eg staff, contractor, other)
Employment status - are you still working
If still working –
Date left:
there?
how long:
Did you raise concerns with the manager
or the provider?
Provide details
About a MH Act Complaint FAQ’s Choose from list
Check that full contact details are provided above
Has this complaint been raised previously?
If No refer t
o FAQ’s to advise on next best course of action
If the complaint has been raised before are you satisfied
If Yes refer t
o FAQ’s to advise on our responsibility and
with the response?
how we will use the information
What are your concerns if you are not satisfied?
Should the complaint be passed to Mental Health team
Yes refer to
FAQ’s to advise on complaints policy
for consideration
No refer t
o FAQ’s to advise on our responsibility and how
we will use the information
Full correspondence address of caller:
Full correspondence address of service user:
(MH essential)
(MH essential)
Detention Details Choose from list
If the Service User is currently
Section
Date
detained:
number:
implemented:
If not currently
Section
Date
detained, date of last
Number:
implemented:
discharge:
Is a CTO in place?
Yes / No
Has SU been
Has CTO been
recalled:
revoked?
Is the SU subject to a guardianship order?
Yes / No
Market research
How did you hear about us (CQC)?
Other:
☐ Local/National Newspaper
☐ Internet
☐ TV
☐ Someone you know
Call closure
I have a reference number for you call today would you
like to take a note of it, should you need to contact us
again about this matter?
Thank you for your call; is there anything else I can help
you with today?