Recommendations from good and outstanding providers

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1 The following recommendations, examples and quotes originate from a review of 300+ Care Quality Commission (CCQ) inspection reports and associated discussions with providers. The examples are drawn from a range of different care services including homecare, residential care, nursing care and supported living services. Recommendations from good and outstanding providers Skills for Care s review of inspection identified some recurring factors that seemingly contributed to a good or outstanding rating. Be proactive Understand the regulations and responsibilities, know your business Provide a qualified, stable and consistent management structure Involve people who need care and support in developing and running the service, consult them regularly and use a structured approach to obtaining feedback Establish robust quality assurance practice and record keeping and actively participate in these processes Always learn from accidents, incidents and areas for improvement, effectively communicating changes Consider what can make things better for people who need care and support. Focus on continual improvement, ensuring it is realistically resourced to achieve targets Ensure expertise extends beyond the registered manager, empowering the wider staff team Share your skills, knowledge and expertise across the organisations and beyond the boundaries of the service Continually develop staff, actively seek to develop new managers and leaders to succession plan for the future Ensure all staff are capable and confident in their roles and responsibilities Engage with peers, experts and the wider community, learn from them and tailor to your service Develop new ways of working, find innovative ways to deliver care Be a figurehead for your organisation, inspire others Leading the way

2 Practical examples from good and outstanding providers The following examples are anonymised from CQC inspection reports. These practical examples have been used by the CQC inspector to help justify the reason for the good or outstanding rating. The registered manager and managing director visited three specialist services for people with dementia in the Netherlands and brought back learning and ideas from their visits. The registered manager had presented their findings and observations at a business planning meeting and shared their experience with staff and people using the service through meetings and newsletters. The registered manager had arranged to admit people that were ready for discharge from hospital over the Christmas period but where community care could not be arranged. This enabled the people to be in a 'safe and homely environment' and also free beds up in the hospital over a very busy period. The hospital were so impressed with the service they have contacted the manager to see if further joint work can be organised. The registered manager sought out connections with other statutory agencies and other providers to develop the service. They had also identified how they needed to be mentored for their own personal development to ensure they were in the best position to enhance the service and could show us mentoring arrangements. They participated in a network of other providers where trust and honesty was promoted so they could learn from each other. They regularly met with local authority and health commissioners and were proactive in making connections to develop integrated working within health and social care, such as sharing best practice and improving standards. The service held a daily 'heads of departments' meeting to catch up on events over the last 24 hours, and how they have impacted on people. The meetings enabled the heads of department to problem solve together and make appropriate decisions around the care provided. Action points were raised and delegated to individuals to act on. Staff were also supported by a clinical lead nurse on day to day clinical issues. They completed a daily report for senior management with information from each department to ensure the service was safe and any risks identified were swiftly addressed. Extensive research was conducted prior to the implementation of new projects, for example an initiative to give people free phone calls, was based on research from the NHS and a recent campaign to reduce loneliness in people who have mental health needs.

3 Following discussions at a meeting with people and their relatives the registered manager was actively working with local care homes to have mutual visits to the homes to enable people to build new friendships and have new experiences. In pursuit of providing a high calibre service, the registered manager reviewed the 'outstanding' rated CQC inspection reports for other services. They used them as a way to benchmark the quality of care at the service. The registered manager had developed the staff team to consistently display appropriate values and behaviours towards people. For example, they understood the importance of ensuring all staff worked to a consistent standard of care and had introduced a system to monitor this. This was a 'sense' check through observations which provided the registered manager assurance about how staff interacted with people when providing care and support. Relatives were encouraged to be involved in activities, preparing the newsletter and carrying out surveys and taking people to the local shops and facilities such as the doctors. Telling signs quotes from CQC inspection reports to indicate good or poorer quality care The following comments have been taken from CQC inspection reports. Whether part of a formal survey or captured in the day to day operations of the service, such feedback can be hugely valuable to helping shape a successful service. If similar type comments are expressed within or about your service, these can act as indicators of success or signify for improvement.

4 Good and outstanding comments "My first finding is the home manager and the professionalism and leadership skills she displays to her care support team. It also amazes me that the manager actually spends time with her residents and knows each and every one of them Healthcare professional "They demonstrate a genuine commitment to improving the standards of care locally.in the interests of doing things right. Healthcare professional The manager explained the ethos to us a friendly, positive place, with a huge emphasis on human dignity. We have found this to be the case. This is the best you can get." Family member "The upper management obviously strive for continuous improvement and this is reflected in the care that our relative receives Family member "We are all family, we know we can go to the seniors and managers with anything." Staff member "There is very good communication throughout the whole service. The manager shares everything with us and that means we feel valued and included." Staff member We were impressed with the registered manager's knowledge of the service. Their passion and determination to deliver exceptional care for people was clear in the way they spoke about what they did for people and how they tried to meet people's individual needs. The registered manager had a positive professional reputation and was highly regarded by their peers. We are not afraid to say no to new referrals if we cannot meet people's needs. We are focused on our values and don't want to let people down by saying we can do something which we cannot." I want staff to walk in the shoes of the people who use the service. It's about giving staff the creativity and tools to help people." I like to grow my own, a lot of staff here started as support workers and worked their way up. You've got to give people the skills to move around. It's not about job titles, it's about working together to provide a really good service and champion older people. "I want to make a difference to the lives of people who live here and want to be ahead of the game making sure we use the best and newest practice." "We look at what is happening Nationally in relation to the care of older people and learn from failings to establish if there is a possibility of that occurring here."

5 Inadequate and requiring improvement comments "We've had three or four different managers in. When the administrators took over the place it just nose-dived" "I've found with the registered manager she's very quickly onto the person she can blame. Tends to push complaints to carers". They used to send surveys, but we've not had one for a long time" We saw that although regular audits were being undertaken the provider continued to be in breach of Regulations and had failed to identify and improve the quality of care in relation to the use of agency staff. The policies and procedures had been updated and reviewed, but we found the reviews ineffective as incorrect legislation and facts were used in the statement of purpose, complaints / compliments procedure and abuse policy statement. We are all exhausted and the residents don't get the care they deserve. We have all asked for more staff and keep getting told the provider won't allow it" Care worker We are all exhausted and the residents don't get the care they deserve. We have all asked for more staff and keep getting told the provider won't allow it". Care worker "I'll hold my hands up, we've been very lapse"