Reform in Focus: Draft Audit Evidence Collection Tool. Building a Culture of Readiness for Registration.

Clinical Facilitators Network: Reform Series

Overview: The Importance of Audit Readiness

From 1 November 2025, providers applying for initial registration, variation and renewal, under Categories 4, 5, or 6 will be required to complete an Audit Evidence Collection Tool.

This tool demonstrates how an individual or organisation conforms to the Strengthened Aged Care Quality Standards (2025)

In this Reform Series blog,, we explore how Clinical Facilitators can shape a culture of readiness, ensuring care teams collect meaningful, audit ready evidence as part of their everyday practice rather than as a last minute exercise.

Reviewing evidence of quality supports.

What is Required?

The current Draft Audit Evidence Collection Tool is:

• A mandatory component of the registration process as from 1 November 2025.

• It is structured around the Strengthened Aged Care Quality Standards (2025).

•  Designed to show evidence of how each standard is met in real practice.

• It has focus on quality, safety, consumer dignity, and continuous improvement.

This process is not about producing audit documents, rather, it is about demonstrating that quality is embedded in the organisation’s daily activities.

Why This Matters to Clinical Facilitators

Clinical Facilitators are uniquely positioned to translate policy into practice. Your work touches on every aspect of quality and safety, including:

• Staff education, reflective practice, and supervision

• Care documentation, incident management, and consumer feedback

• Embedding evidence-based care and continuous improvement

By coaching teams to document what they do, and why it matters, you help build the evidence base that auditors will later review.

Example Action Areas: Building Evidence Trail

Focus area	What Facilitators Can Do
Standard 1: The Individual	Help staff link care actions to the person’s values and goals. Include quotes or decisions made by the older person directly in the care plan/ progress notes.
Standard 3: The Care and Services	Reinforce outcome-focused documentation, which does not just focus on list of tasks, but highlights measurable impacts on wellbeing.
Standard 8: Governance	Log team reflections, clinical supervision notes, or internal audits as part of governance evidence.
Complaints & Incidents	Support teams to record follow-up improvements and learning outcomes, not just the incident reports.
Consumer Voice	Capture and document how consumer feedback has influenced change, even small service adjustments count as valuable evidence.

Reflection Prompt:

 “If an auditor asked us to show proof that we listen to the people we support, what could we show them from this month?”

Use this question during team huddles, supervision sessions, or reflective practice meetings. It shifts the mindset from compliance to continuous learning.

Building a Culture of Quality Assurance:

The Audit Evidence Collection Tool is more than a checklist; it reflects an organisation’s culture of quality assurance.

Clinical Facilitators play a vital role in ensuring that:

• Staff understand how their work contributes to registration readiness.

• Documentation reflects the impact of care, not just the activity.

• Evidence of quality, safety, and consumer engagement is gathered naturally as part of daily work.

Now is the time to build systems that are not scrambling for paperwork, but are proud to showcase the quality of care delivered every day.

Conclusion: Embracing the Future of Aged Care:

As the sector moves toward November 2025, the call for audit readiness is also a call for practice excellence.

By embedding quality principles into everyday routines, Clinical Facilitators can ensure care teams are not only prepared for audits but are also delivering the best possible care to older people and communities.