FDAP Workshop David Finney Social Care Consultant 11 November 2010

Aims of workshop Think about quality Fit for purpose Measurable change Continual Improvement Think about excellence Exceeding the mark Going the extra distance

Focus of this workshop Care Quality Commission definitions Overlap with NDTMS, Supporting People, TOPS & others Examples from the CQC “Provider Compliance Assessment” document Think about – what we mean by outcomes – and how this links with commissioners expectations

From Standards to Outcomes From...“You will have..... “three meals a day, including at least one cooked meal,....etc” To...“You demonstrate that... “people who use services are supported to have adequate nutrition and hydration”

From Standards to Outcomes (2) “ The home carries out a needs assessment covering :- Suitable accommodation & personal support Meaningful education, training and/or occupation Family/social contact Provision of disability equipment Method of communication Etc “People who use services experience effective, safe and appropriate care, treatment & support that meets their needs and protects their rights”

From Standards to Outcomes (3) From inputs to outcomes From processes to experience of people in services Generalised statements – allows for flexibility Example: Care is “centred on them as an individual and considers all aspects of individual circumstances” Means – you need to demonstrate that

How to measure quality? Demonstrate that you have the evidence that outcomes are met Say how the “experience of people using services” is improved through service delivery

Outcome Evidence (1) Principles Show how individual needs are met The views of people using services Describe the experience people have Say how equality, diversity & human rights are protected Show how people are directly involved in decision making about: Planning their own care Running of the establishment Describe how people are kept safe

Outcome evidence (2) Policies & procedures? List is not enough – not sufficient on their own Say how put into practice to ensure needs are met Impact they have on outcomes How help meet needs How people are involved in their development How they are reviewed

Outcome evidence (3) Summary Best evidence comes directly from clients Focus on the experience of individuals Demonstrates: Appropriate assessments and care planning How risks are addressed and minimised How feedback has been listened to Results of any improvements

Great sources of evidence Written comments from service users or carers Notes of community meetings

Where do we find the CQC outcomes?

CQC – what they expect (1) Regulation 10 Registered person must:- “Regularly assess and monitor the quality of the services provided in the carrying on of the regulated activity....”

CQC – what they expect (2) Regulation 10 The Registered person must send to the Commission, -when requested to do so:- -a written report - (quality monitoring) -Together with any plans for improving the service So – Self Assessment is the key

Written Report? The Provider Compliance Assessment Report (PCA)

Provider Compliance Assessment Covers 16 Outcomes – in 16 sections Is a “living document” – continually updated Any outcome can be singly requested by CQC Asks for evidence for each “prompt” One for each “location”

How do providers fill in the summary of evidence? Look at key principles in each outcome Assess for compliance Identify if an action plan is needed.

Lets look at an example! Outcome 1 – Involvement & information Note that there are some which apply specifically to “Residential Substance Misuse Services” 1L Work through some of the prompts

Involvement & Information Outcomes 1 General principles How do you – help people understand the options open to them – to enable them to make an informed choice Brochure Rules and restrictions - explained Treatment philosophy Pre-assessment phase Make sure people can have a say about how their individual needs are met Assessment conducted in cooperation with a client Individual needs & preferences are highlighted How treatment programme meets their needs Includes equality & diversity information Involve people in the running of the service Community meetings Policy review Privacy & dignity – how maintained?

Personalised care & support Outcomes 4, 5 & 6 Make sure people have – Personalised care plan Involvement in drawing up care plan Involved in reviewing care plan Health issues are well documented Healthy living choices – including nutrition - outlined Cooperation with other providers/professionals Protocols or agreements in place Discharge arrangements are thorough (see 4N & 4O)

Safeguarding & Safety Outcomes 8,9,10 & 11 Safeguarding Cleanliness & Infection control Management of medicines Premises & equipment.

Safeguarding Principles Take action to identify and prevent abuse Staff and s/u understand aspects of abuse – 7Q Guidelines for staff Respond appropriately when abuse suspected Have local safeguarding procedures available Have internal procedures regarding safeguarding Understand how diversity influences safeguarding Protect others from negative behaviour Specific procedures regarding money – 7M

Premises Outcomes 10 & 11 Regulations specify:- Suitable design & layout – sharing & room sizes n/a !! Security Maintenance Specific issues Suitability – you explain Legislation – H&SAW, Fire, COSHH, DDA, Food, Elec Disposal of clinical waste Risk assessment – include self harm – 10P - RSM Space – toilets, therapeutic activity, outdoor – 10M

Staff Outcome 12 Requirements Recruitment – checks, qualified, legally in UK, registered with professional body. Employment practice – job description, roles & responsibilities Agency – need written confirmation of checks Expectations – (which accord with excellence) Communication Promote independence Identify & respond to changing needs Aware of company policies & procedures

Staffing Outcome 13 Sufficient staff Competencies Qualifications Skills Based on a needs analysis Management structures that enable effective maintenance of staffing levels Respond to changing circumstances – leave, sickness, vacancies, emergencies

Supporting Staff Outcome 14 Induction Skills for Care – 14E Learning & development (contributes to excellence) Based on needs of people using service Plan which covers mandatory & sector requirements Record of staff attendance Resources made available Supervision One to one or group – so can be peer support At a time & frequency agreed with line manager

Quality & Management Outcome 16 Relevant sources:- Feedback from people who use services Observations Audits Adverse events, incidents, errors & near misses Comments & complaints Investigations into misconduct Expert bodies What about your clinical governance arrangements?

The CQC system (1) The Quality Risk Profile

The CQC system (2) Wide range of sources of information Stakeholders Own surveys Direct contact with service – telephone or visit “Intelligence” – safeguarding, complaints, notifications Provider Compliance Assessment

Excellence (1) SCIE have identified four key areas: Control over significant life decisions Day to day choices for the individual – decision to participate How a place is run – community meetings Management listen to staff & service users Evidence of changes as a result of listening Positive relationships Partners/family/friends /community – a process Staff treat with dignity – match this with challenge! Focus on people as individuals – personalise the programme Sensitivity to changes in peoples lives

Excellence (2) Meaningful activities Finds out what people want to do – emphasize agreement in participating in treatment Seeks to develop independence – emphasize goals of treatment Community activities – challenge to consider external Organisation factors Quality assurance through review -learning organisation Commitment to excellent outcomes for service users Commitment to staff development Introduction in Spring 2011.

The ongoing journey Have you got an approach to the CQC Assessment? What elements of excellence are you aiming for? Is there crossover with NDTMS, TOPS & SP Quality framework? Is there a better way?

And finally Training – Consultancy – External review Simplex solutions Best of luck for the future