Transcription
Good andoutstanding careguide - updatedOnline edition
Good and outstanding care guideIntroductionIt’s positive to see that the majority of adult social care services areachieving ‘good’ and ‘outstanding’ ratings from their Care QualityCommission (CQC) inspection. This is a testament to the dedication andleadership of thousands of staff across the sector, that are working tirelesslyto provide high-quality care and support.Since the CQC revised its regulation and inspection approach in November 2017, adult socialcare employers have regularly contacted Skills for Care to better understand how they canachieve a ‘good’ or ‘outstanding’ rating.This guide shares best practice examples from over 350 CQC inspection reports, andrecommendations from ‘good’ and ‘outstanding’ rated services, to help other services tomaintain, and improve, standards of care.It also looks at how services can best prepare for inspection to ensure that you showcase whatyou’re achieving during the inspection process.The guide is arranged into five sections that are aligned to the CQC five key questions.This workbook edition includes questions and activities to help you to reflect on the good andbest practice that’s outlined in the guide, and consider how you could use/adapt it in yourservice. Feedback from people that have used the guide suggests that they find the activitiesparticularly useful to prompt team meeting discussions and plan continuous improvement.For inadequate rated services and those placed in special measures, there is a different journeyahead which will often require significantly more investment and change. Knowing what good(and outstanding) looks like can help these providers to hopefully plan for a more successfulfuture. But they’ll also need to draw on wider support (e.g. other services and experts,including improvement agencies such as the Social Care Institute for Excellence (SCIE), theNational Institute for Health and Care Excellence (NICE) and Skills for Care).We hope the guide’s insight into good and best practice and examples of how providers deliverhigh standards of care is useful to your organisation. The next step would be for each employerto think about how they can implement ideas in a way that best fits them.This second edition of the guide is based on analysis and feedback conducted up until January2018.2
Good and outstanding care guideWho is this guide for?The guide is aimed at a range of roles primarily within CQC regulated adult social careservices including: ownersdirectorsboard membersregistered managersnominated individualsoperational leadsquality and compliance managerscare coordinatorslearning and development leadssenior care workerssupervisorscommissioners of care.How can you use the guide?We hope that the guide gives you a better understanding into good and best practice, andexamples of how you can deliver them. After reading the guide, we’d encourage you to takesome of the ideas and think about how you can implement them in your service, to ensurethat it delivers high-quality, person-centred care and support.If you work in a service that’s rated ‘good’ or ‘outstanding’ by the CQC, you can use therecommendations and examples in the guide to think about how you can maintain, andimprove, your rating.If you work in a service that’s rated ‘requires improvement’ and you want to progressto ‘good’, the guide can help you to understand what ‘good’ looks like in practice, andgives you some examples of how you can improve your rating. It also outlines some of thecommon mistakes that services with these ratings make, so that you know what to avoid.If you work in a service that’s rated ‘inadequate’ or that’s placed in special measures, theguide can help you to plan for a more successful future. Your journey will often requiresignificantly more investment and change, and you might need to draw on wider support,for example, from improvement agencies such as the Social Care Institute for Excellence(SCIE), the National Institute for Health and Care Excellence (NICE) and Skills for Care.3
Good and outstanding care guideAbout this workbook editionThis workbook edition has been developed primarily for adult social care leaders andmanagers. You can use the workbook to support you with inspection and develop yourself asa manager. You can work through the entire workbook or focus on the sections that are mostimportant to the improvement of your service.If you’re a new service, you can use the workbook to help you shape your service and startgathering evidence for your first inspection. If you’re part of a well-established service, you canuse the workbook to reflect on what you do now and what you can improve.You can download all of the activities as separate PDF documents from:www.skillsforcare.org.uk/GOonline.How did we develop the guide?Skills for Care reviewed over 350 CQC inspection reports from adult social care services acrossEngland and identified the common practices that result in a service meeting or failing to meetthe fundamental standards.We’ve also drawn on the expertise of ‘good’ and ‘outstanding’ rated services to develop aconsensus view of what ‘good’ care and support is and how to make it happen. This includesthe new and revised areas of inspection from the framework introduced by the CQC inNovember 2017. This edition of the guide is based on analysis and feedback conducted up untilJanuary 2018.It provides recommendations and examples from a range of service types, including residentialcare, community services, Shared Lives, supported living and domiciliary care. This editionof the guide doesn’t include hospices, as these organisations are now inspected by the CQCusing the healthcare framework.Common themesOne of the common themes from the analysis is the importance of recruiting and retaining theright staff and managers, who create effective approaches to providing high-quality, personcentred care and support. This includes approaches such as using values-based recruitmentand providing regular learning and development for staff.We also found that ‘good’ and ‘outstanding’ rated services are well prepared for inspectionand know how to evidence what they’re doing. We’ve shared this learning in the section aboutpreparing for inspection, so that your inspection rating accurately reflects the great work thatyou do.4
Good and outstanding care guidePraise for our first editionWe published the first edition of this guide in 2017 and over 7500 people downloaded it.Here’s what people said about it.I would highly recommend this guide to all care providers. It’s helped us torecognise our own good practice that we don’t always give ourselves enoughcredit for.I would highly recommend this guide to all care providers. It’s helped usrecognise our own good practice that we don’t always give ourselves enoughcredit for.Susan WilkinsonNightingale Court Care HomeThis guide is excellent to use to improve your service. It demonstrates examplesfrom all aspects of providers, whether good or bad, which provides valuablelearning opportunities for you and your staff.Jackie TimbersC&S Care Services LtdPractical, concise, bite-sized information have enabled staff to preparefor inspections.Graham KennardGuidepostsA good solid base from which to raise quality and standards, useful as a toolin itself and as a support for planning training and in supervision.Bernie MayallMayall Management LtdI found this very useful to see how other services work and how good andoutstanding was achieved.Alison O’HalloranRoche Health CareA must read for new registered managers facing their first inspection.Laura SmithCreative Support5
Good and outstanding care guideAlso available.Good and outstanding care guide:workbook editionThis free online version of the ‘Good andoutstanding care guide’ is complementedby our printed workbook edition whichcan be purchased from the Skills forCare bookshop. The workbook edition ispriced at 35 or 20 for Skills for Care’sRegistered Manager Members.Practical activities for managers,leaders and staff teamsThe ‘Good and outstanding care guide workbookedition’ has over 100 additional pages of exclusivecontent. This includes over 50 practical activitiesfor leaders, managers and staff teams to completeto help them best prepare for CQC inspection.Each activity helps services to reflect on existinggood practice or identify potential weaknesses toimplement improvements.Availablefrom theSkills for CarebookshopThe questions and activities have been designed to help you to reflect on the guide andconsider how you would demonstrate similar high standards of care. Whilst they can beundertaken alone, we encourage you to consider how they can be used or adapted intogroup work exercises with different audiences (senior team, wider staff team, people whoneed care and support etc.).Exclusive online content and activity templatesFor those purchasing the workbook edition, all activitiesare also available electronically. As with the free onlineguide, we’ve updated the workbook edition and thisincludes adding 50% more activities reflecting the newand revised areas of CQC inspection.Caring - Dignity and respectGood and outstanding care guideConsider the practices of your service and the impact this has on theSafe - Medicinesguideg caredignity of a personreceivingsupport.Completethe table below.and outstandinGoodGood and outstandinntEffective - Recruitmegcare guideVisit thePracticeHowdoes this impact onHowcan I makesure thatmedicatihelpson relatedent approachsections of theconsiderdignity?dignityis preserved?whethercare isyour recruitmfollowing websitesyour serviceand well-ledto the CQC howis deliveringand, responsiveResponsivsimilar goodyour currentDemonstratingeffectiveguidesafe,Personalor ebestg careto deliverhelp you consider- Maximpractice:willhygienethe serviceandising indepoutstandin questionsGoodt. 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Good and outstanding care guideContentsCelebrating good and outstanding careWhat the rating means to the owner, manager, senior care worker, care worker,person who needs care and support and their families and those commissioningcare.8Preparing for inspection and providing a true insight into yourservice16Comparing ratings34CQC key questions related recommendations and examples fromgood and outstanding providers44What guidance and support is available, as well as recommendations from goodand outstanding providers on how to ensure you’re fully prepared and able todemonstrate what your service is achieving.What are the key characteristics that differentiate services rated between outstandingand inadequate? This section throws light on what you need (or need to avoid) to begood and outstanding.From our review of inspection reports and input from good and outstanding ratedservices, this includes a selection of recommendations, practical examples and tipson what to avoid relating 2257 7
Good and outstanding care guideCelebrating good and outstanding careCelebrating good and outstanding careAdult social care services rated good or outstanding should be proudof their achievement. In the development of this guide, Skills for Carecontacted providers rated good and outstanding to learn what this meansto them and the people who need care and support.“Adult social care needs toshout from the rooftops aboutgood local services, so this istheir chance to shine, and havea much deserved turn in thespotlight.”Sharon AllenCEO, Skills for Care“Since achieving outstanding, the care and support teams areeven more driven to improve their own practice and enhancelife experiences of those they support. They want to strive forexcellence in their own practice and be put forward for recognition.Retention rates improved, sickness fell and motivation increased.Management has been inundated with opportunities to continuouslyimprove through invitations to sit on development boards toinformation sharing groups. This has given the management a freshfocus, as well as a sense of pride and satisfaction. It also gives usfurther opportunities to develop knowledge and improve services.The recognition that the rating reflects each employee’s dailycontribution, is pushing them to achieve beyond their self-imposedbarriers. They belong to something outstanding and they want tocontinuously improve, to ensure the reputations of the company andemployees are maintained.”Kevin HewlettDirector, Hale Place Care Homes8
Good and outstanding care guideCelebrating good and outstanding care“Without a doubt, achieving outstanding has made the staffextremely proud – it gave formal recognition from the top thatthey helped make this home outstanding. I think it alwaysholds more weight when praise has come from outsideobservers of the home.Following our outstanding rating, we refurbished thestaffroom as part of a practical gesture of thanks; there wasalso a bonus for staff. We purchased new summer polo shirtsfor all care staff with outstanding embroidered on them.Staff couldn’t quite comprehend the small percentage ofhomes that had achieved this award and whilst they wereshocked and surprised at how low this was – it made themmore proud to be a part of it.”Ann AmbroseRegistered Manager, Nazareth Lodge“I can well remember the buzz the first time we achieved a top rating: itwas everything we set out to do. By the beginning of 2018, of the sevenhomes we run that have been inspected, two have been rated goodand five have achieved outstanding.Far from becoming complacent, we’ve found that success breedssuccess. Everyone who works with us, at every level, shares theachievement. We’re proud of what we have done, but we’re notstanding still.Living up to outstanding is now our benchmark. We demand more ofourselves and support each other so that we can sustain the effortrequired to stay at the top of our game.Doing the best job is never routine, but it does become second nature.Doing the best job becomes a reflex, leaving us free to be morecreative, more innovative and more attentive. That all counts towardsa good review. But more important, it enriches the lives of the youngpeople in our care.”Mike BielanskiManaging Director, London Care Partnership9
Good and outstanding care guideCelebrating good and outstanding careWhat works for usCare Plus GroupFor our public website, we drew on whatwas in the report to showcase what theservice was achieving. For our news story,we included the positive feedback theCQC inspector had highlighted comingfrom people using our service. We alsoraised awareness of the kindness andcompassion of our staff, alerting the widercommunity as to what they can expectfrom Care Plus.The word proud doesn’t cover the feelingthat swept through Care Plus whenwe found out about our ‘IntermediateCare at Home’ service, including our‘Crisis Support Service’ had been ratedoutstanding by the CQC.This was something we wanted tocelebrate and our first priority wasensuring that those who worked forus and engaged with our service knewabout this achievement, including thewider community and a visiting MPattending our first conference ‘DeliveringOutstanding Care in an Age of Austerity’where we also delivered a workshoparound our outstanding rating.In contrast, our public blog focusedon a step by step approach to how weachieved outstanding as this is clearlyof interest to others delivering careand support. We presented this in asimple but effective list that spelled out‘outstanding’.We promoted the inspection outcome viaour staff intranet, a public blog and newsarticle on our website, our social mediachannels as well as a press release.Our press release was picked up by theGrimsby Telegraph and resulted in a verypositive story which explained to readerswhat the service was doing well includingdignity and respect, safety, staff trainingetc. We also ensured a photo of ouroutstanding team was included in thepress.The intranet article included a quote andthanks to staff from our Chief Executive.It was important to recognise our muchvalued and dedicated staff contribution inhelping us to achieve outstanding.Jay SadlerTeam Manager, Care Plus Group10
Good and outstanding care guideCelebrating good and outstanding careWhat works for usWelmede Housing AssociationThere has been a real focus on achievingoutstanding and staff motivation hasincreased with each success. We know itis achievable and so the drive to attain it,and maintain it has risen. This has a directimpact on the quality of support delivered.It’s too early to say whether it has affectedretention but certainly our reputationhas grown and this can only be goodfor people who use services, staff, thebusiness, recruitment and retention.With all of our services achieving a goodor outstanding rating across each of thekey lines of enquiry (KLOEs) the impact onour staff has been huge.Staff are extremely proud of theirachievements and the ratings have madeteams even stronger than they werebefore. There is a sense of“we are really good at what we do” andthis has, of course, made staff happy,proud and confident in their work.It’s been a pleasure informing the peopleusing our services and their families thatwe have been rated good or outstandingat inspections and they have been thrilledwith our achievements.To be recognised for their hard work bysuch an accolade has definitely boostedstaff morale across the organisation. Wehave felt reassured that all of the systemsand processes we’ve worked very hard toput into place actually work.Families have been very reassured by theratings. To know your loved one is beingcared for in a service that goes aboveand beyond the standards expected is ofcourse what we would all want.The organisation as a whole has cometogether even more, with staff at all levelsand from all departments celebrating thesuccesses.Cressida RapelaRegional Operations Manager,West Surrey11
Good and outstanding care guideCelebrating good and outstanding careAll services registered with the CQC must display their inspection rating on their website andtheir premises. There are additional graphics available from the CQC for services rated goodand outstanding.Publishing the CQC rating is one way of raising awareness amongst staff, as well aspeople who need care and support, their family/advocates and the wider community. Manyorganisations help to raise the profile of their organisation and their achievements furtherthrough a range of initiatives, including the use of social and more traditional media.With only a very small percentage of regulated services achieving outstanding and much tocelebrate within providers rated good, Skills for Care encourages all services to promote yourachievements. Increased awareness of a provider’s good and outstanding rating can attractnew talent and retain existing staff, as well as informing the choice of those needing card andsupport and those organisations responsible for commissioning care.“Achieving outstanding has been very positive. Staff feel their hardwork has been identified. The team were already proud of the workthey do, however to have it identified was a huge boost.It also gives the team a sense of now we have outstanding we haveto keep it and therefore they understand the high standards of carethat is required of them. The management team often tell the staffthat without their hard work and dedication the home wouldn’t bewhat it is today and that they are truly appreciated for this.When we informed the residents that we had achieved outstandingwe were informe
recommendations and examples in the guide to think about how you can maintain, and improve, your rating. If you work in a service that's rated 'requires improvement' and you want to progress to 'good', the guide can help you to understand what 'good' looks like in practice, and gives you some examples of how you can improve your .
