Getting an outstanding Care Quality Commission (CQC) rating can sometimes seem unattainable given the current challenges being faced by social care in the UK.
But the CQC has found that improvements are being made despite financial constraints and increased demand.
One of the best ways to learn how to get an outstanding CQC rating is to look at what other caregivers have done to achieve the rating.
We’ve summarised the behaviours and practices in place at some of the top care providers in the UK. Many of these are covered in the CQC’s celebrating good care, championing outstanding care report and the Skills for Care’s good and outstanding care guide.
Services that are rated outstanding perform exceptionally well. They go above and beyond what is expected. This is what differentiates them from good services which perform well, but only meet rather than exceed expectations.
In the CQC report, one care home was compared to a 5 star hotel. This level of service should be at the forefront of your mind when you are working towards an outstanding rating.
Making the extra effort to achieve an outstanding CQC rating is worthwhile for many reasons. It is likely to boost staff morale and in turn, levels of absenteeism are likely to improve. So is your staff retention rate. It will also become easier to recruit top talent to look after the people in your care. As your reputation for excellence grows, people will be more likely to choose you to take care of their loved ones.
You cannot underestimate the effect good leadership can have on making changes to the level of service provided.
In a recent report from the CQC, leadership was clearly shown to be central to several care providers achieving an outstanding rating. The report said that “services that improve tend to have leaders who are visible and accountable to staff, promote an open and positive organisational culture, and engage effectively with partners.”
Leadership at the top service providers were recognised for having a clear governance framework but they also took a hands on approach. At the Woodgrange Medical Practice in London, leaders were commended for being a great example of what outstanding looks like. They were said to provide the practice with a clear vision of their top priorities and were also active in making changes.
Top CQC rated homes also had leaders who were committed to continually improving their service, even when they were already doing well. At one care home for people with physical and learning disabilities, the leadership were commended for continuous learning.
In the good and outstanding care guide, leaders at outstanding care providers were said to:
Have a strong, visible person-centred culture
Deliver stretching but realistic objectives
Involve people in shaping the service; from recruitment to making developments
Strive for excellence and seek out the latest best practice and new technologies
Be externally recognised and work collaboratively with other services
Good leaders can make a difference to the culture in a place by being approachable, so staff feel comfortable raising concerns with them.
It goes without saying that staff are an integral part of delivering outstanding care, but they are also invaluable when it comes to identifying how improvements can be made.
At University Hospitals Bristol NHS Foundation Trust, staff-led forums played an important role in making improvements and achieving an outstanding rating.
To help shape your service, staff should know the details of your CQC reports - not just the overall rating - and they should understand inspection criteria. They should feel confident about the inspection process and explaining what they do at any time - not just when a CQC visit is imminent.
Don’t take for granted that they know what inspectors ask when rating care providers. Skills for Care, who deliver seminars to care providers, were surprised to find registered managers who were unfamiliar with many of the practical tools and guidance produced by the CQC.
Investing in staff training should therefore never be deprioritised, even when resources are stretched. They need to be given time to work on developing their expertise. In some cases, this might mean going into a clinical setting to refresh their skills, for example.
You can’t get outstanding CQC ratings without giving staff the support and training they need to do their job effectively. Inspectors are likely to ask staff questions about:
What their role involves
Their length of service
The recruitment and induction process
How their learning is kept up to date
How supported they feel
They may also check their understanding of safeguarding, dignity and respect, feedback, complaints and recording incidents.
Suffolk County Council recently shared how they made their service outstanding and the tips they gave are arguably applicable to care providers in different settings.
Allan Cadzow, director of children and young people services, emphasised the importance of trusting staff to work flexibly rather than enforcing “over-prescriptive procedures and policies”. Their staff are guided by listening to parents and children rather than processes.
The council gives staff opportunities for development which has been important for retention rates. Staff wellbeing is also a priority. Staff have access to specialist counselling and flexible working is supported as much as possible. They can also purchase up to an additional eight weeks of annual leave a year.
Social care is emotionally taxing work which means looking after staff’s mental wellbeing is particularly important. Supporting staff and showing they are valued is bound to have a positive knock on effect.
Unfortunately, when pressures are high the people being cared for might not be given the attention they deserve. It can be hard to give each person individualised care when you are rushed off your feet. But this is exactly what outstanding care providers need to do.
Staff need to be given the time to get to know the people they care for and build a relationship with them. It is important that they also have time to speak and listen to the family or advocates of the people they care for.
For each person they care for they should ask:
What are their likes and dislikes?
What are they passionate about?
What is their background?
What is important to them?
What is likely to upset them?
Do they have cultural or religious needs?
Do they have dietary preferences?
Using the same carer over time will also help them build a relationship with the people they care for. And if they do need to handover to a new carer, then they should make sure they give the most up-to-date information on the person being cared for and document it too.
People should also feel involved in their own care as much as possible. This means being given the opportunity to make decisions about their care. Getting feedback after activities is one way they can be involved.
Some of the examples of best practice covered in the Skills for Care report include matching carers to clients according to personality, interests and skills.
Caregivers also made use of mental health tools like Recovery Star which provides a way of measuring people’s recovery progress. Recovery Star can be used to identify people’s goals and the support they need to meet them, and it can also help organisations measure how effective their service is.
Some made use of technology to help them. For example, one home said they used Google Earth on iPads to look at places that were important to the people they cared for and spark a conversation.
Technology is also being used to help staff do their job well. Joanne Charnley National Care Advisor at Bluebird Care said: “Communication is key. Typically our care teams have mobile phones, which helps us to keep them regularly informed. Care plans are accessible via an app on their phones and can be instantly updated.”
Building a community rather than an institutional feel also helps make people more confident. Mary-Jane Hoyle, a registered manager at the Westwood Care Group, said:
“We are a home based upon the principles of family life, there is no staff room as we all eat together to reduce the risk of a staff/client divide. Members are encouraged to be involved in all activities of daily living from cleaning their rooms to laundering their clothes.”
Some of the services rated outstanding by the CQC were commended for making positive memories for people and their families. One care home run a scheme where people were asked what they’d like to achieve during the year. When one person said they’d like to see Elvis, the registered manager arranged for an Elvis impersonator to perform.
In another care home, when a craft course that a resident was due to attend was cancelled, staff learned how they could design a course they could deliver instead.
These examples of carers going above and beyond to meet people’s needs truly exemplify outstanding care; and should be something your staff strive for.
For the latest news and developments in the care home industry, head over to our blog. You can also get in touch with us to discuss how we can help you achieve an outstanding CQC rating, and provide excellent service to those in your care.