Key drivers for being an outstanding service Paula Eaton & Paula Morgan 25th January 2017 1 1

CQC purpose and role Our purpose Our role We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve Our role We monitor, inspect and regulate services to make sure they meet fundamental standards of quality and safety and we publish what we find, including performance ratings to help people choose care

Our five key questions

Ratings - Four point scale High level characteristics of each rating level Innovative, creative, constantly striving to improve, open and transparent Consistent level of service people have a right to expect, robust arrangements in place for when things do go wrong May have elements of good practice but inconsistent, potential or actual risk, inconsistent responses when things go wrong Significant harm has or is likely to occur, shortfalls in practice, ineffective or no action taken to put things right or improve 4

State of Care 2016: Adult social care The good news Many services are providing good quality care – over 70% More than three-quarters of re- inspected inadequate locations improved 84% of community social care locations, including 92% Shared Lives services, Good or Outstanding Caring achieves highest scores – 90% Good, 2% Outstanding

For a good service to be rated outstanding ..there are additional key characteristics that make the service exceptional and distinctive CQC publication. Residential adult social care services handbook appendices – March 2015

Making decisions - Is it outstanding?

State of Care: leadership Strong leadership is emerging as more crucial than ever to delivering good care Effective planning Focus on delivering for people Culture of openness and staff engagement Willingness to collaborate with partners 8

The importance of managers 9

Themes from Well-Led – Inadequate Unawareness of best practice and notifications not being made to CQC Lack of supervision and training opportunities Ineffective systems to identify and manage risks / no process to assess lessons learned Regular management changes / no registered manager Poor care planning / lack of personalised care Closed culture – views not listened to or acted on Underdeveloped partnership working and community links CQC Published reports – sampled for data on well-led. Sample size 177, 50 services with outstanding ratings (all outstanding ratings for well-led when the sample was extracted) for and 127 for services with inadequate ratings for well-led.

Themes from Well-Led – Outstanding People who use services, relatives and staff speak highly of the service Effective monitoring and quality assurance 75% of services had a registered manager in post consistently Open culture – people who use services/ staff/ relatives shared views and issues Good leadership extends beyond the manager and those values inspire staff A can do, will do attitude – staff dedication Strong links with local community Safe care actively promoted – effective oversight of care and staff communication CQC Published reports – sampled for data on well-led. Sample size 177, 50 services with outstanding ratings (all outstanding ratings for well-led when the sample was extracted) for and 127 for services with inadequate ratings for well-led.

Outstanding characteristics People are at the centre and staff want to give them a life not just a service Good leadership extends beyond the manager and those values are cascaded to inspire staff Open culture – people who use services/ staff/ relatives shared views and issues Strong links with local community 75% have registered manager in post consistently A can do, will do attitude – staff dedication Safe care actively promoted – effective oversight of care and staff communication Always looking to improve LAs – How can you commission for these outstanding qualities? How can you manage existing contracts to reach and value services which demonstrate these qualities? The better the relationship between LA and CQC, and the more a LA works proactively in partnership with local providers, the better the quality of care.

Common themes from ‘well-led’: Outstanding “This place is brilliant, management care so much, as do the staff, everybody knows their role and the atmosphere is amazing.” “I’m made to feel important, I’m constantly encouraged to always better myself.” Passion Excellence Integrity Cooperation CQC Published reports – sampled for data on well-led. Sample size 177, 50 services with outstanding ratings (all outstanding ratings for well-led when the sample was extracted) for and 127 for services with inadequate ratings for well-led.

What does this mean for individuals? “I feel safe, I can live the life I want and I am supported to manage any risks” “I am in control of planning my care and support” “I have care and support that is directed by me and responsive to my needs” “I can plan ahead and keep control in a crisis” think local act personal – MAKING IT REAL Marking progress towards personalised, community–based support

An outstanding care home ‘Relatives and friends visiting the home told us they only had positive experiences and praise for this service’ ‘Staff told us that they would not like to work anywhere else’ Vida Hall, Harrogate Generic ASC deck (June Final)

‘Outstanding’ can be achieved "We didn't think we were outstanding. And perhaps that's why we were – I think it's because we see every single person as an individual. It is our privilege to support them to live the last years of their life with as much happiness, love and security as we can give them." Suzanne, Prince of Wales House, Ipswich Generic ASC deck (June Final)

management inspire confidence and lead by example Prince of Wales House, Ipswich innovative and creative ‘My Story’ booklets give detailed biography of a person – with the clear message that their lives do not stop when they move into care commitment by managers to continually improve vibrant and friendly environment staff are motivated by a strong culture of inclusivity considers individuals and their views and preferences care is person-centred management inspire confidence and lead by example strong and visible leadership

Outstanding ASC published reports

Top tips for achieving an outstanding rating Set out your ambition to be outstanding – It has to start at the top Involve staff, residents, their relatives and other health professionals in developing strategies to help you achieve your ambition Determine where you are now and identify the gaps you need to plug Can you easily identify the outstanding features in your home? Will your staff, residents, other health professionals support your view? What makes a difference between good and outstanding is often how the service pays attention to detail – simple things done well that have a significant impact on the people using the service Think about how you will sustain high quality performance Work hard on ‘your’ ability to demonstrate the impact your intervention is having on people. Ask yourself whether people, their relatives, staff and other professionals will corroboration your assessment of your quality when asked.

A wise woman once said… “People will forget what you said, people will forget what you did, but people will never forget how you made them feel” Maya Angelou 20

Paula Morgan Inspector Thank you www.cqc.org.uk enquiries@cqc.org.uk @CareQualityComm Paula Eaton Inspection Manager Paula Morgan Inspector