How to get an outstanding CQC rating - Advantage Accreditation

How to get an outstanding CQC rating

For many providers, reaching an ‘outstanding’ rating with the Care Quality Commission (CQC) can seem like a difficult task. For others, it’s an ambition that is at the centre of their mission.

Of course, achieving ‘outstanding’ is meant to be difficult. Only 2% of inspected social care services achieved the rating in 2018, a statistic that has remained largely static since 2014. More domiciliary care services rank outstanding compared to residential services, and similarly nearly five times as many residential settings are rating as ‘inadequate’ as domiciliary services. This speaks to the different challenges between the two types of service provision.

Below are some tips that may help you if your ambition is to be outstanding. It may not surprise you that planning is key.

 

Planning and Preparation

Planning for a CQC inspection - Advantage Accreditation

As with anything, the key to a great CQC inspection is plenty of planning and preparation. There should be no surprises when the inspector calls: all the standards they measure you against are available for free online.

Firstly, you should be aware of what type of inspection you are due to receive. There are three types:

  • Comprehensive inspection – A holistic inspection usually carried out where there is a risk of a deterioration in quality or an upturn in quality that may affect your rating.
  • Focused inspection – More structured, narrow inspections carried out in response to a complaint or to follow up on specific findings from a previous inspection. These are usually unannounced.
  • Combined inspection – Where the organisation provides services that span different areas of health and social care, for example, “mental health, community health, and care homes”. Different inspections are carried out by specialists for each service area.

If you know what type of inspection you are likely to receive, you will be able to plan more effectively. Focused inspections are the simplest to plan for, since you will likely already be aware of the issue to which they are responding. Comprehensive inspections require much more planning and work. All inspections will emphasise your equality and diversity credentials – such as providing reasonable adjustments – and your compliance with the Mental Capacity Act and Deprivation of Liberties Safeguards.

Fortunately, the CQC’s criteria is public and open for all. Here’s two of the key documents you should be aware of:

 

Assessment Methodology

The CQC document ‘How we regulate health and social care’ should be your first port of call when planning for an inspection. The document summarises how the CQC inspects. It also includes the appeals and complaints procedures should the inspection not go the way you hoped. The document signposts you to other documents that will be of help.

 

Assessment Framework – the Key Lines of Enquiry (KLOEs)

The KLOEs are the primary questions any CQC inspector will ask as part of their visit. There are five key areas of focus:

  1. Are service users safe from abuse and harm?
  2. Is the care delivered effective? Does it lead to good outcomes?
  3. Are staff caring and compassionate towards those in their care?
  4. Are services responsive to the needs of service users?
  5. Is the organisation well-led? Are there effective governance arrangements in place?

Beneath these areas of focus are a series of questions that the inspector will ask. They will, of course, need evidence to support any answers you provide. The CQC KLOEs documentation also gives an explanation as to what providers must do to get an outstanding rating for each question. It is important to compare your service against these criteria. This will give you an indication as to where you are likely to fall in your inspection.

The KLOEs underwent some changes in November 2017. Advantage have a guide to the updates available to download for free.

 

CQC reports online

As since the CQC is a public regulator, all its reports are available online. Reading the reports of ‘outstanding’ services will give you a good indication of what inspectors are looking for when they visit. Conversely, reading reports of ‘good’ services will give you an idea of the gap between these ratings and ‘outstanding’ and what you need to correct. All inspection reports can be found on the CQC website alongside the details of the different providers.

You will notice in some reports that there are specific mentions of instances where the inspector believes the organisation is exceptional or innovative. If you have developed a particular procedure or use a piece of technology that you believe will differentiate yourself from other providers, make sure you highlight it on your inspection.

 

Aim for two questions to be outstanding

Not many know that, of the five key questions asked by the CQC, only two need to be outstanding for you to get an overall outstanding rating. Although you need to need to deliver as best as you possibly can in all five areas, you will likely already be relatively strong in at least two areas compared to others.

If that is the case, you should build on your strengths. You should understand why you are so strong in these areas and focus on them. It is easier to concentrate your efforts and to make a real impact with staff on a limited number of areas, rather than spread your resources too thinly.

 

Use an evidence file

Evidence file - Advantage Accreditation

It is not enough for you to answer questions well. Inspectors need evidence. Nor should you rely on the inspectors being able to find good or outstanding practice. You need to be proactive. You should maintain an evidence file that you are constantly updating, preferably something that the inspector will be able to take away with them. This may include documents such as:

  • Your policies and procedures
  • Organisation chart
  • Minutes of senior management meetings and meetings with outside agencies
  • Records of any incident investigations, including the outcomes, or any meetings where safeguarding issues are discussed
  • DBS records for staff
  • Health and safety and fire risk assessments
  • Training needs analyses and evidence of staff training
  • Legionella test records
  • Equipment maintenance records, including PAT tests
  • Compliance with data protection requests

If you are consistently updating this file – best categorised as per the KLOEs – then will be fully prepared when an inspection occurs.

This file is not just about ticking boxes, though. You should record examples of where you feel your organisation has developed practices or delivered care that are innovative or particularly exceptional. You should also record examples of good team work, where your staff have gone above and beyond, or great feedback from service users and/or their families. If you have had any requests for information from the CQC, such as online provider information collection (PIC) or provider information return (PIR) requests, keep records of what the request was and your response.

 

Surveys and feedback

Feedback - Advantage Accreditation

The best evidence that you are delivering excellent care is feedback from the people in your care and their families. Of course, you can obtain this through individual requests, and it may be a good idea for you as a manager to get out and talk to the people in your care or their families.

If time is a factor, though, a survey – paper or digital – can help. Any survey must strike a balance between hitting some of the key criteria required by the CQC, and ensuring it is not too long and foreboding for someone to complete. Do not be tempted, however, to throw out any survey results that criticise your services. Negative feedback collected in these surveys is, in fact, hugely beneficial for two main reasons:

  • It validates the survey and all the other responses by showing that the results are genuine and unfiltered
  • It provides an opportunity for you to demonstrate to the inspector that you have acted on people’s concerns

It is best, if you can, to collect feedback consistently over a long period of time. This will help give you a more accurate picture of how your organisation is functioning and take account of changes in staff and service users.

For those seeking to use digital surveys, there are a range of online providers. SurveyMonkey is one of the most popular and has a free option.

 

Carry out mock inspections

CQC inspectors will not just interview you. They will also interview your staff to ensure they are aware of your organisation’s policies and procedures and of their responsibilities as carers. Carrying out mock inspections will get them used to questioning and help you identify where there are gaps in staff knowledge. It will build confidence, meaning that you and your staff will be able to talk about how great your services are with more authenticity.

You should not, though, prepare a ‘script’ for your staff. CQC inspectors will be able to see through it. It will also have long-term negative consequences, creating a culture of mistrust in your organisation. If your organisation is well-led and has a mission to deliver excellent care, you should largely be able to trust your staff to show off how good you are.

Again, staff surveys will help you an insight into carers’ awareness of their responsibilities and how they feel about your organisation. A people-oriented organisation will regularly solicit staff feedback to help improve its services.

You can carry out the inspections yourself, have a senior member of staff do it, or procure outside help. There are now a number of organisations that can carry out mock audits and inspections. Get in touch with us to find out who we recommend.

 

Ensure all staff training is up to date

Staff training is one of the easiest things to fall short on. All your care staff should be up to date on their mandatory training, including health and safety training, fire training, and all the mandatory care subjects. You must ensure that records are kept of all the training, including copies of the certificates.

Innovative care organisations will look beyond the bare minimum, of course. Outstanding providers will have development plans for members of staff. This will not just help the CQC inspection but also improve staff retention and morale. They will also be able to demonstrate an ongoing system of staff training that highlights when a training need is likely to emerge. Advantage centres use our accreditation portal to help keep track of training needs and records.

Getting your training or training systems accredited demonstrates a commitment to quality, consistent training. Click here to find out how Advantage Accreditation may be able to help you with this.

 

Be aware of limiters

Even if you perform well against the ‘well-led’ KLOE, you may be unable to reach an outstanding rating under certain circumstances. These ‘limiters’ are:

  • If the setting has no registered manager when it should have, or if there have been insufficient attempts to hire one
  • There is another condition of registration that has not been met
  • You did not alert the statutory authorities about a relevant event
  • The provider has not completed a PIC request

You should also be aware that, in some cases, the CQC will not be able to give a rating. This is only likely if it is a brand new organisation, if there has been a significant change in operations or ownership, or if there isn’t enough evidence.

 

Now for the inspection …

Provided you have done your preparation and planning, the inspection itself will go a lot smoother. Here’s some tips though that may help you:

  • Shout about your successes – act as if the inspector is a potential client
  • Smile, and get your staff to smile too
  • Highlight anything you do that is innovative to stand out from other settings
  • Don’t lie and don’t be afraid to say if you don’t know the answer – trying to cover your tracks will only come back to bite you later

If you are a truly outstanding organisation, then you won’t need any tricks or shine. Hopefully this guide will help you put a plan in place to ensure that your greatness really shines through!

If you need any more advice, get in touch with the Advantage Accreditation team.

How our accreditation works - Advantage Accreditation

Our Accreditation Process

Advantage accredits your internal training, trainers and training system. But what does that actually mean in practice? What process do we go through?

1. Your courses or ours?

Advantage’s accreditation takes two forms: we can either accredit your courses, or accredit your trainers to deliver our Advantage Awards.

Our Awards are suitable if you do not have your own courses to deliver, if you wish to replace your current courses, or if you want to supplement your own portfolio. They are developed by our curriculum team, which consists of our in-house curriculum team but also our external, expert curriculum specialists. If you choose to deliver our Awards, we will need to check your internal trainers’ experience and qualifications to ensure they are fit to do so (see below for more on internal trainers).

Many of our centres choose for us to accredit their own courses, including training providers. In these cases, we need to make sure the content is accurate and fit for purpose. We do this by mapping the courses against external standards, such as:

The mapping process is carried out by our internal curriculum team or, if it is a particularly high-level or specialist course, one of our Curriculum Specialists. Of course, many organisations providing their own training do so because they want to include their own practices and policies in their courses. We can help with that too, advising on the most effective way to do so.

2. Internal trainers

If you are an organisation looking to provide training to your own staff, then you will need to tell us who is going to deliver that training. Of course, if you are a training provider, then you will probably already have a bank of trainers.

Whether it is an experienced trainer or just an in-house subject expert, then the process is the same: we look at the individual’s work experience, qualifications and skills to ensure they are appropriate to deliver the course. Our Train the Trainer courses can help familiarise trainers with new course content, help inexperienced trainers learn how to pass their expert knowledge onto others, or just make sure their training skills are as good as they can be.

3. Policies and processes

An often overlooked piece of the jigsaw is the policies and processes that underlie your training: your training records, how you decide who to train and when, and how you keep your courses up to date. We will provide an outside overview on your training systems to make they’re optimised. Centres also get access to our online client portal. This can serve as a digital repository for all of your records of who attended a course, when, and how they performed. It can also help you schedule your courses.

4. Helping you keep on track

Once we’ve looked at your courses, training qualifications and experience and your processes, and if you meet our standards, then we can accredit you. If you fall short in some areas, we can help you put it right.

For us, however, the accreditation journey does not end when we let you lose our quality mark. Our office support and curriculum teams are available to help with any queries or problems. We also carry out audits. This sounds intimidating, but it is vital for two purposes:

  • To show you and your stakeholders that we are serious about upholding our standards
  • To help you use Advantage’s services as effectively and as fully as you can

How to start along the journey?

Get in touch with us for a no-commitment chat. We won’t pressure you, just talk about your requirements and how we might be able to help.

Give us a call on 020 7405 9999, or email us at [email protected]

 

Old man and carer

Choosing the perfect care home

BBC News have published an article online today advising people on ‘how to choose the perfect care home‘. We liked the article because it included a checklist from Age UK on what to ask potential residential or nursing homes before you or your family member moves in.

The list is useful for providers though, too. Very often we focus on complex issues and forget the basics. This checklist is great for bringing us back down to earth, and ensuring we have the fundamentals of care right:

  • Can residents choose their daily routines?
  • Are senior staff on duty at all times?
  • What is the ratio of staff to residents?
  • What is the annual turnover of staff?
  • What dementia support is available?
  • Do GPs visit the home?
  • What is included in the fees?
  • What meals are provided?
Mountain climbers

The biggest problem with training, and what you can do about it

We've all been on a training course of some form or another. It might be something compliance based - like health and safety - or something that really impacts on how we perform in our role. The problem, however, is that it often isn't built around the learner.

The reason why is clear: training and education has traditionally been a process of passing knowledge from one person to another or to several others. Consider the typical set-up of a classroom: the teacher stands and speaks, authoritatively, the children sit and listen as subjects. The teacher is focused on passing on the knowledge, not on addressing its meaning and application to the learner. 

It is well established, though, that people who discover their own learning are better for it. Carl Rogers, one of the founding thinkers of 'student-centred learning', stated that "the only learning which significantly influences behaviour is self discovered". If you're a tutor a small proportion of any classroom will be able to take in what you say and remember it. A much larger proportion will keep it with them if they have discovered it themselves.

That's why inductive learning, otherwise known as guided discovery, is the big fashion in modern teaching and training. With language, tutors often now provide learners with an example of a phrase or sentence and facilitate learners to work out the rules for themselves. Even in football, Manchester United manager Jose Mourinho is a well known practitioner of guided discovery, coaching his players to be able to make decisions for themselves on the pitch based on an overall model of play. 

So, when you're building your own training programmes, think about how you can aid learners to discover facts and patterns of behaviour for themselves. For example, you can give them real world scenarios, and ask them how they would react. Rather than explain the Social Model of Disability to them, get them to empathise and see things from the perspective of those for whom they care. If you are able to observe them working afterwards, talk to them at intervals and ask them how they think they could improve based on the training. It's only little details, but they can add up to make a big difference to changing behaviours for the long-term. 

 

Build your own training programmes with Advantage

The best health and social care resources

Finding up to date information on health and social care can be hard. If you're in a position where you're responsible for providing training into the sector, it can be time consuming trying to keep track of regulation and best practice changes, as well as keeping your own CPD going.

So, to give you a helping hand, we've assembled some links to online resources that will help you keep on track. Get them bookmarked! 

 

1. Skills for Care/Skills for Health

Granted, they're not the easiest websites to navigate, but they're a must read if you want to keep track of the latest best practice. The best thing to do is to follow the blogs, which should make sure you're capturing everything important.

www.skillsforcare.org.uk

www.skillsforhealth.org.uk

 

2. CQC

When researching regulations, you may as well go straight to the source. The CQC have a number of interesting resources available on their website. They publish the majority of the research and surveys they undertake, allowing you to form your own opinion on the findings. There's also the latest guidance easily accessible for providers across the sector.

www.cqc.org.uk

 

3. SCIE

The Social Care Institute for Excellence (SCIE) provides a wealth of resources on every topic imaginable in the sector, including explanatory videos on a lot of them. It's all helpfully arranged by region and letter too!

www.scie.org.uk

 

4. CareTalk

CareTalk is an online magazine that covers the care sector. We like it because it's often upbeat and emphasises the good things going on in the sector, which is refreshing when you consider what usually makes it into the mainstream news. Definitely worth following!

www.caretalk.co.uk

 

5. Care Industry News

Exactly what it says on the tin. If you can get past the garish background, there's some really good content that is regularly updated. In fact, if you get our newsletter, you'll see that we link to them a lot.

www.careindustrynews.co.uk

Want to keep up to date? Sign up to the Advantage newsletter

A look at Teeside’s ‘outstanding’ care home

Nunthorpe Care Home in Middlesbrough has just received the highest rating possible from the CQC of ‘outstanding’. How did it do it?

According to its residents and the CQC report, a “homely” feel, stimulating activities, and a passionate workforce.

Take a closer look by clicking here

New start-up presents new model for care

A new start-up is seeking to let more people with dementia live in their own home by using technology.

Adam and Daniel Pike started SuperCarers in response to their own family’s experience with dementia. Their grandmother suffered with the disease, but preferred to stay in her own home. Lacking the finances to pay for private carers, the family relied on local authority carers until eventually Adam and Daniel’s mother took over. As the condition worsened, however, the family had to turn to residential care. The Pikes’ grandmother, they say, resented the decision, and made their mother feel guilty about it until the day she died. The impact is still with their mother even ten years later.

Recognising that 90% of over-50s who need care would rather stay in their own home, SuperCarers is attempting to reduce the costs by linking carers and families online directly, eliminating the need for agencies and their associated costs and overheads. SuperCarers acts as an introducer, and as such is not regulated by the CQC.

The Pikes argue that this gives more families more cost effective care over which they can exercise more control. Further, since SuperCarers is an introducer and not an agency, carers are self-employed and can set their own rates, meaning they will typically earn more than if they were part of an agency.

This new model has led to calls from some, including the UK Homecare Association, for the government to introduce new regulations to take account of changes in the health and social care market. This does not seem to be on the horizon, though. Further, SuperCarers seems to be taking its role seriously, with its team of advisers including luminaries from the CQC, the National Dignity Council, and even an ex-minister. It’s next step, according to the founders, is to build relationships with the NHS to help speed-up discharges and reduce the 445,000 days a year elderly people to spend in hospital while waiting for in-home care.

 

 

Care crisis: funding alone not the solution

A piece in The Guardian has highlighted that funding alone will not be the solution to the country’s care crisis. Instead, focusing on talent within the sector will be the key.

The article by Paul Dosset calls for a radical rethink of “our strategy towards the health and happiness of the British people”. A shift in thinking from focusing on the problems to the solutions is required. The country should not “just see health and social care as a burden on the budget”, and we must “learn how to do more with less” to ‘future-proof’ the sector.

In particular, the piece argues that talent within the sector is essential to improving its efficiency and raising standards. The Government has signalled an end to reliance on low-skilled labour from the EU and a willingness to nurture homegrown talent. There must therefore be moves within health and social care to “safeguard talent”.

These arguments echo comments made by Leon Williams, General Manager of Advantage Accreditation, earlier this week. Leon called for a new emphasis on skills development and improving training programmes in care organisations.

“Any increase in social care funding will no doubt be widely welcomed throughout the health and social care sector”, said Leon. “Ensuring that care trainers and care workers have the latest knowledge and skills, however, is the best way promote efficiency and achieve better outcomes for service users.”

Advantage Accreditation work with training companies and care organisations across the UK, providing quality assurance and verification against external standards. For more information, contact 020 7405 9999, or email [email protected]